Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Psychol Med. 2013 Sep;43(9):1883-93. doi: 10.1017/S0033291712002838. Epub 2012 Dec 7.
Cognitive impairment is a core feature of schizophrenia. Its relationship with duration of untreated psychosis (DUP), a potentially malleable prognostic factor, has been less studied, with inconsistent findings being observed in the literature. Previous research investigating such a relationship was mostly cross-sectional and none of those prospective studies had a follow-up duration beyond 2 years. Method A total of 93 Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. DUP and pre-morbid adjustment were measured using a structured interview incorporating multiple sources of information. Psychopathological evaluation was administered at intake, after clinical stabilization of the first psychotic episode, and at 12, 24 and 36 months. Cognitive functions were measured at clinical stabilization, and at 12, 24 and 36 months.
DUP exerted differential effects on various cognitive domains, with memory deficits being the most related to DUP even when potential confounders including pre-morbid adjustment and sex were adjusted. Prolonged DUP was associated with more severe impairment in visual memory at clinical stabilization and verbal memory at 24 and 36 months. Further, patients with a long DUP were found to have worse outcomes on negative symptoms at 36 months. The effects of DUP on verbal memory remained significant even when negative symptoms were taken into consideration.
Our findings provided further supportive evidence that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes. In addition, DUP may specifically affect memory function and its adverse impact on verbal memory may only become evident at a later stage of the recovery process.
认知障碍是精神分裂症的核心特征。它与未治疗的精神病发作持续时间（DUP）的关系，作为一个潜在的可改变的预后因素，研究得较少，文献中观察到的结果不一致。之前研究这种关系的研究大多是横断面研究，而且没有一项前瞻性研究的随访时间超过 2 年。方法：共有 93 名年龄在 18 至 55 岁的首次出现精神分裂症谱系障碍的香港华人参与了这项研究。使用包含多种信息来源的结构化访谈来测量 DUP 和发病前的适应情况。在首次精神病发作临床稳定后、12、24 和 36 个月时进行心理病理评估。在临床稳定时、12、24 和 36 个月时测量认知功能。结果：DUP 对各种认知领域产生了不同的影响，记忆缺陷与 DUP 的关系最密切，即使在调整了发病前适应和性别等潜在混杂因素后也是如此。DUP 延长与临床稳定时视觉记忆和 24 个月和 36 个月时言语记忆的更严重损伤有关。此外，DUP 较长的患者在 36 个月时的阴性症状方面的结局更差。即使考虑到阴性症状，DUP 对言语记忆的影响仍然显著。结论：我们的研究结果进一步提供了支持性证据，表明首次精神病发作的延迟治疗与较差的认知和临床结局有关。此外，DUP 可能特别影响记忆功能，并且其对言语记忆的不良影响可能仅在恢复过程的后期才变得明显。
