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Early detection and management of mental disorders - part 2

Trầm cảm trong khóa học Bệnh sớm như là một chỉ số tiên lượng của khóa học Sau đó Chúng tôi nghiên cứu quá trình bệnh và hiệu quả hơn nữa các dự báo của triệu chứng báo trước trong 115 tập phim bệnh đầu tiên từ subsample đại diện của 130 nhập học đầu tiên tại sáu mặt cắt hơn năm năm sau khi nhập học đầu tiên | EARLY DETECTION OF SCHIZOPHRENIA 21 Depression in the Early Illness Course as a Prognostic Indicator of the Later Course We studied the further illness course and the predictive efficiency of prodromal symptoms in 115 first illness episodes from the representative subsample of 130 first admissions at six cross-sections over five years after first admission 114 . Patients with schizophrenia who suffered from depressive mood 14 days in the early illness course were compared with age- and gender-matched patients without depressive episodes. The group with depression in the early course of schizophrenia showed significantly higher scores of depressive but also of positive negative and nonspecific symptoms in the first episode than did nondepressed patients. With remission of the episode the mean score for depressive symptoms fell with psychotic symptoms without any indication of a wave of postpsychotic depression and remained more or less stable until five years after first admission. The presence of depressive symptoms in the early illness course predicted the occurrence of neither positive nor depressive or nonspecific symptoms after remission of the psychotic episode. In contrast the absence of depressive symptoms in the early course was significantly correlated with affective flattening in the five years following first admission. The implication of this finding is that prodromal depression predicts a severe first psychotic episode whereas a low score of prodromal depressive symptoms predicts more affective flattening after the remission of the episode. Early Functional Impairment and Social Consequences Because of the early emergence of negative symptoms and functional impairment most patients with schizophrenia started to suffer from social disability Disability Assessment Schedule DAS score 2 51 to 24 months before first admission long before they received appropriate treatment. Two years before first admission 57 of the patients were considerably impaired when