首发精神分裂症复发高危因素的回归分析

目的探讨首发精神分裂症5年内复发的危险因素。方法对406例首发精神分裂症患者痊愈后5年内进行随访，并分析复发患者的临床特点。结果5年复发率为70．3％；回归分析发现DUP（duration of untreated psychosis未治疗的精神病期）、依从性、遗传、年龄、是否按医嘱复诊与复发的关系密切，其中坚持按医嘱复诊、服药是减少复发最重要的条件。结论影响首发精神分裂症复发的因素很多，其中最重要的是遗传、DUP、依从性、年龄以及是否按医嘱复诊。     

影响首次住院精神分裂症患者复发的多因素判别分析

目的　系统探讨首发精神分裂症患者复发的影响因素。方法　采用一系列标准化评定工具对 2 0 1例首发精神分裂症住院患者出院后进行 1年的随访 ,评估复发者与非复发者的临床特征和影响疾病复发的因素。结果　首发住院精神分裂症病人出院后 1年内的复发率为 2 1.3 %。逐步判别分析提示 ,病前职业功能水平、随访期间的家庭社会支持及出院后维持治疗是影响疾病复发的主要因素。据此 3个因素预测病人复发的准确性为 82 .6%。结论　疾病的复发受多种因素的影响 ,而可人为干预的因素起重要作用。     

211例精神分裂症复发情况的随访研究

随访经住院治疗获得痊愈的211例精神分裂症,4～5年后145例(68.72％)复发,其中130例在出院后3年内复发。近亲中有精神病患者、住院前病程较长的病人复发率较高。就维持治疗及如何预防的问题进行了简短的讨论。     

精神分裂症复发的原因和对策

对80例临床痊愈的精神分裂症患者进行随访,平均随访时间为29.28±8.81月,发现复发率为45.00％,在2年内复发率最高。复发组和未复发组服药情况和社会适应功能的比较有显著性差异,提示停药、不规则服药和低水平的社会适应功能是病情复发的主要原因。认为在维持治疗的基础上,加强以生活技能训练为中心的康复治疗,及时发现和处理复发的早期表现,是降低复发率的有效途径。     

首发精神分裂症复发因素的研究

目的:研究影响首先精神分裂症复发的因素.方法:对111例首发精神分裂症状患者出院5年内每年随访,分析其复发原因,结果:2年复发率41.4%,5年复发率73.0%,复发与发病年龄,性格,遗传,文化程度,起病形式, 从性,对精神疾病知识的了解程度和社会支持有明显相关.结论:精神分裂症的复发受多种因素影响,应及早干预.     

首发精神分裂症治疗4周BPRS减分率与复发关系的探讨

目的探讨精神分裂症复发与简明精神症状评定量表减分率(简称减分率)快慢的关系。方法随机入组首发精神分裂症患者310例,住院治疗4周,按减分率>50%和<50%分成2组,随访2 a比较2组复发率。结果减分率>50%220例,2 a内67例复发;减分率<50%的90例中71例复发,显著高于前者。减分率快者155例中39例复发;减分率低者155例中99例复发,后者显著高于前者复发率。结论首发精神分裂症早期治疗,减分率越快复发越低,早发现、早诊断、早治疗,尽快控制症状对预防复发甚为重要。     

情感性精神障碍维持治疗探讨

目的 :探索情感性精神障碍痊愈后维持治疗与复发的关系。　方法 :对痊愈病人进行 5年随访 ,分析停药者与维持治疗者的复发率。　结果 :情感性精神障碍复发率 66.4 % ,维持治疗者复发率 66.2 % ,停药者复发率 66.7%。　结论 :情感性精神障碍待自然病程结束后不需维持治疗     

家庭综合因素与首发精神分裂症患者出院后病情变化关系的临床分析

目的探讨家庭综合因素与首发精神分裂症患者出院后病情变化的关系。方法纳入100例经住院治疗后痊愈的首发精神分裂症患者,在出院后以每3个月为1周期采用阳性与阴性症状量表(PANSS)进行测评,了解其1年内病情变化,采用家庭环境量表中文版(FES-CV)和家庭功能评定量表(FAD)在患者出院后1年末对其家属进行测评,比较病情复发组与病情稳定组的评分情况。结果 100例患者出院后有35例复发,复发率为35%。复发组FES-CV家庭的矛盾性及控制性评分高于稳定组(t=3.236,2.364,P0.01);而情感表达、亲密性、独立性、成功性、娱乐性评分低于稳定组(t=-3.452~-3.126,P0.05或0.01);复发组FAD问题解决、沟通、情感反应、情感介入、总的功能5个分量表评分高于稳定组(t=2.321~3.231,P0.05或0.01)。结论良好的家庭环境(如家庭成员的亲密度、娱乐性、控制性等)和家庭功能(如情感介入、行为控制水平、情感反应)与首发精神分裂症患者病情稳定相关。     

早期干预对首发精神分裂症预后的影响

目的：了解早期干预对首发精神分裂症复发的影响。方法：对30例首发精神分裂症患者，病期在3个月以内知的，在住院期间配合积极家庭干预及出院后继续干预（干预组）并与30例首发精神分裂症患者，病期在3个月以上治疗条件相仿，无家庭干预（对照组）进行对照。对两组的复发率进行比较。结果：干预组疗效明显好于对照组，干预组复发率明显少于对照组（P＜0.05）。结论：积极的家庭干预能促进服药的依从性，减少复发率，促进康复。     

不同剂量奥氮平对首发精神分裂症患者维持期治疗的影响

目的:探讨不同剂量奥氮平对首发精神分裂症患者维持期治疗的影响，为首发精神分裂症维持期服药剂量提供参考。方法:将2016年7月至2018年12月嘉兴市康慈医院、桐乡市第一人民医院200例使用奥氮平系统治疗进入维持期阶段的首发精神分裂症患者随机分为维持组及减量组，每组各100例。采用阳性和阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)及治疗中出现的不良反应量表(TESS)在基线、3个月、6个月、12个月、18个月、24个月各时点分别评定患者的精神症状、社会功能及药物不良反应。结果:随访至2年末，两组复发率比较差异无统计学意义。两组PANSS阴性症状评分、PANSS总分、SDSS评分、TESS评分的组别主效应、时间主效应及两者的交互效应均有统计学意义(P均<0.05)。维持组的阴性症状评分、PANSS总分及SDSS评分在18个月、24个月两个时点比较均高于减量组，差异有统计学意义(P均<0.05)。结论:首发精神分裂症患者维持治疗期继续使用奥氮平时，逐渐缓慢减少药物剂量至有效低剂量，不会增加患者的复发风险，且有利于减轻其阴性症状和药物不良反应，改善患者的社会功能。     

Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder

BACKGROUND: We examined relapse after response to a first episode of schizophrenia or schizoaffective disorder. METHODS: Patients with first-episode schizophrenia were assessed on measures of psychopathologic variables, cognition, social functioning, and biological variables and treated according to a standardized algorithm. The sample for the relapse analyses consisted of 104 patients who responded to treatment of their index episode and were at risk for relapse. RESULTS: Five years after initial recovery, the cumulative first relapse rate was 81.9% (95% confidence interval [CI], 70.6%-93.2%); the second relapse rate was 78.0% (95% CI, 46.5%-100.0%). By 4 years after recovery from a second relapse, the cumulative third relapse rate was 86.2% (95% CI, 61.5%-100.0%). Discontinuing antipsychotic drug therapy increased the risk of relapse by almost 5 times (hazard ratio for an initial relapse, 4.89 [99% CI, 2.49-9.60]; hazard ratio for a second relapse, 4.57 [99% CI, 1.49-14.02]). Subsequent analyses controlling for antipsychotic drug use showed that patients with poor premorbid adaptation to school and premorbid social withdrawal relapsed earlier. Sex, diagnosis, obstetric complications, duration of psychotic illness before treatment, baseline symptoms, neuroendocrine measures, methylphenidate hydrochloride challenge response, neuropsychologic and magnetic resonance imaging measures, time to response of the initial episode, adverse effects during treatment, and presence of residual symptoms after the initial episode were not significantly related to time to relapse. CONCLUSIONS: There is a high rate of relapse within 5 years of recovery from a first episode of schizophrenia and schizoaffective disorder. This risk is diminished by maintenance antipsychotic drug treatment.     

Effectiveness of risperidone long-acting injection in first-episode schizophrenia: in naturalistic setting

Patients with first-episode schizophrenia frequently relapse during the first years of the illness. This may be associated with clinical deterioration. It is important to prevent relapses in first-episode schizophrenia. We examine whether risperidone long-acting injection (RLAI) could effectively act to prevent relapse in first-episode schizophrenia. We conducted a prospective, naturalistic, controlled, and open-label study over 2 years in 50 patients with first-episode schizophrenia. 22 patients with schizophrenia were assigned to the RLAI group and 28 patients with schizophrenia to the oral risperidone group as control. We compared medication adherence, time to non-adherence, and relapse rate between the RLAI and control groups. There were no significant difference in sociodemographic findings and initial psychometric measures between two groups. The RLAI group showed significantly lower relapse rate and higher medication adherence than the control group. The result demonstrated by Kaplan-Meier survival analysis that time to non-adherence is associated with the difference in the groups. Cox proportional survival analysis revealed that time from baseline to relapse was associated with time to non-adherence. This result showed that RLAI could be effective in maintaining medication adherence and preventing relapse. However, studies with a larger sample size will be needed to examine whether these results are applicable to schizophrenic population.     

A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients

BACKGROUND: Cognitive predictors of relapse have been extensively explored only in few long term longitudinal studies of first-episode schizophrenia. METHOD: This study prospectively followed 93 patients with first-episode schizophrenia, schizophreniform disorder, and schizoaffective disorder for 3 years after their first-episode illness. Cognitive domains including verbal intelligence, verbal and visual memory, verbal fluency, and Wisconsin Card Sorting Test performance were investigated as potential predictors of relapse. RESULTS: We found that by the first year 21% patients had relapsed, by the second year 33% had relapsed, and by the third year 40% had relapsed. There was a significant difference in the relapse rate between patients with good adherence and patients with poor adherence to medication regimes. A multiple logistic regression analysis revealed that after controlling for medication adherence, perseverative error in the Wisconsin Card Sorting Test was the only cognitive function that significantly predict relapse with an odds ratio of 2.4. CONCLUSIONS: Cognitive flexibility in set shifting is related to tendency towards relapse in first-episode schizophrenic patients. Other cognitive factors appear not to be related to relapse. Possible mechanisms included the link between prefrontal dysfunction and sub-cortical dopamine system stability, as well as the effects of executive dysfunction on insight impairment and adherence behavior.     

利培酮与奥氮平治疗首发精神分裂症的1年随访研究

目的评价利培酮与奥氮平治疗首发精神分裂症的疗效与不良反应。方法本研究为开放性，平行对照，药物剂量可调整的临床试验。采用自然观察研究方法，结合全病程管理模式对研究对象进行1年随访研究。分别有131例和136例首发精神分裂症患者被分入利培酮组和奥氮平组。利培酮组剂量为3—6mg，平均（3．8±1．3）mg，奥氮平组剂量为10—20mg，平均（12．9±5．6）mg。疗效主要统计指标为阳性和阴性症状评定量表（PANSS）的总分值及有效率，持续治疗时间。PANSS减分率≥50％定义为有效。次要统计指标为复发率、复发时间及药物不良反应。用副反应量表（TESS）评估药物不良反应。结果12月末时，利培酮组有85例患者（64．9％）完成随访，奥氮平组为93例（68．4％），两组差异无统计学意义（P〉0．05）。治疗终点利醅酮和奥氮平组有效率分别为62．6％和69．8％，差异无统计学意义（P〉0．05），随访中其他时点（2、3、6、8个月）两组有效率差异亦无统计学意义。12个月末利培酮组和奥氮平组的复发率（14．5％、12．5％）、持续治疗时间（9．5±3．8月、9．7±3．8月）、复发时间（4．0±2．9月、5．1±2．8月）等差异均无统计学意义（均P〉0．05）。不良反应方面，利培酮组锥体外系反应比例高于奥氮平组，奥氮平组体重增加比例高于利培酮组。结论利培酮与奥氮平治疗首发精神分裂症1年疗效均好，利培酮组锥体外系反应发生较多，奥氮平组体重增加较多。     

The 5-Year Course of Obsessive-Compulsive Symptoms and Obsessive-Compulsive Disorder in First-Episode Schizophrenia and Related Disorders

Objective: To determine the course of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) in first-episode schizophrenia and related disorders and their relationship with clinical characteristics. Methods: Consecutively, admitted patients with a first-episode of schizophrenia, schizophreniform disorder, or schizoaffective disorder were screened for OCS, and these were measured with the Yale-Brown Obsessive-Compulsive Scale. Positive and Negative Syndrome Scale and Montgomery Åsberg Depression Rating Scale were used to assess severity of other symptoms. The course of 3- and 5-year symptoms, psychotic relapse, substance use, remission, full recovery, suicide, and social functioning were assessed. Results: One hundred and eighty-six consecutively admitted and consenting patients were included. Five years after admission, OCS could be assessed in 172 patients. Ninety-one patients (48.9%) reported no OCS symptoms on any of the assessments. OCS restricted to the first assessments occured in 15.1%, 13.4% had persistent OCS, 7.0% had no OCS at first assessment but developed OCS subsequently, and 15.6% had intermittent OCS. The proportion of patients with comorbid OCD varied between 7.3% and 11.8% during follow-up. OCD was associated with more severe depressive symptoms and poorer premorbid functioning and social functioning at follow-up. Conclusions: The 5-year course of OCS/OCD in patients with first-episode schizophrenia or related disorders is variable. OCS/OCD comorbidity was not associated with a more severe course of psychotic symptoms and relapse. Comorbid OCD was associated with more severe depressive symptoms, social dysfunction and worse premorbid functioning. Specific treatment options for schizophrenia patients with comorbid OCD are needed.     

影响门诊精神分裂症首次发病患者随访一年疗效的相关因素研究

目的 探讨影响精神分裂症首次发病(以下简称首发)患者疗效和复发的相关因素.方法 采用前瞻性队列研究,结合全病程管理模式,对453例符合国际疾病分类第10版精神分裂症和分裂样精神障碍诊断标准、基线阳性和阴性症状量表(PANSS)总分≥60分、病程≤5年的患者,进行1年随访,对13项相关因素与近期疗效及复发情况进行单因素分析,并采用Spearman相关分析和t检验.结果 PANSS总分减分率与性别(r=0.083)、病程(r=-0.228)、起病形式(r=-0.180)、发病诱因(r=0.080)、持续用药时间(r=0.153)存在相关关系(P<0.05～0.01);疾病复发与性别(r=-0.131)、持续用药时间(r=0.131)亦存在相关关系(P<0.01).结论 女性、病程短、起病形式急、病前有诱因、持续用药时间长的精神分裂症首发患者1年的疗效相对好;男性患者及持续用药时间短的患者易复发.     

维思通维持性治疗首发精神分裂症的剂量选择及其随访结果

目的；为探讨采用维思通维持特性治疗首发精神分裂症的最佳剂量。方法：将1998年3月－1998年12月从我院出院服用维思通治疗的首发精神分裂症患者23例，随机分成治疗量维持组和治疗量的半量维持组，并采用简明精神量评定量表（BPRS）、大体评定量表（GAS）和副反应评定量表（TESS）对患者进行了2年的调查研究。结果：两组患者复发率、缓解率和副反应出现频率均无显著差异。结论：采用维思通治疗量的半量可能是维持性治疗首发精神分裂症的最佳治疗剂量。     

Psychotic relapse and maintenance therapy in paranoid schizophrenia: a 15 year follow up

In spite of numerous reports on a 1 to 2 year maintenance neuroleptic treatment of schizophrenia, there is little systematic information on decade-long maintenance therapy. We conducted a retrospective study in fifty outpatients with paranoid schizophrenia who have been seen at our clinic for a duration of 15 years or more since their first psychotic episodes. Relapse rate within 2, 5, 10, and 15 years from remission of the first psychotic episode were 52, 60, 86, and 90%, respectively. However, the incidence of relapse decreased with time. This decrease was accounted for by the decrease of relapse observed when off drug. Conversely, the incidence of relapse occurred on drug remained unchanged. The average maintenance dose 15 years after remission of the first psychotic episode was 5.41 ± 7.28 mg/d (haloperidol equivalents: mean ± SD). The maintenance dose correlated significantly with the number of relapses and total duration of psychotic episodes. These results suggest that maintenance treatment remained effective for decades, although it did not ameliorate the liability to relapse itself. Repeated relapse may be associated with requirement for a higher neuroleptic dose for relapse prevention. Received: 16 December 1997 / Accepted: 23 November 1998     

Progressive decrease of left superior temporal gyrus gray matter volume in patients with first-episode schizophrenia

OBJECTIVE: Smaller temporal lobe cortical gray matter volumes, including the left superior temporal gyrus, have been reported in magnetic resonance imaging (MRI) studies of patients with chronic schizophrenia and, more recently, in patients with first-episode schizophrenia. However, it remains unknown whether there are progressive decreases in temporal lobe cortical gray matter volumes in patients with first-episode schizophrenia and whether similarly progressive volume decreases are present in patients with affective psychosis. METHOD: High-spatial-resolution MRI scans at initial hospitalization and 1.5 years later were obtained from 13 patients with first-episode schizophrenia, 15 patients with first-episode affective psychosis (mainly manic), and 14 healthy comparison subjects. MRI volumes were calculated for gray matter of superior temporal gyrus and for the amygdala-hippocampal complex. RESULTS: Patients with first-episode schizophrenia showed significant decreases in gray matter volume over time in the left superior temporal gyrus compared with patients with first-episode affective psychosis or healthy comparison subjects. This progressive decrease was more pronounced in the posterior portion of the left superior temporal gyrus (mean=9.6%) than in the anterior portions (mean=8.4%). No group differences in the rate of change over time were present in other regions. CONCLUSIONS: These findings demonstrate a progressive volume reduction of the left posterior superior temporal gyrus gray matter in patients with first-episode schizophrenia but not in patients with first-episode affective psychosis.     

Recurrence of first-episode geriatric depression after discontinuation of maintenance antidepressants.

OBJECTIVE: Later age at onset of depression appears to be a risk factor for early recurrence. Therefore, the authors examined the 2-year outcomes of elderly patients with first-episode major depression following discontinuation of their maintenance antidepressant medication. METHOD: The study group consisted of 21 elderly patients who had recovered from a first lifetime episode of major depression. They had taken maintenance antidepressant medication for 2 years and had not had a relapse or recurrence during that time. The antidepressant was then withdrawn, and patients were followed for another 2 years or until recurrence, whichever occurred first. RESULTS: The cumulative probability of suffering a recurrence of major depression was 61%. Eleven of the 12 patients who suffered a recurrence restarted the antidepressant, and 10 responded. CONCLUSIONS: Elderly patients with first-episode major depression were at high risk of recurrence following discontinuation of maintenance antidepressant medication. However, the vast majority of patients who experienced a recurrence responded to reinstated treatment.