Abstract

This study was aimed at characterizing long-term outcomes of first-admission psychosis and examining their baseline predictors. Participants were assessed at baseline for 38 candidate predictors and re-assessed after a median follow-up of 21 years for symptomatic, functional, and personal recovery. Associations between the predictors and the outcomes were examined using univariate and multivariate Cox regression models. At baseline, 623 subjects were assessed for eligibility, 510 met the inclusion/exclusion criteria and 243 were successfully followed-up (57.3% of the survivors). At follow-up, the percentages of subjects achieving symptomatic, functional, and personal recovery were 51.9%, 52.7%, and 51.9%, respectively; 74.2% met at least one recovery criterion and 32.5% met all three recovery criteria. Univariate analysis showed that outcomes were predicted by a broad range of variables, including sociodemographics, familial risk, early risk factors, premorbid functioning, triggering factors, illness-onset features, neurological abnormalities, deficit symptoms and early response to treatment. Many of the univariate predictors became nonsignificant when entered into a hierarchical multivariate model, indicating a substantial degree of interdependence. Each single outcome component was independently predicted by parental socioeconomic status, family history of schizophrenia spectrum disorders, early developmental delay, childhood adversity, and mild drug use. Spontaneous dyskinesia/parkinsonism, neurological soft signs and completion of high school remained specific predictors of symptomatic, functional, and personal outcomes, respectively. Predictors explained between 27.5% and 34.3% of the variance in the outcomes. In conclusion, our results indicate a strong potential for background and first-episode characteristics in predicting long-term outcomes of psychotic disorders, which may inform future intervention research.

中文翻译：

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首次入院精神病的长期结果：针对症状、功能和个人康复及其基线预测因素的 21 年自然随访研究

摘要

本研究旨在描述首次入院精神病的长期结果并检查其基线预测因素。参与者在基线时接受了 38 个候选预测因子的评估，并在中位随访 21 年后重新评估了症状、功能和个人恢复情况。使用单变量和多变量 Cox 回归模型检查预测变量和结果之间的关联。在基线时，623 名受试者接受了资格评估，510 名受试者符合纳入/排除标准，243 名受试者成功随访（幸存者的 57.3%）。随访时，受试者症状、功能和个人恢复的百分比分别为 51.9%、52.7% 和 51.9%；74.2% 满足至少一项回收标准，32.5% 满足所有三项回收标准。单变量分析显示，结果是由广泛的变量预测的，包括社会人口统计学、家族风险、早期危险因素、病前功能、触发因素、发病特征、神经系统异常、缺陷症状和早期治疗反应。当进入分层多变量模型时，许多单变量预测变量变得不显着，表明存在很大程度的相互依赖。每个单一的结果组成部分都是通过父母的社会经济状况、精神分裂症谱系障碍家族史、早期发育迟缓、童年逆境和轻度吸毒来独立预测的。自发性运动障碍/帕金森症、神经软体征和高中毕业仍然分别是症状、功能和个人结果的具体预测因素。预测变量解释了 27.5% 到 34.3% 的结果差异。总之，我们的结果表明背景和首发特征在预测精神障碍的长期结果方面具有强大的潜力，这可能为未来的干预研究提供信息。