Linszen D H, Dingemans P M, Nugter M A, Van der Does A J, Scholte W F, Lenior M A
Dept. of Psychiatry, University of Amsterdam, The Netherlands.
Schizophr Bull. 1997;23(1):119-30. doi: 10.1093/schbul/23.1.119.
In the context of a prospective, controlled treatment study, contrasting family interventions with individual treatment, the role of expressed emotion (EE) as a predictor of relapse was examined in patients with recent-onset schizophrenia and related disorders (n = 97). EE was compared with 13 predictor variables. The variables, taken from EE and family intervention studies, related to demography, premorbid functioning, present and past illness history, and comorbid substance abuse. Psychotic relapse was operationalized with a conservatively measured relapse criterion, composed of monthly ratings based on the Brief Psychiatric Rating Scale and on clinical judgment during the 12 months of outpatient treatment. Of the 14 predictor variables entered in stepwise survival analyses, 6 variables had probable predictive power on the conservative relapse criterion. These variables were entered in a Cox regression model. EE turned out to be the major predictor of relapse in the overall sample (hazard ratio [HR] 4.90; confidence interval [CI] 1.05-22.92). This finding remained when only patients with a first psychotic episode (p = 0.02) and patients in the individual treatment condition (p = 0.001) were examined. Cannabis abuse was the major predictor of relapse in patients with high-EE families (HR 4.27; CI 1.12-16.29).
在一项前瞻性对照治疗研究中，将家庭干预与个体治疗进行对比，研究了近期发病的精神分裂症及相关障碍患者（n = 97）中，表达性情绪（EE）作为复发预测指标的作用。将EE与13个预测变量进行比较。这些变量取自EE和家庭干预研究，涉及人口统计学、病前功能、当前和既往病史以及共病物质滥用情况。精神病性复发通过保守测量的复发标准进行操作化定义，该标准由基于简明精神病评定量表的月度评分以及门诊治疗12个月期间的临床判断组成。在逐步生存分析中纳入的14个预测变量中，有6个变量对保守复发标准具有可能的预测能力。这些变量被纳入Cox回归模型。结果显示，EE是总体样本中复发的主要预测指标（风险比[HR] 4.90；置信区间[CI] 1.05 - 22.92）。仅对首次精神病发作的患者（p = 0.02）和接受个体治疗的患者（p = 0.001）进行检查时，这一发现依然成立。在高EE家庭的患者中，大麻滥用是复发的主要预测指标（HR 4.27；CI 1.12 - 16.29）。
