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Short-term Clinical Outcome of Previously Untreated and Treated Schizophrenia and Impact of Duration of Untreated Psychosis.

INDIAN JOURNAL OF PSYCHOLOGICAL MEDICINE(2023)

Govt Med Coll | GGSMCH | Civil Hosp

Cited 0|Views19
Abstract
Background: Duration of untreated psychosis (DUP) is an important modifiable factor affecting schizophrenia outcomes. A dearth of research in India on untreated versus treated schizophrenia warrants further research. Methods: This was a longitudinal study in a tertiary hospital over 2 years. Inpatients diagnosed with schizophrenia ( N = 116), aged 18–45, were divided into untreated and treated groups. Diagnostic confirmation, severity assessment, and clinical outcome were done using ICD-10 criteria, Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) scale. Follow-up was done at 12 and 24 weeks. DUP was measured, and its association with the outcome was assessed. Results: Final analysis included 100 patients, 50 each of previously untreated and treated. Untreated patients had lower age and duration of illness (DOI), but higher DUP ( p < .001). Treated patients showed much improvement on CGI-I at 12 weeks ( p = .029), with no difference at 24 weeks. PANSS severity comparison showed no difference, and both groups followed a declining trend. In untreated patients, age of onset (AoO) was negatively correlated with severity (except general symptoms at baseline) at all follow-ups (‘ r’ range = −0.32 to –0.49, p < .05), while DOI showed a positive correlation with negative and general symptoms at 12 weeks ( r ~ 0.3, p < .05). Treated patients showed inconsistent and lower negative correlation between AoO and PANSS, with no correlation between severity and DOI. The mean sample DUP was 17.9 ± 31.6 weeks; it negatively correlated with education ( r = –0.25, p = .01) and positively with PANSS severity (‘ r’ range = 0.22 to 0.30, p < .05) at all follow-ups, especially negative symptoms. Patients with no or minimal improvement on CGI at 24 weeks had higher DUP (Quade’s ANOVA F[1,98] = 6.24, p = .014). Conclusion: Illness variables in untreated schizophrenia affect severity, which has delayed improvement than treated schizophrenia. Higher DUP is associated with negative symptoms of schizophrenia.
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Key words
DUP,Duration of untreated psychosis,Outcome,Psychosis,Schizophrenia,Treated,Untreated
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要点】:研究探讨了未经治疗和已治疗的的精神分裂症短期临床结局以及未治疗精神病持续时间(DUP)对结局的影响,发现未经治疗的精神分裂症患者病情改善较慢,DUP与负性症状相关。

方法】:采用纵向研究设计,在一家三级医院对年龄在18至45岁之间的116名精神分裂症住院患者进行研究,分为未经治疗和已治疗两组,使用ICD-10标准、阳性与阴性症状量表(PANSS)和临床总体印象(CGI)量表进行诊断确认、严重程度评估和临床结局评估。

实验】:在12周和24周进行随访,测量DUP并评估其与结局的关联。最终分析包括100名患者,每组50名。结果显示,未经治疗的患者年龄和病程较短,但DUP较长。已治疗患者在12周时CGI-I有显著改善,而24周时无差异。PANSS严重程度比较显示两组均呈下降趋势,但未经治疗患者在所有随访中年龄与病情严重程度呈负相关,病程与负性和一般症状在12周时呈正相关。已治疗患者的年龄与PANSS严重程度的负相关性不一致且较低,病程与严重程度无相关性。平均样本DUP为17.9±31.6周,与教育程度负相关,与PANSS严重程度正相关,特别是负性症状。在24周CGI无或最小改善的患者中,DUP较高。