首发精神分裂症患者抑郁症状9年随访

目的:探讨首发精神分裂症病人接受抗精神病药物治疗后9年中抑郁症状的转归及与其他相关因素的关系。方法:本研究纳入符合中国精神疾病分类方案与诊断标准第二版修订本(CCMD-2-R)精神分裂症诊断标准的164例首次发病住院患者,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)对患者在入院时及治疗后9年中每年进行一次评定,并据此计算缓解时间。结果:共139例患者完成随访。从治疗后的第1年起,每年末HAMD总分≥8分的患者所占比例为3.6%～13.7%,治疗后1～9年的HAM D总分均低于入院水平(P0.001)。入组时HAM D总分与治疗后9年中的缓解时间、9次年末的去除焦虑抑郁因子BPRS总分、SANS-CV、CGI及GAF分均无统计学意义相关。结论:经抗精神病药治疗1年之后,首发精神分裂症患者急性期的抑郁症状迅速减轻,此后在较低水平上略有波动;急性期抑郁症状水平不能预测精神分裂症的长期预后。

Depressive symptoms in first-episode schizophrenia:A 9-year follow-up study

Objective:To explore the variation of depressive symptoms before and after antipsychotic treatment and relations between depressive symptoms and outcomes among treatment-naive,first-episode schizophrenic patients in a 9-year follow-up study.Methods:Totally 164 first-episode inpatients met for Chinese Classification of Mental Disorders,Second Edition,Revised(CCMD-2-R) criteria of schizophrenia were recruited.They were assessed with the Hamilton Depression Rating Scale(HAMD),Brief Psychiatric Rating Scale(BPRS),Scale for the Assessment for Negative Symptoms Chinese Version(SANS-CV),Clinical Global Impression scale(CGI),and Global Assessment of Functioning scale(GAF) at admission and each of 9 years after admission.Results:Totally 139 cases were analyzed in ITT analysis.The rates of depressive symptoms in every year assessments for 9-year follow-up were 9.4%,13.7%,7.2%,8.6%,7.9%,6.5%,3.7%,6.5%,and 3.6%,(Cochran Q=22.18,P=0.005).The total scores of HAMD assessed at 1 to 9 years were all lower than that at admission(Ps<0.001).There were slight differences among 1 to 9 years’ total scores of HAMD(Ps<0.01).The total scores of HAMD at admission were not significantly correlated with the remission time,1 to 9 years’ total scores of SANS,GAF,CGI,and BPRS except depressive-anxiety subscale.Conclusion:It suggests that after 1-year’ s antipsychotic treatment,the depressive symptoms of patients with schizophrenia could remit rapidly,and depressive symptoms fluctuate around a relatively low level.The severity of depressive symptoms at acute phase of first-episode schizophrenia could not predict long time outcomes of the disease.