Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane).
Am J Psychiatry. 2020 Apr 1;177(4):327-334. doi: 10.1176/appi.ajp.2019.19030324. Epub 2020 Feb 12.
At first hospitalization, a long duration of untreated psychosis (DUP) predicts illness severity and worse treatment outcomes. The mechanism of this association, however, remains unclear. It has been hypothesized that lengthy untreated psychosis is toxic or that it reflects a more severe form of schizophrenia. Alternatively, the association may be an artifact of lead-time bias. These hypotheses are tested in a longitudinal study of schizophrenia with 2,137 observations spanning from childhood to 20 years after first admission.
Data were from the Suffolk County Mental Health Project. The cohort included 287 individuals with schizophrenia or schizoaffective disorder. DUP was defined as days from first psychotic symptom to first psychiatric hospitalization. Psychosocial function was assessed using the Premorbid Adjustment Scale and the Global Assessment of Functioning Scale. Psychosocial function trajectories were estimated using multilevel spline regression models adjusted for gender, occupational status, race, and antipsychotic medication.
Both long- and short-DUP patients experienced similar declines in psychosocial function, but declines occurred at different times relative to first admission. Long-DUP patients experienced most of these declines prior to first admission, while short-DUP patients experienced declines after first admission. When psychosocial function was analyzed relative to psychosis onset, DUP did not predict illness course.
The association between DUP and psychosocial function may be an artifact of early detection, creating the illusion that early intervention is associated with improved outcomes. In other words, DUP may be better understood as an indicator of illness stage than a predictor of course.
在首次住院时，较长的未治疗精神病期（DUP）可预测疾病严重程度和较差的治疗结局。但是，这种关联的机制尚不清楚。有人假设，长时间未治疗的精神病具有毒性，或者它反映了更严重的精神分裂症形式。或者，这种关联可能是领先时间偏差的一种表现。在一项对精神分裂症的纵向研究中，对这些假设进行了检验，该研究共观察了 2137 次，从儿童时期到首次入院后 20 年。
数据来自萨福克县心理健康项目。该队列包括 287 名精神分裂症或分裂情感障碍患者。DUP 定义为从首次出现精神病症状到首次精神病住院的天数。使用前驱调整量表和总体功能评估量表评估社会心理功能。使用多水平样条回归模型估计社会心理功能轨迹，该模型调整了性别、职业状况、种族和抗精神病药物。
长 DUP 和短 DUP 患者的社会心理功能均经历了相似的下降，但下降发生的时间相对于首次入院不同。长 DUP 患者在首次入院前经历了大部分下降，而短 DUP 患者在首次入院后经历了下降。当根据精神病发作来分析社会心理功能时，DUP 并未预测疾病进程。
DUP 与社会心理功能之间的关联可能是早期发现的一种假象，给人一种早期干预与改善结局相关的错觉。换句话说，DUP 可能被更好地理解为疾病阶段的指标，而不是病程的预测指标。
