思覺失調症病人急性期緩解之臨床相關因子

Clinical Correlates of Remission in Acute Exacerbated Patients with Schizophrenia

背景：思覺失調症緩解工作小組(theRemissioninSchizophreniaWorkGroup,RSWG)提出思覺失調症緩解準則，但在台灣的族群中關於緩解率、緩解與臨床上之相關因子以及緩解之穩定度無明確之資料。方法：這是納入北台灣的164位住院的思覺失調症病人，為期五年的前瞻性研究。我們收集基準期之人口學與臨床資料並且定期以正性與負性量表評估精神症狀嚴重性。使用RSWG緩解準則。比較緩解組與非緩解組間人口學與臨床資料以及精神症狀嚴重度之差異。使用邏輯回歸分析探索緩解之相關預測因子。結果：34位病人(20.73%)達到緩解準則。緩解組之正性與負性量表分數在追蹤的期間皆持續低於非緩解組。緩解組在功能面相之分數顯著較非緩解組高。發病年齡較晚、較高的教育程度以及在基準期較低之負性症狀分數可預測是否可達到緩解。結論：緩解與非緩解組之分組在追蹤期間呈現相對穩定之狀態並與其在功能表現相符合。發病年齡、教育程度以及基準期的負性症狀可預測之後的緩解。

Background: The Remission in Schizophrenia Working Group (RSWG) proposed a set of criteria for remission in patients with schizophrenia. But it is unclear whether these criteria apply to the Taiwan population when assessing rates of remission or when evaluating the clinical correlates of remission and the stability of remission in patients with schizophrenia. Methods: Subjects in this prospective fi ve-year follow-up study comprised 164 inpatients with schizophrenia who were being treated at three hospitals in northern Taiwan. We gathered data of sociodemographic factors and baseline clinical profi les at the time of index admission. Severity of psychiatric symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) regularly. Remission status was defi ned according to RSWG criteria. Differences in demographic data, clinical profi les and severity of psychiatric symptoms between achievers and non-achievers of remission were evaluated using logistic regression. Results: Of the 164 inpatients recruited in the study, 34 (20.73%) fulfi lled the RSWG criteria for remission. PANSS scores among patients who achieved remission of psychotic symptoms were signifi cantly lower at all follow-up period (p < 0.05). In addition, functional scores were consistently signifi cantly higher among patients in the remission subgroup. Regression analysis revealed that older age at onset (p < 0.01), higher educational level (p < 0.05) and lower severity of negative symptoms (p < 0.05) at index admission were signifi cant predictors of remission of psychotic exacerbations. Conclusion: The remitted and unremitted subgroups remained rather stable and also validated in functional status. Further research is warranted to explore other outcome dimensions that might contribute to remission in schizophrenia including cognitive defi-cits and brain imaging studies.