Objectives:We investigated the long-term course and outcome of first-episode schizophrenia spectrum disorder and the relationship between duration of untreated psychosis (DUP) and clinical characteristics and outcome variables.
Methods:We identified 80 patients with schizophrenia spectrum disorder (schizophreniform disorder, schizophrenia and schizoaffective disorder according to the criteria of DSM-III-R) who were hospitalized in psychiatric ward, Chonbuk National University Hospital from 1998 to 2002. Forty five patients of them could be followed up. Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDSS), Self-Report Insight Scale (IS), frequency and duration of relapse/readmission, frequency of suicidal attempt and violent episode, and types of course were assessed. In addition, we analysed the relationship between DUP and various outcome variables.
Results:1) Twelve (26.7%) subjects had attempted suicide and 2 of them committed suicide. At the point of investigation, twenty five patients had a full-time occupation for the last 1 year. The types of course were classified as a single episode with current remission (28.9%), two or more episodes with current remission (33.3%), two or more episodes with active positive symptoms currently (17.8%) and continuously psychotic without remission (20%). During the follow-up period, twenty three subjects experienced relapses and twenty four were re-hospitalized. 2) Seven subjects were recovered and all of them were female. They had higher proportion of married persons and shorter DUP than the unrecoverd group. 3) The mean of DUP was 36.98±35.12 weeks and median of DUP was 24 weeks. DUP was significantly longer in those who had lived alone. No significant differences were found between DUP and sex, educational level and family history for psychiatric illness. The short DUP group (≤1 year) was found to live with family more frequently and to have higher educational level than the long DUP group (>1 years). No significant differences were found between the short and long DUP groups in terms of various outcome variables.
Conclusion:Our subjects with first-episode schizophrenia spectrum disorder were found to have more favorable outcomes in employment, relapse and patterns of course than many previous studies. We did not find any difference in the various outcome variables between the short and long DUP groups. However, the recovered group had a shorter DUP than the unrecovered group. This result suggests that early detection and intervention of psychotic patients may play an important role in determining recovery from the illness. (Schizophrenia Clinics 2005;8:64-73) |
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