首发精神分裂症精神病未治期对认知功能和社会功能的影响

目的探讨首发精神分裂症精神病未治期(duration of untreated psychosis,DUP)对认知功能和社会功能的影响。方法纳入首发且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)评定患者的临床病理症状,Matrics公认认知成套测验(Matrics consensus cognitive battery,MCCB)评定所有被试认知功能,个人和社会功能量表(personal and social performance scale,PSP)和功能大体评定量表(global assessment function scale,GAF)评定所有被试社会功能。结果精神分裂症组在连线测验、符号编码、范围流畅性测验、Stroop色词测验、持续操作测验、空间广度、霍普金斯言语记忆测验-修订版(Hopkins verbal learning test-revised,HVLT-R)、简易视觉空间记忆测验(brief-visuospatial memory test-revised,BVMT-R)和迷宫测验方面的得分均低于对照组,且差异有统计学意义(均P0.05)。精神分裂症组的GAF得分和PSP得分均低于对照组,差异具有统计学意义(均P0.05)。精神分裂症患者DUP与HVLT-R2(r=-0.265,P=0.010)和BVMT-R3(r=-0.328,P=0.001)分别呈负相关,DUP与GAF(r=-0.292,P=0.005)和PSP(r=-0.397,P0.001)得分分别呈负相关。结论首发精神分裂症患者存在社会功能和广泛的认知功能损害,且DUP越长,患者的认知功能和社会功能越差。     

首发精神分裂症患者未治疗期对治疗及预后影响

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。     

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。     

精神分裂症首次发病未用药患者认知功能的改变

目的:探讨精神分裂症首次发病未用药患者认知功能改变的相关性。方法:124例首发未治疗精神分裂症患者为研究组,同期健康体检者60名作为对照组,采用MCCB、Stoop色词测验对两组的认知功能进行评价,采用阳性和阴性症状量表(PANSS)评估症状。结果:研究组患者认知功能各项评分均显著低于对照组,差异有统计学意义(P0.05);相关因素分析结果显示,首发未治疗精神病患者MCCB总分、Stroop色词测验与患者受教育年限呈正相关,与PANSS总分及各因子分呈负相关;数字广度测试与教育年限呈正相关;与阳性症状分、PANSS总分成负相关。回归分析表明精神分裂症患者认知功能与受教育年限及PANSS总分相关。结论:首发未治疗精神分裂症患者认知功能明显低于正常人,且患者的认知受损程度和其精神病症状有关。     

首发未用药精神分裂症认知功能及生活技能与临床特征的关系

目的探讨首发未用药精神分裂症患者认知功能、生活技能状况及其与临床特征的关系。方法纳入首发精神分裂症住院患者145例和65名正常对照,采用精神分裂症认知功能成套测验中文版(MATRICS consensus cognitive battery,MCCB)、Stroop色词测验等评估两组认知功能,加州大学圣地亚哥分校基于任务的生活技能测验(University of California,San Diego performance-based skill assessment,UPSA)评估生活技能,阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评估患者精神症状。结果患者组的MCCB总分、10项分测验、数字广度测验、情绪识别测验、Stroop色词测验得分均低于对照(均P0.05);患者组的UPSA财务技能分、交流技能分及UPSA总分均低于对照组(均P0.05)。偏执型精神分裂症患者的语言记忆、视觉记忆评分、Stroop色词测验、UPSA交流技能分、UPSA总分高于非偏执型患者(均P0.05)。Logistic回归分析显示MCCB的影响因素为受教育年限(OR=1.29,95%CI:1.13~1.47)及PANSS总分(OR=0.95,95%CI:0.92~0.97)。结论首发未用药精神分裂症认知功能、生活技能明显受损,损害程度与精神病理症状有关联,偏执型患者的认知功能、生活技能好于非偏执型患者。     

首次发病住院精神分裂症患者未治期的影响因素

目的:探究影响首次发病住的精神分裂症患者未治期(DUP)的因素。方法:采用自编问卷、精神分裂症首发症状评定量表(SOS)、阳性与阴性症状量表(PANSS)及家庭关怀度指数量表(APGAR)调查218例首次发病住院精神分裂症患者DUP时间、症状严重程度及其家庭关系。结果:患者DUP中位数为7(3,14)个月,其中短DUP组(DUP≤7个月)98例,长DUP组(DUP7个月)120例;两组患者起病形式、家庭结构、PANSS评分及APGAR评分比较差异有统计学意义。Logistic回归分析显示,患者起病慢、居住在农村、缺陷型家庭是DUP的危险因素;患者及家属受教育程度高、PANSS中阳性症状及兴奋敌对因子评分高、APGAR评分高是DUP保护因素。结论:影响DUP的因素是多方面的,但家庭关怀是重要的保护因素。     

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.     

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。     

首发未治疗精神分裂症血清脑源性神经营养因子水平研究

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。     

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。     

Symptomatic and functional remission in patients with first-episode psychosis

Verma S, Subramaniam M, Abdin E, Poon LY, Chong SA. Symptomatic and functional remission in patients with first‐episode psychosis. Objective: For patients suffering from psychotic disorders and their caregivers, ‘recovery’ remains important. Our study aims to examine the rates of both symptomatic and functional remission in first‐episode psychosis (FEP) patients at 2 years and identify sociodemographic and clinical factors associated with recovery. Method: In this naturalistic study, all consecutive FEP patients presenting to an early psychosis intervention programme were recruited. Symptomatic remission was defined by the Schizophrenia Working Group’s criteria; functional remission was defined as a Global Assessment of Functioning (GAF) disability score of ≥61 with engagement in age‐appropriate vocation. Simple and multiple logistic regressions using stepwise method were used. Results: Out of 1175 patients, 636 (54.1%) met criteria for symptomatic remission, 686 (58.4%) for functional remission, while 345 (29.4%) met for both. Multiple logistic regression revealed female gender (OR 1.47; 95%CI, 1.12–1.93), those married (OR 1.49; 95%CI, 1.02–2.18), younger age (OR 0.98; 95%CI, 0.95–0.99), tertiary education (OR 1.56; 95%CI, 1.02–2.38), shorter DUP (OR 0.99; 95%CI, 0.98–0.99), lower baseline PANSS negative scores (OR 0.97; 95%CI, 0.95–0.99), and early response at month 3 (OR 1.78; 95%CI, 1.31–2.42), as significant predictors of recovery at year 2. Conclusion: Our results indicate that strategies to reduce DUP and achieve early response could improve remission rates in FEP patients.     

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     

One year outcome in first episode psychosis: influence of DUP and other predictors

BACKGROUND: A number of studies have reported evidence of a relationship between longer duration of untreated psychosis (DUP) and poorer outcome at 1 year while others have failed to find such evidence. It is possible that several other predictors may confound this relationship and there may be different predictors for different dimensions of outcome. In the current study we examined relationship between DUP and several other predictors, and 1 year outcome on rate and level of remission as well as level of positive, negative, depressive and anxiety symptoms in a community cohort of first episode psychosis patients. METHOD: All potential cases of a first episode of non-affective psychosis were assessed and offered treatment in a comprehensive treatment program. Data were collected on all patients who completed 1 year of treatment on a number of predictor variables (DUP, length of the prodromal period, age of onset, gender, pre-morbid adjustment during childhood and adolescence, diagnosis) and outcome variables (level of remission, positive, negative, depression and anxiety symptoms based on ratings on SAPS, SANS, CDS and HAS, respectively). Data were analysed using an analysis of variance, bivariate correlations and hierarchical regression analysis. RESULTS: Of a total of 130 patients were offered treatment, 106 completed 1 year of treatment and complete data were available on 88 subjects, 80% of whom met criteria for schizophrenia spectrum psychosis. The rate and level of remission were significantly higher for patients with shorter DUP (<22 weeks). DUP was the only independent predictor of the level of remission as well as reality distortion at 1 year; for disorganization syndrome and negative symptoms it was the age of onset and level of premorbid adjustment in adolescence, respectively; while the level of anxiety was predicted by the length of the prodrome. Additional predictors increased the variance explained by each model. CONCLUSION: Our results confirmed the independent role of DUP in remission and positive symptom outcome at 1 year, thus providing support for the enthusiasm for early intervention. However, the model including DUP and premorbid adjustment in early adolescence explained a greater amount of variance in outcome on positive symptoms than DUP alone. On the other hand, outcome on negative symptoms, disorganization and anxiety are more likely to be influenced by longer term characteristics such as premorbid adjustment, earlier age of onset, gender and the length of the prodromal period, and therefore may not be as responsive to effects of early intervention.     

Olfactory identification deficits in first-episode psychosis may predict patients at risk for persistent negative and disorganized or cognitive symptoms

OBJECTIVE: One-third of patients with a schizophrenia spectrum disorder have a measurable olfactory identification deficit at first examination. The authors studied the relationship of this deficit to symptom remission after 1 year of treatment. METHOD: Fifty-eight patients naive to antipsychotic medication who entered the Nova Scotia Early Psychosis Program were symptomatically rated with the Positive and Negative Syndrome Scale (PANSS) (at baseline and 1 year). At baseline, the University of Pennsylvania Smell Identification Test (UPSIT) was also completed. Remission was determined for four symptom factors derived from the PANSS (positive, negative, cognitive/disorganized, and anxiety/depression). Patients with and without remission were compared on UPSIT scores. RESULTS: Patients with nonremission of negative and cognitive/disorganized symptoms had significantly lower baseline UPSIT scores compared with patients with remission. UPSIT scores were unrelated to remission of positive or anxiety/depression symptoms. CONCLUSIONS: UPSIT scores can be used to identify patients at risk for persistent negative and disorganized/cognitive symptoms.     

Duration of untreated psychosis (DUP): an useful predictor of outcome in schizophrenia?

The concept of DUP has gained much interest as a possible predictor of outcome variables. The review of the current state of research suggests that DUP may be related to remission, social functioning and severity level of symptomatology. In the present retrospective-prospective study 50 first-time admitted patients were interviewed with the "Interview for the Retrospective Assessment of the Onset of Schizophrenia" (IRAOS). Outcome was measured after six months and one year with the "Positive and Negative-Syndrom Scale" (PANSS) and the "Disability Assessment Schedule" (DAS). Patients with long DUP had a worse outcome regarding the severity level of positive symptoms, of general symptoms and social disability. Corresponding well with some other studies, there was no association between DUP and negative symptoms. CONCLUSION: DUP can be regarded as an useful predictor of outcome in schizophrenia. However, further research is required to confirm these results in long-term studies.     

Duration of untreated psychosis and outcome in first-episode psychosis. Perspective from a developing country

OBJECTIVE: To investigate the association between duration of untreated psychosis (DUP) and treatment outcome in a sample of subjects from a developing country. METHOD: Forty-eight subjects with a first episode of psychosis were evaluated prior to treatment and at 3-month intervals over a period of 24 months. We first examined correlations between DUP and symptom improvement as measured on the Positive and Negative Symptom Scale (PANSS), and then performed multivariate analysis to determine the validity of DUP as a predictor of outcome. RESULTS: DUP was significantly correlated with improvement in PANSS total and negative subscale scores as well as the PANSS depression factor at 21 and 24 months. Multivariate analysis found DUP to be the only significant predictor of improvement in negative symptoms at 24 months. CONCLUSION: DUP was a significant predictor of outcome in a cohort form a developing country. This study provides support for early detection and intervention strategies.     

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.     

Apathy in first episode psychosis patients: One year follow up

IntroductionThis study describes how the negative subsyndrome of apathy develops over the first year in first episode psychosis (FEP) patients, with an emphasis on the prevalence of enduring apathy and the relationship between apathy, other symptoms and functioning.MethodsEighty four FEP patients were assessed both at baseline and after one year with the abridged clinical version of the Apathy Evaluation Scale (AES-C-Apathy). Other symptoms were assessed with the Positive and Negative syndrome scale (PANSS) and functioning with the split version of the Global Assessment of Functioning Scale (GAF-F).ResultsThe mean level of AES-C-Apathy decreased from baseline to the one year follow up for the whole group of FEP patients. High levels of apathy at 1 year were best predicted by high levels of apathy at baseline, a long DUP and a diagnosis within the Schizophrenia spectrum. The presence of depression and level of medication only had a minor influence. AES-C-Apathy had a stronger association to GAF-F than other PANSS symptom areas.Twenty five (30%) FEP patients had high enduring levels of apathy. This group consisted of significantly more males, had a longer duration of untreated psychosis, a greater likelihood of a Schizophrenia spectrum diagnosis, fewer were in remission of positive symptoms and they had significantly poorer functioning at both baseline and follow up.ConclusionThis study confirms that the negative subsyndrome of apathy is significantly related to poor functioning in FEP. Including negative symptoms and its subsyndromes in early detection strategies are warranted.