Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China.
Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, P.R. China.
Aust N Z J Psychiatry. 2021 Mar;55(3):314-323. doi: 10.1177/0004867420969810. Epub 2020 Nov 3.
Antipsychotic drugs are widely used for treating patients with first episode of psychosis, targeting threshold psychotic symptoms. The clinical high risk of psychosis is characterized as subthreshold psychotic symptoms and it is unclear whether they can also benefit from antipsychotic drugs treatment. This study attempted to determine whether initiating antipsychotic drugs treatment in the clinical high risk of psychosis phase was superior to initiating antipsychotic drugs treatment in the first episode of psychosis phase, after the 2-year symptomatic and functional outcomes.
Drawing on 517 individuals with clinical high risk of psychosis from the ShangHai At Risk for Psychosis program, we identified 105 patients who converted to first episode of psychosis within the following 2 years. Patients who initiated antipsychotic drugs while at clinical high risk of psychosis (CHR_AP; = 70) were compared with those who initiated antipsychotic drugs during a first episode of psychosis (FEP_AP; = 35). Summary scores on positive symptoms and the global function scores at baseline and at 2 months, 1 year and 2 years of follow-up were analyzed to evaluate outcomes.
The CHR_AP and FEP_AP groups were not different in the severity of positive symptoms and functioning at baseline. However, the CHR_AP group exhibited significantly more serious negative symptoms and total symptoms than the FEP_AP group. Both groups exhibited a significant reduction in positive symptoms and function ( < 0.001). Repeated-measures analysis of variance revealed group by time interaction for symptomatic ( = 3.196, = 3, = 0.024) and functional scores ( = 7.306, = 3, < 0.001). The FEP_AP group showed higher remission rates than the CHR_AP group (χ = 22.270, < 0.001). Compared to initiating antipsychotic drug treatments in the clinical high risk of psychosis state, initiating antipsychotic drugs treatments in the first episode of psychosis state predicted remission in a regression model for FEP_AP (odds ratio = 5.567, 95% confidence interval = [1.783, 17.383], = 0.003).
For clinical high risk of psychosis, antipsychotic drugs might be not the first choice in terms of long-term remission, which is more reasonable to use at the first episode of psychosis phase.
抗精神病药物被广泛用于治疗首发精神病患者，针对的是阈下精神病症状。精神病的临床高风险特征为阈下精神病症状，目前尚不清楚它们是否也能受益于抗精神病药物治疗。本研究试图确定在首发精神病阶段开始抗精神病药物治疗是否优于在精神病临床高风险阶段开始抗精神病药物治疗，以评估 2 年后的症状和功能结局。
本研究纳入了来自上海精神病风险项目的 517 名精神病临床高风险个体，其中有 105 名患者在随后的 2 年内转化为首发精神病。比较了在精神病临床高风险时开始抗精神病药物治疗（CHR_AP； = 70）与在首发精神病时开始抗精神病药物治疗（FEP_AP； = 35）的患者。分析了基线及 2 个月、1 年和 2 年随访时阳性症状和总体功能评分的总和评分，以评估结局。
CHR_AP 和 FEP_AP 组在基线时阳性症状和功能的严重程度无差异。然而，CHR_AP 组的阴性症状和总症状严重程度明显高于 FEP_AP 组。两组的阳性症状和功能均显著改善（ < 0.001）。重复测量方差分析显示，症状（ = 3.196，df=3， = 0.024）和功能评分（ = 7.306，df=3， < 0.001）存在组间时间交互作用。FEP_AP 组的缓解率高于 CHR_AP 组（χ = 22.270， < 0.001）。与在精神病临床高风险状态下开始抗精神病药物治疗相比，在首发精神病状态下开始抗精神病药物治疗可预测 FEP_AP 的缓解（优势比 = 5.567，95%置信区间 = [1.783, 17.383]， = 0.003）。
对于精神病临床高风险患者，抗精神病药物可能不是长期缓解的首选，在首发精神病阶段使用更为合理。
