Davidson L, McGlashan T H
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
Can J Psychiatry. 1997 Feb;42(1):34-43. doi: 10.1177/070674379704200105.
To review variations in outcomes in schizophrenia across individual, historical, and cross-cultural boundaries, as well as within specific domains of functioning.
Research literature on the outcomes of schizophrenia appearing within the last 8 years was reviewed.
First, a review of follow-up studies published in the developed world suggests that heterogeneity in outcome across individuals with schizophrenia remains the rule, with affective symptoms, later and acute onset, and responsiveness to biological treatments predictive of good outcome. Negative symptoms are associated with poor outcome, cognitive impairments, and incapacity in social and work domains. Deterioration appears to occur within the first few months of onset if not already in the prodrome, with recent early-course studies finding longer duration of untreated psychosis associated with insidious onset, negative symptoms, social and work incapacity, and poor outcome. Second, a review of recent cross-cultural and historical studies provides evidence that outcome varies across time and place, schizophrenia having a more favourable outcome in the developing world and becoming a more benign disorder over the course of this century. Third, a review of studies of the domains of functioning within individuals identifies 4 relatively independent dimensions of depression and negative, psychotic, and disorganized symptoms. Cognitive deficits, which are associated with negative symptoms, also constitute a relatively stable dimension over time, showing neither marked deterioration nor improvement once established early in the course of disorder.
The early appearance and stability over time of negative symptoms and cognitive impairments call for assertive intervention efforts early in the course of disorder to prevent chronicity and prolonged disability.
回顾精神分裂症在个体、历史和跨文化界限方面以及特定功能领域内的结局差异。
对过去8年发表的关于精神分裂症结局的研究文献进行综述。
首先，对发达国家发表的随访研究进行综述表明，精神分裂症患者结局的异质性仍然是常态，情感症状、起病较晚和急性起病以及对生物治疗的反应性可预测良好结局。阴性症状与不良结局、认知障碍以及社交和工作领域的功能丧失有关。如果在发病的最初几个月内没有出现恶化（即使在前驱期没有出现），那么恶化似乎会发生，近期的早期病程研究发现，未治疗精神病的持续时间较长与隐匿起病、阴性症状、社交和工作功能丧失以及不良结局有关。其次，对近期跨文化和历史研究的综述提供了证据，表明结局随时间和地点而变化，精神分裂症在发展中国家有更有利的结局，并且在本世纪的进程中成为一种更良性的疾病。第三，对个体功能领域研究的综述确定了抑郁、阴性、精神病性和紊乱症状4个相对独立的维度。与阴性症状相关的认知缺陷也构成一个随时间相对稳定的维度，一旦在疾病早期确立，既没有明显恶化也没有改善。
阴性症状和认知障碍的早期出现及随时间的稳定性要求在疾病早期积极进行干预，以预防慢性病和长期残疾。
