Effects of duration of untreated psychosis on the clinical course and neurocognitive features of schizophrenia

Abstract

Introduction Prolonged duration of untreated psychosis (DUP) is one of the negative factors in the course of schizophrenia. The purpose of our study was to detect the long‐term effects of DUP on the clinical and neurocognitive features of schizophrenia patients. Methods One hundred and sixty‐two schizophrenia patients were divided into two groups (short and long‐term DUP) according to the median duration (<6 months). The groups were then stratified according to duration of illness (DI) as short‐term (≤10 years) and long‐term. Psychopathology and clinical signs were evaluated by Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale (CGI) and Global Assessment of Functioning Scale (GAF). Executive functions were assessed using Frontal Assessment Battery (FAB), Colour Trail Test (CTT) and Wisconsin Card Sorting Test (WCST). Results Symptoms, cigarette consumption, treatment response, CGI, GAF, positive, negative and general subscales of the PANNS and FAB showed significant differences between the short‐ and long‐term DUP groups. These differences were more significant in the long‐term DI group. Positive correlation between DUP and age, cigarette consumption, length of illness, number of hospitalizations, resistance to treatment, compliance, and negative and total scores in PANNS were detected in the whole group of patients. However, the correlation of DUP with CGI and percentage of conceptual level response of WCST were negative. Conclusion Long‐term DUP may have a negative effect on the clinical and neurocognitive features of schizophrenia. This effect more significantly appears in schizophrenia patients with longer DI.

Short-term Clinical Outcome of Previously Untreated and Treated Schizophrenia and Impact of Duration of Untreated Psychosis

“…The findings by Kaymak et al were in line with the current study. 26 Ran et al found an association of longer DUP with higher age, being unmarried, living alone, and having lower educational achievements ( p < .01). 8 Other studies found that untreated patients were more among 15–29 year olds (84%) than higher age groups; 27 were mostly males; 28 were artisans, followed by students and unemployed; 29 belonged to urban areas; 30 had more positive family psychiatric history (53.8%–55.1%), 29 , 30 and had an AoO of 26.0 ± 8.9 years.…”

Factors associated with changes in hospitalisation in patients prescribed clozapine

“…Clarke et al (2006) showed that the long term consequences of a prolonged untreated psychosis include a reduced likelihood of remission and reduced functional outcome, as well as increased psychopathology. Cognitive function (Alptekin et al, 2005; Tirupati et al, 2004; Üçok et al, 2006; Vyas et al, 2007), occupational functioning (Norman et al, 2007; Penttila et al, 2011), forensic risk (Large and Nielssen, 2008), subsequent psychiatric admissions (Helgason, 1990) and even smoking habits (Kaymak et al, 2012) have all been shown to be adversely affected by a long untreated psychosis. The initiation of antipsychotic medication in the first episode of psychosis results in better outcomes (May and Tuma, 1965; May et al, 1976; May et al, 1981; Wyatt et al, 1997), and the latency of that treatment is a significant predictor of time to treatment response (Loebel et al, 1992).…”