| BackgroundSchizophenia is a serious disorder that often affects quite young persons, while its outcome is often poor. The early detection and intervention in first-episode schizophenia has been the subject of extensive investigation throughout the twentieth century. To date, two types of early intervention strategies are possible: (a) early intervention in the prodromal phase and (b) early intervention after the onset of psychosis. The prodrome that is a retrospective concept refers to nonspecific signs and symptoms which prognostic accuracy is still waiting to be examined.lt has been proposed that the outcome of the disorder can be improved by reducing the duration of untreated psychosis (DUP). Several studies have shown mean DUPs of 1 year or more. Staying psychotic for months or years will obviously influence social, occupational, and interpersonal functioning. Most studies on first-episode psychosis have provided indirect evidence that a longer DUP generally is associated with a poorer longitudinal course. However, other newer data suggest that this is not always the case.ObjectiveThe study aimed at an examination of the prognostic accuracy of initial prodromal symptoms to determine if they can indeed predict the subsequent development of psychosis, and we also aimed to identify the illness-related factors which delay treatment and investigate the relationship between DUP and the outcome of the disorder including measures of several dimensions such as level of remission,social function and quality of life,both to exclude confounding variables and to estimate the likely gains from early intervention.MethodPatients who were recruited from consecutive day- and in-patient admission for first episodes of psychosis over a 5-year period and met criteria for a diagnosis of schizophenia in CCMD-2-R were interviewed. 71 patients were investigated retrospectively with self-compiled early manifestation of psychosis scale and 140 patients completed PANSS, GQOLI-74, LSIA and SDSS assessment. The 62 controls in prodromal symptom study were all healthy volunteers with no individual and family history of mental disease.Result1. The difference of the incidences of all prodromal symptoms between two groups was significant. 25 items were specific, among which 10 with sensitivity over 25% and positive predictive value over 70% were followed by marked impairment in personal hygiene and grooming, marked peculiar behavior, inappropriate affect,overelaborate speech and vague speech,marked isolation etc.2.Median DUP was 28 weeks. The exist of hostility. passive/apathetic social withdrawal (from PANSS item P7, N4 respectively) at first admission was associated with a longer DUP, while the symptom of depression or poor impulse control (from PANSS item G6, G14 respectively)was linked with a shorter DUP.3. Longer DUP was not significantly associated with poorer symptom remission or poorer quality of life at follow-up,but showed 1 inks wi th the body funct ion domain of QOL (P=0. 049), whi le female and persistent medication showed a better level of symptom remission and QOL.Conclusions1.We found that several prodromal symptoms performed well in the early detection of schizophrenia. It therefore might be useful for the prediction of the disorder, especially if it is further refined to select these items with particularly high prognostic accuracy.2. At face value there was little evidence of any association between DUP and deterioration in the schizophrenic illness orthe development of the social function and the quality of life. Some social variables were related to the outcome. Biological measures of neurotoxicity are needed to examine the biologic toxicity hypothesis more directly. |
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