首发精神分裂症未经治疗时间与临床疗效间关系:4年随访研究（英文）

背景:精神疾病未经治疗的时间和长期临床结局之间关系仍然存在争议。目标:前瞻性评估浦东精神卫生中心2007年1月至2008年12月收治的首发精神分裂症患者未经治疗的时间与临床结果之间的关系。方法:采用简明精神病评定量表(BPRS)、不良反应量表(TESS)、康复状态量表(MRSS)、以及社会功能缺陷筛选量表(SDSS)分别于基线、2010年6月和2012年6月收集一般健康状况,精神症状和社会功能相关信息。结果:共43例首发精神分裂症患者参与研究,将其分为精神疾病未治疗(DUP)短期(≤24周)和精神疾病未治疗(DUP)长期(24周)两组。短期DUP组的平均随访时间为1197(SD=401)天,长期DUP组平均随访时间为1412(SD=306)天(t=9.98,p=0.055)。尽管初诊时长期DUP组患者的精神病性症状较短期DUP组不明显(BPRS平均分,42.5[8.4]v.50.0[10.6],t=2.42,p=0.0210),并且两组临床复发次数类似(基于BPRS阳性症状量表评估),长期DUP组患者更可能在初诊时需要住院治疗(52%[11/21]v.9%[2/22],χ2=9.55,p=0.002),并且在治疗的头两年更有可能再次住院(67%[14/21]v.32%[7/22],χ2=5.22,p=0.022)。另外,经过四年的常规治疗后,虽然两组患者的阳性症状严重程度类似,但是治疗前具有较长DUP的患者比DUP较短的患者社会功能减退更明显。(SDSS平均,7.0[5.2]v.3.4[4.9],t=2.20,p=0.035)。结论:这些结果表明,与治疗前DUP较短的精神分裂症患者相比,尽管DUP较长的患者精神病性症状的严重程度类似(由BPRS测量),但长期社会功能较差。这证实了对慢性精神障碍患者早期识别和及时治疗的临床重要性。     

Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia

BACKGROUND: In first-episode schizophrenia, longer duration of untreated psychosis (DUP) predicts poorer outcomes. AIMS: To address whether the relationship between DUP and outcome is a direct causal one or the result of association between symptoms and/or cognitive functioning and social functioning at the same time point. METHOD: Symptoms, social function and cognitive function were assessed in 98 patients with first-episode schizphrenia at presentation and 1 year later. RESULTS: There was no significant clinical difference between participants with short and long DUP at presentation. Linear regression analyses revealed that longer DUP significantly predicted more severe positive and negative symptoms and poorer social function at 1 year, independent of scores at presentation. Path analyses revealed independent direct relationships between DUP and social function, core negative symptoms and positive symptoms. There was no significant association between DUP and cognition. CONCLUSIONS: Longer DUP predicts poor social function independently of symptoms. The findings underline the importance of taking account of the phenomenological overlap between measures of negative symptoms and social function when investigating the effects of DUP.     

Duration of untreated psychosis and the long-term course of schizophrenia.

This study examines the relationship between duration of untreated psychosis (DUP) and long-term symptomatic and social outcome in 205 patients with schizophrenia, whose parents are member of a consumer organisation. We found only a tendency that longer DUP was related to negative symptoms, but no relation to other outcome domains. The results of this study do not support antipsychotic intervention at the earliest sign of psychosis in order to 'protect the brain'.     

Duration of untreated psychosis and cognitive deterioration in first-episode schizophrenia

Cognitive impairment is an important clinical feature in many individuals with schizophrenia. Factors associated with cognitive deficit are not well established. Duration of untreated psychosis (DUP) has recently gained interest as a prognostic factor in schizophrenia. This study reports on the association between DUP and cognitive function. Subjects comprised 42 individuals (30 males, 12 females) who experienced a first-episode of DSM-III-R schizophrenia or schizophreniform disorder. Cognitive function was determined at clinical stabilization using the WAIS-R. An estimate of cognitive deterioration was based on the WAIS-R subtest profile. Longer DUP, male gender, higher premorbid IQ and younger age at admission independently predicted cognitive deterioration. Poorer performance on Digit Symbol and Comprehension subtests was associated with longer DUP. The findings suggest that untreated psychosis compromises some aspects of cognitive function. Studies investigating the association between DUP and outcome should control for potentially confounding variables. Early treatment of psychosis could help to reduce the prominent cognitive deficit in first-episode schizophrenia.     

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。     

Duration of untreated psychosis and treatment outcome in schizophrenia patients untreated for many years

OBJECTIVE: The duration of untreated psychosis (DUP) influences treatment outcome in schizophrenia but its relevance in untreated patients, ill for a very long duration, is not known. This study examined outcome and factors related to it after one year of treatment of schizophrenia patients who were ill for many years and not previously treated. METHOD: Among 75 never-treated patients with schizophrenia detected in a community survey in Chennai, India, 49 took treatment and were followed up prospectively for one year. Evaluation at intake and outcome was carried out using standardized methods. RESULTS: A good clinical outcome in 29%, social outcome in 35%, occupational outcome in 51% and global outcome in 31% was observed at the end of one year. Patients with poor global outcome did not significantly differ from those with good outcome on demographic and clinical variables at intake but for the presence of delusions and formal thought disorder. The proportion with good outcome in clinical, work and global measures fell steadily with increasing DUP. This difference was significant for clinical and global outcomes after a DUP of 5 years. CONCLUSIONS: The relationship between DUP and response to treatment held good even in chronic stages of schizophrenia with longer DUP associated with poorer outcome.     

DUP和家庭功能对首发精神分裂症患者1年内复发的影响研究

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.     

Unipolar mania over the course of a 20-year follow-up study

OBJECTIVE: Using data from a longitudinal study of the mood disorders, the investigators address the phenomenon of unipolar mania. METHOD: Subjects diagnosed as having Research Diagnostic Criteria mania at intake into the study were prospectively followed for up to 20 years. RESULTS: Twenty-seven subjects had the diagnosis of unipolar mania at the time they entered the study and had no history of major depression before enrolling in the study. Seven of these subjects did not suffer any episodes of major depression during the 15- to 20-year follow-up. CONCLUSIONS: These data support the diagnostic validity of unipolar mania.     

Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study.

The aim of this study was to investigate possible clinical predictors of the outcome of first-episode schizophrenia. The clinical charts of the first episode of psychosis and the follow-up period over at least 4 years for 67 DSM-III-R schizophrenic patients were reviewed. According to the number of psychotic relapses observed during the follow-up period, patients were sub-divided into two groups: mono- and multi-episode patients. The main demographic and clinical variables recorded at the first episode were compared between the two groups. A logistic regression analysis was performed to test a model for the possible predictors of the two different patterns of outcome.Multi-episode patients had an earlier onset of the illness and a longer "duration of untreated psychosis" (DUP), defined as the interval between the onset of the first psychotic symptoms and the first antipsychotic treatment. The Brief Psychiatric Rating Scale (BPRS) total scores were lower and the "avolition/apathy" scores of the scale for the assessment of negative symptoms (SANS) were higher in multi-episode patients. The logistic regression analysis results confirmed the DUP and the pre-treatment BPRS scores to be significant predictors of the outcome. These findings confirm that the timing in recognizing and treating the early symptoms of schizophrenia, even when subtle, is a core issue for the clinical management of the disorder.     

A 20-year follow-up study on schizophrenia in Singapore

OBJECTIVE: To assess the outcome and predictors of patients with schizophrenia 20 years later. METHOD: The patients, aged 15-39 years, with diagnosis of schizophrenia and first admitted to a national mental hospital in Singapore in 1975 were included. In 1980, 1985, 1990 and 1995, their hospital records were examined and the patients were interviewed to determine their working and treatment status. Possible predictors of good outcome and suicide data were determined. RESULTS: A total of 402 patients were included. Over 20 years, there was lower percentage of patients working full time and proportionately more patients were receiving out-patient treatment. Overall, about two-third of the patients had a good/fair outcome. Shorter illness duration before admission was significantly associated with a good outcome. The suicide rate was the highest in the first 10 years. CONCLUSION: Most patients with schizophrenia had a good/fair outcome at 20 years.     

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.     

Duration of untreated psychosis may predict acute treatment response in first-episode schizophrenia

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.     

精神病风险综合征与分裂样精神病临床对照研究

目的 探讨精神病风险综合征(PRS)与分裂样精神病(SFP)临床症状学结构的异同.方法 依据国际疾病分类第10版(ICD-10)及精神病风险综合征定式访谈(SIPS),从病历资料完整的住院患者中筛选出PRS患者71例及SFP患者39例,采用精神病高危症状量表(SOPS)和简明精神病评定量表(BPRS)评估两组疾病症状严重性.结果 两组患者起病形式存在显著性差异(x2=9.24,P=0.010),PRS组以亚急性发病常见(76％),SFP组以急性为主(61％);相关分析显示,SOPS总分与BPRS缺乏活力、思维障碍、敌对猜疑因子分及总分呈正相关(P＜0.01);SFP组SOPS阳性症状因子评分及总分均显著高于PRS组,BPRS总分及思维障碍、激活性因子评分均显著高于PRS组(P ＜0.05,P＜0.01).结论 精神病风险综合征与分裂样精神病是同源类疾病的不同状态,分裂样精神病阳性症状严重于精神病风险综合征.     

哈尔滨大型企业精神病流行学调查

目的：了解哈尔滨市大型企业中精神病人状况。方法：按１２地区精神疾病流行病学调查小组标准，设计方案，进行学习和调查。结果：７家大型企业精神疾病患病率为６．０４‰，精神分鲜明症患病率为３．７４‰，，肇事病人占２２．３％，结论：加强大中型企业中精神病人的管理十分重要。     

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.     

1-year follow-up study of cognitive function in first-episode non-affective psychosis

The longitudinal course of primary cognitive dysfunction seen in schizophrenia has yet to be fully clarified. Whereas some studies in chronic patients have revealed a progressive decline in cognitive abilities, those studies with first-episode patients have indicated that initial cognitive deficits might remain stable over time. The aim of this study was to examine the longitudinal course of cognitive functioning in patients with a first episode of schizophrenia. 112 patients with a first episode of schizophrenia-spectrum disorders and 22 healthy controls completed clinical and cognitive evaluations at baseline and again after 1 year. An extensive neuropsychological battery that comprised seven cognitive domains was used. Patients and controls improved their cognitive performance in virtually all the cognitive domains after one year. However, patients continued to show marked cognitive deficits after one year, unlike healthy volunteers. The longitudinal cognitive changes were similar in patients and controls in all domains except Verbal Memory (F = 11.67; df = 1; P = 0.001). The increase in cognitive scores found during early phases of the illness seems to be associated to practice-related changes and would not reflect a real cognitive enhancement but rather stability of deficit. Patients' deficits remained stable over time in all cognitive domains except Verbal Memory, in which less performance improvement was found. Further investigations are warranted to discern the variability in patterns of specific cognitive deficits over time.     

Suicidality and psychosis: the predictive potential of symptomatology and insight into illness

Recent research indicates that suicidal ideation and intent effect the majority of psychotic patients, a large proportion of whom eventually complete suicide. Some evidence suggests that psychotic symptomatology and awareness of the disorder may increase the suicidal risk in this patient population. This study investigated the predictive potential of insight into illness, years of treatment, recent traumatic stress, and depressive, manic, cognitive, anxiety, and psychotic symptomatology in the genesis of suicidality with psychotic patients. Results showed that increased insight into illness, fewer years of treatment, and more severe depressive symptoms each significantly heightened patients' risk of suicidality. Research and practice implications of these findings are discussed.     

Duration of untreated psychosis predicts functional and clinical outcome in children and adolescents with first-episode psychosis: A 2-year longitudinal study

Longer duration of untreated psychosis (DUP) in adult patients with first-episode psychosis (FEP) has been associated with poor clinical and social outcomes. We aimed to estimate the influence of DUP on outcome at 2-year follow-up in subjects with an early-onset (less than 18 years of age) FEP of less than 6 months' duration. A total of 80 subjects (31.3% females, mean age 16.0 ± 1.8 years) were enrolled in the study. The influence of DUP on outcome was estimated using multiple regression models (two linear models for influence of DUP on the C-GAF at 2 years and C-GAF change through the follow-up period, and a logistic model for influence of DUP on 41 PANSS remission at 2 years in schizophrenia patients (n = 47)). Mean DUP was 65.3 ± 54.7 days. Median DUP was 49.5 days. For the whole sample (n = 80), DUP was the only variable significantly related to C-GAF score at 2-year follow-up (Beta = − 0.13, p < 0.01), while DUP and premorbid adjustment (Beta = − 0.01, p < 0.01; and Beta = − 0.09, p = 0.04, respectively) were the only variables significantly related to C-GAF change. In schizophrenia patients, DUP predicted both C-GAF score at 2 years and C-GAF change, while in patients with affective psychosis (n = 22), DUP was unrelated to outcome. Lower baseline C-GAF score (OR = 0.91, p < 0.01) and shorter DUP (OR = 0.98, p = < 0.01) were the only variables that significantly predicted clinical remission in schizophrenia patients. In conclusion, longer DUP was associated with lower C-GAF at 2 years, less increase in C-GAF, and lower rates of clinical remission in early-onset FEP. Our findings support the importance of early detection programs, which help shorten DUP.