Murru Andrea, Carpiniello Bernardo
Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
Neurosci Lett. 2018 Mar 16;669:59-67. doi: 10.1016/j.neulet.2016.10.003. Epub 2016 Oct 4.
The first psychotic episode is classically viewed as a critical period which management is important in determining the long-term outcome of the schizophrenia (SCZ). For this reason, the duration of untreated illness (DUI), defined as the interval between the onset of the psychiatric disorder and the administration of the first pharmacological treatment, is a clinical variable that has been increasingly investigated due to its potentially modifiable nature and its value as a predictor of outcome. DUI is poorly applicable and highly unreliable in psychosis. The present critical review examines the impact of DUI and its more operative definition of "duration of untreated psychosis" (DUP) in the course and outcome of SCZ, focusing on its epidemiologic, clinical, prognostic factors. Length of DUP has been identified as positively related to a worst treatment response, symptom control and overall functional outcome in SCZ. Negative symptoms appear to be prominently related to longer DUP. Neuroimaging correlates of DUP have not been clearly outlined: few of the studies considering first-episode patients and DUP showed structural abnormalities. A low proportion of significant associations were found mostly in cerebellum and occipital lobe of patients with longer DUP. Also, evidence of an inverse correlation between cognitive alterations and DUP is not conclusive. DUI and DUP are multidimensional constructs that imply both intrinsic, illness related (e.g. subtle symptoms at onset) and extrinsic factors (e.g. access to mental health services), so that from its study sprouted in the last decades First-Episode Units, aimed at providing secondary prevention in SCZ such as providing a timely diagnosis and treatment to patients experiencing their first psychotic episode. Early intervention seems to ensure a shortened DUP, especially for people presenting with brief limited intermittent psychotic symptoms, and, ultimately, ensure a more favorable prognosis for patients affected by SCZ.
首次精神病发作传统上被视为一个关键时期，在此期间进行管理对于确定精神分裂症（SCZ）的长期预后至关重要。因此，未治疗疾病持续时间（DUI），定义为精神障碍发作与首次药物治疗给药之间的间隔，是一个临床变量，由于其潜在的可改变性质及其作为预后预测指标的价值，越来越受到研究。DUI在精神病中适用性差且高度不可靠。本综述批判性地研究了DUI及其更具操作性的“未治疗精神病持续时间”（DUP）定义对SCZ病程和预后的影响，重点关注其流行病学、临床、预后因素。已确定DUP的长度与SCZ中较差的治疗反应、症状控制和总体功能结局呈正相关。阴性症状似乎与较长的DUP显著相关。DUP的神经影像学相关性尚未明确界定：很少有考虑首发患者和DUP的研究显示结构异常。在DUP较长的患者中，大多在小脑和枕叶发现低比例的显著关联。此外，认知改变与DUP之间存在负相关的证据也不确凿。DUI和DUP是多维概念，既意味着内在的、与疾病相关的因素（例如发病时的细微症状），也意味着外在因素（例如获得心理健康服务的机会），因此在过去几十年中出现了旨在为SCZ提供二级预防的首发单元，例如为首次经历精神病发作的患者提供及时的诊断和治疗。早期干预似乎可以确保缩短DUP，特别是对于出现短暂有限间歇性精神病症状的人，并最终确保SCZ患者有更有利的预后。
