Wyatt R J, Green M F, Tuma A H
Neuropsychiatry Branch, IRP, National Institute of Mental Health, NIMH Neuropsychiatric Hospital, Washington, DC 20032, USA.
Psychol Med. 1997 Mar;27(2):261-8. doi: 10.1017/s0033291796004345.
The authors examined data from a follow-up study of first admission schizophrenic patients treated with and without antipsychotic medications, who were discharged from the hospital within 6 months. It was predicted that patients who did not require antipsychotic medications for discharge would have a more favourable long-term outcome.
The subjects were part of the Camarillo State Hospital study conducted by May and colleagues in the late 1950s and early 1960s. Patients had been randomly assigned to treatment with and without antipsychotic medications. The number of rehospitalization days and total prescribed chlorpromazine equivalents were calculated for each patient for the 2 years following discharge. In order to assess patients' continuing ability to function, 11 patients from each group who met DSM-IV criteria for schizophrenia were matched for age, educational status at first admission, race, and gender; their Global Assessment of Functioning Scale (GAF) score was estimated across a period of 6-7 years following discharge.
During the second year following discharge, patients initially treated with antipsychotic medications required fewer rehospitalization days than the initially non-medicated patients. Furthermore, 6-7 years following initial discharge, those patients initially treated with medications were functioning at a higher level, as measured by GAF scores, than patients not initially treated with antipsychotic medications.
The results of this study suggest that, at least for this subgroup of patients, early treatment with antipsychotic medications both decreases the immediate morbidity associated with schizophrenia, and prevents detrimental changes possibly related to prolonged untreated psychosis.
作者研究了首次入院的精神分裂症患者的随访数据，这些患者在6个月内出院，部分接受了抗精神病药物治疗，部分未接受。据预测，出院时不需要抗精神病药物的患者长期预后会更好。
研究对象是20世纪50年代末和60年代初梅及其同事进行的卡马里洛州立医院研究的一部分。患者被随机分配接受或不接受抗精神病药物治疗。计算每位患者出院后2年的再次住院天数和氯丙嗪等效剂量的总处方量。为了评估患者的持续功能能力，从每组中选取11名符合精神分裂症DSM-IV标准的患者，按照年龄、首次入院时的教育程度、种族和性别进行匹配；在出院后的6至7年期间评估他们的总体功能评估量表（GAF）得分。
出院后的第二年，最初接受抗精神病药物治疗的患者再次住院天数比最初未接受药物治疗的患者少。此外，首次出院6至7年后，通过GAF得分衡量，最初接受药物治疗的患者功能水平高于未接受抗精神病药物治疗的患者。
本研究结果表明，至少对于这一亚组患者，早期使用抗精神病药物治疗既能降低与精神分裂症相关的即时发病率，又能预防可能与长期未治疗的精神病相关的有害变化。
