Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai.
Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou.
Pharmacopsychiatry. 2021 Jan;54(1):23-30. doi: 10.1055/a-1252-2942. Epub 2020 Oct 12.
In a previous report, we used canonical correlation analysis to classify individuals with clinical high risk (CHR) of psychosis into the 3 subtypes: subtype-1, characterized by extensive negative symptoms and cognitive deficits, appeared to have the highest risk for conversion to psychosis; subtype-2, characterized by thought and behavioral disorganization, with moderate cognitive impairment; subtype-3, characterized by the mildest symptoms and cognitive deficits. The present study attempted to identify these subtypes' response to antipsychotic (AP) treatment.
A total of 289 individuals with CHR were identified and followed up for 2 years. Individuals with CHR were classified by subtype. Use of APs was examined at 2-month, 1-year, and 2-year follow-up interviews that inquired after the subjects' medication history since the first visit. The main outcome was remission, determined according to global assessment of function (GAF) score (i. e., functional outcome) and SIPS positive symptom score (symptomatic outcome) at the follow-up points.
Among the 289 individuals with CHR included in the current analysis, 223 (77.2%) were treated using APs for at least 2 weeks during the follow-up period. Individuals with CHR tended to show significant improvement in both symptoms and function after 2 years, but subtypes exhibited significantly different trajectories. Subtype status can predict AP treatment outcome in terms of remission. The likelihood of remission differed significantly among the subtype groups. The remission rates for individuals with subtypes 1-3 treated using AP were 13.5%, 36.1%, and 67.0%, respectively.
These subtypes may be of clinical value in AP treatment decision-making in the CHR population.
在之前的报告中，我们使用典型相关分析将具有精神病临床高风险（CHR）的个体分为 3 种亚型：亚型 1，表现为广泛的阴性症状和认知缺陷，似乎具有最高的精神病转化率；亚型 2，表现为思维和行为紊乱，伴有中度认知障碍；亚型 3，表现为最轻微的症状和认知缺陷。本研究试图确定这些亚型对抗精神病药物（AP）治疗的反应。
共确定了 289 名 CHR 个体并进行了 2 年的随访。根据亚型对 CHR 个体进行分类。在 2 个月、1 年和 2 年的随访访谈中，询问了自首次就诊以来的药物使用史，以检查 AP 的使用情况。主要结局是根据功能全面评估（GAF）评分（即功能结局）和 SIPS 阳性症状评分（症状结局）在随访点确定的缓解。
在当前分析中纳入的 289 名 CHR 个体中，有 223 名（77.2%）在随访期间至少接受了 2 周的 AP 治疗。CHR 个体在 2 年后往往在症状和功能方面都有显著改善，但各亚型的轨迹存在显著差异。亚型状态可以预测 AP 治疗的缓解结局。不同亚型组的缓解率存在显著差异。接受 AP 治疗的个体，1 型、2 型和 3 型的缓解率分别为 13.5%、36.1%和 67.0%。
这些亚型在 CHR 人群的 AP 治疗决策中可能具有临床价值。
