Clinical and Social Correlates of Duration of Untreated Psychosis and Impact on Short-Term Outcome in Patients with First-Episode Psychosis

Abstract

Abstract Background: The duration of untreated psychosis (DUP) impacts symptomatic and functional outcome in patients with psychosis. Objectives: This study assessed DUP, its association with sociodemographic and clinical factors and its impact on short-term clinical and functional outcome in patients with first episode psychosis. Methodology: Sixty-nine first contact patients with first episode psychosis who had not received adequate treatment for psychosis (adequate treatment - antipsychotic medication of ≥3.5 mg haloperidol equivalents for ≥ 4 weeks) previously were assessed with Symptom Onset in Schizophrenia Inventory to determine DUP. They were followed up for 12 weeks. Positive and Negative Syndrome Scale and World Health Organization Disability Assessment Scale – II were used to assess symptoms and functioning at presentation and after 12 weeks. Results: The mean DUP for the sample (n=69) was 56.7 ± 89.1 weeks (13.2 ± 20.8 months). About three fifths (60.9%) of the subjects had DUP ≤ 3 months (short DUP) and two fifths (39.1%) had DUP > 3 months (long DUP). Univariate analysis found age, employment, mode of onset and diagnosis to be significant. At followup, treatment-related improvement in positive, general and total symptom scores was significantly negatively correlated with DUP and improvement in functioning was significantly greater in patients with DUP < 3 months. A step-wise multiple logistic regression model identified mode of onset, age, and history of prior attempts at treatment as independent predictors of membership to the two DUP categories; insidious onset led to a 20-fold and a history of prior treatment attempts indicated a 400% increase in the odds of belonging to the long DUP category. An average of 9% increase in odds of having long DUP was observed with every one-year increase in age. Conclusion: Early detection (short DUP) of psychosis was found to have a salutary impact on clinical and functional outcome.