一项来自《精神分裂症研究》（Schizophrenia Research）杂志的综述及meta分析显示：药物治疗依从性不佳，持续性药物使用障碍，护理人员的批评，病前适应不良是首发精神分裂症（FEP）患者病情复发的4种重要预测因素。然而，研究人员并未发现影响复发率的临床和一般人口学资料证据。
该研究团队通过文献检索进行纵向研究，至少有12个月的随访，研究了FEP患者复发的社会人口学，临床，心理，生物，以及治疗预测因素。共涉及29项研究，依据纳入标准共纳入3978例受试者。其中12项来自欧洲（1550例），5项来自亚洲（636例），8项来自北美（1147例），4项来自澳大利亚（645）。
数据分析显示，FEP患者中阳性症状在随访1年期、1-1.5年期及3年期的平均复发率分别为28％、43％、和54％；109种复发预测因素中，3项或3项以上的研究中仅对24种进行了评估，其中可利用的预测因素数据仅20种。
研究结果发现：药物依从性差，持续性药物使用障碍，护理人员的批评，和病前适应不良分别使FEP患者的复发风险增加4.0，3.0，2.3，和2.2倍。然而，疾病未治疗期，自知力下降，阳性精神症状，阴性精神症状，发病年龄，性别，婚姻状况，教育，就业，和认知变量与复发风险无明显相关。
“上述研究结果对于预防精神分裂症的早期复发有着直接的临床意义，干预治疗可能改善其长期预后”，Alvarez-Jimenez及其研究团队在《精神分裂症研究》中总结称：“未来的研究应着眼于保护因素和可修正因素的确定，发现既往研究方法上的疏漏，并对综合了生物-心理-社会因素参与复发病因的理论推导模型进行评估”。（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.
