Onu Justus Uchenna, Ohaeri Jude Uzoma
Mental Health Unit, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria.
Department of Psychological Medicine, University of Nigeria, Enugu Campus, Nsukka, Enugu State, Nigeria.
Niger Postgrad Med J. 2020 Jan-Mar;27(1):21-29. doi: 10.4103/npmj.npmj_127_19.
Longitudinal outcome studies based on incident and predominantly neuroleptic-naïve cases of schizophrenia are uncommon in the modern literature.
To determine the proportion of persons with schizophrenia with different levels of clinical and functional outcome at monthly intervals of naturalistic treatment follow-up for 4 months: response, remission and recovery; and to examine the predictors of outcome.
Consecutive incident cases that fulfilled stringent criteria for schizophrenia were recruited into the study. After a baseline assessment, 160 incident cases of schizophrenia were followed up 4-weekly for indicators of symptomatic and functional outcome for 16 weeks. Standard rating scales were used to assess clinical and functional outcome. Sociodemographic and clinical variables were evaluated as predictors of outcome using multiple regression analysis.
The attrition rate at week 16 was 29.4%; hence, 113 subjects (out of 160) were available for assessment at the end of follow-up. Of the 113, 66.4%, by Brief Psychiatric Rating Scale (BPRS), met criteria for response (i.e., >50% reduction), while 20.3% could be judged to be clinically non-responsive to treatment (i.e., <20% decrease). Also, 60.2%, by BPRS, met the criteria for remission, while 44.5% met the criteria for recovery. The most important predictor, at week 16, of clinical and psychosocial outcome was social support (48.7%-51.8% of variance).
Although as a preliminary report, the present findings are hypothesis-generating, the implication of the results is that, as a group, over a 4-month period of modern hospital treatment, schizophrenia patients who were incident cases progressively experienced significant reduction in psychopathology. The findings, therefore, support earlier international cross-cultural reports of relatively good clinical outcome from developing countries, thereby encouraging the idea of treatment optimism in schizophrenia in Africa.
在现代文献中，基于新发且主要为未使用过抗精神病药物的精神分裂症病例的纵向结局研究并不常见。
确定在为期4个月的自然主义治疗随访中，每月不同临床和功能结局水平的精神分裂症患者的比例：反应、缓解和康复；并检查结局的预测因素。
招募符合精神分裂症严格标准的连续新发病例进入研究。经过基线评估后，对160例精神分裂症新发病例进行为期16周的随访，每4周评估症状和功能结局指标。使用标准评定量表评估临床和功能结局。采用多元回归分析将社会人口统计学和临床变量作为结局的预测因素进行评估。
第16周时的失访率为29.4%；因此，随访结束时160例中有113例（受试者）可供评估。在这113例中，根据简明精神病评定量表（BPRS），66.4%达到反应标准（即减少>50%），而20.3%可判断为对治疗无临床反应（即减少<20%）。此外，根据BPRS，60.2%达到缓解标准，44.5%达到康复标准。在第16周时，临床和心理社会结局的最重要预测因素是社会支持（方差的48.7%-51.8%）。
尽管作为初步报告，目前的研究结果只是提出假设，但结果的意义在于，作为一个群体，在现代医院治疗的4个月期间，新发精神分裂症患者的精神病理学症状逐渐显著减轻。因此，这些研究结果支持了早期国际跨文化报告中关于发展中国家相对良好临床结局的观点，从而鼓励了非洲对精神分裂症治疗持乐观态度的想法。
