Patient-Level Predictors and Clinical Correlates of Duration of Untreated Psychosis Among Hospitalized First-Episode Patients
Patient-Level Predictors and Clinical Correlates of Duration of Untreated Psychosis Among Hospitalized First-Episode Patients
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DOI：
10.4088/jcp.09m05704yel
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发表时间：
2011-02-01
影响因子：
5.3
通讯作者：
Kaslow, Nadine J.
中科院分区：
文献类型：
--
作者：
Compton, Michael T.;Gordon, Tynessa L.;Kaslow, Nadine J.
目的：未经治疗的精神病(DUP)的持续时间与非情感性精神障碍的早期病程预后不良有关；然而，对DUP的预测因素知之甚少。这项研究考察了DUP的患者水平预测因素以及DUP和未治疗疾病持续时间(DUI)的临床相关性，这两者都被认为是预后指标。方法：参与者包括109名首发患者，他们在3个服务于城市、社会弱势、以非裔美国人为主的社区的公立精神病院住院。使用标准化方法测量DUP、DUI以及一些临床和心理社会变量。结果：DUP和DUI的中位数分别为22.3周和129.9周。生存分析显示，在任何给定的时间点，在控制精神病的发病模式后，不与家人住在一起的患者住院的可能性平均是与家人住在一起的患者的1.5倍左右。在控制MODE的情况下，非贫困患者住院的可能性平均是贫困患者的1.6倍左右。阴性症状负担越重，DUP时间越长(r=0.23，P=0.02)，自知力差与DUI时间越长(r=-0.24，P=0.01)。更长的DUP和DUI与不同的不良临床特征有关，如全球功能损害更大，社会功能更差，以及更多的心理社会问题。结论：有必要针对家庭(以及与他们一起生活的患有新出现的精神障碍或直接未经治疗的精神病综合征的亲人)，特别是面临重大社会经济挑战的家庭，进行早期干预。《临床精神病学杂志》2011；72(2)：225-232(C)版权所有，2011年医师研究生出版社，Inc.
Objective: Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators.Method: Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders.Results: The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r=0.23, P=.02), and poorer insight was associated with longer DUI (r=-0.24, P=.01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems.Conclusions: There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges. J Clin Psychiatry 2011;72(2):225-232 (C) Copyright 2011 Physicians Postgraduate Press, Inc.