Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis

OBJECTIVE: This study examines 1year outcome in patients having first-episode non-affective psychosis, with emphasis on Duration of Untreated Psychosis (DUP) and premorbid functioning, in order to clarify how these factors interact. METHOD: Forty-three consecutively admitted patients were all rated on the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning Scale (GAF), both upon hospitalization and at 1year follow-up. In addition, premorbid functioning, DUP, duration of hospitalization, and social functioning were rated. RESULTS: Fifty-six per cent were in remission, 18% suffered multiple relapses and 26% were continuously psychotic at 1 year follow-up. Both poor premorbid functioning and long DUP are significantly correlated with more negative symptoms and poorer global functioning at follow-up. Long DUP is also significantly correlated with more positive symptoms. Even when we control for other factors, including premorbid functioning and gender, DUP is a strong predictor of outcome. To a limited degree premorbid functioning and DUP interact, but DUP has an independent influence on outcome. CONCLUSIONS: these findings strengthen the rationale for establishing health service programs for early detection and treatment of first-onset psychosis     

Lack of an inverse relationship between duration of untreated psychosis and cognitive function in first episode schizophrenia

This study assessed the relationship between duration of untreated psychosis (DUP) and cognitive measures in order to assess if longer DUP was associated with worse performance. One hundred two patients with first episode schizophrenia or schizoaffective disorder were assessed on cognitive measures of speed of processing, episodic memory, executive function, and visual spatial processing at baseline (when patients were drug naive and after 16 weeks of olanzapine or risperidone treatment), so that a change score could be derived. DUP was defined by the emergence of psychiatric symptoms and the emergence of psychotic symptoms. Data were analyzed correlationally, parametrically (after the group was divided into long and short DUP by median split), and by regression. We found that DUP for psychotic symptoms in this group of patients was long, with a median of 46 weeks. Neither correlational, parametric analyses in which DUP served as a class variable, nor multiple regression indicated that longer DUP was associated with worse cognition at baseline or smaller magnitude of improvement in cognition. Our results suggest that while early intervention may be critical for symptom amelioration by shortening DUP, early intervention for treatment of psychiatric symptoms may have little or no impact on cognitive function. Furthermore, assuming that cognition is a core symptom of schizophrenia, the notion that ongoing psychosis is somehow toxic for a variety of information processing domains appears questionable.     

The key to reducing duration of untreated first psychosis: information campaigns

The TIPS early intervention program reduced the duration of untreated psychosis (DUP) in first-episode schizophrenia from 16 to 5 weeks in a health care sector using a combination of easy access detection teams (DTs) and a massive information campaign (IC) about the signs and symptoms of psychosis. This study reports what happens to DUP and presenting schizophrenia in the same health care sector when the IC is stopped. METHODS: Using an historical control design, we compare 2 cohorts of patients with first-episode Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, non-affective psychosis at admission to treatment. The first cohort (N = 108) was recruited from January 1997 to December 2000, using an IC to raise awareness about recognizing psychosis to the public, the schools, and to general practitioners. The second cohort (N = 75) was recruited from January 2002 to June 2004 with no-IC. Easy access DTs were available to both cohorts. RESULTS: In the no-IC period, DUP increased back up to 15 weeks (median) and fewer patients came to clinical attention through the DTs. No-IC patients were diagnosed less frequently with schizophreniform disorder, more Positive and Negative Syndrome Scale positive and total symptoms, and poorer Global Assessment of Functioning (symptom) Scale scores. CONCLUSIONS: Intensive education campaigns toward the general public, the schools, and the primary health care services appear to be an important and necessary part of an early detection program. When such a campaign was stopped, there was a clear regressive change in help-seeking behavior with an increase in DUP and baseline symptoms.     

Obsessive-compulsive and panic symptoms in patients with first-admission psychosis

OBJECTIVE: The occurrence, persistence and specificity of the association between comorbid obsessive-compulsive and panic symptoms and three psychotic disorders--schizophrenia/schizoaffective disorder, bipolar disorder with psychosis, and major depression with psychosis--were examined in a first-admission, epidemiologically defined group of patients with psychotic symptoms. METHOD: The Structured Clinical Interview for DSM-III-R obsessive-compulsive and panic modules were administered at baseline and 24-month follow-up to patients with schizophrenia/schizoaffective disorder (N=225), bipolar disorder with psychosis (N=138), and major depression with psychosis (N=87) participating in the Suffolk County (N.Y.) Mental Health Project. The rates of subsyndromal symptoms and disorder criteria met were compared across the three psychosis groups. Recognition and treatment of anxiety symptoms at initial discharge and impact of the baseline presence of anxiety symptoms on 24-month clinical status were also examined. RESULTS: Obsessive-compulsive and panic symptoms were present at baseline in 10%-20% of all three groups. There was no specific association between obsessive-compulsive symptoms and any specific psychosis diagnosis; however, women with major depression with psychosis had a significantly higher rate of panic symptoms than the other two groups, and schizophrenia/schizoaffective disorder patients with baseline panic symptoms were significantly more likely to exhibit positive symptoms of psychosis after 24 months. CONCLUSIONS: The authors found no specific association between obsessive-compulsive symptoms and diagnosis early in the illness course, but the finding of an association between panic symptoms and psychotic depression among female patients and between baseline panic and positive psychotic symptoms in schizophrenia/schizoaffective disorder patients at 24 months suggests the need for further study.     

Treatment delay and response rate in first episode psychosis

OBJECTIVE: There is no consistent evidence of long duration of untreated psychosis (DUP) predicting long time to response (TTR) in first psychosis. This study aims to investigate the predictors of DUP and TTR in a first episode patient population. METHOD: An epidemiologically representative sample of 157 non-affective first psychotic episode patients was interviewed and followed-up for at least half a year. RESULTS: The mean DUP was 46 weeks, the median 31 days. Long DUP was associated with being unemployed before treatment and male gender. Short DUP, having a job, and living with a partner before treatment predicted early response. CONCLUSION: Early intervention likely improves short-term treatment response in first episode psychosis. The best strategy to reduce DUP probably is to direct attention to the substantial number of patients who do not engage in regular treatment.     

White-matter hyperintensities in first-episode psychosis

BACKGROUND: White-matter hyperintensities have been associated with both schizophrenia and mood disorders, particularly bipolar disorder, but results are inconsistent across studies. AIMS: To examine whether white-matter hyperintensities are a vulnerability marker for psychosis or are specifically associated with bipolar disorder. METHOD: T(2)-weighted magnetic resonance imaging data were acquired in 129 individuals with first-episode psychosis (either affective or non-affective psychoses) and 102 controls who were randomly selected from the same geographical areas. Visual white-matter hyperintensity ratings were used for group and subgroup comparisons. RESULTS: There were no statistically significant between-group differences in white-matter hyperintensity frequency or severity scores. No significant correlations were found between white-matter hyperintensity scores and duration of illness, duration of untreated psychosis, or severity of psychotic, manic or depressive symptoms. CONCLUSIONS: White-matter hyperintensities are not associated with vulnerability to psychosis in general, or specifically with affective psychoses. Further, first-episode psychosis investigations using more quantitative methods are warranted to confirm these findings.     

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。     

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 (DUP) and the course of schizophrenia in a 20-year follow-up study

Our aims were to analyze the relationship between the duration of psychosis (DUP) and short- and long-term outcomes of treatment, and to determine the cut-off point between short and long DUP at which differences in treatment outcomes are most significant. We assessed 80 participants with schizophrenia at the point of their first hospitalization. Fifty participated in all four follow-ups over 20 years. DUP was divided into short (up to 6 months) and long (over 6 months). ANOVA and Chi-square tests were employed to identify significant differences in both clinical and social indicators of functioning. ROC curves were used to estimate the best DUP division point. Significant differences favoring the short-DUP group were found for: GAF, total severity of symptoms and severity of positive symptoms, social functioning measured according to DSM-III criteria, employment, and social contacts. The optimal cut-off point for DUP was the 23rd week. We concluded that: (1) the relationship between longer DUP and worse overall treatment outcomes was sustained throughout the 20 years, (2) a positive correlation between DUP and the severity of psychopathological symptoms was observed over the first 12 years of illness, (3) the results indicate the efficacy of early therapeutic interventions in psychosis.     

Diagnostic stability 2 years after treatment initiation in the early psychosis intervention programme in Singapore

OBJECTIVE: To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis. METHODS: One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis. RESULTS: The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. CONCLUSION: It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.     

Patient characteristics and diagnostic discrepancy in first-episode psychosis

Despite the operational criteria in diagnostic systems there is still marked diversity between clinical and research diagnoses in populations with psychotic disorders. The objective of the current study was to explore the association of patient-related factors with diagnostic agreement between clinical diagnoses and Schedules for Clinical Assessment in Neuropsychiatry (SCAN-2) diagnoses in first-episode psychosis. The sample included 80 consecutive patients. As explanatory variables we used demographic characteristics (gender, age, living circumstances, education, and social activities), measures of psychopathology (Positive and Negative Symptom scale [PANSS], Hamilton Depression Scale, Global Assessment of Functioning Scale [GAF], and Strauss-Carpenter Scale), duration of untreated psychosis, and diagnostic category according to SCAN-2 interview. The overall agreement value between the clinical and research diagnoses was 0.55 (kappa). In the whole sample low scores on the PANSS negative subscale, low level of education, and high score on the PANSS item for delusions predicted diagnostic discrepancy. Acute and transient psychotic disorder as a research diagnosis predicted diagnostic agreement. In the schizophrenia group, young age and lack of social activities predicted diagnostic agreement. Bivariate comparisons of treatment compliance, perceived medication side effects, or negative attitudes towards treatment showed no associations with diagnostic agreement. The results confirm some of the findings in the few previous studies. The diagnosis of schizophrenia is likely to be delayed and there is a need for further education with clinicians in recognizing the symptoms of schizophrenia.     

Acute psychopathology as a predictor of global functioning in patients with ICD-10 non-affective psychosis: a prospective study in 11 European countries

This prospective analysis aimed to study the influence of psychopathological dimensions on the global functioning of persons suffering from psychotic disorders, taking into account the role of a broad range of potential confounders. A large international cohort (n=1888) with ICD-10 non-affective psychosis was evaluated both at baseline during a hospital admission and three months after discharge. Trained interviewers administered a global functioning scale (GAF) and a psychopathological scale (BPRS) at baseline and follow-up). Baseline BPRS psychopathological dimensions were extracted using Principal Component Analysis. Results of multiple linear regression analyses demonstrated that affective symptoms (depressive or manic) prospectively predict a better global functioning, whilst agitation/cognitive symptoms determined poorer global functioning. Other predictors showing an independent effect on better global functioning were medication compliance, country of residence, female gender, married or coupled status, younger age and having a diagnosis of schizoaffective disorder rather than schizophrenia or other ICD-10 psychosis. A predicting model for global functioning in patients with psychosis is provided, showing that assessment of affective and agitation/cognitive symptoms should be emphasised during admission as they can be more informative than positive/negative symptoms in prospectively planning follow-up care that is geared towards a better functional recovery.     

复发精神分裂症患者的精神病治疗前期间与家庭功能及精神症状的相关分析

目的了解复发精神分裂症患者精神病治疗前期间（DUP）与复发、家庭功能及精神症状之间的关系及其临床意义。方法选用精神分裂症首发症状评定量表（SOS）回顾性调查600例复发精神分裂症患者DUP,并选用家庭关怀度指数量表（APGAR）及阳性与阴性症状量表（PANSS）评定患者的家庭功能情况及精神症状。结果（1）DUP与复发次数、第一次复发时间呈强正线性相关（r值分别为0.085、0.266,P值分别为0.038、0.000）,与第二次、第三次复发时间呈负线性相关（r值分别为-0.160、-0.196,P值均为0.000）;（2）精神分裂症患者DUP与APGAR总分及适应度、合作度、成长度、情感度和亲密度五个因子均呈正相关（P〈0.05）;（3）DUP与PANSS总分、阴性症状分和一般精神病理分呈正相关（R值分别为0.155、0.144、0.082;P值分别为0.000、0.000、0.045）,与阳性症状分无关;（4）DUP与年龄呈正相关（r=0.141,P=0.001）,与病程和受教育程度无关（r值分别为0.009、0.024,P值分别为0.821、0.565）。结论DUP越长复发次数越多,阴性症状的严重程度越重;良好的家庭支持可缩短DUP。     

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.     

Negative symptoms in first episode non-affective psychosis

OBJECTIVE: To determine the prevalence of negative symptoms and to examine secondary sources of influence on negative symptoms and the role of specific negative symptoms in delay associated with seeking treatment in first episode non-affective psychosis. METHOD: One hundred and ten patients who met Diagnostic Statistical Manual-IV (DSM-IV) criteria for a first episode of schizophrenia spectrum psychoses were rated for assessment of negative, positive, depressive and extrapyramidal symptoms, the premorbid adjustment scale and assessment of demographic and clinical characteristics including duration of untreated psychosis (DUP). RESULTS: Alogia/flat affect and avolition/anhedonia were strongly influenced by parkinsonian and depressive symptoms, respectively. A substantial proportion (26.8%) of patients showed at a least moderate level of negative symptoms not confounded by depression and Parkinsonism. DUP was related only to avolition/anhedonia while flat affect/alogia was related to male gender, diagnosis of schizophrenia, age of onset and the length of the prodrome. CONCLUSION: Negative symptoms that are independent of the influence of positive symptoms, depression and extra pyramidal symptoms (EPS) are present in a substantial proportion of first episode psychosis patients and delay in seeking treatment is associated mainly with avolition and anhedonia.     

Duration of untreated psychosis and neuropsychological function in first episode psychosis

PURPOSE: We investigated whether duration of untreated psychosis (DUP) prior to first presentation was associated with cognitive function in first episode psychosis (FEP) subjects. We predicted that longer DUP would be associated with greater neurocognitive impairment. METHOD: 180 subjects with schizophrenia (and 93 subjects with Other Psychoses) performed a neurocognitive battery assessing IQ, verbal learning, working memory, visual learning and speed of processing. DUP was defined as the number of days between first onset of psychotic symptoms and first contact with psychiatric services. RESULTS: Longer DUP was associated with impaired performance in verbal IQ (p=0.04), verbal learning (p=0.02), and verbal working memory (p=0.04) in FEP subjects with schizophrenia. These associations remained significant for verbal IQ when scores were corrected for age, gender, educational level and ethnicity. CONCLUSIONS: Longer DUP is associated with poorer neurocognitive ability in schizophrenia subjects at time of first presentation. Since this was a cross-sectional study we can not tell whether longer DUP was a cause or a consequence of the poorer performance.     

Predictors of psychosis remission in psychotic disorders that co-occur with substance use

OBJECTIVE: To examine rates and predictors of psychosis remission at 1-year follow-up for emergency admissions diagnosed with primary psychotic disorders and substance-induced psychoses. METHOD: A total of 319 patients with comorbid psychosis and substance use, representing 83% of the original referred sample, were rediagnosed at 1 year postintake employing a research diagnostic assessment. Remission of psychosis was defined as the absence of positive and negative symptoms for at least 6 months. Likelihood ratio chi-square tests and multivariate logistic regression were the main means of analysis. RESULTS: Of those with a baseline diagnosis of primary psychotic disorder, 50% were in remission at 1 year postintake, while of those with a baseline diagnosis of substance-induced psychosis, 77% were in remission at this time point. Lower Positive and Negative Syndrome Scale (PANSS) symptom levels at baseline, better premorbid functioning, greater insight into psychosis, and a shorter duration of untreated psychosis predicted remission at 1 year in both diagnostic groups. No interaction effects of baseline predictors and diagnosis type were observed. A stepwise multivariate logistic regression holding baseline diagnosis constant revealed the duration of untreated psychosis (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.95, 0.997), total PANSS score (OR = 0.98; 95% CI = 0.97, 0.987), Premorbid Adjustment Scale score (OR = 0.13; 95% CI = 0.02, 0.88), and Scale to Assess Unawareness of Mental Disorders unawareness score (OR = 0.84; 95% CI = 0.71, 0.993) as key predictors of psychosis remission. CONCLUSIONS: The association of better premorbid adjustment, a shorter duration of untreated psychosis, better insight into psychotic symptoms, and lower severity of psychotic symptoms with improved clinical outcome, reported previously in studies of schizophrenia, generalizes to psychosis remission in psychotic disorders that are substance induced.     

Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder.

BACKGROUND: Psychotic symptoms may be present in up to 40% of patients with combat-related posttraumatic stress disorder (PTSD). In this study, we hypothesized that severity of psychotic symptoms would also reflect severity of PTSD symptoms in patients with well-defined psychotic features. METHODS: Forty-five Vietnam combat veterans with PTSD but without a primary psychotic disorder diagnosis underwent a Structured Clinical Interview for DSM-III-R with Psychotic Screen, and the Clinician Administered PTSD Scale (CAPS). Patients identified as having psychotic features (PTSD-P), (n = 22) also received the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale (HDRS). RESULTS: There was a significant positive correlation between the CAPS and PANSS global ratings (p < .001) and the HDRS and PANSS (p < .03) in the PTSD-P patients. Many CAPS and PANSS subscales also demonstrated significant intercorrelations; however, the CAPS-B subscale (reexperiencing) and the PANSS positive symptom scale were not correlated, suggesting that psychotic features may not necessarily be influenced or accounted for by more severe reexperiencing symptoms. Fifteen (68%) of the PTSD-P patients had major depression (MDD). Both CAPS and PANSS ratings were significantly higher in the PTSD-P patients with comorbid MDD. CONCLUSIONS: As postulated, patients with more severe psychosis ratings are likely to have more severe PTSD disease burden if psychotic features are present. This study further documents the occurrence of psychotic features in PTSD that are not necessarily due to a primary psychotic disorder, suggesting that this may be a distinct subtype; however, a significant interaction likely exists between PTSD, depression, and psychotic features.     

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。     

Family history of psychosis negatively impacts age at onset, negative symptoms, and duration of untreated illness and psychosis in first-episode psychosis patients

Family history (FH) of psychosis has been a focus of investigations attempting to explain the heterogeneity in schizophrenia. Previous studies have demonstrated that FH is associated with earlier age at onset, severity of positive and negative symptoms, and the duration of untreated illness (DUI). The current study examined the impact of FH on the clinical presentation and help-seeking behaviors of a well-characterized, first-episode sample. The present study utilized the Symptom Onset in Schizophrenia (SOS) Inventory, the Positive and Negative Syndrome Scale (PANSS), and structured interviews on FH to examine these relationships in a large (n=152) sample of predominantly African American patients. Results showed that patients with a first-degree FH of psychosis had a younger age at onset of both the prodrome and psychosis, but did not differ in duration of prodromal period. Furthermore, FH and sex interacted to influence severity of negative, but not positive symptoms. Finally, FH interacted with sex to influence both the DUI and DUP in that only males with FH had longer DUI and DUP. The findings have implications for understanding the impact of specific family-related mechanisms on both clinical and help-seeking factors, as well as for informing future family-based intervention efforts.