首发精神分裂症病人的抑郁症状

目的探讨首发精神分裂症病人抑郁症状的发生率、特征及相关因素。方法于入院、治疗3、6、9、12月时用汉密尔顿抑郁量表(HAMD)、简明精神病评定量表(BPRS)、阴性症状量表中文版(SANS-CV)、临床总体印象量表(CGI)及功能总体评定量表(GAF)对164例首发精神分裂症患者进行评定。结果急性期首发精神分裂症病人轻度或以上程度抑郁症状的发生率为71%,但在缓解期降至12%。急性期突出的抑郁表现为认知障碍与迟缓(因子分各占HAMD总分的35%和29%)。抑郁症状随着精神病性症状的缓解而减轻,与性别、发病年龄、受教育时间、病程及前驱期长短无关。HAMD总分在急性期仅与BPRS的焦虑抑郁因子分有关,但在缓解期与阴阳性症状、临床总体印象以及总体功能均有密切的相关性;急性期以及治疗3个月时的抑郁症状与随后的阴阳性症状、总体功能的变化无关。结论首发精神分裂症急性期的抑郁症状可能是一个独立的症状群,抑郁程度不能作为预测首发精神分裂症病人预后的指标。     

奥氮平治疗首发精神分裂症的疗效分析

目的 评价奥氮平治疗首发精神分裂症的疗效及安全性。方法 用奥氮平治疗首发精神分裂症32例,疗程8周;用简明精神病评定量表(BPRS)和副反应量表(TESS)评定疗效及副反应。结果 完成8周治疗的32例首发精神分裂症患者,显效18例(56.2％)、有效11例(34.4％)、无效3例(9.4％),总有效率为90.6％,副作用轻微,无明显心血管系统不良反应。结论 奥氮平治疗首发精神分裂症安全有效。     

Diagnosis-related regional gray matter loss over two years in first episode schizophrenia and bipolar disorder.

BACKGROUND: We examined gray- and white-matter brain volumes in first episode psychosis (FEP) at initial presentation and at two-year follow-up. We predicted that FEP subjects would show longitudinal reductions in fronto-temporal gray- and white-matter volumes compared with controls. Furthermore, we expected groups to be differentiated by diagnosis-related reductions. METHODS: Twenty-five schizophrenia and 8 bipolar disorder FEP patients underwent a structural MRI scan at first presentation and 2 years later. Matched healthy subjects (n = 22) underwent a single identical scan. RESULTS: At initial presentation FEP subjects had significantly less gray- and white-matter than healthy subjects. Diagnostic dissociations were revealed both at first presentation and at follow-up. In schizophrenia patients, gray-matter deficits were observed in lateral and medial frontal regions and in bilateral posterior temporal lobe regions, with additional extensive losses over time in lateral fronto-temporal regions and left anterior cingulate gyrus. By contrast, gray matter deficit in bipolar patients was localized to bilateral inferior temporal gyri with additional loss over time observed only in the anterior cingulate cortex. CONCLUSIONS: The results are consistent with a dual process model of psychosis, in which the diagnosis-related gray matter loss is determined by neurodevelopmental gray-matter volumetric differences which predate symptom onset, and diagnosis-related neurodegenerative gray-matter loss over time.     

Negative symptoms in first episode non-affective psychosis

OBJECTIVE: To determine the prevalence of negative symptoms and to examine secondary sources of influence on negative symptoms and the role of specific negative symptoms in delay associated with seeking treatment in first episode non-affective psychosis. METHOD: One hundred and ten patients who met Diagnostic Statistical Manual-IV (DSM-IV) criteria for a first episode of schizophrenia spectrum psychoses were rated for assessment of negative, positive, depressive and extrapyramidal symptoms, the premorbid adjustment scale and assessment of demographic and clinical characteristics including duration of untreated psychosis (DUP). RESULTS: Alogia/flat affect and avolition/anhedonia were strongly influenced by parkinsonian and depressive symptoms, respectively. A substantial proportion (26.8%) of patients showed at a least moderate level of negative symptoms not confounded by depression and Parkinsonism. DUP was related only to avolition/anhedonia while flat affect/alogia was related to male gender, diagnosis of schizophrenia, age of onset and the length of the prodrome. CONCLUSION: Negative symptoms that are independent of the influence of positive symptoms, depression and extra pyramidal symptoms (EPS) are present in a substantial proportion of first episode psychosis patients and delay in seeking treatment is associated mainly with avolition and anhedonia.     

氯丙嗪或利培酮治疗首发精神分裂症患者发生代谢综合征风险的1年观察

目的比较首发精神分裂症患者接受氯丙嗪或利培酮治疗1年后发生代谢综合征的风险,探索干预新模式以降低抗精神病药物导致的代谢综合征。方法首发精神分裂症住院患者分别给予氯丙嗪或利培酮治疗。于人组时、治疗第1、3、6及12个月末,检测空腹血糖、餐后2小时血糖、糖化血红蛋白、高密度脂蛋白、低密度脂蛋白、总胆固醇、三酰甘油水平和血压、体重等。结果共入组198例患者。入院时及治疗第12个月末代谢综合征阳性分别为22例（11．1％）和28例（14．1％）,差异有统计学意义（x2=26．21,P〈0．01）。氯丙嗪组,入组时和治疗1年后发生代谢综合征阳性人数分别为12例（11．7％）和17例（16．5％）,差异有统计学意义（校正x2=20．85,P〈0．01）。利培酮组分别为10例（10．5％）和11例（11．6％）,差别无统计学意义（校正x2=1．97,P=0．16）。治疗第12个月末,利培酮组血浆三酰甘油水平、空腹血糖、餐后2小时血糖、糖化血红蛋白含量低于氯丙嗪组,差异有统计学意义。代谢综合征的发生与患者入组时的代谢异常（r=0．36,P〈0．01）和男性（r=0．17,P：0．02）有关,与治疗药物无关（r=0．07,P=0．32）。结论氯丙嗪和利培酮可引起或加重首发精神分裂症患者代谢综合征。抗精神病药物对患者的影响尚需要进一步的研究。     

吸烟对利培酮治疗首发精神分裂症疗效、认知功能的影响

目的探讨吸烟对利培酮治疗首发精神分裂症的疗效和认知功能的影响。方法选择符合美国精神障碍诊断与统计手册第4版（DSM-IV）诊断标准的首发精神分裂症住院患者90例,其中吸烟患者27例,非吸烟患者63例,均使用利培酮治疗。详细收集临床资料,使用住院患者烟草使用状态调查表对患者吸烟状况进行详细调查,使用阳性和阴性症状量表（PANSS）评定基线时及治疗12周末的临床症状;威斯康星卡片分类（WCST）、重复性神经心理测查系统（RBANS）对患者在基线时及治疗12周末进行认知功能的检测,分别对吸烟组和非吸烟组的患者治疗前、后临床症状和认知功能变化值进行比较。结果基线时吸烟组患者PANSS总分（91.3±20.9）vs.（80.6±17.2）、阴性症状量表分（20.7±8.6）vs.（17.4±6.3）、一般精神病理症状量表分（43.4±12.3）vs.（38.2±10.8）均高于非吸烟组（均P〈0.05）;非吸烟组的正确应答数高于吸烟组（50.6±18.2）vs.（42.2±14.3）,P〈0.05,而错误应答数低于吸烟组（75.5±21.9）vs.（85.3±15.8）,P〈0.05。治疗12周末,吸烟组患者阴性症状减分值为（12.2±10.4）,非吸烟组（6.1±5.8）两组比较有显著性差异（t=2.7,P〈0.05）;吸烟组患者WCST中完成测查总应答数、错误应答数以及学习到学会的改善值显著高于非吸烟组,差异有统计学意义（t分别为-2.2、-2.1、2.0;P均〈0.05）;RBANS总分及各分量表分的增分值在两组之间差异不显著,无统计学意义（P均〉0.05）。结论吸烟患者临床症状、认知功能受损程度重于非吸烟患者;但是吸烟患者阴性症状、认知功能在治疗后的改善明显好于非吸烟患者。     

Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany

Abstract.Background: Several first-episode studies of schizophrenia suggest that many patients experience psychotic symptoms for a long time before receiving appropriate treatment. To reduce the time of untreated psychosis, it is necessary to know the patients pathways to psychiatric care. This study was designed to examine patients help-seeking contacts and the delays on their pathways to psychiatric care in Germany.Method: Sixty-six patients with first episode of schizophrenia spectrum psychosis were assessed by the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS) and were interviewed about their helpseeking contacts before psychiatric admission.Results: In contrast to other findings of long duration of untreated psychosis (DUP), 53% of our patients were admitted after 8 weeks (median) of untreated positive symptoms, although the mean value of 71 weeks corresponds well with the results of other studies. There were important differences in DUP depending on which kind of statistical parameter (median or mean) was used. In contrast to studies from other countries, only 18% of our patients had their first contact with a general practitioner. However, this was the fastest way to psychiatric admission. No differences were found between patients with short (< 1 year) and long (> 1 year) DUP in the duration of time from the first help-seeking contact up to admission.Conclusion: In Germany, a large number of mental health professionals in private practice or different services of psychosocial contact facilities exist in every region and general practitioners are not so important as a link to psychiatric care, although they seem to be functioning well if it is necessary. Therefore, programs designed to reduce the delay of treatment should focus less on general practitioners than on other health services.     

Alterations of white matter connectivity in first episode schizophrenia

Cerebral disconnectivity due to white matter alterations in patients with chronic schizophrenia assessed by diffusion tensor imaging has been reported previously. The aim of this preliminary study is to investigate whether cerebral disconnectivity can be detected as early as the first episode of schizophrenia. Intervoxel coherence values were compared by voxel-based t test in 12 patients with first episode schizophrenia and 12 age- and gender-matched control groups. We detected 14 circumscribed significant clusters (P < 0.02), 3 of them with higher, and 11 of them with lower IC values for patients with schizophrenia than for healthy control groups. We interpret these white matter alterations in different regions to be disconnected fiber tracts already present early in schizophrenic disease progression.     

Antipsychotic prophylaxis is needed after remission from a first psychotic episode in schizophrenia patients: Results from an aborted randomised trial

Abstract

Objective. To assess the effect of withdrawal of antipsychotic treatment on relapse risk in remitted first-episode schizophrenia patients. Methods. First-episode 1-year stable and remitted outpatients with a schizophrenic disorder were randomly allocated to continuation of their antipsychotic regimen for at least 6 months (N = 9), or gradual withdrawal (N = 11). Primary outcome was the difference in cumulative relapse-free survival at 9 months. Results. Recruitment was terminated prematurely on 26 October 2005. The cumulative relapse-free survival was 88% (SE = 0.12) in the continuation and 18% (SE = 0.12) in the discontinuation group (P = 0.001) at 9 months follow-up. Conclusions. Discontinuation of antipsychotic medication markedly increases the risk of relapse in stable remitted first-episode schizophrenia patients. In future studies the topics of safety monitoring and sampling of patients should receive extra attention.     

Illicit substance use and its correlates in first episode psychosis

Mazzoncini R, Donoghue K, Hart J, Morgan C, Doody GA, Dazzan P, Jones PB, Morgan K, Murray RM, Fearon P. Illicit substance use and its correlates in first episode psychosis. Objective: To determine if substance use (particularly cannabis) is more frequent among first episode psychosis patients and associated with a more problematic clinical presentation. Method: All first episode psychosis (FEP) patients presenting to secondary services were recruited from London and Nottingham, over 2 years, in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study broad framework. Clinical and sociodemographic variables were assessed using a set of standardized instruments. A schedule was created to retrospectively collate substance use data from patients, relatives and clinicians. Results: Five hundred and eleven FEP were identified. They used three to five times more substances than general population. Substance use was associated with poorer social adjustment and a more acute mode of onset. Cannabis use did not affect social adjustment, but was associated with a more acute mode of onset. Conclusion: Cannabis has a different impact on FEP than other substances. Large epidemiological studies are needed to disentangle cannabis effect.     

Neurological soft signs, clinical symptoms and treatment reactivity in patients suffering from first episode schizophrenia

OBJECTIVE : (a) To investigate the correlation between clinical symptoms and neurological soft signs in patients suffering from their first episode of schizophrenia and (b) to examine the relationship between soft signs and the reactivity of first episode treatment. METHODS: The trial included 92 male patients undergoing a first episode of schizophrenia. The clinical symptoms of the patients were rated on the positive and negative syndrome scale (PANSS). The PANSS scale was used to provide a measure for three syndromes: psychomotor poverty, disorganisation, and reality distortion. Neurological soft signs were assessed with the help of the neurological evaluation scale. RESULTS: The findings corroborated significant positive correlations between soft neurological signs on the one hand and negative symptoms and reduced treatment response on the other. CONCLUSION: Our study of the population of patients with first episode schizophrenia has corroborated the findings of those trials that found a correlation between neurological soft signs and the negative symptomatic dimension of schizophrenia. Another finding of the trial is that neurological soft signs were associated with poorer response to treatment of the first episode of schizophrenia.     

Social support and three-year symptom and admission outcomes for first episode psychosis

This paper presents the first published findings examining the relationship of social support to three-year symptom outcome and hospitalizations for a group of first episode patients with psychotic disorders. Social support was measured using items from the provider version of the Wisconsin Quality of Life Scale as assessed at the time of initiation of treatment for 113 patients. Outcome was assessed by level of positive and negative symptoms at three-year follow-up and number of psychiatric admissions during those three years. Higher levels of social support were found to correlate with lower levels of positive symptoms and few hospitalizations at follow-up. The relationship of social support to follow-up symptoms and hospitalization was independent of other potential predictors such as gender, age, premorbid adjustment and duration of untreated illness.     

Scale for the Assessment of Negative Symptoms structure in first episode psychosis

Previous studies in schizophrenia samples suggest negative symptoms can be categorized as expressivity or experiential. This study examines the structure of the Scale for the Assessment of Negative Symptoms (SANS) at two separate interviews in a first episode psychosis (FEP) sample. SANS structure was determined with principal components analysis in a schizophrenia spectrum (SSD, N=191) and non-schizophrenia spectrum (NSSD, N=246) sample at first presentation. Confirmatory factor analysis (CFA) was conducted in the entire FEP sample (N=197) at a follow-up assessment. A three factor model solution was extracted in both SSD and NSSD at first presentation. The three components, consisting of expressivity, experiential and alogia/inattention components, explained 26.1%, 16.6% and 13.6% of the variance respectively in SSD. In NSSD the same three components explained 24.2%, 17.9% and 13.1% of the variance respectively. CFA at follow-up showed similar model fit for both the original SANS five factor and for a three factor model solution. The results indicate that either a three or five factor SANS model solution may be appropriate in a psychosis sample inclusive of both SSD and NSSD. The findings also provide initial support for expressivity and experiential domain research in NSSD.     

EEG abnormalities and 3-year outcome in first episode psychosis

Objective: This study assesses the relationship of EEG to several aspects of 3 year symptomatic and functional outcome in first episode psychosis. Method: A total of 117 patients with first episode psychosis had their baseline EEG classified by modified Mayo Clinic criteria as normal, essentially normal or dysrhythmia. Socio‐demographic variables, duration of illness and of untreated psychosis and premorbid adjustment were also recorded. Positive and negative symptoms of psychoses, depression, anxiety and global functioning were rated on entry and after 3 years of treatment. Results: Patients with a dysrhythmic EEG at entry into treatment showed significantly greater persistence in both positive and negative symptoms of psychoses as well as anxiety and depression over 3 years. These findings were independent of duration of untreated illness or premorbid adjustment. Conclusion: An abnormal baseline EEG in patients with first episode psychosis is associated with a poorer symptomatic outcome at 3‐year follow‐up.     

首次发作精神分裂症患者出院服药情况1年调查

目的 了解首次发作(以下简称首发)精神分裂症患者出院服用抗精神病药的特点.方法 对137例首发精神分裂症患者出院后的服药情况进行问卷式跟踪随访调查1年,并比较服用第1代抗精神病药患者(64例)和第2代抗精神病药患者(73例)的差异.结果 首发精神分裂症患者服药依从性随时间推延逐渐降低,与所服药物类型无关.第1代抗精神病药组出院后第1、3、6、12个月的停药率分别为0%、7%、18%、50%,第2代抗精神病药组的停药率依次为3%、11%、21%、55%,2组各时点的差别无统计学意义.第1代抗精神病药锥体外系不良反应明显多于第2代抗精神病药,随访第12个月时分别为30%、7%, χ2=12.310,P<0.01.而后者在随访第12个月时出现内分泌系统不良反应比例(40%)高于第1代抗精神病药(5%)(χ2=13.433,P<0.05).结论 如何提高首发精神分裂症长期维持治疗的依从性是精神卫生服务的重要内容.     

分裂样精神病与首发精神分裂症临床特征比较

目的:比较分裂样精神病与首发精神分裂症的临床特征。方法:选取同期出院的分裂样精神病、首发精神分裂症患者各45例进行临床特征比较。结果:分裂样精神病与首发精神分裂症在思维贫乏、懒散、紧张恐惧和冲动破坏方面差异显著。结论:分裂样精神病与首发精神分裂症相比,某些症状有显著差异。