精神病临床高危综合征人群临床转化的相关因素分析
Analysis of related factors of clinical outcome in patients with clinical high risk syndromes
目的:探讨精神病临床高危(clinical high risk, CHR)状态群临床转化的相关因素。方法:2011?年2?月至2014?年5?月在上海市精神卫生中心精神科门诊使用精神病临床高危综合征结构式访谈(Structured Interview for Psychosis-Risk Syndromes, SIPS)筛选并在2?年随访时间点评估CHR人群的临床症状和总体功能,收集其处方用药信息。使用Kaplan-Meyer生存分析和Cox回归分析探索CHR临床转化的相关因素。结果:实际入组206?例,失访38?例,最终168?例CHR完成随访研究。生存分析显示,阳性症状评分 [χ 2( df=1)=4.395, P=0.036]、解体症状评分[χ 2( df=1)=4.425, P=0.035]、临床高危综合征量表总分[χ 2( df=1)=3.881, P=0.049]、功能总体评估评分[χ 2( df=1)=5.961, P=0.015]、服用抗抑郁药[χ 2( df=1)=6.751, P=0.009]、服用抗精神病药[χ 2( df=1)=9.455, P=0.002]和抗精神病药服药剂量[χ 2( df=1)=7.488, P=0.006]、服药时长[χ 2( df=1)=5.368, P=0.021]与CHR的临床结局有关,并且服用抗精神病药( β=0.844, P=0.007)是CHR临床转化的危险因素,服用抗抑郁药( β=-0.731 ,P=0.026)可能是临床转化的保护因素。 结论:CHR的临床转化与处方药物种类存在一定关联性,但其中因果关系仍需进一步研究。
更多Objective:To explore the related factors for the clinical conversion of patients in clinical high risk(CHR).Methods:From February 2011 to May 2014, patients in the psychiatric clinics of Shanghai Mental Health Center were screened by the Structured Interview for Psychosis-risk Syndromes (SIPS) and re-assessed at a 2-year follow-up to measure their clinical symptoms and overall function. Patient′s prescribed medication were collected at the same time. Kaplan-Meyer survival analysis and Cox regression analysis were used to explore the relevant factors of CHR clinical conversion.Results:A total of 206 patients were enrolled, 38 patients were lost and/or withdrawn, and 168 patients completed the follow-up assessment. Survival analysis showed that positive symptoms (χ 2( df=1)=4.395, P=0.036), disorganize symptoms (χ 2( df=1)=4.425, P=0.035), total scores of psychosis-risk symptoms (χ 2( df=1)=3.881, P=0.049), overall function (χ 2( df=1)=5.961, P=0.015), antidepressant drugs (χ 2( df=1)=6.751, P=0.009), antipsychotics drugs (χ 2( df=1)=9.455, P=0.002), their corresponding dose (χ 2( df=1)=7.488, P=0.006) and length of treatment (χ 2( df=1)=5.368, P=0.021) were significantly related to clinical conversion for CHR. In addition, taking antipsychotics drugs may be a risk factor for clinical outcomes (β =0.844, P=0.007), while taking antidepressants may be a protective factor (β=-0.731, P=0.026). Conclusions:The clinical conversion of CHR patients may be related to the type of prescriptions. Further studies are warranted to examine the causal relationship in detail.
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