Gupta S, Andreasen N C, Arndt S, Flaum M, Hubbard W C, Ziebell S
Mental Health Clinical Research Center, University of Iowa College of Medicine, Iowa City 52242-1057, USA.
Schizophr Res. 1997 Jan 17;23(1):1-13. doi: 10.1016/S0920-9964(96)00078-3.
The natural history of schizophrenia remains unclear. One strategy to further inform this area is to prospectively evaluate individuals early in the course of the disorder, both in terms of symptomatic and psychosocial/occupational functioning. Subjects were recruited into the study if they were in the midst of their first psychiatric hospitalization for a non-'organic' psychotic disorder. Subjects were extensively evaluated at index with semi-structured interviews including the Comprehensive Assessment of Symptoms and History (CASH), and followed at 6-month intervals. Data are presented on 35 subjects who were followed through 1 year. There was a significant improvement in overall symptomatology during index hospitalization, but this was accounted for primarily by improvement of positive symptoms, with negative symptoms remaining prominent. No further improvement was noted between discharge and 1-year follow-up in any of the symptom measures. Employment, interpersonal relationships, and sexual activity remained markedly impaired throughout the follow-up period. These data demonstrate that; (1) negative symptoms are prominent and stable early in the course of the disorder; (2) symptom severity at discharge from index hospitalization is predictive of symptom severity at 1 year; and (3) despite substantial overall symptomatic improvement during the first hospitalization, psychosocial and occupational functioning were found to be markedly impaired at 1-year follow-up.
精神分裂症的自然病程仍不明确。进一步了解该领域的一种策略是对疾病早期的个体进行前瞻性评估，包括症状以及心理社会/职业功能方面。如果受试者因非“器质性”精神障碍首次住院接受精神病治疗，则将其纳入研究。在基线时，通过包括症状与病史综合评估（CASH）在内的半结构化访谈对受试者进行全面评估，并每6个月随访一次。本文呈现了对35名受试者进行1年随访的数据。在基线住院期间，总体症状有显著改善，但这主要是由阳性症状的改善所致，阴性症状仍然突出。在出院至1年随访期间，任何症状指标均未出现进一步改善。在整个随访期间，就业、人际关系和性活动仍然明显受损。这些数据表明：（1）阴性症状在疾病早期突出且稳定；（2）基线住院出院时的症状严重程度可预测1年时的症状严重程度；（3）尽管首次住院期间总体症状有显著改善，但在1年随访时发现心理社会和职业功能明显受损。
