Korean J Schizophr Res.  2020 Apr;23(1):1-7. 10.16946/kjsr.2020.23.1.1.

Factors Affecting the Duration of Untreated Psychosis in Community-Dwelling Patients with Schizophrenia Spectrum Disorder

• Kim M
• Kim JK
• Jhon M
• Kim JW
• Lee JY
• Kim JM
• Shin IS
• Yoon JS
• Lee MS
• Kim SW

• KMID: 2500470
• DOI: http://doi.org/10.16946/kjsr.2020.23.1.1

Abstract

Objectives
This study aimed to identify factors affecting the duration of untreated psychosis (DUP) in patients with schizophrenia spectrum disorder.
Methods
Six-hundred patients with schizophrenia spectrum disorder were recruited from mental health welfare centers in Gwangju Metropolitan City and Gyeonggi-do. Subjects were categorized into two groups according to median DUP. Demographic and clinical characteristics were compared between the two groups.
Results
The mean DUP was 80.8 weeks, and the median DUP was 15.9 weeks. Patients with Medicaid, higher age, and longer duration of the schizophrenia prodrome were more likely to have a longer DUP. The DUP was shorter in patients who were consulted by family/relatives prior to treatment. Patients visiting university hospitals were more likely to have a shorter DUP compared with those visiting psychiatric clinics or small-sized mental hospitals, i.e., with less than 100 beds. A multivariate regression analysis showed that the duration of the prodrome was a factor that significantly affected DUP.
Conclusion
The vulnerable group of patients with schizophrenia with a long DUP should be monitored closely. Moreover, it is necessary to develop a strategy to identify patients who have an insidious course of psychosis to reduce the DUP.

Keyword

Community; Duration of untreated psychosis (DUP); Early intervention; Psychosis; Schizophrenia

Reference

1. Lieberman JA, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry. 2001; 50:884–897.

2. Brewer WJ, Lambert TJ, Witt K, Dileo J, Duff C, Crlenjak C, et al. Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes. Lancet Psychiatry. 2015; 2:29–37.

3. Norman RM, Malla AK. Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med. 2001; 31:381–400.

4. McGlashan TH. Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biol Psychiatry. 1999; 46:899–907.

5. 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 Psychiatry. 2005; 162:1785–1804.

6. 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 Psychiatry. 2005; 62:975–983.

7. Penttila M, Jaaskelainen E, Hirvonen N, Isohanni M, Miettunen J. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2014; 205:88–94.

8. Lloyd-Evans B, Crosby M, Stockton S, Pilling S, Hobbs L, Hinton M, et al. Initiatives to shorten duration of untreated psychosis: systematic review. Br J Psychiatry. 2011; 198:256–263.

9. Kvig EI, Brinchmann B, Moe C, Nilssen S, Larsen TK, Sorgaard K. Geographical accessibility and duration of untreated psychosis: distance as a determinant of treatment delay. BMC Psychiatry. 2017; 17:176.

10. Fond G, Boyer L, Andrianarisoa M, Godin O, Brunel L, Bulzacka E, et al. Risk factors for increased duration of untreated psychosis. Results from the FACE-SZ dataset. Schizophr Res. 2018; 195:529–533.

11. Kalla O, Aaltonen J, Wahl-ström J, Lehtinen V, Cabeza IG, De Chávez MG. Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain. Acta Psychiatr Scand. 2002; 106:265–275.

12. Souaiby L, Gauthier C, Kazes M, Mam-Lam-Fook C, Daban C, Plaze M, et al. Individual factors influencing the duration of untreated psychosis. Early Interv Psychiatry. 2019; 13:798–804.

13. Buckley PF, Wirshing DA, Bhushan P, Pierre JM, Resnick SA, Wirshing WC. Lack of insight in schizophrenia. CNS Drugs. 2007; 21:129–141.

14. Broussard B, Kelley ME, Wan CR, Cristofaro SL, Crisafio A, Haggard PJ, et al. Demographic, socio-environmental, and substancerelated predictors of duration of untreated psychosis (DUP). Schizophr Res. 2013; 148:93–98.

15. 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 Psychiatry. 2006; 189:446–452.

16. Larsen TK, Johannessen JO, Opjordsmoen S. First-episode schizophrenia with long duration of untreated psychosis: pathways to care. Br J Psychiatry. 1998; 172:45–52.

17. Malla A, Norman R, McLean T, MacDonald C, McIntosh E, DeanLashley F, et al. Determinants of quality of life in first-episode psychosis. Acta Psychiatr Scand. 2004; 109:46–54.

18. Park S, Kim D, Nam J, Lee H. Psychosocial correlates of duration of untreated psychosis in the first-episode schizophrenia. J Korean Neuropsychiatr Assoc. 2005; 44:439–445.

19. Jon DI, Lee S, Kong J. Clinical correlates of duration of untreated psychosis in patients with schizophrenia. J Korean Neuropsychiatr Assoc. 2004; 43:401–406.

20. Yoo JM, Ahn SR, Cho YS, Lee MS. A study of duration of untreated psychosis (DUP) for first episode psychosis. Seoul: Mental Health Center: The Mental Health;2011. p. 12–16.

21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Publishing;2013.

22. Lee YJ, Sung Y, Yun KW, Kim SI, Lim W. Study on the association of duration of untreated period with cognitive impairment and negative symptoms in 1st episode psychosis. J Korean Soc Biol Ther Psychiatry. 2011; 17:211–220.

23. Bora E, Yalincetin B, Akdede BB, Alptekin K. Duration of untreated psychosis and neurocognition in first-episode psychosis: a meta-analysis. Schizophr Res. 2018; 193:3–10.

24. Galderisi S, Davidson M, Kahn RS, Mucci A, Boter H, Gheorghe MD, et al. Correlates of cognitive impairment in first episode schizophrenia: the EUFEST study. Schizophr Res. 2009; 115:104–114.

25. Amminger G, Edwards J, Brewer W, Harrigan S, McGorry P. Duration of untreated psychosis and cognitive deterioration in firstepisode schizophrenia. Schizophr Res. 2002; 54:223–230.

26. Malla AK, Norman RM, Manchanda R, Ahmed MR, Scholten D, Harricharan R, et al. One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophr Res. 2002; 54:231–242.

27. Loebel AD, Lieberman JA, Alvir JM, Mayerhoff DI, Geisler SH, Szymanski SR. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry. 1992; 149:1183–1188.

28. Lutgens D, Lepage M, Iyer S, Malla A. Predictors of cognition in first episode psychosis. Schizophr Res. 2014; 152:164–169.

29. Jackson HJ, McGorry PD. The EPPIC follow-up study of first-episode psychosis: longer-term clinical and functional outcome 7 years after index admission. J Clin Psychiatry. 2010; 71:716–728.

30. Adamson V, Barrass E, McConville S, Irikok C, Taylor K, Pitt S, et al. Implementing the access and waiting time standard for early intervention in psychosis in the United Kingdom: an evaluation of referrals and post?assessment outcomes over the first year of operation. Early Interv Psychiatry. 2018; 12:979–986.

31. Mueser KT, Penn DL, Addington J, Brunette MF, Gingerich S, Glynn SM, et al. The NAVIGATE program for first-episode psychosis: rationale, overview, and description of psychosocial components. Psychiatr Serv. 2015; 66:680–690.

32. Ito S, Nemoto T, Tsujino N, Ohmuro N, Matsumoto K, Matsuoka H, et al. Differential impacts of duration of untreated psychosis (DUP) on cognitive function in first-episode schizophrenia according to mode of onset. Eur Psychiatry. 2015; 30:995–1001.

33. Hui CL, Lau WW, Leung CM, Chang WC, Tang JY, Wong GH, et al. Clinical and social correlates of duration of untreated psychosis among adult-onset psychosis in Hong Kong Chinese: the JCEP study. Early Interv Psychiatry. 2015; 9:118–125.

34. Møller P, Husby R. The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophr Bull. 2000; 26:217–232.