The "Doses" of Initial, Untreated Hallucinations and Delusions: A Proof-of-Concept Study of Enhanced Predictors of First-Episode Symptomatology and Functioning Relative to Duration of Untreated Psychosis
The "Doses" of Initial, Untreated Hallucinations and Delusions: A Proof-of-Concept Study of Enhanced Predictors of First-Episode Symptomatology and Functioning Relative to Duration of Untreated Psychosis
复制标题
DOI：
10.4088/jcp.09m05841yel
复制
发表时间：
2011-11-01
影响因子：
5.3
通讯作者：
Walker, Elaine F.
中科院分区：
文献类型：
--
作者：
Compton, Michael T.;Gordon, Tynessa L.;Walker, Elaine F.
目的：关于未经治疗的精神病持续时间（DUP）的文献的一个突出局限性是，研究人员仅研究了作为早期病程预测因素的单维持续时间，忽略了初始未经治疗的精神病的频率/严重程度的潜在影响。这项研究证明了初始的、未经治疗的幻觉和妄想的“剂量”概念的实用性，代表了更完整的“暴露”测量——相对于单独的 DUP，作为症状学/功能的增强预测因子。方法：根据 DSM-IV 轴 I 障碍标准的结构化临床访谈，对 109 名首发精神障碍患者在为城市、城市提供服务的 3 个公共部门精神科单位进行了评估。 社会弱势群体，主要是 2004 年 7 月至 2008 年 6 月期间的非裔美国人社区。因变量包括阴性症状、一般精神病理学、洞察力和初次住院时的整体功能。结果：当添加到基线模型（年龄、性别和病前学术和社会功能）时，DUP 预测了当前的阴性症状（P = .02，模型 R(2) = 0.20），尽管幻觉剂量和剂量 妄想没有。然而，对于一般的精神病理学症状，DUP 并不能预测，但在控制其他 5 个变量时，妄想的剂量可以预测（P = .02，模型 R(2) = 0.15）。 DUP 并不是洞察力的显着预测因子，尽管幻觉剂量是这样的，即初始未治疗的幻觉剂量越大，与初次住院时更好的洞察力相关（P < .01，模型 R(2) = 0.20）。 DUP 与整体功能相关（P = .05），妄想剂量显着增加了这一预测（P = .04；模型 R(2) = 0.13）。结论：最初未经治疗的幻觉和妄想剂量显着增加了对早期症状和功能的预测，尽管存在差异。研究结果表明，需要对治疗前精神病症状的频率/严重程度进行重点研究，超出持续时间的衡量标准。
Objective: A prominent limitation of literature on duration of untreated psychosis (DUP) is that researchers have studied only unidimensional duration as an early-course predictor, neglecting potential effects of frequency/severity of initial, untreated psychosis. This study demonstrates utility of the concept of "doses" of initial, untreated hallucinations and delusions representing more complete measures of "exposure"-as enhanced predictors of symptomatology/functioning relative to DUP alone.Method: 109 first-episode patients with a psychotic disorder based on Structured Clinical Interview for DSM-IV Axis I Disorders criteria were assessed at 3 public-sector psychiatric units serving an urban, socially disadvantaged, predominantly African American community between July 2004 and June 2008. Dependent variables included negative symptoms, general psychopathology, insight, and global functioning at initial hospitalization.Results: When added to a baseline model (age, gender, and premorbid academic and social functioning), DUP predicted current negative symptoms (P = .02, model R(2) = 0.20), though dose of hallucinations and dose of delusions did not. However, regarding general psychopathology symptoms, DUP was not predictive, though dose of delusions was, when controlling for the other 5 variables (P = .02, model R(2) = 0.15). DUP was not a significant predictor of insight, though dose of hallucinations was, such that a greater dose of initial, untreated hallucinations was associated with better insight at initial hospitalization (P < .01, model R(2) = 0.20). DUP was associated with global functioning (P = .05), and dose of delusions added significantly to this prediction (P = .04; model R(2) = 0.13).Conclusions: Doses of initial, untreated hallucinations and delusions add substantively, though differentially, to the prediction of early-course symptomatology and functioning. Findings suggest a need for focused research on frequency/severity of pretreatment psychotic symptoms beyond duration measures.