Verdoux H, van Os J, Sham P, Jones P, Gilvarry K, Murray R
Department of Psychological Medicine, Institute of Psychiatry, London.
Br J Psychiatry. 1996 May;168(5):620-6. doi: 10.1192/bjp.168.5.620.
It as been suggested that in schizophrenia an association exists between family history of schizophrenia and poor outcome on the one hand, and family history of affective disorders and good outcome on the other.
We tested for associations between four-year outcome and familial loading for psychotic disorders in a mixed sample of 150 consecutively admitted patients with functional psychosis (schizophrenia, psychotic affective disorders, other psychotic disorders) of recent onset. For each proband, a familial loading score for (i) broadly defined psychotic disorder, (ii) schizophrenia, and (iii) affective disorder was calculated using information on relatives obtained through the Family History Research Diagnostic Criteria method and direct interviews of relatives with the Schedule for Affective Disorders and Schizophrenia.
In our sample of psychotic patients, familial loading for psychotic disorder predicted persistent negative symptoms over the follow-up period (OR 1.5; 95% CI 1-2.2), especially in schizophrenia, and was also associated with more time hospitalised (P < 0.05) [corrected], and more social disability at follow-up (P < 0.05). Greater familial loading for schizophrenia predicted a greater likelihood of non-recovery (OR 2.2; 95% CI 1.1-4.4) and a greater likelihood to have had persistent negative symptoms over the follow-up period (OR 1.7; 95% CI 0.9-3.1). No association was found between outcome and familial loading for affective disorder.
We conclude that familial loading may be a continuous risk factor for some dimensions of clinical outcome in the functional psychoses. This suggests that there is a continuum of genetic liability not only to the emergence of psychotic illness, but also the subsequent chronicity of the disorder.
有人提出，在精神分裂症中，一方面精神分裂症家族史与不良预后相关，另一方面情感障碍家族史与良好预后相关。
我们在150例近期发病的功能性精神病（精神分裂症、精神性情感障碍、其他精神障碍）连续入院患者的混合样本中，测试了四年预后与精神病性障碍家族负荷之间的关联。对于每个先证者，使用通过家族史研究诊断标准方法获得的亲属信息以及通过情感障碍和精神分裂症日程表对亲属进行直接访谈，计算（i）广义定义的精神病性障碍、（ii）精神分裂症和（iii）情感障碍的家族负荷评分。
在我们的精神病患者样本中，精神病性障碍的家族负荷预测了随访期间持续的阴性症状（比值比1.5；95%可信区间1 - 2.2），尤其是在精神分裂症中，并且还与更多的住院时间（P < 0.05）[校正后]以及随访时更多的社会残疾相关（P < 0.05）。精神分裂症家族负荷越大，预测未康复的可能性越大（比值比2.2；95%可信区间1.1 - 4.4），并且在随访期间出现持续阴性症状的可能性越大（比值比1.7；95%可信区间0.9 - 3.1）。未发现预后与情感障碍家族负荷之间存在关联。
我们得出结论，家族负荷可能是功能性精神病临床结局某些维度的持续风险因素。这表明不仅在精神病性疾病的发生方面存在遗传易感性的连续体，而且在该疾病的后续慢性化方面也存在。
