Craig T J, Bromet E J, Fennig S, Tanenberg-Karant M, Lavelle J, Galambos N
Department of Veterans Affairs, Veterans Integrated Service, Network 3, Bronx, NY, USA.
Am J Psychiatry. 2000 Jan;157(1):60-6. doi: 10.1176/ajp.157.1.60.
The authors examined the duration of untreated psychosis, defined as the interval from first psychotic symptom to first psychiatric hospitalization, in a county-wide sample of first-admission inpatients who had received no previous antipsychotic medication. Differences between diagnostic groups in 24-month illness course and clinical outcomes as well as relationships between outcomes and duration of untreated psychosis were evaluated.
The data were derived from subjects in the Suffolk County Psychosis Project who were diagnosed at 24-month follow-up according to DSM-IV as having schizophrenia or schizoaffective disorder (N=155), bipolar disorder with psychotic features (N=119), or major depressive disorder with psychotic features (N=75). Duration of untreated psychosis was derived from the Structured Clinical Interview for DSM-III-R, medical records, and information from significant others. Measures at 24-month follow-up included consensus ratings of illness course, Global Assessment of Functioning Scale scores for the worst week in the month before interview, and current affective and psychotic symptoms.
The median duration of untreated psychosis was 98 days for schizophrenia, 9 days for psychotic bipolar disorder, and 22 days for psychotic depression. Duration of untreated psychosis was not significantly associated with 24-month illness course or clinical outcomes in any of the diagnostic subgroups.
Although these findings require replication in other epidemiologically based first-admission samples, at face value they do not support the suggestion of a psychotoxic effect of prolonged exposure to untreated psychosis.
作者在一个全县范围内首次入院且未接受过抗精神病药物治疗的住院患者样本中，研究了未治疗精神病的持续时间，该持续时间定义为从首次精神病症状出现到首次精神科住院的间隔时间。评估了诊断组在24个月病程和临床结局方面的差异，以及结局与未治疗精神病持续时间之间的关系。
数据来源于萨福克郡精神病项目的受试者，这些受试者在24个月随访时根据《精神疾病诊断与统计手册》第四版被诊断为患有精神分裂症或分裂情感性障碍（N = 155）、伴有精神病性特征的双相情感障碍（N = 119）或伴有精神病性特征的重度抑郁症（N = 75）。未治疗精神病的持续时间来自《精神疾病诊断与统计手册》第三版修订本的结构化临床访谈、病历以及来自重要他人的信息。24个月随访时的测量指标包括病程的一致性评分、访谈前一个月中最差一周的功能总体评定量表得分，以及当前的情感和精神病性症状。
精神分裂症未治疗精神病的中位持续时间为98天，精神病性双相情感障碍为9天，精神病性抑郁症为22天。在任何诊断亚组中，未治疗精神病的持续时间与24个月病程或临床结局均无显著关联。
尽管这些发现需要在其他基于流行病学的首次入院样本中进行重复验证，但从表面价值来看，它们并不支持长期暴露于未治疗精神病会产生精神毒性作用这一观点。
