Köhn D, Pukrop R, Niedersteberg Antje, Schultze-Lutter Frauke, Ruhrmann S, Bechdolf A, Berning Julia, Maier W, Klosterkötter J
Klinik für Psychiatrie und Psychotherapie der Universität zu Köln.
Fortschr Neurol Psychiatr. 2004 Nov;72(11):635-42. doi: 10.1055/s-2004-818418.
Several studies on first episode schizophrenia suggest that a longer duration of untreated psychosis (DUP) results in poorer clinical outcome. The same is expected for the duration of untreated illness (DUI). It is therefore important to expose people at risk of schizophrenia to adequate treatment early on. The improvement of pathways to adequate treatment within the health care system might well be helpful. Therefore, an analysis of the pathways to care is necessary. Thus, in this present study 80 in-patients with first episode psychosis were investigated using the semi-structured interview IRAOS ("Interview for the Retrospective Assessment of the Onset of Schizophrenia") and data about the pathways to care before psychiatric admission were collected. The results indicate that patients contact on average three carers. Contact to a psychiatrist or a psychotherapist was only made two and a half years after onset of illness; general practitioners were only contacted after more than five years. However, there was a significant time lapse between first contact to psychiatrist/ psychotherapist and psychiatric admission. Only 31 % of patients sought help in the prodromal phase of the illness. Two strategies for a public campaign can be derived from these results: firstly, a public awareness campaign has to be implemented to shorten the interval from onset of illness to first help-seeking behaviour and secondly, professionals need to have more knowledge and better awareness of prodromal signs in order to reduce the time between diagnosis and adequate treatment.
几项关于首发精神分裂症的研究表明，未治疗精神病持续时间（DUP）越长，临床结局越差。未治疗疾病持续时间（DUI）也可能如此。因此，尽早让有精神分裂症风险的人接受充分治疗非常重要。改善医疗保健系统内获得充分治疗的途径可能会有所帮助。因此，有必要对就医途径进行分析。因此，在本研究中，使用半结构化访谈IRAOS（“精神分裂症发病回顾性评估访谈”）对80名首发精神病住院患者进行了调查，并收集了精神病入院前就医途径的数据。结果表明，患者平均联系三位护理人员。在发病两年半后才联系精神科医生或心理治疗师；五年多后才联系全科医生。然而，首次联系精神科医生/心理治疗师与精神病入院之间存在显著时间间隔。只有31%的患者在疾病的前驱期寻求帮助。从这些结果可以得出两项公众宣传策略：第一，必须开展公众意识宣传活动，以缩短从发病到首次寻求帮助行为的间隔时间；第二，专业人员需要对前驱症状有更多了解和更好的认识，以减少诊断与充分治疗之间的时间。
