一項(xiàng)來(lái)自《精神分裂癥研究》（Schizophrenia Research）雜志的綜述及meta分析顯示：藥物治療依從性不佳,，持續(xù)性藥物使用障礙，護(hù)理人員的批評(píng),，病前適應(yīng)不良是首發(fā)精神分裂癥（FEP）患者病情復(fù)發(fā)的4種重要預(yù)測(cè)因素,。然而，研究人員并未發(fā)現(xiàn)影響復(fù)發(fā)率的臨床和一般人口學(xué)資料證據(jù),。
該研究團(tuán)隊(duì)通過(guò)文獻(xiàn)檢索進(jìn)行縱向研究,，至少有12個(gè)月的隨訪，研究了FEP患者復(fù)發(fā)的社會(huì)人口學(xué),，臨床,，心理，生物,，以及治療預(yù)測(cè)因素,。共涉及29項(xiàng)研究，依據(jù)納入標(biāo)準(zhǔn)共納入3978例受試者,。其中12項(xiàng)來(lái)自歐洲（1550例）,，5項(xiàng)來(lái)自亞洲（636例），8項(xiàng)來(lái)自北美（1147例）,，4項(xiàng)來(lái)自澳大利亞（645）,。
數(shù)據(jù)分析顯示，F(xiàn)EP患者中陽(yáng)性癥狀在隨訪1年期,、1-1.5年期及3年期的平均復(fù)發(fā)率分別為28％,、43％、和54％,；109種復(fù)發(fā)預(yù)測(cè)因素中,，3項(xiàng)或3項(xiàng)以上的研究中僅對(duì)24種進(jìn)行了評(píng)估，其中可利用的預(yù)測(cè)因素?cái)?shù)據(jù)僅20種,。
研究結(jié)果發(fā)現(xiàn)：藥物依從性差,，持續(xù)性藥物使用障礙，護(hù)理人員的批評(píng),，和病前適應(yīng)不良分別使FEP患者的復(fù)發(fā)風(fēng)險(xiǎn)增加4.0,，3.0，2.3，和2.2倍,。然而,，疾病未治療期，自知力下降,，陽(yáng)性精神癥狀,，陰性精神癥狀，發(fā)病年齡,，性別,，婚姻狀況，教育,，就業(yè),，和認(rèn)知變量與復(fù)發(fā)風(fēng)險(xiǎn)無(wú)明顯相關(guān)。
“上述研究結(jié)果對(duì)于預(yù)防精神分裂癥的早期復(fù)發(fā)有著直接的臨床意義,，干預(yù)治療可能改善其長(zhǎng)期預(yù)后”,，Alvarez-Jimenez及其研究團(tuán)隊(duì)在《精神分裂癥研究》中總結(jié)稱(chēng)：“未來(lái)的研究應(yīng)著眼于保護(hù)因素和可修正因素的確定，發(fā)現(xiàn)既往研究方法上的疏漏,，并對(duì)綜合了生物-心理-社會(huì)因素參與復(fù)發(fā)病因的理論推導(dǎo)模型進(jìn)行評(píng)估”,。（生物谷Bioon.com）
doi:10.1016/j.schres.2012.05.007
PMC:
PMID:
Risk factors for relapse following treatment for first episode psychosis: A systematic review and meta-analysis of longitudinal studies
M. Alvarez-Jimeneza, b, , , A. Priedec, S.E. Hetricka, b, S. Bendalla, b, E. Killackeya, b, A.G. Parkera, b, e, P.D. McGorrya, b, J.F. Gleeson
Background
Preventing relapse is an essential element of early intervention in psychosis, but relevant risk factors and precise relapse rates remain to be clarified. The aim of this study was to systematically compile and analyse risk factors for and rates of relapse in the early course of psychosis.
Methods
Systematic review and meta-analysis of English and non-English language, peer-reviewed, longitudinal studies, with a minimum 12-month follow-up and at least 80% of participants diagnosed with a first episode of psychosis (FEP) that reported risk factors for relapse.
Results
Of 153 potentially relevant articles, 29 were included in the study. Pooled prevalence of relapse of positive symptoms was 28% (range = 12–47%), 43% (35–54%), 54% (40–63%) at 1, 1.5–2, and 3 years follow-up, in that order. A total of 109 predictors were analysed, with 24 being assessed in at least 3 studies. Of those, 20 predictors could be extracted for meta-analysis. Medication non-adherence, persistent substance use disorder, carers' critical comments (but not overall expressed emotion) and poorer premorbid adjustment, increased the risk for relapse 4-fold, 3-fold, 2.3-fold and 2.2-fold, respectively.
Conclusions
Clinical variables and general demographic variables have little impact on relapse rates. Conversely, non-adherence with medication, persistent substance use disorder, carers' criticism and poorer premorbid adjustment significantly increase the risk for relapse in FEP. Future studies need to address the methodological limitations of the extant research (e.g. definition of relapse), focus on the identification of protective factors and evaluate theoretically derived models of relapse.
