精神分裂症未治期前驱症状及影响因素分析

目的了解精神分裂症患者未治疗期间（DUP）前驱症状及其家庭因素的影响。方法应用诺丁汉起病症状量表（NOS）调查卢湾区精神卫生中心的精神分裂症患者,共收集59例。同时,应用家庭问卷对患者家属进行访谈,调查可能影响患者及时就诊的因素。结果（1）精神分裂症患者DUP中位数是465d;（2）首发非特异性精神症状以猜疑和行为障碍最为常见,出现频度超过24％;首发精神病性症状以妄想和幻听最为常见,出现频度达到58％;（3）影响患者就诊的主要因素是家属希望患者自己恢复和患者不愿接受治疗;（4）以DUP中位数465d将患者区分为长DUP组和短DUP组,发现：短DUP家属组（DUP≤465的）在思维中的奇怪观念和魔术性思维的比例显著高于长DUP组（χ2=14.75,P=0.0001;χ2=4.54,P=0.033）。结论精神分裂症患者从发病到开始治疗的疾病未治疗期间较长,患者的思维障碍促进患者家属积极寻求治疗。     

精神分裂症未治期及其影响因素研究

目的 了解精神分裂症患者首次正式开始治疗前的疾病未治疗期间(duration of untreated illness, DUI)和精神病未治疗期间(duration of untreated psychosis,DUP)及其影响因素.方法 应用诺丁汉起病症状量表(Nottingham onset schedule, NOS)调查上海市精神卫生中心的精神分裂症患者,共收集117例.同时,应用自编问卷对患者家属进行访谈,调查可能影响患者及时就诊的因素.结果 ① 精神分裂症患者DUI中位数是181天, DUP中位数是84天.② 首发非特异性精神症状以失眠和情绪障碍最为常见,出现频度超过50%;首发精神病性症状以幻听和被害妄想最为常见,出现频度达到47%.③ 影响患者就诊的主要因素是家属不认识精神病和患者不愿接受诊治.④ 以DUI中位数181天将患者区分为长DUI组和短DUI组,发现:长DUI组中回答家庭成员意见不一致是延误就诊因素的比例显著高于短DUI组(χ2=3.9,P<0.05).结论 精神分裂症患者从发病到开始治疗的疾病未治疗期间较长.影响DUI和DUP的因素是多方面的,值得进一步深入研究.     

浙江省精神卫生工作状况的调查分析

对浙江省精神卫生工作的现状作了调查;至1991年底,全省共有31所精神病医院,84个综合医院精神科,5378张精神科病床,773名精神病医生。结合存在的问题提出了相应的工作建议,希望能对各地同道有所参考。     

西安市精神分裂症患者未治期特点及影响因素

目的：了解西安市精神分裂症患者未治期（DUP）特点、影响因素,分析患者未积极接受治疗、复查、康复的主要原因。方法采用多阶段分层随机抽样法,对西安市1581例精神分裂症患者及其家属进行问卷调查,主要运用描述性统计和χ2检验对数据进行分析。结果被调查的1581例精神分裂症患者未治期中位数为30 d 。影响未治期的因素主要有病耻感、求神拜佛、居住方式、家庭类型。未积极治疗的主要原因为经济问题、自认为病情轻;没有复查的主要原因是自认为病情痊愈、经济问题;未接受康复治疗的主要原因是经济问题、不知道需要接受康复治疗。结论患者及其家属的健康教育工作仍需加强,卫生政策支持需进一步落实。     

青海省藏族精神分裂症未治期及影响因素分析

目的探讨藏族精神分裂症患者精神病未治期(duration of untreated psychosis,DUP)的影响因素。方法采用精神分裂症患者精神卫生服务利用调查问卷及精神分裂症首发症状评定量表对188例藏族精神分裂症患者的社会人口学资料、精神疾病家族史、家庭类型、起病形式、医疗付款方式、居住地、自评家庭收入水平、首发症状出现的时间等进行调查,分析DUP影响因素。结果患者DUP呈偏态分布,中位数375 d(QL=4 d,QU=1661 d)。将患者分为短DUP组(DUP≤375 d)90例和长DUP组(DUP375 d)98例,不同DUP组患者的起病形式、婚姻状况、文化程度、家庭类型、居住地的组间差异有统计学意义(P0.05)。DUP影响因素的logistic回归分析显示,结构缺失的家庭(OR=2.340,95%CI:1.130~4.847,P=0.022)、慢性起病(OR=2.136,95%CI:1.172~3.891,P=0.013)、居住在农牧区(OR=2.239,95%CI:1.097~4.571,P=0.027)与长DUP相关联。结论藏族精神分裂症DUP较长,受多种因素影响,主要的危险因素有结构缺失的家庭、慢性起病、居住在农牧区。     

48例首发抑郁症患者的精神科初诊情况调查

目的:了解抑郁症患者有关精神科初诊情况。方法:对48例首发抑郁症患者初次就诊精神科时的病程、主动性、非精神科诊治史等进行调查分析。结果:初诊时平均病程(6.4±4.4)个月,仅33.3%患者主动来诊,72.9%曾求治过非精神科。逐步回归分析显示,影响初诊时病程的因素为躯体症状、起病形式、发病年龄及悲观程度;影响就诊主动性的因素是自知力;非精神科就诊行为主要受躯体症状影响。结论:抑郁症患者多就诊不够及时、主动和恰当,其根本原因是对该病的认识不足。     

精神卫生服务需求研究:Ⅶ.就诊途径及家属心理压力分析(摘要)

本文就精神病人就诊途径及病者家属的心理压力作简单分析。方法对已确诊的对象用需求问卷(重性精神病人使用家属问卷)进行调查,内容主要包括:早期表现、专科就诊时间、求助顺序、未去专科就诊的因素、家属心理压力程度、经济损失程度等。43例神经症病人资料较完整;重性精神病人中,除7例独居、2例死亡、4例未遇到家属外,资料均完整。     

攀枝花市精神科“120”出诊情况调查

目的了解攀枝花市精神科“120”出诊情况，为探索精神病人的管理提供参考。方法采用回顾性调查方法，对攀枝花市精神卫生中心2004～2007年“120”出诊情况资料进行了分析。结果近4年来精神科“120”出诊233次：出诊对象多为“三无”人员，流浪精：冲病患者、精神病在家滋事家属求助以及急性醉酒后闹事者；要求出诊者依次是政府、公安派出所、群众及患者家属；5．75％的出诊对象存在医疗费用困难，无陪护及明确的法定监护人等。结论精神科“120”的出诊需要专科医院、政府／社区、公安派出所、司法、民政／救助站等相关部门配合，精神病患者的救治需社会综合救助。     

精神分裂症首次发病患者未治期的影响因素分析

目的：探讨首发精神分裂症患者未治期（ DUP）的影响因素。方法：采用一般资料调查表、阳性与阴性症状量表（ PANSS）、诺丁汉起病症状量表（ NOS）以及疾病家庭负担量表（ FBS）对206例首次发病精神分裂症患者的疾病严重程度、起病形式以及因疾病给家庭带来的负担进行评估。结果：首发精神分裂症患者DUP的中位数为6（2,12）个月,其中男性5（1,12）个月,女性7（2,12）个月,男女比率差异无统计学意义（P>0.05）。将患者分为短DUP组（DUP≤6个月）112例和长DUP组（DUP>6个月）94例比较结果显示,不同DUP组的起病形式（χ2=61.99,P=0.000）、家属对患者的关心程度（t=4.09,P=0.000）、疾病对家庭娱乐活动的影响（t=-2.22,P=0.03）以及疾病对家庭成员心理健康的影响（t=-2.53,P=0.01）两组间存在统计学意义。Logistic 回归分析发现,起病形式（ OR =11.46,95%CI =5.70~23.04）是DUP的危险因素;家属对患者的关心程度（OR=0.73,95%CI=0.60~0.90）是DUP的保护性因素。结论：影响首发精神分裂症患者DUP的因素是多方面的,但起病形式及家属对患者的关心程度是主要因素。     

抑郁症患者首次至精神科首次就诊的特征

目的:调查精神科首诊抑郁症患者特征.方法:调查196例初次就诊精神科的抑郁症患者,对病程、就诊主动性、非精神科求治史等特征及其他相关因素进行分析. 结果:患者至精神科门诊初诊时平均病程(6.4±4.4)个月,仅37.6％患者主动来诊,46.7％曾求治过非精神科.逐步回归分析显示,影响初诊时病程的因素为性别、文化程度及发...     

Duration of untreated psychosis and pathways to psychiatric services in first-episode schizophrenia

The aim of the present study was to examine the duration of untreated psychosis (DUP) in first-episode schizophrenia patients in Japan and to investigate the available pathways to psychiatric services. Eighty-three patients who visited Keio University Hospital (n = 54) or Oizumi Mental Hospital (n = 29) were evaluated retrospectively with regard to their DUP, living situation, social participation level, referral pathway, reason for seeking treatment, and their global assessment of functioning (GAF) score. The mean DUP was 13.7 months (median, 5.0 months) overall. No significant difference in DUP was found between subjects living alone and those living with others; however, employed patients had a significantly shorter DUP (8.1 months) than unemployed patients (18.7 months). Pathways to psychiatric services were totally different between the two institutions. Fifty-two subjects (62.7%) came to the services directly: 40 patients (74.1%) came to the university hospital and 12 patients (41.4%) came to the mental hospital. At the mental hospital, nine patients (31.0%) had been admitted because of a legal obligation, and six (20.7%) had been referred through public health centers. None of the patients had been referred to either of the services by general practitioners. The main reason for seeking treatment was psychiatric symptom aggravation (59.3%) at the university hospital and acting out (64.3%) at the mental hospital. Some universal psychosocial factors appear to influence the DUP but the characteristics of specific psychiatric services may also affect treatment delays.     

The impact of mode of onset of psychosis on pathways to care in a hospitalized, predominantly African-American, first-episode sample

Aim: Given recent findings that mode of onset is a determinant of duration of untreated psychosis (DUP), along with a dearth of research coupling the mode of onset and pathways to care constructs, this study explored the possible effects of mode of onset on pathways to care. Methods: The study included 76 patients hospitalized for first‐episode, nonaffective psychosis in two urban, public‐sector psychiatric units. Consensus‐based best estimates were derived for mode of onset, pathways to care variables and DUP. Associations between mode of onset and several types of pathways to care variables were examined: (i) two key duration variables during the pathway; (ii) four variables pertaining to services contacted, sources of help and reasons for psychiatric contact; and (iii) the number of help‐seeking contacts during the pathway. Results: None of the sociodemographic or clinical variables examined (except DUP) were associated with mode of onset. In further assessing the association between mode of onset and DUP, mode of onset was related to the first component of DUP – delay in initiating any help contact – but not with the duration from initiating the first help contact until hospitalization. Mode of onset was not significantly associated with a number of other key pathways to care variables (e.g. type of first help‐seeking contact, number of help‐seeking contacts). Conclusion: The present findings suggest that both community‐wide informational campaigns and early intervention programmes may benefit from focusing on gradually developing psychosis, which confers a longer delay to initiating care.     

The impact of family experience on the duration of untreated psychosis (DUP) in Hong Kong

BACKGROUND: Previous family experience of psychotic illness may play an important role in whether and when a patient seeks help in first-episode psychosis. This study investigated the relationship between family experience of psychosis and the duration of untreated psychosis in a prospective sample of first-episode psychosis patients in Hong Kong. We also studied the effects of pre-morbid adjustment, educational level, living alone, and mode of onset as potential determinants of the duration of untreated psychosis (DUP). METHODS: A total of 131 first-episode psychosis patients in Hong Kong were recruited in a study of the DUP and related factors. The Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS) was used to measure the DUP and to provide a structured assessment of family history, educational level, household arrangement, and mode of onset. RESULTS: Previous family experience of psychiatric illness (the presence of another family member who has been receiving psychiatric treatment) and an acute mode of onset were significant predictors of a shorter DUP. Educational level had a modest effect on its own, but was not significant in the binary logistic regression model. Living alone had a moderate effect size, but was non-significant, possibly because of the small proportion of single-person households in the sample. The symptom profile, pre-morbid adjustment, and other demographic factors were not significantly related to the DUP. CONCLUSION: In addition to the mode of onset, previous family experience plays an important role in the presentation of early psychosis. Educational efforts that target the family should be an important part of any strategy for the early detection of psychosis.     

Background factors as determinants of satisfaction with care among first-episode psychosis patients

Objective To evaluate the impact of demographic and psychosocial background factors and psychiatric and functional status before and at admission on the patients' satisfaction with care (PSC) among first-episode psychosis (FEP) patients. Method One year after entering the Parachute Project, 134 FEP patients completed a patient satisfaction questionnaire. The association with demographic and psychosocial background factors, together with psychiatric and functional status before and after admission, was analysed. Results Twenty-nine per cent of the variance of PSC was explained by factors such as educational level, social network, duration of untreated psychosis (DUP) and Global Assessment of Functioning (GAF) the year prior to onset. Negative symptoms and lack of hope at admission were also predictors of PSC. The strongest predictor was DUP. Conclusion Affecting the public knowledge in psychiatric problems and psychiatric treatment, together with early intervention strategies aiming to decrease the prodromal and DUP period among FEP patients, can positively influence the patients' experience of given care. By increasing the knowledge of available psychiatric treatment, the sense of powerlessness might decrease among the affected persons, and the possibility of early help seeking might increase.     

The patterns of the health care seeking behavior and related factors in the schizophrenic patients]

Three hundreds schizophrenic out-patients, from 6 different socioculture background psychiatric facilities in Hunan were investigated by structured interview with definite schedule. The results show that after the recognition of the problem by decision maker, 45% subjects were delayed at least one month for help-seeking, 61.3% subjects first visited the non-psychiatric agencies, and 74.3% subjects has counselled with non-psychiatric doctors or healers at least one time, especially to the healer providing superstitious or religious therapy. The help-seeking styles mainly attributes to the lower socioeconomic status of the family, inconvenient referral to the psychiatric facilities, especially if the decision maker is a female, rural resided under-educated person knowing nothing of modern psychiatry. Based on these findings, the authors urge to improve scientific psychiatric care knowledge in population, develop the resource of mental health service to facilitate the radical change of help seeking behavior of the population.     

Duration of untreated psychosis and pathways to care in patients with first-episode psychosis in Iran

Aim: This is the first study on the duration of untreated psychosis and pathways to care among patients with first‐episode psychosis in Iran as a developing country. Methods: Ninety‐one patients with a first episode of non‐organic psychosis admitted to a university‐affiliated psychiatric hospital in Iran were assessed for duration of untreated psychosis (DUP), pathways to care and mode of onset. Results: Median DUP was 11 weeks (mean = 52.3 weeks). Following the onset of psychosis, most patients were first seen by a psychiatrist (n = 23, 25.3%), a traditional healer (n = 21, 23.1%) or a general practitioner (n = 16, 17.6%). Most referrals to the psychiatric hospital were made by the family (n = 30, 33.1%), or health professionals (n = 29, 31.9%). Acute onset and rural place of residence were associated with shorter DUP in multivariate analysis. Conclusions: Median DUP was not long in an inpatient sample with first‐episode psychosis, which may be due to the preponderance of affective and acute psychoses in this sample and some help‐seeking or service variables.     

Pathway to psychiatric care in Bali

The aim of the present study was to trace the help-seeking pathway of mental patients and to elucidate the role of traditional healing in Bali. The source of care before attending Bangli Mental Hospital (Bali) of 54 consecutive patients with no prior psychiatric treatment was investigated. Subjects who had sought help from traditional healers were asked to evaluate treatment effect retrospectively according to a 5-point scale. The pathway to psychiatric care was dominated by traditional healers. Of the patients, 47 (87.0%) consulted a healer (mean number 2.9) before visiting the mental hospital. Consultation with the healers was associated with treatment delay. However, of the 137 traditional healers on the pathway, 11 (8.0%) recommended that the subjects to go to a mental hospital, and all 11 subjects immediately followed the advice. Of the 47 subjects, 14 (29.8%) evaluated the treatment effect as much improved by at least one traditional healer on the pathway, although they ultimately attended the mental hospital. Subjects without psychotic symptoms tended to evaluate the treatment effect as much improved more often than psychotic subjects. Traditional healers function not only as a barrier to reaching psychiatric care, but as either an effective provider of care or a decision-making support for seeking help from psychiatric care for some mental patients in Bali. The knowledge and recognition of psychological disorders by the traditional healers are crucial for early treatment intervention for psychiatric patients.     

Clinical and social determinants of a longer duration of untreated psychosis of schizophrenia in a Japanese population

Aim: To measure the duration of untreated psychosis (DUP) among patients with schizophrenia in a Japanese population and to investigate clinical and social determinants of the DUP. Methods: A multicentre, retrospective study at seven medical centres in three cities (Tokyo, Toyama and Kochi) was performed. In total, 150 consecutive patients (78 men) with neuroleptic-naïve first-episode schizophrenia were investigated; their DUP and demographic, clinical and social variables were obtained from their medical charts and analysed. Results: The intraclass correlation coefficient for the DUP was quite good (ICC = 0.849). The mean DUP of all the subjects attending the seven psychiatric services was 20.3 months, and the median DUP was 6.0 months. Fourteen patients (9.3%) had a DUP of more than 60 months, and 47 patients, or about one-third, had a DUP of more than 24 months. No significant differences in the mean DUPs were observed among the three cities. Patients who were employed or who were students had a significantly shorter DUP (14.3 months). The median DUP for those with an insidious onset of psychosis (n = 85) was 18.0 months, compared with a median of 2.0 months for those with a sudden and acute onset (n = 61). However, no other clinical or social variables examined in this study were associated with differences in the DUP. Conclusions: The DUP of patients with schizophrenia is relatively long in Japan. The provision and modification of psychiatric services for easy access and a system for the early recognition and detection of mental illness are needed.