Duration of untreated psychosis: Impact of the definition of treatment onset on its predictive value over three years of treatment

Golay, Philippe; Alameda, Luis; Baumann, Philipp S.; Elowe, Julien; Progin, Pierre; Polari, Andrea; Conus, Philippe

doi:10.1016/j.jpsychires.2016.02.017

Cited by 40 publications

(30 citation statements)

References 33 publications

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“…A recent study investigating differences in outcome based on onset of either medical treatment, SEI treatment, or both combined indicated that the beneficial impact of short DUP on outcome was strongest if the end of DUP was defined as both adequate medical treatment and enrollment in a SEI program. 24 Our finding of an effect on the negative symptoms for participants with a total treatment delay of <6 months support the notion that adequate treatment for patients with newly diagnosed schizophrenia should be considered both medical treatment and psycho-social treatment.…”

Section: Discussionsupporting

confidence: 72%

The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders

et al. 2017

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The duration of untreated psychosis (DUP) has been shown to have an effect on outcome after first-episode psychosis. The premise of specialized early intervention (SEI) services is that intervention in the early years of illness can affect long-term outcomes. In this study, we investigate whether DUP affects treatment response after 5 years of SEI treatment compared to 2 years of SEI treatment. As part of a randomized controlled trial testing the effect of prolonged SEI treatment 400 participants diagnosed within the schizophrenia spectrum were recruited. For this specific study participants were dichotomized based on DUP, treatment delay, and time from first symptom until start of SEI treatment. The groups were analyzed with regard to treatment response on psychopathology, level of functioning, and cognitive functioning. The participants with a short DUP had a tendency to respond better to the prolonged treatment with regards to disorganized and negative dimension. For participants with short duration from first symptom until start of SEI treatment there was a significant difference on the negative dimension favoring the prolonged OPUS treatment. The finding of an effect of prolonged treatment for participants with a short total treatment delay could mean that prolonged SEI treatment is more beneficial than treatment as usual (TAU) so long as it is provided in the early years of illness and not just in the early years after diagnosis.

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Section: Discussionsupporting

confidence: 72%

The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders

et al. 2017

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“…Our sample contained 52.2% male patients and we did not find significant differences in the sample by gender. This finding differs from other studies that showed that in non- affective psychosis male patients are represented slightly more (Kvig et al, 2017), (Szöke et al, 2014;Malla et al, 2004), and there is a reported odds ratio of 2.37 for nonaffective psychosis patients being male (Golay et al, 2016).…”

Section: Discussioncontrasting

confidence: 99%

Clinical and Sociodemographic Characteristics in First-Episode Psychosis Patients in a Rural Region of Latvia

Berze

Bezina

Pavlovs

et al. 2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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The first psychosis is a crucial point for further development of mental disorders. Previous evidence has demonstrated that psychotic disorders, including schizophrenia, are associated with a large number of years living with the disability. It is a global aim to improve prognosis of psychotic disorders, especially in rural regions, where mental health care possibly is not so easily accessible for patients. The aim of this study was to investigate clinical and sociodemographic determinants in association with patient and illness related factors to improve knowledge and understanding of first time psychosis patients in a rural region. This is a descriptive, cohort-based study of all consecutive first episode psychosis (F20, F23, ICD 10) patients admitted in the Daugavpils Psychoneurological Hospital (DPNH) between January 2016 and December 2017. Of the 94 first-time patients hospitalised in DPNH with symptoms of psychosis, 69 met the inclusion criteria. Our results showed that median age of patients was 33 years (IQR 27.5–42.0), median duration of untreated illness (DUI) was 30 months (IQR 11.0–60.0), and median duration of untreated psychosis (DUP) was 8 weeks (IQR 4.0–48.0). The results showed that 55.1% of first psychosis patients had not seen any health care specialist before being admitted to the psychiatric hospital. We found statistically significant differences between some sociodemographic aspects in DUI/DUP. Patients who lived with relatives had the longest DUI — 36 months, compared with 12 months for those who had established their own family. Unemployed patients had longer DUI — 36 months, compared with 12 months for employed patients. Similar findings were shown for associations with DUP. To our knowledge this study adds several important findings that help to better understand first psychosis patients.

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“…The second strand of evidence is a large body of research on the deleterious long-term effects of a long DUP. Although there may be alternative explanations for this association (eg, long DUP may reflect particularly severe presentations), and the empirical evidence has been constructed with studies of variable methodology (Polari et al, 2011), the signal has been remarkably consistent and it is improved when treatment onset is defined more stringently, including by requiring adequate antipsychotic adherence (Golay et al, 2016). Comprehensive meta-analyses indicate that the longer the DUP, the worse patients fare clinically and functionally, both in the short-term (Perkins, Gu, Boteva, & Lieberman, 2005) and the long-term (Penttila et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

Horvitz-Lennon

Predmore

Orr

et al. 2018

Early Intervention Psych

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Aim Duration of untreated psychosis in early schizophrenia impacts long‐term outcomes. Because long‐acting injectable (LAI) antipsychotic drugs improve adherence in early‐stage patients, they could reduce additional time in uncontrolled psychosis (TUP) during the critical period of the illness. However, the long‐term benefit of early LAI use over oral formulations has not been quantified. This study explores the potential magnitude of the benefit with a simulation approach. Methods A microsimulation models the effects of 11 treatment pathways reflecting alternative decisions on whether and when LAI agents are used during a “calibration phase” that starts at treatment entry and lasts until the end of the 3‐year critical period. Treatment failure prolongs time in psychosis. Long‐term outcomes are predicted over the ensuing 7‐year period as a function of TUP. Results An “early LAI” pathway where LAI treatment follows the second oral treatment failure is compared to an oral‐only pathway. Under these pathways, 69% and 46% of patients, respectively, are estimated to exit the calibration phase with adequate symptom control (total positive and negative syndrome scale score below 68). Relative to the oral‐only pathway, the early LAI pathway is predicted to increase competitive employment by 39% (25% vs 18%) and independent or family living by 22% (71% vs 58%), and to decrease receipt of disability benefits by 36% (42% vs 66%) and hospital admissions per 1000 patient‐years by 15% (249% vs 294%). Conclusions While these simulation results need to be confirmed empirically, they suggest that earlier use of LAI antipsychotics can meaningfully improve patient outcomes.

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Duration of untreated psychosis: Impact of the definition of treatment onset on its predictive value over three years of treatment

Cited by 40 publications

References 33 publications

The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders

The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders

Clinical and Sociodemographic Characteristics in First-Episode Psychosis Patients in a Rural Region of Latvia

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

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