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1.
精神分裂症未治期前驱症状及影响因素分析   总被引:1,自引:0,他引:1  
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。  相似文献   

2.
目的:探究首发住院精神分裂症患者未治疗期(duration of untreated psychosis,DUP)对患者预后的影响。方法:共入组193例首发精神分裂症患者,回顾性对其DUP进行评估,依据中位数约48周将其分为短DUP组103例和长DUP组90例;对两组出院阳性与阴性症状量表(PANSS)评分、用药剂量以及住院时间等进行对比。结果:长DUP组患者首次住院时间[(71.74±34.54)d]较短DUP组[(35.93±17.57)d]明显延长(P0.001),差异有统计学意义。长DUP组平均用药剂量明显高于短DUP组(P0.01)。对入院量表评分进行对比发现,短DUP组阳性症状评分大于长DUP组(P0.01),阴性症状评分小于长DUP组(P0.001);对出院PANSS评分进行对比发现,短DUP组总分小于长DUP组(P0.001),阳性症状评分差异无统计学意义,阴性症状评分短DUP组显著小于长DUP组(P0.001)。结论:尽早治疗可明显缩短首发精神分裂症患者住院时间、减少用药剂量,预后更好。  相似文献   

3.
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。  相似文献   

4.
首发精神分裂症患者就诊途径调查   总被引:4,自引:0,他引:4  
目的:调查首发精神分裂症患者在精神病医院和非精神病医院就诊途径。方法:完成对71例首发患者及家属调查,包括人口学资料、非精神病专科就诊情况、延迟至精神科求助原因、精神科就诊途径及原因、精神病未治疗期病程等。结果:非精神科主要求助方式为宗教迷信和非专科医生;精神科求助途径主要为家属意愿;精神病未治疗期病程(DUP)中位数为6个月,未发现DUP与其他调查因素相关;造成延迟至精神科求助主要原因是患者及家属对精神卫生知识缺乏。结论:加强社区精神卫生知识宣传普及对于缩短DUP非常必要。  相似文献   

5.
目的 探讨精神病未治疗期(DUP)对首发未服药精神分裂症患者脑白质完整性的影响.方法 应用汉化的诺丁汉发病症状量表评定39例首发未服药精神分裂症患者的DUP,以其中位数为界将患者分为长DUP组和短DUP组,同时比较两组患者的性别构成、年龄、受教育年限、阳性和阴性症状量表总分.采用自旋回波序列得到弥散张量磁共振成像资料,以DTI-Studi0软件和统计参数图软件(SPM5)对所得图像进行预处理,得到的分子各向异性分数(FA)图像在SPM5软件中进行两样本t检验,获得两组FA差异统计参数图.结果 两组患者性别构成、年龄、受教育年限、阳性和阴性症状量表总分比较差异无统计学意义(P>0.05).在P值小于0.001(未校正)水平下,长DUP组患者大脑右侧前扣带束(x=8,y=40,z=24)和左侧前额叶白质(x=32,y=34,z=4)FA值较短DUP组降低.结论 延长的DUP会降低首发未服药精神分裂症患者脑白质的完整性.  相似文献   

6.
文章分析了2002年以来关于首发精神病人(first-episode psychosis)未治疗病程(the duration of untreated psychosis,DUP)的研究,总结了DUP对患者的影响,DUP的决定因素、评估方法及应用价值,并提出对我国DUP研究方向的看法。  相似文献   

7.
目的 研究未治疗精神病期(duration of unmediacted psychsis,DUP)和家庭功能等因素对首发精神分裂症患者1年内复发的影响.方法 调查经临床治愈的首发精神分裂症患者的DUP及其家庭功能,同时随访患者在接受治疗1年间的复发时间及治疗前后的精神症状.使用家庭关怀度指数量表(APGAR)评定患者的家庭功能情况,应用简明精神病评定表(BPRS)和阳性与阴性症状量表(PANSS)评定精神症状.根据患者1年内的复发情况,分为复发组和未复发组进行比较.结果 (1)共入组95例患者,其中87例完成1年随访,有34例在1年中复发.复发组的DUP明显长于未复发组(4.59±3.79)月 vs (3.12±1.78)月,t=2.121,P=0.04;(2)复发组患者随访1年末PANSS阴性量表分与DUP有相关性(r=0.483,P=0.004);(3)复发组与未复发组患者比较,APGAR总分、适应度、亲密度分均有显著差异(APGAR总分:(5.91±1.62) vs (7.13±1.47),t=-3.631,P=0.000;适应度:(1.53± 0.51) vs (1.71±0.34),t=-2.752,P=0.008;亲密度:(1.09±0.29) vs (1.25±0.43),t=-2.028,P=0.046.结论 长DUP和低家庭功能水平,对首发精神分裂症患者1年内的复发可能有不良影响.  相似文献   

8.
目的探究首发住院精神分裂症患者未治疗期(duration of untreated psychosis,DUP)的影响因素及其与临床疗效的关系。方法搜集350例首发精神分裂症患者的临床资料,依据中位数48周将其分为短DUP组和长DUP组,探究DUP的影响因素,以及DUP对临床疗效的影响。结果男性患者平均首次就诊年龄为(30.01±11.98)岁,女性患者为(35.3±13.28)岁,存在统计学差异性(P0.05),女性患者要明显晚于男性患者。短DUP组已婚患者77例(40.7%)明显多于长DUP组26例(17%)。短DUP组离异患者23例(12.2%)少于长DUP组38例(23.6%)。两组患者家族史存在统计学差异性(P0.05),短DUP组患者中家族史阳性人数相对较多。两组患者烟酒史存明显差异,短DUP组烟酒史阴性患者170(89.9%)明显多于长DUP组126(78.3%)。两组患者诊断类型并不存在明显统计学差异性,但短DUP组紧张型12例(6.3%)明显多于长DUP组1例(0.6%),差异较明显。二元logistics回归分析发现婚姻状况、家族史、烟酒史以及临床类型对DUP有影响。对两组出院BPRS量表总分进行对比,发现短DUP组较长DUP组评分明显较低(P0.001)。BPRS量表治疗前后评分差值反映临床疗效,短DUP组评分差值(19.50±5.73)与长DUP组(11.06±4.27)存在显著差异(P0.001),提示长DUP组患者临床疗效相对较差。结论婚姻状况、家族史、烟酒史以及临床类型与DUP之间存在相关性,随着DUP的延长,患者临床疗效显著降低。  相似文献   

9.
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。  相似文献   

10.
目的探讨首发未治疗精神分裂症患者血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)水平的变化,及其与精神病未治期(duration of untreated psychosis, DUP)的关系。方法纳入首发未治疗且DUP≤2年的精神分裂症患者93例和正常对照93名。采用阳性和阴性症状量表(positive and negative symptoms scale,PANSS)评定患者的临床症状,并对所有受试者采用酶联免疫吸附法测定血清BDNF浓度。结果精神分裂症组患者血清BDNF水平(10.33±4.68)ng/mL,低于对照组(13.30±5.74)ng/mL,且差异有统计学意义(t=2.191,P=0.033)。患者DUP与其血清BDNF水平无相关性(r=-0.070,P=0.570)。结论首发未治疗精神分裂症患者的血清BDNF水平明显降低;而未治期与血清BDNF水平之间可能没有关联。  相似文献   

11.
《L'Encéphale》2016,42(4):361-366
IntroductionPrognosis of schizophrenia has not significantly improved despite extensive research. There is often a relatively long delay between onset of symptoms and treatment initiation. Lately, duration of untreated psychosis (DUP), the time between the onset of psychosis and initiation of treatment, has been one of the most studied variables in patients presenting for a first psychotic episode in order to evaluate the impact of early intervention on the prognosis of schizophrenia. In the literature, a variety of criteria have been used to define both transition to psychosis and initiation of treatment. Furthermore, the dating of both of these variables is usually retrospective, further complicating the measurement of DUP.MethodsWe conducted a comprehensive review about DUP using Pubmed and Google Scholar databases up to January 2015 using the following keywords “schizophrenia”, “duration of untreated psychosis”, “duration of untreated illness” and “early intervention”. Papers were included if they were published in French or English.ResultsThe mean DUP was found to be 2 years but it can vary according to multiple factors such as denial of illness by the patient and family, withdrawal and isolation from friends and relatives, diagnostic errors, paranoid views of the mental health treatment systems, or negative symptoms. Long DUP may also be a correlate of poor premorbid functioning or of an insidiously unfolding psychosis. Considerable discrepancies exist in the way that DUP is estimated in different studies. Although the clinical interview remains the most common way of measuring DUP, so far there is no evidence for favoring one method over another. Regardless of measurement method, a longer DUP is found to be associated with poorer outcome in schizophrenia in both the short and long-term across a number of domains: symptoms severity, remission rates, the risk of relapse, global functioning and quality of life. Its role in functional outcome appears to be mediated largely by negative symptoms, for which there is still no effective treatment. A recent meta-analysis has shown that shorter DUP is associated with less severe negative symptoms at short and long-term follow-up, especially when DUP is shorter than 9 months. The mechanism of the relationship between DUP and outcome is still undefined. A hypothesis is that the shorter the DUP, the more likely the intervention is being applied during the period in which neurobiological deficit processes in schizophrenia are most active.DiscussionA study of the duration of untreated illness (DUI), which is defined as the DUP and the prodromal phase, seems necessary because results of studies evaluating the effect of early detection and intervention in individuals with clinical high risk for psychosis are promising. A number of interventions such as omega 3 fatty acids and integrated psychosocial interventions seem to delay transition in the at-risk population. However, replication studies are lacking, and a great proportion of at high-risk individuals will spontaneously remit or develop diseases other than chronic psychosis, making us question the advantages and disadvantages of a treatment. Taking into consideration the high prevalence of comorbidities in individuals referred for clinical high-risk state and their effect on the individual's functioning, future interventions in the field need to address not only the preventative efficacy on psychosis transition but also their effectiveness in improving the functioning of this population and their effect on the outcome of schizophrenia when transition to psychosis has occurred.ConclusionDespite the huge advances in the field of schizophrenia, many questions remain unanswered and huge efforts are still necessary to understand the pathophysiology of this illness in order to improve its outcome.  相似文献   

12.
Aim: Evidence suggests that treatment delay, represented by the duration of untreated illness (DUI) and the duration of untreated psychosis (DUP), may be a potentially powerful determinant of the early course of primary psychotic disorders. Yet, research on the predictors of treatment delay has only just begun. To date, there are virtually no empirical data on the relationship between family functioning and treatment delay in the context of first‐episode psychosis. In this study, it was hypothesized that family strengths would be inversely correlated with DUI and DUP; and families of patients with a short DUI/DUP would have greater family strengths than those of patients with a long DUI/DUP. Methods: Family strengths (including pride and accord dimensions), DUI and DUP were assessed in 34 African Americans hospitalized for first‐episode psychosis and their respective 34 family members most involved in initiating care. Results: The total score of the Family Strengths scale and the accord subscale score were significantly inversely correlated with both DUI and DUP, although the correlation between the pride subscale score and DUI/DUP was not as strong and failed to reach statistical significance. Similarly, the family members of patients with a short DUI/DUP had higher family strength scores than those of patients with a long DUI/DUP. Conclusions: Given the dearth of research on the functioning of families beginning to initiate care for individuals with first‐episode psychosis, it is imperative to further clarify the role family characteristics may play in understanding treatment delay (DUI/DUP) and in the development of preventive interventions to facilitate early intervention for at‐risk populations.  相似文献   

13.
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。  相似文献   

14.
There is growing evidence for a relationship between the duration of untreated psychosis (DUP) and the prognosis in schizophrenia. The objective of this study is to evaluate whether DUP and premorbid level of social functioning are related to treatment response in acute treatment of first-episode schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed with BPRS, SAPS, and SANS on admission and discharge during their first hospitalisation. Percentage of the difference between admission and discharge in total scores of all scales were taken as measures of absolute symptom reduction. The median DUP was 6 months (mean=8.6). DUP was correlated with reduction in BPRS and SAPS scores but not SANS scores. Patients with a short DUP (n=41) also showed a higher reduction in BPRS, and SAPS scores than those with a long DUP. Premorbid Adjustment Scale (PAS) scores were inversely correlated with age at onset and positively correlated with BPRS scores at admission. We did not find any relationship between PAS scores and response to treatment. Our findings suggest that DUP may be an important predictor of response in acute treatment of first-episode schizophrenia and thus, attempts for early diagnosis may also have a positive effect on acute treatment response.  相似文献   

15.
Aim: The aim of this study was to investigate the demographic, illness and methodological factors associated with mean and median duration of untreated psychosis (DUP). Methods: A systematic review and meta‐analysis of the published studies of DUP and an examination of available DUP distributions. Results: DUP was longer in samples with a higher proportion of patients with schizophrenia and was shorter in samples that included affective psychosis. Sex, age, and the methods of measuring the onset and end‐point of DUP and the type of service in which the studies were performed did not contribute to the heterogeneity of the mean or median DUP values. Mean DUP is significantly prolonged by a small number of patients, and the median DUP is a poor indicator of the rate at which patients present. Conclusions: The DUP of patients with affective and non‐affective psychosis should be examined separately in order to make measures of DUP more meaningful and comparable, and DUP should be reported using more comprehensive measures. We suggest a method of reporting DUP based on the rate of presentation of first‐episode psychosis patients rather than the length of DUP.  相似文献   

16.
Aims: We examined the duration of untreated psychosis (DUP) and its social and clinical correlates in patients with schizophrenia in a rural/suburban region of Japan. Methods: We conducted a retrospective cohort study of patients with first‐episode psychosis from 11 hospitals in Kochi Prefecture. There were 108 patients who met the eligibility criteria, and data regarding their DUP and social/clinical variables were collected. Results: The median (mean) DUP of our cohort was 10.5 (34.6) months. Longer DUP was associated with younger age at onset, older age at first consultation, less educational attainment, insidious mode of onset and not being accompanied by another person at first consultation. After adjusting for confounding factors, age at onset, age at first consultation and mode of onset remained significantly and independently associated with DUP. In terms of treatment and response, longer DUP was associated with less antipsychotics prescribed upon first visit, and worse Clinical Global Impression Severity and Improvement scores after 1 year. Conclusion: The patients treated in a rural/suburban region of Japan had a long DUP, and shortening their DUP through promoting family involvement could improve their outcomes.  相似文献   

17.
Introduction: Duration of untreated psychosis (DUP) determines the outcome of schizophrenia. Previously, there was no information about the DUP among patients in Malaysia with schizophrenia. The aim of the present study was to investigate the association between DUP and patients' demographic, social cultural background and clinical features. Method: This is a cross‐sectional study on patients who presented with first episode schizophrenia. Data from 74 primary care centers and hospitals between 1 January 2003 and 31 December 2007 were included in the analysis. All patients with first‐episode schizophrenia were enrolled in the study. Results: The mean DUP was 37.6 months. The indigenous community appeared to have the shortest DUP compared to the Malay, Chinese and Indian communities. Female, people with lower educational level, and comorbidity with medical illness during contact had longer DUP. Discussion: DUP in this multiethnicity country was found to be significantly short among the indigenous people, which may sugest that traditional values and strong family and community ties shorten the DUP. Educational level may need to be further investigated, because as upgrading the general educational level could lead to shorter DUP among the patients as well.  相似文献   

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