Does duration of untreated psychosis predict very long term outcome of schizophrenic disorders? results of a retrospective study
Tóm tắt
Studies performed to assess the relevance of duration of untreated psychosis (DUP) as a predictor of long-term outcome (i.e. follow-ups of ten years or more) are somewhat limited. The aim of this study was to evaluate the potential association between DUP and very long-term outcome (16-33 yrs) of schizophrenia by means of a retrospective design. Retrospective data obtained from clinical records were collected regarding DUP and outcome variables (number of hospitalizations; number of attempted suicides; course of illness; GAF scores at last observation) for a cohort of 80 outpatients (52 Males, 28 Females, mean age 51.0+/-11.58 years) affected by schizophrenia according to DSMIVTR attending a university community mental health centre. Mean duration of follow up was 25.2 +/- 8.68 years; mean duration of untreated psychosis was 49.00 months (range 1-312 mo), with no significant difference according to gender. Patients with a shorter DUP (=/< 1 year) displayed more frequent “favourable” courses of illness (28.9% vs 8.6%) (p = 0.025), more frequent cases with limited (=/< 3) number of hospital admissions (85.7% vs 62.1%) (p = 0.047) and a better functioning (mean GAF score = 50.32+/-16.49 vs 40.26+/-9.60, p = 0.002); regression analyses confirmed that shorter DUP independently predicted a more positive outcome in terms of number of hospital admissions, course of illness, functioning (GAF scores). A shorter DUP appears to act as a significant predictor of better outcome in schizophrenia even in the very long-term.
Tài liệu tham khảo
Lambert M, Karow A, Leucht S, Schimmelmann BG, Naber D: Remission in schizophrenia: validity, frequency, predictors, and patient’s perspective 5 years later. Dialogues Clin Neurosci. 2010, 12: 393-407.
Warner M: Recovery from schizophrenia and the recovery model. Curr Opin Psychiatry. 2009, 22: 374-380. 10.1097/YCO.0b013e32832c920b.
Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T: Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiat. 2005, 63: 975-983.
Perkins DO, Gu H, Boteva K, Lieberman JA: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am. J. Psychiat. 2005, 162: 1785-1804. 10.1176/appi.ajp.162.10.1785.
Keshavan MS, Amirsadri A: Early intervention in schizophrenia: current and future perspectives. Curr Psychiatry Rep. 2007, 9: 325-328. 10.1007/s11920-007-0040-8.
Marshall M, Rathbone J: Early intervention for psychosis. Cochrane Database Syst Rev. 2011, 15 (6): CD004718 -
Carbone S, Harrigan S, McGorry PD, Curry C, Elkins K: Duration of untreated psychosis and 12-month outcome in first-episode psychosis: the impact of treatment approach. Acta Psychiatr Scand. 1999, 100: 96-104. 10.1111/j.1600-0447.1999.tb10830.x.
Larsen TK, McGlashan TH, Moe LC: First-episode schizophrenia: Early course parameters. Schizophr Bull. 1996, 22: 241-256. 10.1093/schbul/22.2.241.
McGlashan TH: Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? . Biol Psychiatry. 1999, 46: 899-907. 10.1016/S0006-3223(99)00084-0.
Bottlender R, Strauss A, Moller H: Impact of duration of symptoms prior to first hospitalization on acute outcome in 998 schizophrenic patients. Schizophr Res. 2000, 44: 145-150. 10.1016/S0920-9964(99)00186-3.
Drake RJ, Haley CJ, Akhtar S, Lewis SW: Causes and consequences of duration of untreated psychosis in schizophrenia. Brit Journ Psychiat. 2000, 177: 511-515. 10.1192/bjp.177.6.511.
Scully PJ, Coakley G, Kinsella A, Waddington JL: Psychopathology, executive (frontal) and general cognitive impairment in relation to duration of initially untreated versus subsequently treated psychosis in chronic schizophrenia. Psychol Med. 1997, 27: 1303-1310. 10.1017/S0033291797005722.
Huber G: The heterogeneous course of schizophrenia. Schizophr Res. 1997, 28: 177-185. 10.1016/S0920-9964(97)00113-8.
Wiersma D, Nienhuis FJ, Sloof CJ, Giel R: Natural course of schizophrenic disorders: a 15-years follow-up of a Dutch incidence cohort. Schizophr Bull. 1998, 24: 75-85. 10.1093/oxfordjournals.schbul.a033315.
Wiersma D, Wanderling J, Dragomirecka E, Ganev K, Harrison G, An Der Heiden W, Nienhuis FJ, Walsh D: Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres. Psychol Med. 2000, 30: 1155-1167. 10.1017/S0033291799002627.
Bottlender R, Sato T, Jäger M, Wegener U, Wittmann J, Strauss A, Möller HJ: The impact of the duration of untreated psychosis prior to first psychiatric admission on the 15-year outcome in schizophrenia. Schizophr Res. 2003, 62: 37-44. 10.1016/S0920-9964(02)00348-1.
Hua J, Wong KE, Kua EH, Tsoi WF: A 20-year follow-up on schizophrenia in Singaphore. Acta Psych Scand. 2003, 108: 118-125. 10.1034/j.1600-0447.2003.00107.x.
American Psychiatric Association: Diagnostic and Statistical Manual for Mewntal Duisodres. 2000, American Psychiatric Association, Washington DC, Fourt Edition
First MB, Spitzer RL, Williams JBW, Gibbon M: Structured Clinical Interview for DSM IV Axis I Disorders – Research Version (SCID I, Version 2.0). 1996, Biometrics Research Department, Sate Psychiatric Institute, New York
Carpiniello B, Baita A, Carta MG, Sitzia R, Macciardi AM, Murgia S, Altamura AC: Clinical and Psychosocial outcome of patients affected by panic disorder with or without agorafobia: result of a naturalistic follow-up study. Eur Psych. 2002, 17: 394-398. 10.1016/S0924-9338(02)00701-0.
Conti L, Dell’Osso L, Cassano GB: Il sistema AMDP. Manuale per la valutazione e la Documentazione della Psicopatologia. 1988, Versione Italiana, Milano: Mazzuchelli
American Psychiatric Association: Global Assessment of Functioning Scale (GAF). 1994, American Psychiatric Association. American Psychiatric Press, Washington, DC, 32-Fourth edition (DSM-IV)
Szymanski S, Lieberman JA, Alvir JM, Mayerhoff D, Loebel A: Geisler S, Chakos M, Jody, D, Kane, J: Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. Am Journ Psychiat. 1995, 152: 698-703.
Altamura AC, Bassetti R, Sassella F, Salvatori D, Mundo E: Duration of Untreated Psychosis as a predictor of outcome in first episode schizophrenia: a retrospective study. Schizophr Res. 2001, 52: 29-36. 10.1016/S0920-9964(00)00187-0.
Harris MG, Henry LP, Harrigan SM, Purcell R, Schwartz OS, Farrely SE, Prosser AL, Jackson HJ, McGorry PD: The relationship between duration of untreated psychosis and outcome: An eight-year prospective study. Schizophr Res. 2005, 79: 85-93. 10.1016/j.schres.2005.05.024.
Falloon IR, Kydd RR, Coverdale JH, Laidlaw TM: Early detection and intervention for initial episodes of schizophrenia. Schizophr Bull. 1996, 22: 271-282. 10.1093/schbul/22.2.271.
De Quardo JR: Pharmacologic treatment of first-episode schizophrenia: early intervention is the key to the outcome. Journ Clin Psych. 1998, 59: 9-17.
Altamura AC, Camuri G, Dell’Osso B: Understanding the role of the duration of untreated illness in psychiatric disorders: a narrative review. Riv Psichiatr. 2010, 45: 197-208.
Singh SP: Outcome measures in early psychosis: relevance of duration of untreated psychosis. Brit J Psych. 2007, 50: S58-S63.
Emsley R, Chiliza B, Schoemann R: Predictors of long term outcome in schizophrenia. Curr Opin Psychiat. 2008, 21: 173-177. 10.1097/YCO.0b013e3282f33f76.
White C, Stirling J, Hopkins R, Morris J, Montague L, Tantam D, Lewis S: Predictors of 10-year outcome of first-episode psychosis. Psychol Med. 2009, 39: 1447-1456. 10.1017/S003329170800514X.
Cechnicki A, Hanuszkiewicz I, Polczyk R, Bielańska A: Prognostic value of duration of untreated psychosis in long-term outcome of schizophrenia. Med Sci Monit. 2011, 17: CR277-CR283.
Röpcke B, Eggers C: Early-onset schizophrenia: a 15-year follow-up. Eur J Child Adol Psych. 2005, 14: 341-501. 10.1007/s00787-005-0483-6.
de Haan L, van Der Gaag M, Wolthaus J: Duration of untreated psychosis and the long-term course of schizophrenia. Eur Psychiat. 2000, 15: 264-267. 10.1016/S0924-9338(00)00234-0.
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. Ind J Psychiat. 2010, 52: 164-167. 10.4103/0019-5545.64583.
Volz HP: Successfully treating acutely ill patients: does it improve long-term outcome in psychiatric disorders?. BMC Psychiat. 2007, 7 (1): S70-10.1186/1471-244X-7-S1-S70.