Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China.
Shanghai Xinlianxin Psychological Counseling Co., Ltd, Shanghai, PR China.
Psychiatry Res. 2023 Nov;329:115522. doi: 10.1016/j.psychres.2023.115522. Epub 2023 Oct 6.
The impact of the duration of untreated psychosis on the outcomes of schizophrenia has been extensively studied. However, there is a notable gap in the current understanding of the relationship between the duration of untreated prodromal symptoms (DUPrS) and the development of psychosis in individuals at clinical high risk (CHR). A sample of 704 individuals with CHR was identified through a structured interview, of who 145 (20.6 %) converted to psychosis (CHR-C) during the 3-year follow-up. The DUPrS was defined as the period between the onset of the first attenuated psychotic positive symptom and the commencement of professional assistance at mental health services. Quantile regression was applied for quantile levels between 0.1 and 0.9, and adjusted for age, sex, and education.The overall sample had a mean DUPrS of 7.1 months. No significant differences were observed in the DUPrS between the CHR-C and non-converter (CHR-NC) groups. Quantile regression analysis highlighted variations in the effects of the DUPrS on clinical variables across the different quantiles. We observed a positive association between DUPrS rank and positive symptoms below the 0.3 quantile, while a positive association between DUPrS rank and negative symptoms above the 0.3 quantile (except 0.7 and 0.9 quantile). A longer DUPrS (> 3 months) was associated with younger age (odds ratio [OR] = 0.948, p = 0.003), a higher proportion of women (OR = 1.474, p = 0.003), higher baseline global function (OR = 1.044, p = 0.003), lower previous global function (OR = 0.921, p < 0.001), and higher negative symptoms (OR = 1.061, p = 0.001). This study sheds light on the pivotal role of DUPrS as a potential intermediary factor in the complex pathway of psychosis.
未治疗精神病持续时间对精神分裂症结局的影响已得到广泛研究。然而，目前人们对未治疗前驱症状持续时间（DUPrS）与临床高风险（CHR）个体发生精神病之间的关系的理解存在明显差距。通过结构化访谈确定了 704 名 CHR 个体样本，其中 145 名（20.6%）在 3 年随访期间转化为精神病（CHR-C）。DUPrS 定义为首次衰减阳性精神病症状出现与开始接受心理健康服务之间的时间段。对 0.1 到 0.9 的分位数水平应用了分位数回归，并进行了年龄、性别和教育的调整。总体样本的平均 DUPrS 为 7.1 个月。CHR-C 组和未转化组（CHR-NC）之间的 DUPrS 无显著差异。分位数回归分析突出了 DUPrS 对不同分位数临床变量的影响存在差异。我们观察到，DUPrS 等级与低于 0.3 分位数的阳性症状之间呈正相关，而 DUPrS 等级与高于 0.3 分位数的阴性症状之间呈正相关（除了 0.7 和 0.9 分位数）。较长的 DUPrS（>3 个月）与年龄较小（比值比 [OR] = 0.948，p = 0.003）、女性比例较高（OR = 1.474，p = 0.003）、基线时的整体功能较高（OR = 1.044，p = 0.003）、先前整体功能较低（OR = 0.921，p < 0.001）和阴性症状较高（OR = 1.061，p = 0.001）相关。这项研究揭示了 DUPrS 作为精神病复杂途径中的潜在中介因素的关键作用。
