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Compton MT, Bakeman R, Alolayan Y, Balducci PM, Bernardini F, Broussard B, Crisafio A, Cristofaro S, Amar P, Johnson S, Wan CR. Personality domains, duration of untreated psychosis, functioning, and symptom severity in first-episode psychosis. Schizophr Res 2015. [PMID: 26209478 PMCID: PMC4929617 DOI: 10.1016/j.schres.2015.06.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Early-course psychotic disorders have been extensively studied in terms of phenomenology, but little is known about the influence of personality traits on clinical features of first-episode psychosis. The aim of this study was to explore how the "big five" personality domains (neuroticism, extraversion, openness, agreeableness, and conscientiousness) are associated with treatment delay (duration of untreated psychosis, DUP), functioning, and positive and negative symptom severity. METHODS Data for these analyses were obtained from 104 participants enrolled from psychiatric inpatient units in Atlanta, Georgia, between August 2008 and March 2011. The NEO Five-Factor Inventory (NEO-FFI) was used to assess personality domains, and all other variables were measured in a standardized and rigorous manner using psychometrically sound instruments. Correlational analyses and multiple linear regressions were carried out to examine the strength of associations between variables of interest. RESULTS Findings indicated that except for openness, all of the other personality variables contributed to some extent to the variance in DUP. Conscientiousness was positively correlated with functioning. Agreeableness was independently negatively associated with positive symptom severity and extraversion was independently negatively correlated with negative symptom severity. CONCLUSIONS We report the first evidence suggesting that DUP is in part driven by personality domains. Functioning and symptom severity are also associated with those domains. Personality should be taken into account in order to better understand the phenomenology of early-course psychotic disorders as well as treatment-seeking behaviors.
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Affiliation(s)
- Michael T. Compton
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA,Hofstra North Shore–LIJ School of Medicine at Hofstra University, Department of Psychiatry, Hempstead, NY, USA,Corresponding author: Michael T. Compton, M.D., M.P.H., Lenox Hill Hospital, Department of Psychiatry, 111 E. 77 Street, New York, NY 10075. Tel: 212-434-3215. Fax: 212-434-3306.
| | - Roger Bakeman
- Georgia State University, Department of Psychology, Atlanta, GA, USA
| | - Yazeed Alolayan
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Pierfrancesco Maria Balducci
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA,Scuola di Specializzazione in Psichiatria, Dipartimento di Medicina, Università degli Studi di Perugia, Italy
| | - Francesco Bernardini
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA,Scuola di Specializzazione in Psichiatria, Dipartimento di Medicina, Università degli Studi di Perugia, Italy
| | - Beth Broussard
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA
| | - Anthony Crisafio
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Sarah Cristofaro
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Patrick Amar
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Stephanie Johnson
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Claire Ramsay Wan
- Tufts University School of Medicine, Physician Assistant Program, Boston, MA, USA
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Renwick L, Lyne J, Donoghue BO, Owens L, Doyle R, Hill M, McCarthy E, Pilling M, O'Callaghan E, Clarke M. Prodromal symptoms and remission following first episode psychosis. Schizophr Res 2015; 168:30-6. [PMID: 26187148 DOI: 10.1016/j.schres.2015.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/06/2015] [Accepted: 07/01/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Describing the trajectory of prodromal symptoms has obvious appeal in supporting advances towards sub-clinical intervention. Identifying clinical phenomena associated with unfavourable illness outcomes could have greater significance in explaining some heterogeneity within and between psychotic disorders and advancing understanding of pre-psychotic typologies. Few studies have assessed the continuity, if any, between prodromal phases and illness outcome one year after treatment. METHODS We assessed 375 people with first-episode psychosis (FEP) and 215 (57.4%) were seen approximately one year later. We performed factor analysis on prodromal symptom items obtained by interview with families and participants and identified a five-factor solution. We determined whether these factors predicted non-remission from psychosis in the presence of other factors that may predict outcome including premorbid adjustment, duration of prodrome and untreated psychosis (DUP), baseline symptoms and DSM-IV diagnoses. We used random forest classification to predict the most important variables and logistic regression to identify specific predictors. RESULTS We identified five prodromal symptom factors comprising Negative Symptoms, General Psychopathology, Reality Distortion, Strange Ideas and Irritability. Prodromal symptoms did not predict a greater risk of non-remission with the exception of Irritability and this factor was also associated with earlier age at onset, being male and a diagnosis of substance-induced psychosis. Being male, DUP and baseline positive symptoms predicted non-remission at one year. CONCLUSION Prodromal symptoms were not linked with outcome after a year of treatment which could be explained by greater heterogeneity in illness psychopathology which may be more pronounced in broad FEP diagnoses at different stages. It could also be explained by prodromal symptoms exerting greater influence earlier in the course illness.
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Affiliation(s)
- Laoise Renwick
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
| | - John Lyne
- DETECT Early Psychosis Service, Dublin, Ireland
| | - Brian O Donoghue
- DETECT Early Psychosis Service, Dublin, Ireland; Orygen, The National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Liz Owens
- DETECT Early Psychosis Service, Dublin, Ireland
| | | | | | - Emma McCarthy
- St. John of God Hospital, Dublin, Ireland; School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Mark Pilling
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Eadbhard O'Callaghan
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Mary Clarke
- DETECT Early Psychosis Service, Dublin, Ireland; St. John of God Hospital, Dublin, Ireland; Department of Psychiatry, University College Dublin, Dublin, Ireland
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Heeramun-Aubeeluck A, Liu N, Fischer F, Huang N, Chen F, He L, Yang C, Luo Y, Lu Z. Effect of time and duration of untreated psychosis on cognitive and social functioning in Chinese patients with first-episode schizophrenia: A 1-year study. Nord J Psychiatry 2015; 69:254-61. [PMID: 25731069 DOI: 10.3109/08039488.2014.929738] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Duration of untreated psychosis (DUP) is believed to exert a deleterious effect on cognitive and social function. However, to date, results remain inconclusive. AIMS To investigate the effect of time and DUP on cognitive and social functioning in first-episode schizophrenia (FES) subjects in Shanghai, China. METHODS FES patients were subjected to a comprehensive neuropsychological battery, the Personal and Social Performance scale (PSP) and the Positive and Negative Symptoms Scale (PANSS) at baseline, 6 month and 1 year. DUP was defined as the time from onset of first psychotic symptoms to first contact made with psychiatric services. RESULTS Though the rate of non-completers in our observational study was relatively high (40%), we did not find any significant differences between the completers and non-completers (P-values > 0.05). Significant impairments in verbal learning and memory and executive function were noted over the course of 1 year. Meanwhile, social function improved significantly over the course of 1 year. Although, DUP did not share any significant relationship with cognitive or social function the effect estimate (range: - 0.03 to 0.02) of an increase of 1 month in DUP was clinically non-negligible in this study. CONCLUSIONS In Chinese FES patients, the longitudinal course of cognitive function tends to worsen in verbal learning and memory, executive function and motor speed, while that of social function tends to improve. DUP was not found to be associated with cognitive or social deterioration in Chinese FES.
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Abstract
Students with emerging psychosis often experience delays in diagnosis and treatment that impact mental health and academic outcomes. School systems have tremendous potential to improve early identification and treatment of adolescent psychosis. As a community-based resource, schools can support outreach, education, and screening for adolescents with psychosis and engage identified students and their families for treatment. The concept of duration of untreated psychosis (DUP; the gap between symptom onset and treatment initiation) in adolescent psychosis and the potential role of schools in reducing DUP are reviewed. Future directions for clinical care and research needed to support school-based interventions are proposed.
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Affiliation(s)
- Jason Schiffman
- Department of Psychology, University of Maryland, 1000 Hilltop Circle, Baltimore County, Baltimore, MD 21250, USA.
| | - Sharon Hoover Stephan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 Pratt Street, Baltimore, MD 21201, USA
| | - L Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, MPRC - Tawes, PO Box 21247, Baltimore, MD 21228, USA
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 Pratt Street, Baltimore, MD 21201, USA
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Barrett EA, Mork E, Færden A, Nesvåg R, Agartz I, Andreassen OA, Melle I. The development of insight and its relationship with suicidality over one year follow-up in patients with first episode psychosis. Schizophr Res 2015; 162:97-102. [PMID: 25620119 DOI: 10.1016/j.schres.2015.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/18/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Insight into psychosis has been linked to suicidality, although inconsistently. The co-variation between insight and suicidality over time is under-investigated. The aim of the present study was to investigate predictors of suicidality in patients with first episode of psychosis (FEP) over one year, focusing on the relationship between insight and suicidality. METHODS Patients with FEP (n=146) were interviewed as soon as possible after treatment starts and at one year follow-up. RESULTS At baseline 37% of patients were suicidal, significantly reduced to 20% at follow-up. The effect of insight on suicidality was in different directions at different time-points, with insight at baseline increasing and insight at follow-up decreasing the risk of suicidality at follow-up. Patients with stable levels of insight across baseline and follow-up did not differ in risk for suicidality at follow-up. However, patients who lost insight from baseline to follow-up were more often suicidal at follow-up, whilst patients who gained insight were more seldom suicidal at follow-up. Other predictors of suicidality at follow-up were more depressive episodes before study entry, longer duration of untreated psychosis, more suicide attempts six months prior to follow-up, and depression at follow-up. CONCLUSION The results indicate that the effect of insight on suicidality in FEP-patients depends on time of assessment and of changes in insight. Gaining insight during treatment was associated with reduced risk for suicidality, whilst losing insight had the opposite effect, underlining the need to monitor insight over time and tailor interventions according to illness phase.
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Affiliation(s)
- Elizabeth A Barrett
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Section of Early Psychoses Treatment, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway.
| | - Erlend Mork
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
| | - Ann Færden
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Section for Acute Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Ragnar Nesvåg
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, 0403 Oslo, Norway
| | - Ingrid Agartz
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department of Research and Development, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ole A Andreassen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Ingrid Melle
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
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Anderson KK, Rodrigues M, Mann K, Voineskos A, Mulsant BH, George TP, McKenzie KJ. Minimal evidence that untreated psychosis damages brain structures: a systematic review. Schizophr Res 2015; 162:222-33. [PMID: 25649287 DOI: 10.1016/j.schres.2015.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A longer duration of untreated psychosis (DUP) is associated with poor outcomes in first-episode psychosis (FEP); however, it is unclear whether this is due to the effects of psychosis on brain structure. We systematically reviewed the literature on the association between the length of untreated psychosis and brain structure in first-episode psychosis. METHODS We searched three electronic databases and conducted forward and backward citation searching to identify relevant papers. Studies were included if they: (1) included patients with a psychotic disorder who were treatment naïve or minimally treated; and (2) had correlated measures of DUP or duration of untreated illness (DUI) with structural measures. RESULTS We identified 48 studies that met the inclusion criteria. Forty-three examined the correlation between DUP and brain structure, and 19 examined the correlation between DUI and brain structure. There was evidence of significant associations in brain regions considered important in psychosis; however, the proportion of significant associations was low and the findings were inconsistent across studies. The majority of included studies were not primarily designed to examine whether DUP/DUI is correlated with brain structure, and there were methodological limitations in many studies that prevent drawing a strong conclusion. CONCLUSION To date, there is minimal evidence of an association between untreated psychosis and brain structure in FEP. Although the body of literature is substantial, there are few hypothesis-driven studies with a primary objective to answer this question. Future studies should be specifically designed to examine whether untreated psychosis has a deleterious effect on brain structure.
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Affiliation(s)
- Kelly K Anderson
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Myanca Rodrigues
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Kamalpreet Mann
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Aristotle Voineskos
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Tony P George
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Kwame J McKenzie
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
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Marion-Veyron R, Lambert M, Cotton SM, Schimmelmann BG, Gravier B, McGorry PD, Conus P. History of offending behavior in first episode psychosis patients: a marker of specific clinical needs and a call for early detection strategies among young offenders. Schizophr Res 2015; 161:163-8. [PMID: 25468182 DOI: 10.1016/j.schres.2014.09.078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/05/2014] [Accepted: 09/20/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Previous literature suggests that early psychosis (EP) patients with a history of offending behavior (HOB) have specific clinical needs. The aims of this study were to assess: (1) the prevalence of HOB in a representative sample of EP; (2) the premorbid and baseline characteristics of patients with HOB, and (3) the potential differences in short-term outcome of such patients when compared to patients without HOB. METHODS The Early Psychosis Prevention and Intervention Centre (EPPIC) admitted 786 EP patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. Data of 647 patients could be analyzed. RESULTS HOB patients (29% of the sample) were more likely to be male with lower level of premorbid functioning and education, have used illicit substances and have attempted suicide. They presented with a more complex clinical picture and had poorer 18-month outcome. Most importantly, they had a significantly longer duration of untreated psychosis. CONCLUSIONS On the basis of the high prevalence and specific features of EP patients with HOB, our study confirms a need for additional research in this domain and for the development of specific treatment strategies. Most importantly, it suggests a need for the promotion of early detection strategies among the populations of young offenders, considering that some of them may be going through the early phases of a psychotic disorder and that reduction of treatment delay and provision of well adapted interventions may have a significant impact at numerous levels in such patients.
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Affiliation(s)
- Régis Marion-Veyron
- Treatment and Early Intervention in Psychosis Program(TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, 1008 Prilly, Switzerland.
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Centre for Psychosocial Medicine, Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Melbourne, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Bruno Gravier
- Service of Correctional Medicine and Psychiatry (SMPP) and Legal Psychiatry Institute, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, 1008 Prilly, Switzerland
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Melbourne, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program(TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, 1008 Prilly, Switzerland; Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia
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Padilla E, Molina J, Kamis D, Calvo M, Stratton L, Strejilevich S, Aleman GG, Guerrero G, Bourdieu M, Conesa HA, Escobar JI, de Erausquin GA. The efficacy of targeted health agents education to reduce the duration of untreated psychosis in a rural population. Schizophr Res 2015; 161:184-7. [PMID: 25439394 PMCID: PMC4308442 DOI: 10.1016/j.schres.2014.10.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 10/26/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
The duration of untreated psychosis (DUP) is a key determinant in the severity of symptoms in patients with schizophrenia. DUP is a modifiable factor that if reduced can improve patient outcome and treatment response. We sought to decrease DUP in rural Argentina by instituting annual training of local health agents to better identify signs of mental illness and offer earlier intervention. DUP was estimated using Schedules of Clinical Assessment in Neuropsychiatry (SCAN). Ongoing training was correlated with a reduction in DUP. Reducing DUP through better screening can decrease the psychosocial burden of disease and improve the trajectory of psychosis.
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Affiliation(s)
- Eduardo Padilla
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina,Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy
| | - Juan Molina
- Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy
| | - Danielle Kamis
- Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy
| | - Maria Calvo
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina,Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy
| | - Lee Stratton
- Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy
| | - Sergio Strejilevich
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina
| | - Gabriela Gonzalez Aleman
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina
| | - Gonzalo Guerrero
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina,Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy
| | - Mercedes Bourdieu
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina,Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy
| | - Horacio A. Conesa
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina
| | - Javier I. Escobar
- Roskamp Laboratory for Brain Development, Modulation and Repair. Morsani College of Medicine. University of South Florida, Tampa, FL
| | - Gabriel A. de Erausquin
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA). Argentina,Hospital Neuropsiquiátrico Néstor Sequeiros. Ministerio de Salud. Provincia de Jujuy,Corresponding author: Gabriel A. de Erausquin, MD, PhD, MSc, Roskamp Chair of Biological Psychiatry, Director of the Roskamp Laboratory of Brain Development, Modulation and Repair, Director of the Center for Neuromodulation, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave., MDC14, Tampa, FL 33613, , phone: 813 974 4716, fax: 813 974 3236
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Register-Brown K, Hong LE. Reliability and validity of methods for measuring the duration of untreated psychosis: a quantitative review and meta-analysis. Schizophr Res 2014; 160:20-6. [PMID: 25464915 DOI: 10.1016/j.schres.2014.10.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The duration of untreated psychosis (DUP) has been associated with a wide range of clinical outcomes, and is considered to be one of the key parameters in managing clinical high risk and first episode psychosis patients. However, considerable discrepancies exist in the way that DUP is estimated in different studies. There is no standard or consensus on which method is most reliable and valid for assessing DUP. METHODS This review aimed to quantitatively assess different DUP measurement instruments and definitions by comparing their inter-rater reliability, and their strength of validity in predicting biological and clinical outcomes. RESULTS Nine instruments designed for measuring DUP were found. Their inter-rater reliability were found to be adequate to excellent, although quite varied. This analysis did not show that any instrument was clearly outstanding compared to the others, although the limited available data do not exclude this possibility. DUP was also significantly associated with a range of outcomes, although mostly with small effect sizes. However, non-instrument based, ad hoc clinical interviews remained the most common way of measuring DUP. Definitions of onset of psychosis and onset of treatment were inconsistent among studies. CONCLUSIONS This review did not find quantitative evidence to support the use of one instrument over another. DUP remains a promising modifiable risk factor for a range of long-term clinical outcomes. Future research should quantify and improve the reliability and validity of the structured instruments for DUP measurement.
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Affiliation(s)
- Kelly Register-Brown
- University of Maryland/Sheppard Pratt Psychiatry Residency Training Program, University of Maryland. 701W. Pratt St., 4th Floor, Baltimore, MD 21201, USA.
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD. Tawes Ct., Catonsville, MD 21228, USA
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Marshall M, Husain N, Bork N, Chaudhry IB, Lester H, Everard L, Singh SP, Freemantle N, Sharma V, Jones PB, Fowler D, Amos T, Tomenson B, Birchwood M. Impact of early intervention services on duration of untreated psychosis: data from the National EDEN prospective cohort study. Schizophr Res 2014; 159:1-6. [PMID: 25107851 DOI: 10.1016/j.schres.2014.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/05/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to determine if the inception of Early Intervention Services (EISs) is followed by an improvement in the prompt treatment of people with first episode psychosis. METHOD A prospective cohort study of referrals to new and established EISs was conducted at 1, 2, 3, and 4 years after inception of new EIS. The study was conducted with 14 (seven new and seven established) secondary care EIS within geographically defined catchment areas in England between 2005 and 2009. Participants included 1027 consecutive referrals to EIS aged 14-35 with a first episode of psychosis. Duration of untreated psychosis (DUP) and number of participants treated adequately within 6 months of onset were the main outcome measures. RESULTS A significant downward trend across yearly cohorts for DUP for new EIS (F1,549=8.4, p=0.004) but not for established EIS (F1,429=1.7, p=0.19) was observed. There was a significant upward trend across cohorts in the proportion of referrals treated within 6 months for new EIS (X(2)=8.0, df=1, p=0.005), but not for established EIS (X(2)=0.1, df=1, p=0.72). CONCLUSION The introduction of new EIS was followed by a reduction in DUP and an increase in the proportion of patients treated within 6 months of onset. These trends were not present in the catchment areas of established services where DUP was initially lower, suggesting that there was no general tendency for DUP to fall over time. Hence, the introduction of an EIS was followed by an improvement in the prompt and proper treatment of first episode psychosis.
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Affiliation(s)
- Max Marshall
- School of Medicine, University of Manchester, United Kingdom.
| | - Nusrat Husain
- School of Medicine, University of Manchester, United Kingdom
| | - Natalie Bork
- School of Medicine, University of Manchester, United Kingdom
| | | | - Helen Lester
- University of Birmingham, Birmingham, United Kingdom
| | - Linda Everard
- University of Birmingham, Birmingham, United Kingdom
| | - Swaran P Singh
- Health Sciences Research Institute, University of Warwick, Warwick, United Kingdom
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College, London, United Kingdom
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - David Fowler
- School of Medicine, University of East Anglia, United Kingdom
| | - Tim Amos
- Academic Unit of Psychiatry, University of Bristol, Bristol, United Kingdom
| | | | - Max Birchwood
- University of Birmingham, Birmingham, United Kingdom
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Apeldoorn SY, Sterk B, van den Heuvel ER, Schoevers RA, Islam MA, Bruggeman R, Cahn W, deHaan L, Kahn RS, Meijer CJ, Myin-Germeys I, van Os J, Wiersma D. Factors contributing to the duration of untreated psychosis. Schizophr Res 2014; 158:76-81. [PMID: 25043913 DOI: 10.1016/j.schres.2014.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/25/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shortening the duration of untreated psychosis (DUP) - with the aim of improving the prognosis of psychotic disorders - requires an understanding of the causes of treatment delay. Current findings concerning several candidate risk factors of a longer DUP are inconsistent. Our aim was to identify factors contributing to DUP in a large sample that represents the treated prevalence of non-affective psychotic disorders. METHOD Patients with a non-affective psychotic disorder were recruited from mental health care institutes from 2004 to 2008. Of the 1120 patients enrolled, 852 could be included in the present analysis. Examined candidate factors were gender, educational level, migration status, premorbid adjustment and age at onset of the psychotic disorder. DUP was divided into five ordinal categories: less than one month, one month to three months, three months to six months, six months to twelve months and twelve months and over. An ordinal logistic regression analysis was used to identify the risk factors of a longer DUP. RESULTS Median DUP was less than one month (IQR 2). The factors migration status (p=0.028), age at onset of the psychotic disorder (p=0.003) and gender (p=0.034) were significantly associated with DUP in our analysis. CONCLUSION First generation immigrant patients, patients with an early onset of their psychotic disorder and male patients seem at risk of a longer DUP. These findings can assist in designing specific interventions to shorten treatment delay.
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Affiliation(s)
- S Y Apeldoorn
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands; Rob Giel Research Centre, University Medical Centre Groningen, University of Groningen, the Netherlands.
| | - B Sterk
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, the Netherlands; Department of Psychiatry, University Medical Centre Nijmegen, the Netherlands
| | - E R van den Heuvel
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - R A Schoevers
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - M A Islam
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands; Rob Giel Research Centre, University Medical Centre Groningen, University of Groningen, the Netherlands
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Tang JYM, Chang WC, Hui CLM, Wong GHY, Chan SKW, Lee EHM, Yeung WS, Wong CK, Tang WN, Chan WF, Pang EPF, Tso S, Ng RMK, Hung SF, Dunn ELW, Sham PC, Chen EYH. Prospective relationship between duration of untreated psychosis and 13-year clinical outcome: a first-episode psychosis study. Schizophr Res 2014; 153:1-8. [PMID: 24529612 DOI: 10.1016/j.schres.2014.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/01/2014] [Accepted: 01/22/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP-outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined. OBJECTIVE To explore the relationship between DUP and long-term symptomatic remission. METHODS This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤30days), medium (31-180days) and long (>180days) DUP groups. RESULTS The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission. CONCLUSION The findings support the threshold theory that DUP longer than 30days adversely impacts the long-term outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on long-term outcomes based on well-defined criteria and adequate statistical adjustment.
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Affiliation(s)
| | - Wing-Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | | | | | - Wai-Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Chi-Keung Wong
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Wai-Nang Tang
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Wah-Fat Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Edwin Pui-Fai Pang
- Department of Psychiatry, United Christian Hospital, Hospital Authority, Hong Kong
| | - Steve Tso
- Department of Psychiatry, Castle Peak Hospital, Hospital Authority, Hong Kong
| | - Roger Man-Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hospital Authority, Hong Kong
| | - Se-Fong Hung
- Department of Psychiatry, Kwai Chung Hospital, Hospital Authority, Hong Kong
| | - Eva Lai-Wah Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Pak-Chung Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Eric Yu-Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Ayesa-Arriola R, Rodriguez-Sanchez JM, Gomez-Ruiz E, Roiz-Santiáñez R, Reeves LL, Crespo-Facorro B. No sex differences in neuropsychological performance in first episode psychosis patients. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:149-54. [PMID: 24075821 DOI: 10.1016/j.pnpbp.2013.09.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to verify whether male patients with psychosis have greater neurocognitive impairment than female patients at illness onset. METHOD Participants with a first episode of psychosis (74 women/86 men) and healthy controls (62 women/97 men) were assessed with an extensive neuropsychological test battery. RESULTS Women in the clinical group were older at illness onset and had achieved higher formal education than men. This trend was the same for the control group. The patient group presented with lower premorbid IQ compared to healthy controls, and performed below for most neuropsychological tests. Women scored higher than men on a test of verbal memory, whereas men scored higher than women on a test of reaction time, visual memory, and a planning task. There were no group-by-sex interactions for any of the neuropsychological tests. CONCLUSION The present study shows that at the onset of psychosis there are no differences between males and females in neuropsychological performance. The differential pattern of cognitive performance observed is similar to that in healthy males and females. Furthermore, females with a late onset of psychosis may represent a subgroup with specific visuospatial and problem solving impairments.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.
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Abstract
PURPOSE Cognitive deficits are common in the first episode of psychosis (FEP) and may begin much earlier. While some evidence suggests that the decline in cognition occurs over the untreated symptomatic period, including the prodromal phase, others point to these deficits being present even earlier. We aimed to investigate the differential effect of untreated symptomatic and pre-morbid phases on cognition in a large sample of FEP. METHODS Two hundred and sixty eight FEP patients, admitted into a specialized early intervention service, were administered neuro-cognitive tests. The Circumstances of Onset and Relapse Schedule (CORS) was administered for measurement of duration of untreated psychosis (DUP), the duration of untreated illness (DUI) and demographic factors. The Pre-morbid Adjustment Scale (PAS) was used to measure different domains of pre-morbid adjustment. Seventy three healthy controls were also recruited for neuro-cognitive comparison. RESULTS We observed no effect of DUP and a minimal effect of DUI on cognitive functioning in FEP. Instead, the early educational pre-morbid adjustment domain was most strongly associated with cognition and predicted both global cognitive and verbal memory outcome in FEP. CONCLUSION Our results suggest that symptoms associated with the symptomatic phase of a FEP do not influence cognitive functioning in FEP. Instead, cognitive deficits in FEP may predate illness onset and may indicate susceptibility to such illness.
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Affiliation(s)
- Danyael Lutgens
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
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Mitter N, Subramaniam M, Abdin E, Poon LY, Verma S. Predictors of suicide in Asian patients with first episode psychosis. Schizophr Res 2013; 151:274-8. [PMID: 24200417 DOI: 10.1016/j.schres.2013.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 09/24/2013] [Accepted: 10/07/2013] [Indexed: 11/27/2022]
Abstract
UNLABELLED High rates of suicide have been reported in psychotic disorders, particularly in the early phases. Studies examining suicide risk during the first episode of psychosis (FEP) are lacking, especially in the Asian context. The present study aims to investigate the prevalence of completed suicides and associated risk factors in a multi-ethnic Asian society. METHOD Data from 1397 patients accepted into a local Early Psychosis Intervention Programme (EPIP) was collected. This included sociodemographic and clinical data. Cox proportional-hazards regression models were performed in order to explore factors associated with time to completed suicide. RESULTS The sample comprised of 1397 FEP patients, with 687 females and 710 males. The mean age was 28.2 years. The prevalence of suicide in this sample was 1.9%. Of the 26 FEP patients who committed suicide, data on time to suicide was available for 23 of them. 56.5% committed suicide during the first year of follow-up. A higher risk of suicide was associated with an older age (Hazard Ratio (HR)=1.31, 95% CI, 1.05-1.63), longer DUP (HR=1.05, 95% CI, 1.02-1.11), higher PANSS positive (HR=1.91, 95% CI, 1.37-2.67), higher GAF symptomatology (HR=1.16, 95% CI, 1.04-1.30) and GAF disability scores (HR=1.12, 95% CI, 1.02-1.22). CONCLUSION Older patients with longer DUPs, higher PANSS positive and negative scores and better functioning appear to be at higher risk of suicide in this sample. Early intervention services should focus on a thorough risk assessment in order to reduce the risk of suicide during FEP.
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Affiliation(s)
- Natasha Mitter
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747, Singapore.
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Fawzi MH, Fawzi MM, Fouad AA. Parent abuse by adolescents with first-episode psychosis in Egypt. J Adolesc Health 2013; 53:730-5. [PMID: 23954728 DOI: 10.1016/j.jadohealth.2013.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 07/03/2013] [Accepted: 07/04/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the rate of parent abuse in a sample of Egyptian adolescents with first-episode psychosis (FEP) and to identify the association between parent abuse and a number of sociodemographic and clinical factors of interest in these patients. As yet, the abuse of parents by their children, especially mentally ill children, in contrast to child abuse, has remained a research taboo. METHODS In a cross-sectional study in Zagazig (Egypt), a sample of 150 adolescent outpatients (82 boys; 68 girls), presenting with FEP, was assessed for the occurrence of parent abuse using both interview and questionnaire methods (Abused Parent Questionnaire, APQ). Univariate analyses were used to compare parent abusers and nonabusers along a number of sociodemographic and clinical variables. Variables that were associated with parent abuse were entered into a multivariate logistic regression analysis model. RESULTS We found that 61 patients (40.7%) perpetrated abuse against parents, mostly mothers (55/61; 90.2%). Five significant risk factors for parent abuse were identified by multivariate analysis. These were parent's female gender (95% CI = 7.82-45.56), patient's male gender (95% CI = 3.15-37.14), Childhood Trauma Questionnaire - Short Form total score (95% CI = 1.48-14.91), Positive and Negative Syndrome Scale positive subscale score (95% CI = 1.26-9.59), and duration of untreated psychosis (95% CI = 1.01-4.72). CONCLUSIONS The study indicates that parent abuse, particularly mother abuse, in untreated adolescents with FEP is an issue calling for increased awareness of the problem. The findings may have important implications for parental psychoeducation and support, and earlier access to treatment.
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Devylder JE, Gearing RE. Declining social support in adolescents prior to first episode psychosis: associations with negative and affective symptoms. Psychiatry Res 2013; 210:50-4. [PMID: 23453738 DOI: 10.1016/j.psychres.2013.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 01/11/2013] [Accepted: 02/03/2013] [Indexed: 11/27/2022]
Abstract
Social support for individuals with psychosis is associated with decreased symptom severity, improved outcomes, and recovery. In adolescents, declining social support prior to the first hospitalization has been shown to predict time to relapse, which may have implications for early intervention. Data were collected on adolescents (n=84) following a first hospitalization for a psychotic episode in order to examine how change in social support relates to the duration and type of untreated symptoms. Most adolescents experienced a decline in social support (n=46) prior to index hospitalization. Chi-square analyses showed that declining social support was related to negative symptoms and longer duration of untreated psychosis, whereas stable social support was associated with manic symptoms and diagnosis of Bipolar disorder. When entered together into a logistic regression model, the decline in social support was primarily explained by the type of symptoms, rather than by the duration of untreated symptoms. These findings are relevant for targeting psychosocial treatments toward adolescents who may have particular deficits in social support during the prodromal phase and first episode of psychosis.
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Dominguez MDG, Fisher HL, Major B, Chisholm B, Rahaman N, Joyce J, Woolley J, Lawrence J, Hinton M, Marlowe K, Aitchison K, Johnson S, Hodes M. Duration of untreated psychosis in adolescents: ethnic differences and clinical profiles. Schizophr Res 2013; 150:526-32. [PMID: 24025696 DOI: 10.1016/j.schres.2013.08.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 07/25/2013] [Accepted: 08/14/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Duration of Untreated Psychosis (DUP) is an important measure associated with outcome of psychosis. This first study in the UK compared DUP between adolescent and adult-onset individuals and explored whether the adolescent-onset group showed variations in DUP that could be accounted for by sociodemographic and selected risk factors. METHODS This naturalistic cohort study included 940 new first-episode psychosis cases aged 14-35years (136 adolescent-onset versus 804 adult-onset psychotic individuals) referred to nine Early Intervention Services for Psychosis in London (2003-2009). Sociodemographic characteristics, age of onset, family history of mental illness, duration of untreated psychosis, suicidality and substance use information were collected at entry to the services. RESULTS Adolescents presented with significantly greater median DUP (179days) than adults (81days, p=0.005). Large differences in DUP were found amongst adolescent ethnic groups (median DUP: White: 454days; Black: 103days; Asian and mixed: 28.5days). In addition, younger age of onset and higher lifetime cannabis use were associated with longer treatment delay amongst adolescents. CONCLUSIONS This study of DUP in adolescent-onset psychosis found it to be approximately twice the length of DUP amongst adults. For the adolescent White sub-group, DUP was far greater than the UK Department of Health target (<3months). Both the high rates of lifetime cannabis use and the lower age of onset might explain the long DUP in this ethnic group. Physicians need to be particularly vigilant about identifying and managing early psychosis in adolescents.
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Affiliation(s)
- Maria-de-Gracia Dominguez
- Academic Unit of Child and Adolescent Psychiatry, Division of Brain Sciences, Imperial College London, UK.
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Broussard B, Kelley ME, Wan CR, Cristofaro SL, Crisafio A, Haggard PJ, Myers NL, Reed T, Compton MT. Demographic, socio-environmental, and substance-related predictors of duration of untreated psychosis (DUP). Schizophr Res 2013; 148:93-8. [PMID: 23746486 PMCID: PMC3732564 DOI: 10.1016/j.schres.2013.05.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Longer duration of untreated psychosis (DUP) is associated with poorer early-course and long-term outcomes, and is a target of early detection and intervention efforts. Given the paucity of research on childhood and adolescent stressors (e.g., maltreatment and neighborhood disorder) as potential predictors of DUP, limited research on premorbid substance use as a determinant of DUP, and inconclusive findings on the association between DUP and neurocognition, we conducted three sets of analyses to address these issues. Mode of onset of psychosis was also considered, given its established role as an illness-level correlate of DUP. METHODS We rigorously assessed DUP and other pertinent variables in 180 predominantly African American, low-income, and socially disadvantaged first-episode psychosis patients hospitalized in five psychiatric units. RESULTS Mode of onset of psychosis, prior incarceration, and the level of childhood/adolescent maltreatment were all significant independent predictors of DUP. Regarding premorbid substance use, having ever used cannabis and the amount of premorbid alcohol use were significantly associated with DUP. None of the seven neurocognitive domains assessed were even modestly, or clinically meaningfully, associated with DUP. CONCLUSIONS These and other findings on DUP may be informative for early detection and intervention services. For example, such services might benefit from special outreach to criminal justice settings and disadvantaged neighborhoods, and to young people likely to have a history of childhood/adolescent maltreatment and gradually developing psychotic symptoms.
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Affiliation(s)
- Beth Broussard
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Mary E. Kelley
- Rollins School of Public Health of Emory University, Department of Biostatistics and Bioinformatics, Atlanta, Georgia, USA
| | - Claire Ramsay Wan
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Sarah L. Cristofaro
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Anthony Crisafio
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Patrick J. Haggard
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Neely L. Myers
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Thomas Reed
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Michael T. Compton
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA,Corresponding author: Michael T. Compton, M.D., M.P.H., The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, 2120 L Street, N.W., Suite 600, Washington, DC 20037. Tel: 202-741-3554. Fax: 202-741-2891.
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Thirthalli J, Channaveerachari NK, Subbakrishna DK, Cottler LB, Varghese M, Gangadhar BN. Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India. Indian J Psychiatry 2011; 53:319-23. [PMID: 22303040 PMCID: PMC3267343 DOI: 10.4103/0019-5545.91905] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
CONTEXT Longer duration of untreated psychosis (DUP) is known to be associated with poorer outcome of schizophrenia. DUP is also known to be longer in lower- and middle-income countries. Methodologically sound studies that have examined the association of DUP and outcome of schizophrenia in these countries are lacking. AIM The aim was to evaluate the association between DUP and outcome of never-treated schizophrenia patients. SETTING AND DESIGN This study was conducted at the National Institute of Mental Health and Neurosciences, Bangalore, using a prospective cohort design. MATERIALS AND METHODS 119 patients with schizophrenia/schizophreniform disorder diagnosed using the computerized diagnostic interview schedule for DSM-IV (CDIS-IV) were further assessed for DUP with the interview for retrospective assessment of onset of schizophrenia (IRAOS). After a mean (SD) follow-up period of 55.9 (37.2) weeks, the social and occupational functioning and psychopathology of 93 (80.2% of the surviving patients) patients were assessed using the social and occupational functioning scale (SOFS) and the positive and negative syndrome scale (PANSS), by raters blind to the DUP data. Spearman's correlation and Kendall's tau-B test were used to analyze the relationship between DUP and the outcome variables. RESULTS The mean DUP was 90.2 (median=30.1; SD=121.9) weeks. SOFS and PANSS scores at follow-up were statistically significantly associated with DUP, but not with other baseline variables (SOFS: rho=0.22, P=0.03; PANSS: rho=0.23, P=0.03). Among those with the shortest DUP (<16 weeks; n=33), 45.5%, 30.3%, and 24.2% had no impairment, mild-moderate impairment, and severe impairment, respectively. In contrast, 19.4%, 38.7%, and 41.9% of those with the longest DUP (>72 weeks; n=31) had no, mild-moderate, and severe impairment, respectively (Kendall's Tau-b=0.194; P=0.025). CONCLUSIONS The delay in accessing treatment among patients with psychosis is considerable in India, a lower- to middle-income country. Longer DUP is associated with poorer psychopathological and functional outcomes in persons with schizophrenia/schizophreniform disorder.
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Affiliation(s)
- Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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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. Indian J Psychiatry 2010; 52:164-7. [PMID: 20838506 PMCID: PMC2927888 DOI: 10.4103/0019-5545.64583] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome. Thus, this study found that DUP alone does not determine outcome status confirming the role of psychopathological heterogeneity.
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Affiliation(s)
- Amresh Shrivastava
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; and Lawson Health Research Institute, London, Ontario, Canada
| | - Nilesh Shah
- LTMG Hospital, University of Mumbai, Sion, Mumbai-400 022, Maharashtra, India
| | - Megan Johnston
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Larry Stitt
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, N6A 5C1, Canada
| | - Meghana Thakar
- Mental Health Foundation of India (PRERANA Charitable Trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai-400 602, Maharashtra, India
| | - Gurusamy Chinnasamy
- novaNAIT - Centre for Applied Research and Technology Transfer, The Northern Alberta Institute of Technology, 10504 Princess Elizabeth Avenue, Edmonton, Alberta, Canada T5G 3K4
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Abstract
Early intervention (EI) programs in schizophrenia and other psychoses are aimed at early detection (ED) of the disease; prevent conversion to manifested psychosis and phase-specific treatment to reduce development of chronic disabilities. EI strategies include targeting people at "high risk" for developing schizophrenia, intervening in prodromal phase of schizophrenia, and reducing the "duration of untreated psychosis" (DUP). Services are delivered by a specialized team and are usually resource intensive. Several strategies like treatment with antipsychotics, family interventions, and cognitive behavior therapy have been tried with modest success in prodromal patients. Significant ethical reservations exist regarding exposing prodromal patients to the stigma of labeling as "high risk for schizophrenia" and side effects of psychotropics in the absence of clear evidence of efficacy in favor of ED, intervention by specialist teams, and phase-specific interventions in prodrome of psychosis. More research is warranted to demonstrate the risk-benefit and cost-benefit of such interventions before these can be routinely recommended.
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Affiliation(s)
- Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India
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