Untreated initial psychosis: Relation to cognitive deficits and brain morphology in first-episode schizophrenia
Untreated initial psychosis: Relation to cognitive deficits and brain morphology in first-episode schizophrenia
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DOI：
10.1176/appi.ajp.160.1.142
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发表时间：
2003-01-01
影响因子：
17.7
通讯作者：
Andreasen, NC
中科院分区：
文献类型：
--
作者：
Ho, BC;Alicata, D;Andreasen, NC
目的：对首次出现精神病的患者进行的研究表明，他们通常在 1-2 年内未被诊断和治疗。据推测，长期未经治疗的精神病可能会产生严重影响：对精神安定药物的反应不佳、临床结果不佳以及直接神经毒性。本研究调查了未经治疗的初始精神病持续时间与神经认知功能和高分辨率脑成像测量之间的关系。方法：共有 156 名患有 DSM-IV 精神分裂症、精神分裂样障碍或分裂情感障碍的受试者在首次精神病发作期间接受了评估。测量包括神经认知功能的九个领域、总脑组织、灰质和白质以及脑脊液的体积测量，以及脑表面解剖学的测量。结果：未经治疗的初始精神病的平均持续时间为 74.3 周。神经认知功能、大脑体积测量和表面解剖测量与未经治疗的初始精神病持续时间之间的相关性很弱；没有一个达到统计显着性。当根据未经治疗的初始精神病的中位持续时间对组进行分组时，除了两项指标（语言记忆和皮质沟深度）外，未经治疗的初始精神病持续时间长和短的组之间再次没有显着差异。结论：缺乏强相关性表明未经治疗的初始精神病没有直接的毒性神经效应。这些结果表明，旨在通过在精神病前期或早期精神病阶段进行早期干预来预防神经损伤的大规模举措可能是基于可以避免神经毒性或认知恶化的错误假设。尽管如此，早期治疗是合理的，因为它可以减少痛苦。
Objective: Studies of patients experiencing their first episode of psychosis have demonstrated that they typically remain undiagnosed and untreated for 1-2 years. It has been postulated that prolonged untreated psychosis may have serious effects: poor response to neuroleptic medications, poor clinical outcomes, and direct neurotoxicity. This study investigated the relationships between duration of untreated initial psychosis and neurocognitive functioning and high-resolution imaging brain measurements.Method: A total of 156 subjects with DSM-IV schizophrenia, schizophreniform disorder, or schizoaffective disorder were evaluated during their first episode of psychosis. Measurements included nine domains of neurocognitive functioning, volumetric measures of total brain tissue, gray and white matter, and CSF, and measures of brain surface anatomy.Results: The mean duration of untreated initial psychosis was 74.3 weeks. Correlations between neurocognitive functioning, brain volumetric measurements, and surface anatomy measurements with duration of untreated initial psychosis were weak; none reached statistical significance. When the group was divided on the basis of median duration of untreated initial psychosis, there were again no significant differences between the groups with long and short duration of untreated initial psychosis except on two measures (verbal memory and cortical sulcal depth).Conclusions: The absence of strong correlations suggests that untreated initial psychosis has no direct toxic neural effects. These results suggest that large-scale initiatives designed to prevent neural injury through early intervention in the prepsychotic or early psychosis phase may be based on incorrect assumptions that neurotoxicity or cognitive deterioration may be avoided. Nevertheless, early treatment is justified because it reduces suffering.