Postpartum depression (PPD) is among the most common complications of childbirth, and identifying novel treatments is vital. We aimed to identify potential drug targets for PPD by integrating the plasma proteome, transcriptome and epigenome. We designed a comprehensive analysis pipeline involving two-sample Mendelian randomisation (MR) (for proteins), colocalisation (for coding genes), and summary-based MR (SMR) (for mRNA and DNA methylation) to identify potential therapeutic targets for PPD. Genetic data on the plasma proteome were obtained from 4907 aptamers in 35,559 Icelanders and 7596 proteins in 828 FinnGen participants. The PPD genome-wide association study data were sourced from the Psychiatric Genomics Consortium (PGC) (Ncase = 17,339, Ncontrol = 53,426). A two-step MR approach was used to assess whether brain imaging-derived phenotypes (IDPs) and metabolites from blood, brain and cerebrospinal fluid mediated the observed effects. Across the two proteome datasets, the genetically predicted levels of 18 plasma proteins were nominally significantly associated with PPD, and the expression of steroid receptor RNA activator 1 (SRA1), a regulator of steroid hormone signalling, was significantly associated with PPD. SRA1, angiotensinogen (AGT, a key mediator of the renin-angiotensin and stress-response system), and glycerol-3-phosphate phosphatase (PGP, involved in lipid metabolism and cellular stress) showed increased colocalisation. The methylation of SRA1 at cg02434007 in the brain was associated with increased expression of SRA1 and a high risk of PPD, which aligns with the positive effect of SRA1 gene expression on PPD risk. Isoleucine (mediation proportion: 5.8%, p = 0.042) from blood metabolites and the IDP ICA100 edge 442 (mediation proportion: 7.6%, p = 0.044) may play mediating roles. This study reveals that SRA1 is a novel therapeutic target for PPD, which enhances the understanding of its molecular aetiology and the development of therapeutic strategies.

The elevated prolactin levels in first-episode drug-naïve (FEDN) schizophrenia patients may correlate with long-term stress caused by childhood trauma. This study aimed to assess the relationship between elevated prolactin levels and childhood trauma in FEDN schizophrenia patients, while also considering sex differences. Utilizing a cross-sectional design, the study involved 88 FEDN schizophrenia patients and 76 healthy controls (HCs). Evaluations encompassed measuring prolactin levels in peripheral blood and assessing mental health using the Positive and Negative Syndrome Scale (PANSS), the Childhood Trauma Questionnaire - Short Form (CTQ-SF), as well as evaluating resilience with the Connor-Davidson Resilience Scale (CD-RISC), perceived social support with the Perceived Social Support Scale (PSSS), and demographic characteristics to control for confounding factors. A mediation model was constructed using the RMediation package of the R software. The results suggested prolactin levels in FEDN schizophrenia patients were higher than in HCs(t=-9.938, p = 0.000). Group classification (HCs vs. FEDN schizophrenia patients) (t = 9.291, p = 0.000) and sex (t = 3.282, p = 0.001) were influential factors for prolactin levels. Elevated prolactin(OR = 1.007, p = 0.000), along with higher scores for childhood emotional(OR = 1.469, p = 0.006)andsexual abuse(OR = 1.592, p = 0.018) and lower social support(OR = 0.946, p = 0.026), were associated with the onset of schizophrenia. Positive correlations were found between prolactin levels and childhood emotional (r = 0.268, p = 0.002) /sexual abuse(r = 0.264, p = 0.002), with no sex differences. No significant relationship was observed between prolactin levels and PANSS scores. Mediation analysis revealed that childhood emotional abuse (95

BACKGROUND:Previous studies have highlighted the critical role of the complement system in schizophrenia. Dysregulated levels of complement C3 and C4 may affect structural brain networks in schizophrenia, yet their relationship remains unclear. This study aimed to explore the association between peripheral serum levels of complement and the topological properties of individualized morphological similarity networks (MSNs) in first-episode, drug-naïve schizophrenia (FES). METHODS:This study included 71 patients with FES and 92 healthy controls (HCs). Peripheral blood samples were collected to quantify C3 and C4 levels. Individualized MSNs were constructed for each participant separately based on cortical thickness (CT), gray matter volume (GMV), and surface area (SA), and then graph theoretical analysis was applied to compute topological properties. Group comparisons were performed on complement levels and MSN topological properties, followed by correlation analyses between altered measures. RESULTS:Compared to HCs, FES patients exhibited decreased C3 levels, with no significant difference in C4 levels. The FES group showed significantly lower clustering coefficient (Cp) than HCs. Nodal properties were altered in FES patients, characterized by decreased degree centrality and nodal efficiency in the left superior temporal sulcus and increased nodal efficiency in the left temporal pole for the CT-based networks. Moreover, within the FES group and the overall cohort, C3 levels were positively correlated with the Cp of MSNs. CONCLUSIONS:The present study confirmed that decreased C3 levels are associated with the Cp of MSNs. Our findings suggest that the complement system may contribute to morphological network disruptions in FES.

This study aimed to identify neural biomarkers for schizophrenia (SZ) and bipolar disorder (BP) by analyzing multimodal neuroimaging. Utilizing data from structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (rs-fMRI), multiclass classification models were created for SZ, BP, and healthy controls (HC). A total of 113 participants (BP: 31, SZ: 39, and HC: 43) were recruited under strict enrollment control, from which 272, 200, and 1875 features were extracted from sMRI, DTI, and rs-fMRI data, respectively. A support vector machine (SVM) with recursive feature elimination (RFE) was employed to build the models using a one-against-one approach and leave-one-out cross-validation, achieving a classification accuracy of 70.8%. The most discriminative features were primarily from rs-fMRI, along with significant findings in sMRI and DTI. Key biomarkers identified included the increased thickness of the left cuneus cortex and decreased regional functional connectivity strength (rFCS) in the left supramarginal gyrus as shared indicators for BP and SZ. Additionally, decreased fractional anisotropy in the left superior fronto-occipital fasciculus was suggested as specific to BP, while decreased rFCS in the left inferior parietal area might serve as a specific biomarker for SZ. These findings underscore the potential of multimodal neuroimaging in distinguishing between BP and SZ and contribute to the understanding of their neural underpinnings.

Background: Cognitive deficits are core symptoms of schizophrenia (SZ) and are associated with impaired resilience to stress. Different cognitive functions appeared to be interrelated, and the mechanism may involve neural alterations. The disrupted topological organization indicated abnormalities in the segregation and integration of brain networks that support various cognitive processes in SZ patients. Therefore, this study aimed to assess the direct and indirect effects of resilience on cognitive functions. We hypothesized that topological properties would moderate these associations. Methods: Forty-nine SZ patients and fifty-two healthy controls (HCs) were recruited in this study. The Connor-Davidson Resilience Scale and the MATRICS Consensus Cognitive Battery were used to examine resilience and cognitive functions, respectively, and a graph theory approach was used to assess white matter topological organization. Results: Compared to HCs, SZ patients showed lower levels of resilience and cognitive functions in multiple domains as well as abnormal global properties and nodal metrics. In addition, shorter characteristic path length was associated with a stronger indirect effect of resilience on working memory through processing speed in SZ patients. Conclusion: Characteristic path length might moderate the mediating effects of processing speed in the relationship between resilience and working memory in schizophrenia patients.

Objective:To investigate the correlation between resilience and cognitive function in patients with schizophrenia.Methods:Fifty-nine patients with first-episode schizophrenia and 86 healthy controls were enrolled. Patients with schizophrenia were enrolled from the psychiatric outpatient and inpatient Department of the Third Affiliated Hospital of Sun Yat-sen University from September 2017 to January 2020, while healthy controls were recruited through advertising. The levels of resilience and cognitive function were compared between the two groups.Meanwhile, the partial correlation analysis of resilience and cognitive function of the two groups was performed.Results:There was no statistically significant difference in gender, marriage and age between the two groups (all P>0.05), and there were 39 males and 20 females with an average age of (23.8±7.4) years in the schizophrenia group, while 47 males and 39 females with an average age of (22.9±4.7) years in the healthy control group. However, there was a significant difference inyears of education between the two groups ( P<0.05). The total score of resilience [(56.9±16.7) vs(68.0±14.4)] and scores ofthree factorsin patients with schizophrenia were significantly lower than that in healthy controls(all P<0.05). The total score of MATRICS Consensus Cognitive Battery (MCCB)[(23±12) vs (42±11)] and each subscale score in patients with schizophrenia were significantly lower than that in healthy controls(all P<0.05). Partial correlation analysis showed that the total score of resilience and tenacity were correlated with symbol coding of schizophrenia(partial correlation coefficients were 0.286, 0.289, respectively, both P<0.05). The total score of resilience and the scores of tenacity, strength and optimism were all correlated with emotion management ability of schizophrenia(partial correlation coefficients were 0.334, 0.271, 0.382, 0.308, respectively, all P<0.05). In the healthy controls, the total score of resilience, tenacity and optimism were correlated with symbol coding(partial correlation coefficients were 0.268, 0.225, 0.291, respectively, all P<0.05). Strength and optimism were correlated with Hopkins verbal learning test (HVLT)(partial correlation coefficients were 0.268, 0.225, respectively, both P<0.05). Strength was correlated with spatial span, continuous performance test(partial correlation coefficients were 0.244, 0.217, respectively, both P<0.05). The total scores of resilience and tenacity, strength and optimism were correlated with emotional management ability(partial correlation coefficients were 0.306, 0.230, 0.286, 0.289, respectively, all P<0.05), while the total scores of resilience, strength and optimism were correlated with the total score of MCCB(partial correlation coefficients were 0.291, 0.359, 0.287, respectively, all P<0.05). Conclusion:The current study suggests that resilience and cognitive function of patients with first-episode schizophrenia areimpaired significantly. Resilience in patients with schizophrenia isrelated to partial neurocognitive function and emotion management ability in social cognitive function.

Background: Schizophrenia (SZ) and bipolar disorder with psychosis (BDP) can be clinically confusing. The specific connectomic changes in SZ compared with BDP may lead to a deeper comprehension of the pathophysiological core of SZ. Therefore, this study explored the common and distinct white matter (WM) structural connectomic alterations between these two diseases. Method: Diffusion tensor imaging data were collected from 19 drug-naive patients with first episode SZ, 19 drug-naive patients with BDP, and 19 healthy controls (HC). A graph theoretical approach was used to assess the brain WM network properties. Results: Except for the clustering coefficients, no significant differences in the global parameters was found between SZ and BDP. Five brain regions, the right precentral, right post-cingulum, right insula, left superior occipital, and left inferior temporal gyri, showed specific differences in the nodal parameters in SZ compared with BDP and HC. Nine brain regions, the left rectus, left lingual, right inferior parietal, left superior temporal, right precentral, right postcentral, bilateral middle frontal, and right post-cingulum gyri, showed specific differences in the nodal parameters in BDP. Significant correlations between clinical symptoms and connectomic changes were detected in the right insula and left superior occipital gyrus in patients with SZ but in the left lingual gyrus in patients with BDP. Conclusions: Identifying shared and distinct WM structural networks between SZ and BDP may improve the understanding of the neuroanatomy of mental diseases. Specifically, the insula, the inferior temporal, superior temporal, and the lingual gyri may help to distinguish between SZ and BDP.

Objective: To explore the role of peripheral serum complement protein in the pathogenesis of cognitive impairment by analyzing the correlation between peripheral serum levels of complement protein and cognitive function in first-episode drug-naive patients with schizophrenia. Methods: A total of 66 first-episode drug-naive schizophrenics (schizophrenia group) from the Third Affiliated Hospital of Sun Yat-sen University and 88 healthy volunteers (control group) were enrolled. Peripheral serum levels of complements (C3, C4 and CH50) were separately examined by liposome immunoassay and turbidimetric inhibition immunoassay. The MATRICS Consensus Cognitive Battery (MCCB) was used to assess the cognitive function. Results: Peripheral serum levels of C4, but not C3 and CH50, were significantly lower in patients with schizophrenia [0.20(0.16, 0.25) g/L] than those in the control group [0.23 (0.19, 0.27) g/L] (P<0.05). Moreover the peripheral serum levels of C3, C4 and CH50 were positively correlated with MCCB verbal fluency (r=0.258, r=0.283 and r=0.330, all P<0.05), and the peripheral serum levels of CH50 were negatively correlated with attention and alertness (r=-0.257, P<0.05). Conclusion: The decrease of peripheral serum complement C4 protein levels may be involved in the mechamism of cognitive impairment in schizophrenia.

BACKGROUND:Schizophrenia (SCZ) is a highly heritable disorder associated with brain connectivity changes. Although the mechanism of disease expression and vulnerability of SCZ have been reported by previous studies, the mechanism of resilience to SCZ based on the brain structural connectivity is poorly understood. The goal of the present study was to identify the structural brain connectivity related with the resilience to SCZ, which is defined here as the capacity to avoid or delay the onset of SCZ in unaffected siblings of SCZ probands.METHOD:We collected diffusion tensor imaging (DTI) data of 49 medication-naive, first-episode SCZ (FE-SCZ) patients, 56 unaffected siblings of SCZ probands (SIB-SCZ), and 90 healthy controls. Then we used graph theoretical approach to calculate the topological properties of the brain structural network, including global, subnetwork, and regional parameters. Finally, we compared the parameters between the three groups, and identified the brain structural network related to the resilience, vulnerability and disease expression to SCZ.RESULTS:With respect to resilience, only the SIB-SCZ showed significantly increased connectivity in the subnetworks of the left cuneus-precuneus and left posterior cingulate gyrus-precuneus, and in brain areas of right supramarginal gyrus and right inferior temporal gyrus. With respect to vulnerability, both the FE-SCZ and SIB-SCZ had decreased cluster coefficients and local efficiency, and decreased nodal efficiency in the right medial superior frontal gyrus and right medial orbital superior frontal gyrus compared with the healthy controls. With respect to disease expression, only the FE-SCZ group showed decreased or increased global, subnetwork, and nodal connectivity in broader brain regions compared with the healthy controls.CONCLUSION:Difference in the topological properties of brain structural connectivity not only reflect the underlying mechanism of vulnerability but also that of resilience to schizophrenia. Alteration in the brain structural connectivity associating with resilience and disease expression may contribute to the onset of SCZ.

Research training is important for the development of clinical competency of psychiatrists and psychiatry.This paper introduces the training experience of research capacity of psychiatrists in North America,such as reading report meeting,scientific research theory training,participation in scientific research projects,writing of funds application and papers,academic report,and analyzes the enlightenment to the training of research capacity of psychiatrists in China.To improve the policies and measures for the training of the scientific research capacity of psychiatrists,such as strengthening the requirements for scientific research training,improving the allocation of teachers,ensuring the time of scientific research training,making the curriculum of research training,making the incentive policies for scientific research participation,and participating in research practice,in addition to enriching the training methods and contents of scientific research capacity of psychiatrists.

精神分裂症是一种多基因遗传性脑疾病,主要临床特征为阳性症状﹑阴性症状以及认知功能障碍[1].其起病通常在青春期晚期或成年早期, 这与少突胶质细胞(oligoden-drocyte,OL)和髓鞘发育的时间相重叠[2].髓鞘是OL包绕神经元轴突的多层结构.已有研究表明精神分裂症患者存在少突胶质细胞功能障碍﹑髓鞘受损和白质异常[3],另一方面髓鞘相关基因功能异常参与精神分裂症的发生发展,其基因突变增加精神分裂症的遗传风险[4].本综述旨在对髓鞘相关基因影响精神分裂症及相关行为的研究进展进行总结.

Background This study was to examine the insular cortical functional connectivity in drug naïve patients with first episode schizophrenia and to explore the relationship between the connectivity and the severity of clinical symptoms. Methods Thirty-seven drug naïve patients with schizophrenia and 25 healthy controls were enrolled in this study. A seed-based approach was used to analyze the resting-state functional imaging data. Insular cortical connectivity maps were bilaterally extracted for group comparison and validated by voxel-based morphometry (VBM) analysis. Clinical symptoms were measured using the Positive and Negative Syndrome Scale (PANSS).

目的:探讨自闭症患儿家长心理弹性与社会支持的相关性.方法:采用一般情况问卷、特殊患儿家长心理弹性问卷、社会支持评定量表对广州市某医院29例自闭症患儿家长进行问卷调查.结果:患儿家长的心理弹性得分为3.79分,处于中等偏上水平.社会支持得分为34.00分,低于国内常模.相关性分析显示自闭症患儿家长社会支持和心理弹性整体有相关关系,其中问题解决、控制感、自信心、接纳度等方面与主观社会支持存在显著正相关.结论:应加强对自闭症家庭的社会支持,密切关注患儿家长的心理弹性状况.

Objective To explore the relationship between DNA methyctransferace1(DNMT1)gene polymorphism and cognitive function in the first episode, drug-na?ve schizophrenia. Methods One hundred eighty-six first episode, drug-na?ve schizophrenia patients and 182 healthy controls were examined by using polymerase chain reaction (PCR), denaturing polyacrylamide gel electrophoresis and silver staining to determine genotype and allele of DNMT1 gene. Cognitive function was assessed by using the standardized measurement tools—the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) Chinese version. Comparisons were made on the cognitive function and the genotype and allele distribution of SNP rs2114724 and rs2228611 between schizophrenia group and the control group.The relationship between DNMT1 gene polymorphism and cognitive function was analyzed. Results There was no significant difference of the genotype T/T, T/C, C/C and allele T, C distribution of SNP rs2114724 between schizophrenia group and healthy controls group (P>0.05). There was no significant difference of the genotype G/G, G/A, A/A and allele G, A distribution of SNP rs2228611 between schizophrenia group and healthy control group (P>0.05). There was significant difference in Spatial Span Test (SST) scores(P<0.05)among three different genotype T/T,T/C and C/C of rs2114724 in schizophrenic group.The SST scores of the patients with C/C genotype were higher than that of the patients with T/T or T/C genotype (P<0.05). Conclusion DNMT1 gene polymorphisms is not associated with the first-episode, drug-na?ve schizophrenia, but may be associated with the work memory in cognitive function of schizophrenia in the Chinese Han population.

Intermediate phenotype could be used to investigate genetic susceptibility. However, genetic and environmental heterogeneity may interfere with identification of intermediate phenotypes. In this study, we minimized these interferences by using a novel group strategy. A total of 22 drug-naive and first-episode schizophrenia (FES) patients, along with 22 of their kin healthy siblings (HS), 22 non-kin healthy siblings (nHS) of other schizophrenia patients and 22 healthy controls (HC), were recruited. Brain imaging was acquired from the participants. Voxel-based analysis was used to investigate differences in white matter integrity derived from diffusion tensor imaging among the four groups. Two cognitive tests related to our findings were selected to confirm the related phenotypic changes. All of the FES, HS, and nHS groups showed decreased fractional anisotropy (FA) values in the left inferior frontal gyrus (IFG) compared with the HC group (p < 0.05, FDR corrected). The scores of Hopkins Verbal learning Test-Revised and Animal Naming in FES patients were significantly lower than in participants belonging to the other three groups (p < 0.05). Significant correlation between Animal Naming scores and FA values in the left IFG was found in FES patients (r = 0.53, p = 0.01). Moreover, FES patients also showed decreased FA values in the left medial frontal gyrus, left inferior temporal gyrus, left parahippocampal gyrus, left posterior cingulate, and right middle temporal gyrus compared with HC (p < 0.05, FDR corrected). Decreased FA values in the left IFG is a possible intermediate phenotype of schizophrenia, and this finding supports the hypothesis that disrupted connectivity of white matter may be the key substrate of schizophrenia.

The research effort has focused on the mircroRNAs and the pathogenesis of schizophrenia induced by 22q11 deletion now. The 22q11 deletion, which contribut to mircoRNA-mediated dysregulation, is a genetic risk factor for schizophrenia. Primary candidate genes are DGCR8, which encodes a component of the microprocessor complex essential for microRNA biogenesis, and MIR185, which encodes microRNA 185. Mouse models of 22q11.2DS have demonstrated alterations in brain microRNA biogenesis, and that DGCR8 haploinsufficiency may contribute to these alterations, down regulation of a specific microRNA subset.miR-185 was the top-scoring down-regulated microRNA in both the prefrontal cortex and the hippocampus, brain areas which are the key foci of schizophrenia. In addition, MIR185 has two validated targets (RhoA, Cdc42), both of which have been associated with altered expression levels in schizophrenia .In this paper, literatures on deletion of chromosome 22q11 microRNAs and schizophrenia were reviewed. Key words: Schizophrenia; 22q11deletion; MicroRNA; DGCR8; MIR185; Genetic risk factor

Objective To investigate the psychological disorder state of patients with Crohn′s disease (CD) and its influence on social function and quality of life of the patients. Methods Research Electronic Data Capture (REDCap) system was adopted to launch electronic questionnaire survey. The questionnaire included demographic and clinical date, the Depression, Anxiety and Stress Scale (DASS-21), the Work and Social Adjustment Scale (WSAS) and the Inflammatory Bowel Disease Questionnaire (IBDQ), which was used to evaluate the psychological disorder state, social function and quality of life. Associated scale scores were compared between 169 CD patients and 174 healthy volunteers, and between the patients in active stage and those in remission. Results The DASS scores of CD patients in depression, anxiety and stress were significantly higher than those of healthy volunteers (DASS-D: 5.26±4.67 vs. 2.48±3.55, P<0.05; DASS-A: 4.88±3.99 vs. 2.78 ± 2.91, P<0.05; DASS-S: 6.57±4.59 vs. 3.79±3.87, P<0.05). The WSAS score of CD patients was obviously higher than that of healthy volunteers (13.02±10.21 vs. 2.44±5.58, P<0.05), and WSAS score of CD patients in active stage was obviously higher than those in remission as well (17.00±10.32 vs. 10.06±9.12, P<0.05). While the IBDQ score of CD patients in active stage was significantly lower than those in remission (153.86±29.45 vs. 178.51±27.02, P<0.05). Conclusion CD patients are more accompanied by depression, anxiety and stress with obvious social disability, and CD patients in active stage present the decrease of social function and quality of life. Key words: Crohn′s disease; Social function; Quality of life; Psychological disorder

Background This study was to examine the insular cortical functional connectivity in drug naïve patients with first episode schizophrenia and to explore the relationship between the connectivity and the severity of clinical symptoms. Methods Thirty-seven drug naïve patients with schizophrenia and 25 healthy controls were enrolled in this study. A seed-based approach was used to analyze the resting-state functional imaging data. Insular cortical connectivity maps were bilaterally extracted for group comparison and validated by voxel-based morphometry (VBM) analysis. Clinical symptoms were measured using the Positive and Negative Syndrome Scale (PANSS). Results There were significant reductions in the right insular cortical connectivity with the Heschl’s gyrus, anterior cingulate cortex (ACC), and caudate (p’s<0.001) in the patient group compared with the healthy control (HC) group. Reduced right insular cortical connectivity with the Heschl’s gyrus was further confirmed in the VBM analysis (FDR corrected p<0.05). Within the patient group, there was a significant positive relationship between the right insula-Heschl’s connectivity and PANSS general psychopathology scores (r = 0.384, p = 0.019). Conclusion Reduced insula-Heschl’s functional connectivity is present in drug naïve patients with first episode schizophrenia, which might be related to the manifestation of clinical symptoms.

Schizophrenia (SZ) is a severe neuropsychiatric disorder with significant social cognition impairment. Increasing evidence has suggested that neuropeptides oxytocin (OXT) and arginine vasopressin (AVP) are important mediators of complex social cognition and behavior associates with SZ. In the present study, forty-three first-episode schizophrenia (FES) patients and forty-seven healthy controls (HC) were included. The peripheral mRNA expression of OXT, OXT receptor (OXTR), AVP, AVP 1a receptor (AVPR1a) and CD38 was determined by real-time quantitative polymerase chain reaction (RT-qPCR). The FES patients have a relatively higher mRNA level of OXT and OXTR genes and lower expression of AVP and CD38 genes than HC. No difference was found for AVPR1a between FES patients and HC. As for the sex difference, the mRNA expression of OXT and OXTR showed no difference in both male and female FES patients compared to HC group. The AVP and CD38 genes in female FES patients showed decreased mRNA expression than female HC. Our findings support disrupted OXT and AVP systems in the FES patients.

AIM:Duration of untreated psychosis (DUP) is associated with outcome and functioning. It is expected that scientists will find factors that modulate DUP, but thus far, research on this topic has shown inconsistent results. Furthermore, similar studies in China are insufficient. This study aims to explore social and clinical factors for DUP in South China and to learn the influence that family plays on DUP through their awareness of psychosis.METHODS:Participants included 216 patients with first episode schizophrenia spectrum disorder. The Nottingham Onset Schedule was used to assess DUP. The relationship between DUP and social and clinical characteristics were then analysed by correlation analysis, survival analysis and Cox regression analysis. The awareness of the patient's family for the cause of psychosis, the reason for treatment and the cause for delay of treatment were investigated using a questionnaire.RESULTS:The median DUP was 64.5 days. Insidious onset and being unemployed were found to be risk factors for a long DUP. The family attributed the main cause of psychosis to stress. The main cause for the delay of treatment was because families misjudged the patients' disease. More family members of long DUP patients compared to short DUP patients thought the causes were due to ideological problems or puberty, rather than to mental health.CONCLUSION:The results of this study indicated that some social or clinical characteristics influence DUP. The family's awareness plays an important role when seeking help. To reduce DUP, the public needs more knowledge of mental illness.