Clinical Correlates of Remission in Acute Exacerbated Patients with Schizophrenia

思覺失調症病人急性期緩解之臨床相關因子

張鎔麒(Jung-Chi Chang)；劉震鐘(Chen-Chung Liu)；胡海國(Hai-Gwo Hwu)；林奕廷(Yi-Ting Lin)；謝明憲(Ming H. Hsieh)；黃宗正(Tzung-Jeng Hwang)；劉智民(Chih-Min Liu)

schizophrenia ； remission ； predictor ； stability ； 思覺失調症 ； 緩解 ； 預測因子 ； 穩定度

台灣精神醫學

31卷2期（2017 / 06 / 01）

128 - 139+iii

英文

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 five-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 profiles at the time of index admission. Severity of psychiatric symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) regularly. Remission status was defined according to RSWG criteria. Differences in demographic data, clinical profiles 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%) fulfilled the RSWG criteria for remission. PANSS scores among patients who achieved remission of psychotic symptoms were significantly lower at all follow-up period (p ＜ 0.05). In addition, functional scores were consistently significantly 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 significant 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 deficits and brain imaging studies.

背景：思覺失調症緩解工作小組(the Remission in Schizophrenia Work Group, 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。

1. Agid, O,Kapur, S,Arenovich, T,Zipursky, RB(2003).Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected.Arch Gen Psychiatry,60,1228-1235.
2. AlAqeel, B,Margolese, HC(2012).Remission in schizophre- nia: critical and systematic review.Harv Rev Psychiatry,20,281-297.
3. Andreasen, NC,Carpenter, WT., Jr.,Kane, JM(2005).Remission in schizophrenia: proposed criteria and rationale for consensus.Am J Psychiatry,162,441-449.
4. Cassidy, CM,Norman, R,Manchanda, R,Schmitz, N,Malla, A(2010).Testing definitions of symptom remission in first-episode psychosis for prediction of functional outcome at 2 years.Schizophr Bull,36,1001-1008.
5. Ceskova, E,Prikryl, R,Kasparek, T(2011).Outcome in males with first-episode schizophrenia: 7-year follow-up.World J Biol Psychiatry,12,66-72.
6. Chang, WC,Tang, JY,Hui, CL(2012).Prediction of remission and recovery in young people presenting with first-episode psychosis in Hong Kong: a 3-year follow-up study.Aust N Z J Psychiatry,46,100-108.
7. Cheng, JJ,Ho, H,Chang, C J,Lan, S Y,Hwu, HG(1996).Positive and negative syndrome scale (PANSS): Establishment and reliability study of a mandarin Chinese language version.Chinese Journal of Psychiatry,10(3),251-258.
8. Chiliza, B,Asmal, L,Emsley, R(2012).Early intervention in schizophrenia in developing countries: focus on du- ration of untreated psychosis and remission as a treat- ment goal.Int Rev Psychiatry,24,483-488.
9. Ciudad, A,Alvarez, E,Bobes, J(2009).Remission in schizophrenia: results from a 1-year follow-up obser- vational study.Schizophr Res,108,214-222.
10. Crumlish, N,Whitty, P,Clarke, M(2009).Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis.Br J Psychiatry,194,18-24.
11. Diaz, I,Pelayo-Teran, JM,Perez-Iglesias, R(2013).Predictors of clinical remission following a first epi- sode of non-affective psychosis: sociodemographics, premorbid and clinical variables.Psychiatry Res,206,181-187.
12. Dunayevich, E,Sethuraman, G,Enerson, M,Taylor, CC,Lin, D(2006).Characteristics of two alternative schizo- phrenia remission definitions: relationship to clinical and quality of life outcomes.Schizophr Res,86,300-308.
13. Eberhard, J,Levander, S,Lindstrom, E(2009).Remission in schizophrenia: analysis in a naturalistic setting.Compr Psychiatry,50,200-208.
14. Emsley, R,Oosthuizen, P,Koen, L(2008).Remission in patients with first-episode schizophrenia receiving assured antipsychotic medication: a study with ris- peridone long-acting injection.Int Clin Psychophar- macol,23,325-331.
15. Emsley, R,Oosthuizen, PP,Kidd, M(2006).Remission in first-episode psychosis: predictor variables and symptom improvement patterns.J Clin Psychiatry,67,1707-1712.
16. Emsley, R,Rabinowitz, J,Medori, R,Early Psychosis Global Working G(2007).Remission in early psychosis: Rates, predictors, and clinical and functional out- come correlates.Schizophr Res,89,129-139.
17. Hegelstad, WT,Larsen, TK,Auestad, B(2012).Long- term follow-up of the TIPS early detection in psycho- sis study: effects on 10-year outcome.Am J Psychiatry,169,374-380.
18. Hwu HG: Diagnostic manual of psychiatric medicine Health World Press 1900.
19. Hwu, HG(1998).,Taiwan:National Health Research Institute.
20. Hwu, HG,Chen, CH,Hwang, TJ(2002).Symptom pat- terns and subgrouping of schizophrenic patients: sig- nificance of negative symptoms assessed on admis- sion.Schizophr Res,56,105-119.
21. Kane, JM,Crandall, DT,Marcus, RN(2007).Symptomatic remission in schizophrenia patients treated with aripiprazole or haloperidol for up to 52 weeks.Schizophr Res,95,143-150.
22. Kay, SR,Fiszbein, A,Opler, LA(1987).The positive and negative syndrome scale (PANSS) for schizophrenia.Schizophr Bull,13,261-276.
23. Lambert, M,De, Marinis, T,Pfeil, J,Naber, D,Schreiner, A(2010).Establishing remission and good clinical function- ing in schizophrenia: predictors of best outcome with long-term risperidone long-acting injectable treat- ment.Eur Psychiatry,25,220-229.
24. Levine, SZ,Rabinowitz, J,Ascher-Svanum, H,Faries, DE,Lawson, AH(2011).Extent of attaining and maintaining symptom remission by antipsychotic medication in the treatment of chronic schizophrenia: evidence from the CATIE study.Schizophr Res,133,42-46.
25. Li, CT,Su, TP,Chou, YH(2010).Symptomatic resolu- tion among Chinese patients with schizophrenia and associated factors.J Formos Med Assoc,109,378-388.
26. Lieberman, JA,Phillips, M,Gu, H(2003).Atypical and conventional antipsychotic drugs in treatment-naive first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazine.Neuropsycho- pharmacology,28,995-1003.
27. Liu, CC,Chen, CH,Hwu, HG(2012).Medium-term course and outcome of schizophrenia depicted by the sixth-month subtype after an acute episode.J Formos Med Assoc,111,265-274.
28. Liu, SK,Hwu, HG,Chen, WJ(1997).Clinical symptom di- mensions and deficits on the Continuous Performance Test in schizophrenia.Schizophr Res,25,211-219.
29. Llorca, PM,Lancon, C,Lancrenon, S(2009).The "Functional Remission of General Schizophrenia" (FROGS) scale: development and validation of a new questionnaire.Schizophr Res,113,218-225.
30. Miles, AA,Heinrichs, RW,Ammari, N(2011)."Real world" functioning in schizophrenia patients and healthy adults: assessing validity of the Multidimensional Scale of Independent Functioning.Psychiatry Res,186,123-127.
31. Opler, MG,Yang, LH,Caleo, S,Alberti, P(2007).Statistical validation of the criteria for symptom remission in schizophrenia: preliminary findings.BMC Psychiatry,7,35.
32. Petersen, L,Thorup, A,Oqhlenschlaeger, J(2008).Predictors of remission and recovery in a first-epi- sode schizophrenia spectrum disorder sample: 2-year follow-up of the OPUS trial.Can J Psychiatry,53,660-670.
33. Peuskens, J,Kaufman, L,Van Vleymen, B(2007).Analysis of resolution criteria in patients with schizophrenia treated with olanzapine for an acute psychotic epi- sode.Schizophr Res,95,169-173.
34. Rossi, A,Bagala, A,Del Curatolo, V(2009).Remission in schizophrenia: one-year Italian prospective study of risperidone long-acting injectable (RLAI) in pa- tients with schizophrenia or schizoaffective disorder.Hum Psychopharmacol,24,574-583.
35. Ucok, A,Serbest, S,Kandemir, PE(2011).Remission after first-episode schizophrenia: results of a long-term follow-up.Psychiatry Res,189,33-37.
36. Verma, S,Subramaniam, M,Abdin, E,Poon, LY,Chong, SA(2012).Symptomatic and functional remission in pa- tients with first-episode psychosis.Acta Psychiatr Scand,126,282-289.
37. Wunderink, L,Nienhuis, FJ,Sytema, S,Wiersma, D(2007).Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics.Schizophr Bull,33,792-796.

1. 游淑真(2017)。從旋轉門效應來看精神疾患者的社區照顧服務。社會工作實務與研究學刊，5，59-98。