Relation Between Clinical and Social Variables and Duration of Untreated Psychosis in First Episode Psychosis
Background: Several studies have shown that if untreated, psychosis can cause significant reduction in brain volume and worsening of disease outcome. Reducing Duration of Untreated Psychosis (DUP) is an important early intervention strategy. Factors associated with longer DUP remain poorly understood and there is a paucity of Indian studies in this regard.
Methods: We compared sociodemographic data, premorbid functioning and psychopathology of patients of first episode psychosis with brief (six months or less) or long (more than six months) DUP. Premorbid Adjustment Scale and PANSS were used to assess the premorbid functioning and psychopathology respectively.
Results: Lower age, higher educational status of the patient, acute onset, and higher scores for negative symptom or general psychopathology in PANSS were associated with brief DUP.
Conclusions: Certain sociodemographic and clinical features are associated with brief DUP, and there is a need for more, especially longitudinal, studies on this topic.Â
Lopez AD. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. In: Murray CJ, Lopez AD, editors. Global burden of disease and risk factors. Boston: Harvard University Press; 1996.
Bleuler M. The schizophrenic disorders: long term patient and family studies. (Clements S, Trans) New Haven (CT): Yale University Press; 1978.
Wyatt RJ Neuroleptics and the natural course of Schizophrenia. Schizophr Bull 1991; 17: 325-51.
Pantelis C, Velakoulis D, McGorry PD, Wood SJ, Suckling J, Phillips LJ et al. Neuroanatomical abnormalities before and after onset of psychosis: a crosssectional and longitudinal MRI comparison. Lancet 2003; 361(9354):281â€“8.
Shrivastava A, Shah N, Johnston M, Stitt L, Thakar M, Chinnasamy G. Effects of duration of untreated psychosis on long term outcome of people hospitalized with first episode schizophrenia. Indian J Psychiatry 2010; 52:164-7.
Baldwin P, Browne D, Scully PJ, Quinn JF, Morgan MG, Kinsella A, et al. Epidemiology of first-episode psychosis: illustrating the challenges across diagnostic boundaries through the Cavan- Monaghan study at 8 years. Schizophr Bull 2005; 31(3): 624-38.
Loebel AD, Lieberman JA, Alvir JMJ, Mayerhoff DI, Geisler SH, Szymanski SR. Duration of psychosis and outcome in first episode schizophrenia. Am J Psych 1992; 149(9):1183-8.
Larsen TK, McGlashan TH, Moe LC. First-episode schizophrenia: early course parameters. Schizophr Bull 1996; 22(2):241-56.
World Heath Organization. The ICD-10 Classification of Mental and Behavioral Disorders. Clinical Description and Diagnostic Guidelines. Geneva: WHO; 1992
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 Suppl 20:22-33; 34-57.
Cannon-Spoor HE, Potkin SG, Wyatt RJ. Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 1982; 8:470-84.
Verdoux H, Liraud F, Bergey C, Assens F, Abalan F, van Os J. Is the association between duration of untreated psychosis and outcome confounded? A two year follow-up study of first-admitted patients. Schizophr Res 2001; 49:231â€“41.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13(2):261-76.
Morgan C, Abdul-Al R, Lappin JM, Jones P, Fearon P, Leese M et al Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study Br J Psych 2006;189:446-52.
Craig TJ, Bromet EJ, Fennig S, Tanenberg-Karant M, Lavelle J, Galambos M. Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry 2000; 157(1):60-6.
Naqvi HA, Hussain S, Zaman M, Islam M. Pathways to care: duration of untreated psychosis from Karachi, Pakistan. PLoS ONE 2009; 4(10): e7409. doi:10.1371/journal.pone.0007409
Harrison G, Croudace TJ, Mason P, Glazebrook C, Medley I. Predicting long-term outcome in schizophrenia. Psychol Med 1996;26: 697- 705.
Barnes TRE, Hutton SB, Chapman MJ, Mutsatsa S, Puri BK, Eileen M. West London first episode study of schizophrenia clinical correlates of duration of untreated psychosis Br J Psych 2000; 177:207-11.
Thomas SP, Nandhra HS. Early intervention in psychosis: A retrospective analysis of clinical and social factors influencing duration of untreated psychosis. Primary Care Companion J Clin Psychiatry 2009; 11(5):212-4.