确定未经治疗的精神病(DUP)的持续时间与结果之间的关系在精神病的整个生命周期中纵向持续的程度需要前瞻性,几十年来流行病学代表性发病率队列的系统研究。瞬变,持久性,在这样的时间范围内,DUP和不同结果域之间的关联或异质性仍有待研究。
预期,在6个月和4,8,12和20年(N=171)时,对爱尔兰具有流行病学代表性的首发精神病发病率队列进行了序贯随访研究.线性混合模型分析用于确定DUP与症状的前瞻性关联,功能,在20年的时间内,不同精神病患者的生活质量是一致或不同的.评估包括时间,DUP四分位数,和DUP四分位数的时间相互作用效应。
预期,连续随访显示阳性和阴性症状,函数,和生活质量相对于较短的DUP表现出明显的改善轨迹。尽管过程中存在异质性,并且与病前特征有关系,首次精神病发作20年后,较短的DUP和较大的改善之间的关联仍然很明显.在精神病的长期病程中,较短的DUP和更好的结果之间的关联轨迹在精神病理学领域之间有所不同,功能,和生活质量。然而,这种与较短DUP的关联持续了至少20年.
这些概况表明,虽然DUP和长期结果之间的关联可能因结果领域而异,它们以一种无法完全解释病前特征或提前期偏差的方式持续了几十年。
Determining the extent to which relationships between duration of untreated psychosis (DUP) and outcome endure longitudinally across the lifetime course of psychotic illness requires prospective, systematic studies of epidemiologically representative incidence cohorts across decades. Transience, persistence, or heterogeneity in associations between DUP and distinct outcome domains are yet to be investigated over such time frames.
Prospective, sequential follow-up studies of an epidemiologically representative first-episode psychosis incidence cohort in Ireland were conducted at 6 months and 4, 8, 12, and 20 years (N=171). Linear mixed-model analyses were applied to determine whether prospective associations of DUP with symptoms, functioning, and quality of life were consistent or varied across psychotic illness trajectory over a 20-year period. Evaluations included time, DUP quartile, and DUP quartile-by-time interaction effects.
Prospective, sequential follow-ups showed positive and negative symptoms, function, and quality of life to exhibit distinct trajectories of improvement in relation to shorter DUP. Despite heterogeneity in course and relationship to premorbid features, associations between shorter DUP and greater improvement were still evident 20 years after the first psychotic episode. Across the long-term course of psychotic illness, trajectories of association between shorter DUP and better outcome differed between domains of psychopathology, functionality, and quality of life. Nevertheless, such associations with shorter DUP were sustained for at least 20 years.
These profiles indicate that while associations between DUP and long-term outcome can vary according to the domain of outcome, they are sustained across decades in a manner that could not be fully accounted for in terms of premorbid features or lead-time bias.