Haas G L, Garratt L S, Sweeney J A
Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
J Psychiatr Res. 1998 May-Aug;32(3-4):151-9. doi: 10.1016/s0022-3956(98)00008-9.
The possible adverse clinical effects of untreated psychosis in schizophrenic patients, particularly early in the course of illness, have been a topic of considerable interest in recent years. We examined the timing of first administration of antipsychotic medication after the first onset of psychotic symptoms in 103 patients with DSM-III-R diagnoses of schizophrenia, schizophreniform or schizo-affective disorder. Patients with a delay of one or more years between the onset of the first psychotic symptom and the initiation of antipsychotic treatment demonstrated more severe negative symptomatology on admission to hospital and more severe positive symptoms and negative symptoms at discharge. These effects were present in both first-admission patients, in whom the delay to treatment immediately preceded hospitalization and chronic patients with a history of multiple hospitalizations. Patients with one or more years of untreated psychosis prior to their first antipsychotic treatment displayed a more severe poverty syndrome at the time of admission and discharge and a more severe reality distortion syndrome at discharge from the index hospitalization. These findings were not related to age, premorbid functioning, duration of illness, first- vs multiple-episodes status, or dosage of antipsychotic medication at time of admission or discharge assessment. Findings from the present study suggest that failure to initiate antipsychotic treatment early in the course of the illness may be associated with a recurrent pattern of poorer treatment response and more severe and persistent positive and negative symptomatology. These findings indicate the importance of early detection of illness and early initiation of antipsychotic treatment for the first psychotic symptoms of schizophrenia.
近年来，精神分裂症患者未经治疗的精神病可能产生的不良临床影响，尤其是在疾病早期，一直是备受关注的话题。我们研究了103例被诊断为DSM-III-R精神分裂症、精神分裂症样或分裂情感性障碍的患者首次出现精神病症状后首次使用抗精神病药物的时间。首次精神病症状发作与开始抗精神病治疗之间延迟一年或更长时间的患者，入院时表现出更严重的阴性症状，出院时阳性症状和阴性症状更严重。这些影响在首次入院患者（治疗延迟紧接着住院）和有多次住院史的慢性病患者中均存在。首次抗精神病治疗前有一年或更长时间未经治疗的精神病的患者，在入院和出院时表现出更严重的贫困综合征，在本次住院出院时表现出更严重的现实扭曲综合征。这些发现与年龄、病前功能、病程、首次发作与多次发作状态，或入院或出院评估时抗精神病药物的剂量无关。本研究结果表明，在疾病过程中未能早期开始抗精神病治疗可能与较差的治疗反应反复出现以及更严重和持续的阳性和阴性症状有关。这些发现表明了早期发现疾病和针对精神分裂症的首次精神病症状早期开始抗精神病治疗的重要性。
