Lieberman J A, Koreen A R, Chakos M, Sheitman B, Woerner M, Alvir J M, Bilder R
Hillside Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, Glen Oaks, N.Y., USA.
J Clin Psychiatry. 1996;57 Suppl 9:5-9.
For the majority of patients, schizophrenia is a chronic recurrent disease that leads to significant residual morbidity which occurs through a process of behavioral deterioration. The factors that influence the course of schizophrenia after its onset and the ability of treatment to modify the effects of the patient's illness are not well understood. This article examines specific clinical and biological variables that are associated with treatment response and outcome. These variables, which are both trait and state dependent, include premorbid adjustment, age and mode of onset of illness, gender, duration of psychosis, schizophrenia subtype, primary negative symptoms, and extrapyramidal signs including tardive dyskinesia and plasma HVA and brain pathomorphology. In addition, the chronic effects of antipsychotic drug treatment may influence illness course both favorably and adversely as well as potentially altering the neurobiological substrates that mediate expression of the illness and treatment response. Finally, the question of whether the active phase of the illness involves a pathologic process that leads to illness progression is discussed. In light of this discussion, we can speculate that although certain aspects of the illness in terms of its severity and course may be, to an extent, predetermined, a number of factors can exert favorable and unfavorable effects on the course of the illness and its ultimate outcome. One question for the field is to develop therapeutic strategies that minimize the morbidity of the illness in a way that does not introduce iatrogenic consequences to the patient.
对于大多数患者而言，精神分裂症是一种慢性复发性疾病，会导致严重的残留病状，这种病状是通过行为恶化过程出现的。人们对精神分裂症发病后影响其病程的因素以及治疗改变患者病情影响的能力了解甚少。本文研究了与治疗反应和结果相关的特定临床和生物学变量。这些变量既取决于特质也取决于状态，包括病前适应情况、发病年龄和发病方式、性别、精神病持续时间、精神分裂症亚型、原发性阴性症状以及锥体外系体征（包括迟发性运动障碍）、血浆高香草酸和脑病理形态学。此外，抗精神病药物治疗的长期影响可能对病程产生有利和不利的影响，也可能潜在地改变介导疾病表达和治疗反应的神经生物学底物。最后，本文讨论了疾病的急性期是否涉及导致疾病进展的病理过程这一问题。鉴于此讨论，我们可以推测，尽管疾病在严重程度和病程方面的某些方面可能在一定程度上是预先确定的，但许多因素会对疾病的病程及其最终结果产生有利和不利的影响。该领域的一个问题是制定治疗策略，以一种不会给患者带来医源性后果的方式将疾病的发病率降至最低。
