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Liu W, Jiang X, Deng Z, Xie Y, Guo Y, Wu Y, Sun Q, Kong L, Wu F, Tang Y. Functional and structural alterations in different durations of untreated illness in the frontal and parietal lobe in major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:629-642. [PMID: 37542558 PMCID: PMC10995069 DOI: 10.1007/s00406-023-01625-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/17/2022] [Accepted: 05/22/2023] [Indexed: 08/07/2023]
Abstract
Major depressive disorder (MDD) is one of the most disabling illnesses that profoundly restricts psychosocial functions and impairs quality of life. However, the treatment rate of MDD is surprisingly low because the availability and acceptability of appropriate treatments are limited. Therefore, identifying whether and how treatment delay affects the brain and the initial time point of the alterations is imperative, but these changes have not been thoroughly explored. We investigated the functional and structural alterations of MDD for different durations of untreated illness (DUI) using regional homogeneity (ReHo) and voxel-based morphometry (VBM) with a sample of 125 treatment-naïve MDD patients and 100 healthy controls (HCs). The MDD patients were subgrouped based on the DUI, namely, DUI ≤ 1 M, 1 < DUI ≤ 6 M, 6 < DUI ≤ 12 M, and 12 < DUI ≤ 48 M. Subgroup comparison (MDD with different DUIs) was applied to compare ReHo and grey matter volume (GMV) extracted from clusters of regions with significant differences (the pooled MDD patients relative to HCs). Correlations and mediation effects were analysed to estimate the relationships between the functional and structural neuroimaging changes and clinical characteristics. MDD patients exhibited decreased ReHo in the left postcentral gyrus and precentral gyrus and reduced GMV in the left middle frontal gyrus and superior frontal gyrus relative to HCs. The initial functional abnormalities were detected after being untreated for 1 month, whereas this duration was 3 months for GMV reduction. Nevertheless, a transient increase in ReHo was observed after being untreated for 3 months. No significant differences were discovered between HCs and MDD patients with a DUI less than 1 month or among MDD patients with different DUIs in either ReHo or GMV. Longer DUI was related to reduced ReHo with GMV as mediator in MDD patients. We identified disassociated functional and anatomical alterations in treatment-naïve MDD patients at different time points in distinct brain regions at the early stage of the disease. Additionally, we also discovered that GMV mediated the relationship between a longer DUI and diminished ReHo in MDD patients, disclosing the latent deleterious and neuro-progressive implications of DUI on both the structure and function of the brain and indicating the necessity of early treatment of MDD.
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Affiliation(s)
- Wen Liu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Xiaowei Jiang
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Radiology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Zijing Deng
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yu Xie
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yingrui Guo
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yifan Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Qikun Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Lingtao Kong
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Feng Wu
- Brain Function Research Section, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China.
- Department of Gerontology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China.
- Department of Psychiatry and Geriatric Medicine, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, People's Republic of China.
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McIlwaine SV, Mughal S, Ferrari M, Rosengard R, Malla A, Iyer S, Lepage M, Joober R, Shah JL. Pre-onset subthreshold psychotic symptoms are associated with differential treatment delays before a first episode of psychosis: Initial evidence and implications. Schizophr Res 2024; 264:549-556. [PMID: 38335764 DOI: 10.1016/j.schres.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/17/2023] [Revised: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Help-seeking and treatment delays are increasingly critical areas of study in mental health services. The duration of untreated psychosis (DUP), or the time between illness onset and initiation of treatment, is a predictor of symptom remission and functioning for a first episode of psychosis (FEP). The World Health Organization recommends that specialized treatment for psychosis be initiated within the first three months of FEP onset. As a result, research has focused on factors that are associated with threshold-level DUP, while the experience of subthreshold psychotic symptoms (STPS) prior to a FEP may also complicate and present barriers to accessing care for young people. We therefore examine the possibility that STPS can impact DUP and its components. METHOD Using a follow-back cross-sectional design, we sought to describe duration of untreated illness, length of prodrome, DUP, help-seeking delay, referral delay, and number of help-seeking contacts among FEP patients who did and did not have STPS prior to psychosis onset. RESULTS We found that patients who experienced STPS had a longer median duration of untreated illness, prodrome length, DUP, and help-seeking delay compared to patients who did not have such symptoms. Referral delay did not differ substantially between the two groups. Importantly, treatment delays were extremely lengthy for many participants. CONCLUSIONS Pre-onset STPS are associated with help-seeking delays along the pathway to care even during a FEP. Examining early signs and symptoms may help to improve and tailor interventions aimed at reducing treatment delays and ultimately providing timely care when the need arises.
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Affiliation(s)
- S V McIlwaine
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada.
| | - S Mughal
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - M Ferrari
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - R Rosengard
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - A Malla
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - S Iyer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - M Lepage
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada; Department of Psychology, McGill University, Canada
| | - R Joober
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - J L Shah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
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Luo G, Li Y, Yao C, Li M, Li J, Zhang X. Duration of untreated illness and clinical correlates in first-episode and drug-naïve patients with major depressive disorder. Psychiatry Res 2023; 320:115056. [PMID: 36680911 DOI: 10.1016/j.psychres.2023.115056] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/30/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUNDS The notion that a prolonged duration of untreated illness (DUI) leads to poorer outcomes has contributed to extensive changes in mental health services worldwide. However, most studies on DUI have focused on schizophrenia and related psychosis. This study aimed to assess the possible relationship between DUI and certain clinical correlates in first-episode and drug-naïve patients with major depressive disorder (MDD). METHODS This cross-sectional study recruited 1718 first-episode and drug-naïve MDD outpatients. All participants were scored on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, and thyroid hormone and metabolic parameters were measured. We used the Structure Clinical Interview for DSM-IV for clinical diagnosis and investigated suicide attempts through face-to-face interviews. RESULTS A total of 171 (10%) of MDD patients had co-morbid psychiatric symptoms. Participants who were older, with lower education level, and married were less likely to seek a timely treatment compared to the counterparts. One-month longer untreated duration was associated with 2% to 9% higher odds of being with most of the investigated clinical conditions. For those with the longest DUI, the risk was increased for most of the investigated clinical conditions, with absolute risk differences ranging from 5.19% to 29.48%. CONCLUSIONS These findings suggest that longer DUI may be negatively associated with clinical correlates in MDD. Further long-term follow-up studies are warranted to confirm these preliminary results.
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Affiliation(s)
- Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Yaxi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 3210 Humin Rd, Shanghai 201108, China
| | - Cong Yao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Meijuan Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China.
| | - Xiangyang Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China.
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Menculini G, Verdolini N, Gobbicchi C, Del Bello V, Serra R, Brustenghi F, Armanni M, Spollon G, Cirimbilli F, Brufani F, Pierotti V, Di Buò A, De Giorgi F, Sciarma T, Moretti P, Vieta E, Tortorella A. Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders. Eur Neuropsychopharmacol 2022; 61:60-70. [PMID: 35810585 DOI: 10.1016/j.euroneuro.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/05/2021] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022]
Abstract
Affective disorders represent psychopathological entities lying on a continuum, characterized by high prevalence and functional impairment. A delay in treatment initiation might increase the burden associated with affective spectrum disorders. The present study was aimed at analyzing the correlates of a long duration of untreated illness (DUI) in these conditions. We recruited subjects diagnosed with affective disorders, both in- and outpatients, and collected information concerning socio-demographic, clinical, and psychopathological characteristics. Long DUI was defined according to previous research criteria as >2 years for Bipolar Disorders or >1 year for Depressive Disorders. Bivariate analyses were performed to compare subjects with a long and short DUI (p<0.05). A logistic regression was operated to evaluate the correlates of long DUI. In the present sample (n=135), 34.1% (n=46) subjects showed a long DUI. This subgroup presented with more physical comorbidities (p=0.003), higher body mass index (BMI) (p<0.001), more frequent anxiety onset (p=0.018), younger onset age (p=0.042), and more severe depressive symptoms (Hamilton Depression Rating Scale item 1-depressed mood (p=0.032) and item 2-guilt feelings (p=0.018)). At the logistic regression, higher severity of depressed mood (OR 1.568), higher BMI (OR 1.264), and younger age at onset (OR 0.935) were associated with long DUI. The present study confirmed a possible role of DUI as a construct underpinning higher clinical severity in affective spectrum disorders, possibly linked to worse illness course and unfavorable outcomes. Intervention strategies targeting physical comorbidities and depressive symptoms severity may decrease disease burden in subjects with a long DUI.
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Costa DLDC, de Campos AP, Pereira CADB, Torres AR, Dos Santos AC, Requena G, Ferrão YA, do Rosário MC, Miguel EC, Simpson HB, Shavitt RG, Diniz JB. Latency to treatment seeking in patients with obsessive-compulsive disorder: Results from a large multicenter clinical sample. Psychiatry Res 2022; 312:114567. [PMID: 35490573 DOI: 10.1016/j.psychres.2022.114567] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/19/2021] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to identify the factors associated with a delay in treatment-seeking among patients with obsessive-compulsive disorder (OCD), a disabling neuropsychiatric disorder. To achieve this purpose, we conducted a cross-sectional study examining latency to treatment (LTT) and its associated correlates in 863 patients with OCD. We defined LTT as the time lag between the awareness of discomfort and/or impairment caused by symptoms and the beginning of OCD-specific treatment. To determine the socio-demographic and clinical characteristics associated with LTT, we built an interval-censored survival model to simultaneously assess the relationship between all variables, representing the best fit to our data format. The results of our study showed that approximately one-third of OCD patients sought treatment within two years of symptom awareness, one-third between two and nine years, and one-third after ten or more years. Median LTT was 4.0 years (mean = 7.96, SD = 9.54). Longer LTT was associated with older age, early onset of OCD symptoms, presence of contamination/cleaning symptoms and full-time employment. Shorter LTT was associated with the presence of aggression symptoms and comorbidity with hypochondriasis. The results of our study confirm the understanding that LTT in OCD is influenced by several interdependent variables - some of which are modifiable. Strategies for reducing LTT should focus on older patients, who work in a full-time job, and on individuals with early onset of OCD and contamination/cleaning symptoms.
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Affiliation(s)
- Daniel Lucas da Conceição Costa
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
| | | | - Carlos Alberto de Bragança Pereira
- Institute of Applied Mathematics (INMA), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil; Institute of Mathematics and Statistics, University of Sao Paulo, Sao Paulo, Brazil
| | - Albina R Torres
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil; Deparment of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Allan Christiano Dos Santos
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guaraci Requena
- Institute of Mathematics and Statistics, University of Sao Paulo, Sao Paulo, Brazil; Institute of Exact Sciences, Federal University of Viçosa, Florestal, Minas Gerais, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil; Clinical Medical Department, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil; Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Roseli Gedanke Shavitt
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
| | - Juliana Belo Diniz
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
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Zheng H, Luo G, Yao S, Wang S, Guo G, Quan D, Gao J. Predictors for 12-month long-term outcome in patients with obsessive-compulsive disorder: The influence of duration of untreated illness and age at onset. J Psychiatr Res 2021; 144:202-207. [PMID: 34700207 DOI: 10.1016/j.jpsychires.2021.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/17/2021] [Revised: 09/04/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND It remains unknown whether the duration of untreated illness (DUI) may play a critical role in clinical improvement of patients with obsessive-compulsive disorder (OCD). Using a relatively large sample of subjects with OCD, this study investigated the potential impact of the DUI on patients' clinical course and long-term treatment response. METHODS Two hundred and seven patients with OCD recruited by the OCD outpatient clinic of our university hospital participated in the study. The sample was divided into two groups according to the median DUI (DUI≤3 years and DUI >3 years). Patients were treated with selective serotonin reuptake inhibitors or venlafaxine for 48 weeks in open-label conditions. Treatment response and other clinical variables were analysed. RESULTS The total sample showed a mean (SD) DUI of 4.07 (3.5) years, and the mean (SD) illness duration was 6.27 (6.5) years. More than half of the patients had not been treated before (56.5% for OCD). With a median of 3 years as cutoff DUI, response rates were found to be significantly higher in subjects with a short DUI (p < 0.001). Regression analyses showed that a short (≤3 years) DUI and later age at onset predicted better response and higher Y-BOCS scores percentage changes at the endpoint of 48 weeks (β = -1.11, p = 0.003). In addition, there was no correlation between DUI and age of onset in the total patients (r = -0.13, p>0.05). CONCLUSIONS This preliminary study suggests associations between a shorter duration of untreated OCD and favourable long-term outcomes, and a longer DUI with a worse clinical course.
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Affiliation(s)
- Huirong Zheng
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; South China University of Technology School of Medicine, Guangzhou, China.
| | - Guowei Luo
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Shantou University Medical College, Shantou, China
| | - Siyu Yao
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guangquan Guo
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dongming Quan
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junling Gao
- Centre of Buddhist Studies, Department of Medicine, University of Hong Kong, Hong Kong, China
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Reuter L, Kästner D, Schmidt J, Weigel A, Voderholzer U, Seidel M, Schwennen B, Fehrs H, Löwe B, Gumz A. The development and psychometric evaluation of FABIANA-checklist: a scale to assess factors influencing treatment initiation in anorexia nervosa. J Eat Disord 2021; 9:144. [PMID: 34732246 PMCID: PMC8565008 DOI: 10.1186/s40337-021-00490-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/03/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A long duration of untreated illness (DUI) is an unfavorable prognostic factor in anorexia nervosa (AN) and is associated with chronic illness progression. Although previous preventive measures aimed at reducing DUI and thus improving short- and long-term treatment outcomes have been partially successful, a better understanding of the factors involved in the sensitive phase prior to treatment initiation is needed. To date, there is no validated instrument available to assess these factors specifically for patients with AN. The FABIANA-project (Facilitators and barriers in anorexia nervosa treatment initiation) aims at identifying predictors of the DUI in order to target preventive measures better in the future. As part of this project, the FABIANA-checklist was developed, based on a multi-informant perspective and a multimodal bottom-up approach. The present study focusses on the process of item generation, item selection and psychometric validation of the checklist. METHODS Based upon a previous qualitative study, an initial set of 73 items was generated for the most frequently mentioned facilitators and barriers of treatment initiation in AN. After a process of consensual rating and cognitive pre-testing, the resulting 25-item version of the FABIANA-checklist was provided to a sample of female patients (N = 75), aged ≥ 14 years with AN that underwent their first psychotherapeutic treatment in the last 12 months. After item analysis, dimensionality of the final version of the FABIANA-checklist was tested by Principal Component Analysis (PCA). We evaluated construct validity assuming correlations with related constructs, such as perceived social support (F-SozU), support in the health care system (PACIC-5A), illness perception and coping (BIPQ). RESULTS We included 54 adult and 21 adolescent patients with AN, aged on average 21.4 years. Average BMI was 15.5 kg/m2, age of onset was 19.2 years and average DUI was 2.25 years. After item analysis, 7 items were excluded. The PCA of the 18-item-FABIANA-checklist yielded six components explaining 62.64% of the total variance. Overall internal consistency was acceptable (Cronbach's α = .76) and construct validity was satisfactory for 14 out of 18 items. Two consistent components emerged: "primary care perceived as supportive and competent" (23.33%) and "emotional and practical support from relatives" (9.98%). With regard to the other components, the heterogeneity of the items led to unsatisfactory internal consistency, single item loading and in part ambiguous interpretability. CONCLUSIONS The FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation of patients with AN. Psychometrics and dimensionality testing suggests that experienced emotional and practical support from the primary health care system and close relatives are main components. The results indicate that a differentiated assessment at item level is appropriate. In order to quantify the relative importance of the factors and to derive recommendations on early-intervention approaches, the predictive effect of the FABIANA-items on the DUI will be determined in a subsequent study which will further include the perspective of relatives and primary caregivers. Trial registration Clinical Trials.gov Identifier: NCT03713541: https://clinicaltrials.gov/ct2/show/NCT03713541 .
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Affiliation(s)
- Laurence Reuter
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany.
| | - Denise Kästner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
| | - Justine Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schön Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | - Marion Seidel
- Schön Clinic for Psychosomatic Medicine and Psychotherapy, Bad Arolsen, Germany
| | - Bianca Schwennen
- Medclin Seepark Clinic for Acute Psychosomatic Care, Bad Bodenteich, Germany
| | - Helge Fehrs
- Department of Psychosomatic Medicine and Psychotherapy, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
| | - Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany
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Fico G, Anmella G, Gomez-Ramiro M, de Miquel C, Hidalgo-Mazzei D, Manchia M, Alda M, Gonzalez-Pinto A, Carvalho AF, Vieta E, Murru A. Duration of untreated illness and bipolar disorder: time for a new definition? Results from a cross-sectional study. J Affect Disord 2021; 294:513-520. [PMID: 34330047 DOI: 10.1016/j.jad.2021.07.062] [Citation(s) in RCA: 6] [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: 05/05/2021] [Revised: 06/16/2021] [Accepted: 07/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND We primarily aimed to explore the associations between duration of untreated illness (DUI), treatment response, and functioning in a cohort of patients with bipolar disorder (BD). METHODS 261 participants with BD were recruited. DUI was defined as months from the first affective episode to the start of a mood-stabilizer. The functioning assessment short test (FAST) scores and treatment response scores for lithium, valproate, or lamotrigine according to the Alda Scale Total Score (TS) were compared between patients with short (<24 months) or long DUI. Differences in FAST scores among good (GR; TS≥7), poor (PR; TS=2-6), or non-responders (NR; TS<2) to each mood-stabilizer were analyzed. Linear regression was computed using the FAST global score as the dependent variable. RESULTS DUI and FAST scores showed no statistically significant correlation. Patients with a longer DUI showed poorer response to lithium (Z=-3.196; p<0.001), but not to valproate or lamotrigine. Response to lithium (β=-1.814; p<0.001), number of hospitalizations (β=0.237; p<0.001), and illness duration (β=0.160; p=0.028) were associated with FAST total scores. GR to lithium was associated with better global functioning compared to PR or NR [H=27.631; p<0.001]. LIMITATIONS The retrospective design could expose our data to a recall bias. Also, only few patients were on valproate or lamotrigine treatment. CONCLUSIONS Poor functioning in BD could be the result of multiple affective relapses, rather than a direct effect of DUI. A timely diagnosis with subsequent effective prophylactic treatment, such as lithium, may prevent poor functional outcomes in real-world patients with BD.
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Affiliation(s)
- Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Marta Gomez-Ramiro
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic of Barcelona, Department of Medicine, Neuroscience Institute, Universitat de Barcelona, CIBERSAM, IDIBAPS, Barcelona, Catalonia, Spain
| | - Carlota de Miquel
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | | | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
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9
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Maraone A, Tarsitani L, Pinucci I, Pasquini M. Antiglutamatergic agents for obsessive-compulsive disorder: Where are we now and what are possible future prospects? World J Psychiatry 2021; 11:568-580. [PMID: 34631461 PMCID: PMC8474998 DOI: 10.5498/wjp.v11.i9.568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Recent data suggest that obsessive-compulsive disorder (OCD) is driven by an imbalance among the habit learning system and the goal-directed system. The frontostriatal loop termed cortico-striatal-thalamo-cortical (CSTC) circuitry loop is involved in habits and their dysfunction plays an important role in OCD. Glutamatergic neurotransmission is the principal neurotransmitter implicated in the CSTC model of OCD. Hyperactivity in the CSTC loop implies a high level of glutamate in the cortical-striatal pathways as well as a dysregulation of GABAergic transmission, and could represent the pathophysiology of OCD. Moreover, the dysregulation of glutamate levels can lead to neurotoxicity, acting as a neuronal excitotoxin. The hypothesis of a role of neurotoxicity in the pathophysiology of OCD clinically correlates to the importance of an early intervention for patients. Indeed, some studies have shown that a reduction of duration of untreated illness is related to an earlier onset of remission. Although robust data supporting a progression of such brain changes are not available so far, an early intervention could help interrupt damage from neurotoxicity. Moreover, agents targeting glutamate neurotransmission may represent promising therapeutical option in OCD patients.
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Affiliation(s)
- Annalisa Maraone
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
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Nkire N, Scully PJ, Browne DJ, Baldwin PA, Kingston T, Owoeye O, Kinsella A, O'Callaghan E, Russell V, Waddington JL. Systematic comparison of duration of untreated illness versus duration of untreated psychosis in relation to psychopathology and dysfunction in the Cavan-Monaghan first episode psychosis study (CAMFEPS). Eur Neuropsychopharmacol 2021; 47:20-30. [PMID: 33823369 DOI: 10.1016/j.euroneuro.2021.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/31/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/22/2023]
Abstract
This study systematically compared duration of untreated illness (DUI) with duration of untreated psychosis (DUP) in prediction of impairment at first-episode psychosis and investigated the extent to which these relationships are influenced by premorbid features. The Cavan-Monaghan First Episode Psychosis Study ascertained cases of first-episode psychosis in rural Ireland via all routes to care with limited variations in socioeconomic milieu. Cases were evaluated for DUI and DUP and assessed clinically for psychopathology, neuropsychology, neurology, insight and quality of life, together with premorbid features. Analyses then determined prediction of clinical assessments by DUI versus DUP. The study population consisted of 163 cases of first episode psychosis, among which 74 had a schizophrenia spectrum disorder. Shorter DUI but not DUP predicted less severe positive and general symptoms, while shorter DUP and particularly DUI predicted less severe negative symptoms; neither shorter DUP nor shorter DUI predicted less severe cognitive impairment or fewer neurological soft signs; shorter DUP and DUI predicted increased quality of life; shorter DUI but not DUP predicted greater insight. Only prediction of quality of life was weakened by consideration of premorbid features. Results were generally similar across the two diagnostic groupings. The present findings systematically delineate associations with DUI versus DUP across domains of impairment in first episode psychosis. They suggest that DUI may reflect a more insidious process than DUP and that reduction in DUI may be associated with more consistent and broader diminutions in impairment than for DUP.
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Affiliation(s)
- Nnamdi Nkire
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul J Scully
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Browne
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrizia A Baldwin
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tara Kingston
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Olabisi Owoeye
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anthony Kinsella
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Vincent Russell
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - John L Waddington
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric-Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
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11
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Perris F, Sampogna G, Giallonardo V, Agnese S, Palummo C, Luciano M, Fabrazzo M, Fiorillo A, Catapano F. Duration of untreated illness predicts 3-year outcome in patients with obsessive-compulsive disorder: A real-world, naturalistic, follow-up study. Psychiatry Res 2021; 299:113872. [PMID: 33770711 DOI: 10.1016/j.psychres.2021.113872] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
Duration of untreated illness (DUI) is a predictor of outcome in psychotic and affective disorders. The few available data on the effect of DUI in obsessive-compulsive disorder (OCD) suggest an association between longer DUI and poorer response to treatments. This is a real-world, naturalistic, follow-up study evaluating the impact of DUI on long-term clinical outcomes. The sample consists of 83 outpatients with OCD with a mean DUI of 7.3 (5.8) years. Patients with symmetry/ordering cluster symptoms were younger at onset of the disease (20.4 ± 7.9 vs. 27.8 ± 10.6; p<.05, d = 0.79), had a longer duration of the illness (10.1 ± 4.6 vs. 6.8 ± 4.6, p<.05; d = 0.53) and a longer DUI (7.9 ± 6.5 vs. 5.4 ± 3.6, p<.05, d = 0.49) compared to patients not presenting with those symptoms. Fifty-nine patients completed the follow-up, and 33.9% (N = 20) met the criteria for partial remission, scoring <15 at the Y-BOCS for at least eight weeks. Patients in partial remission for more than 40% of the follow-up were defined as "good outcome" and they had a significantly shorter DUI compared to patients with "poor outcome". Access to adequate treatments is highly delayed in patients with OCD. DUI is strongly associated with poor treatment outcomes. Therefore, strategies to ensure an early diagnosis and treatment are needed.
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Affiliation(s)
- Francesco Perris
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Salvatore Agnese
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carmela Palummo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Catapano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Vigne P, Fortes P, Dias RV, Laurito LD, Loureiro CP, de Menezes GB, Stangier U, Fontenelle LF. Duration of untreated illness in a cross-diagnostic sample of obsessive-compulsive disorder, panic disorder, and social anxiety disorder. CNS Spectr 2019; 24:526-32. [PMID: 30419984 DOI: 10.1017/S1092852918001281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 11/05/2022]
Abstract
OBJECTIVE In this study, we compared duration of untreated illness (DUI) in obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD) patients and investigated its correlates, both within specific diagnoses and across the whole sample. METHODS Eighty-eight patients (33 OCD, 24 SAD, and 31 PD) had their diagnosis confirmed by the Mini International Neuropsychiatric Interview, were assessed for treatment-seeking variables, and were evaluated with instruments aimed at quantifying transdiagnostic features (i.e., the Cause subscale of the Illness Perception Questionnaire-Mental Health and the Anxiety Sensitivity Index-Revised) and severity of illness (i.e., Beck Depression and Anxiety Inventories, the Dimensional Obsessive-Compulsive Scale, the Panic and Agoraphobia Scale, and the Social Phobia Inventory). RESULTS The only differences between groups with short (<2 years) versus long (>2 years) DUI were greater fear of public display of anxiety in the first group and greater social avoidance in the second group. The DUI was significantly different between groups that sought treatment after the onset of illness, with OCD patients having longer DUI than PD patients and shorter DUI than SAD patients. Further, DUI correlated negatively with the perception of OCD being caused by stress and positively with severity of panic-related disability in SAD patients, but not in PD or OCD patients. CONCLUSION There was substantial delay in treatment seeking among the anxiety and obsessive-compulsive disorder patients, particularly those with OCD or SAD. Perception of stress as a cause of OCD prompted treatment seeking, while severity of panic symptoms delayed treatment seeking.
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13
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Serafini G, Santi F, Gonda X, Aguglia A, Fiorillo A, Pompili M, Carvalho AF, Amore M. Predictors of recurrence in a sample of 508 outpatients with major depressive disorder. J Psychiatr Res 2019; 114:80-87. [PMID: 31051436 DOI: 10.1016/j.jpsychires.2019.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/20/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Specific predictors of relapse/recurrence in major depressive disorder (MDD) have been identified but evidence across studies are inconsistent. This study aimed to identify the most relevant socio-demographic/clinical predictors of MDD recurrence in a sample of 508 outpatients. METHODS This naturalistic cohort study included 508 currently euthymic MDD patients (mean age = 54.1 ± 16.2) of which 53.9% had a single and 46.1% recurrent depressive episodes. A detailed data collection was performed and illness histories were retraced through clinical files and lifetime computerized medical records. RESULTS Compared to patients with single episode, MDD patients with recurrent episodes significantly differ regarding current age, gender, working status, positive history of psychiatric disorders in family, first-lifetime illness episode characteristics, first-episode and current psychotic symptoms, current melancholic features and seasonality, age at first treatment, duration of untreated illness, and comorbid cardiovascular/endocrinological conditions. However, after multivariate analyses controlling for current age, gender, educational level, working status differences, psychiatric conditions in family, and age of illness episode, recurrence was associated with older age (p ≤ .001), younger age at first treatment (p ≤ .005), being treated with previous psychoactive treatments (p .001), and longer duration of untreated illness (p .001). CONCLUSIONS The variables associated with MDD recurrence identified in the current study may aid in the stratification of patients who could benefit from more intensive maintenance treatments for MDD. However, clinicians should rapidly identify cases that are not likely to recur in order to avoid unnecessary treatments which are commonly considered as the standard of care.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Francesca Santi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Suicide Prevention Center, Sant'Andrea Hospital, University of Rome, Rome, Italy
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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14
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Fineberg NA, Dell'Osso B, Albert U, Maina G, Geller D, Carmi L, Sireau N, Walitza S, Grassi G, Pallanti S, Hollander E, Brakoulias V, Menchon JM, Marazziti D, Ioannidis K, Apergis-Schoute A, Stein DJ, Cath DC, Veltman DJ, Van Ameringen M, Fontenelle LF, Shavitt RG, Costa D, Diniz JB, Zohar J. Early intervention for obsessive compulsive disorder: An expert consensus statement. Eur Neuropsychopharmacol 2019; 29:549-65. [PMID: 30773387 DOI: 10.1016/j.euroneuro.2019.02.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [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: 11/17/2018] [Revised: 01/04/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the 'toxic' effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.
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15
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Albert U, Barbaro F, Bramante S, Rosso G, De Ronchi D, Maina G. Duration of untreated illness and response to SRI treatment in Obsessive-Compulsive Disorder. Eur Psychiatry. 2019;58:19-26. [PMID: 30763828 DOI: 10.1016/j.eurpsy.2019.01.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 05/08/2018] [Revised: 12/27/2018] [Accepted: 01/19/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The duration of untreated illness (DUI) is a potentially modifiable parameter associated with worst prognosis in several psychiatric disorders, but poorly investigated in Obsessive-Compulsive Disorder (OCD). Our aims were to estimate the mean DUI in a large sample of individuals with OCD and its impact on response to the first ever adequate SRI treatment. METHODS We retrospectively examined records of 251 patients with OCD (SCID-I, DSM-IV) who referred to our Department and were prospectively and naturalistically treated according to International Guidelines. The DUI was defined as the interval between age at onset and age at which patients received their first adequate pharmacological treatment. Response rates were compared in subjects with brief (≤24 months) versus long DUI. Logistic regression models predicting response and 12-week Y-BOCS score were run with DUI (among others) as independent variable. RESULTS The mean DUI was 106.19 ± 118.14 months, with a mean interval between onset of the disorder and when patients sought professional help of 82.27 ± 112.30 months. Response rates were significantly reduced in subjects with a long DUI, using both the cut-off of 24 months and the median value of 60 months. Regression analyses confirmed that a long (>24 months) DUI predicts poorer response and higher Y-BOCS scores at 12 weeks. CONCLUSIONS Our results, although preliminary, seem to suggest that a longer duration of untreated illness in OCD is associated with poorer outcome in terms of response to SRI treatments. It is imperative to do all the possible to shorten the DUI, both by improving access to mental health services, improving the ability of primary care physicians and mental health professionals to recognize OCD, and disseminate best-practice prescription guidelines.
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16
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Herzog A, Shedden-Mora MC, Jordan P, Löwe B. Duration of untreated illness in patients with somatoform disorders. J Psychosom Res 2018; 107:1-6. [PMID: 29502757 DOI: 10.1016/j.jpsychores.2018.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 08/30/2017] [Revised: 12/20/2017] [Accepted: 01/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE A long duration of untreated mental illness (DUI) has been found to be associated with negative long-term outcomes. Although somatic symptom and related disorders are frequent in the general population and in primary care, data regarding the DUI of these disorders is scarce. The aim of this study was to investigate the DUI in patients with somatoform disorders. METHODS In a cross-sectional study, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire (PHQ). In a second step, life-time somatoform disorder diagnosis was established using the Composite International Diagnostic Interview (CIDI). Additionally, DUI was retrospectively assessed via self-reporting and sociodemographic information was collected. Survival analysis was used to estimate the DUI and to identify patient-related predictors of DUI. RESULTS A total of 139 patients with somatoform disorders were included in the analyses. The mean DUI in these patients was 25.2years (median 23.1years). Higher education significantly predicted shorter DUI, whereas gender and age of onset were unrelated to DUI. CONCLUSIONS The results reveal a substantial delay in adequate treatment of patients with somatoform disorders. The reported DUI emphasizes the importance of improvements in the management of patients with these disorders.
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Aguglia A, Signorelli MS, Albert U, Maina G. The Impact of General Medical Conditions in Obsessive-Compulsive Disorder. Psychiatry Investig 2018; 15:246-253. [PMID: 29475243 PMCID: PMC5900370 DOI: 10.30773/pi.2017.06.17.2] [Citation(s) in RCA: 21] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/04/2017] [Accepted: 06/17/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The co-occurrence of general medical conditions (GMCs) and major psychiatric disorders is well documented. The aim of this study was to assess the prevalence of GMCs in patients with a primary diagnosis of obsessive-compulsive disorder (OCD) and, secondly, to investigate which clinical variables are associated with the presence of a GMC. METHODS Subjects with a primary diagnosis of OCD were included. Socio-demographic and clinical characteristics were collected. GMCs were classified using the ICD-10 and grouped according to the Cumulative Illness Rating Scale (CIRS) in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The association between the presence of GMCs and demographic/clinical variables of OCD was investigated. RESULTS A total of 162 patients with OCD were included. 78 (48.1%) patients had at least one comorbid GMC. Most frequent GMCs were endocrine/metabolic diseases (25.9%), followed by upper/lower gastrointestinal (20.5%) and cardio-vascular diseases (13.6%). The presence of a GMC was significantly associated with female gender, older age, duration of untreated illness (DUI), and absence of physical activity. CONCLUSION Patients with OCD have high rates of comorbid GMCs. A longer DUI is associated with having at least one GMCs; this might be due to the long-lasting adoption of unhealthy lifestyles, not counterbalanced by appropriate treatment and psychoeducation.
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Affiliation(s)
- Andrea Aguglia
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Psychiatric Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, AOU Policlinico Hospital, University of Catania, Catania, Italy
| | - Umberto Albert
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Psychiatric Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giuseppe Maina
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Psychiatric Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Havinga PJ, Hartman CA, Visser E, Nauta MH, Penninx BWJH, Boschloo L, Schoevers RA. Offspring of depressed and anxious patients: Help-seeking after first onset of a mood and/or anxiety disorder. J Affect Disord 2018; 227:618-26. [PMID: 29172055 DOI: 10.1016/j.jad.2017.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/10/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Offspring of patients with depressive and/or anxiety disorders are at high risk of developing a similar disorder themselves. Early recognition and treatment may have substantial effects on prognosis. The main aim of this study was to examine the time to initial help-seeking and its determinants in offspring after the first onset of a mood and/or anxiety disorder. METHODS Data are presented of 215 offspring with a mood and/or anxiety disorder participating in a cohort study with 10 year follow-up. We determined age of disorder onset and age of initial help-seeking. Offspring characteristics (gender, IQ, age of onset, disorder type, suicidal ideation) and family characteristics (socioeconomic status, family functioning) were investigated as potential predictors of the time to initial help-seeking. RESULTS The estimated overall proportion of offspring of depressed/anxious patients who eventually seek help after onset of a mood and/or anxiety disorder was 91.9%. The time to initial help-seeking was more than two years in 39.6% of the offspring. Being female, having a mood disorder or comorbid mood and anxiety disorder (relative to anxiety) and a disorder onset in adolescence or adulthood (relative to childhood) predicted a shorter time to initial help-seeking. LIMITATIONS Baseline information relied on retrospective reports. Age of onsets and age of initial help-seeking may therefore be subject to recall bias. CONCLUSION Although most offspring eventually seek help after onset of a mood/anxiety disorder, delays in help-seeking were common, especially in specific subgroups of patients. This information may help to develop targeted strategies to reduce help-seeking delays.
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Bhullar G, Norman RMG, Klar N, Anderson KK. Untreated illness and recovery in clients of an early psychosis intervention program: a 10-year prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:171-82. [PMID: 29188310 DOI: 10.1007/s00127-017-1464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/07/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether duration of untreated psychosis (DUP) and duration of untreated illness (DUI) are associated with measures of both subjective and objective recovery 10 years after a first episode of psychosis. METHODS A cohort of 65 clients from an early psychosis intervention program completed a battery of outcome measures 10 years following initial treatment for first-episode psychosis (FEP). The outcomes of interest were self-perceived recovery scores (Maryland Assessment of Recovery in People with Serious Mental Illness Scale) and occupational activity, defined as engagement in work and/or school on a full/part-time basis. Multiple linear and logistic regression analyses were used to estimate the associations between DUP and DUI with each measure of recovery, adjusting for potential confounding factors. RESULTS We did not find a statistically significant association between DUP and either occupational activity (OR = 1.26, 95% CI 0.81-1.95) or self-perceived recovery score (β = - 0.73, 95% CI - 2.42 to 0.97). However, we found a significant negative association between DUI and self-perceived recovery score (β = - 0.52, 95% CI - 0.87 to - 0.16). CONCLUSIONS Our findings suggest that DUI may have a stronger influence than DUP on recovery from FEP at 10-year follow-up. This suggests the potential value in targeted interventions for people with a long DUI to increase the likelihood of achieving recovery after the first episode of psychosis.
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Kvitland LR, Ringen PA, Aminoff SR, Demmo C, Hellvin T, Lagerberg TV, Andreassen OA, Melle I. Duration of untreated illness in first-treatment bipolar I disorder in relation to clinical outcome and cannabis use. Psychiatry Res 2016; 246:762-768. [PMID: 27814886 DOI: 10.1016/j.psychres.2016.07.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/10/2016] [Revised: 05/24/2016] [Accepted: 07/10/2016] [Indexed: 12/22/2022]
Abstract
There is little knowledge about the role of the duration of untreated bipolar (DUB) illness in first-treatment bipolar disorder I (BD I), its association with symptoms at start of first treatment, and development over the first year, and limited knowledge about factors that influence the length of DUB. Substance use has shown to delay identification of primary psychiatric disorders, and while cannabis use is common in BD the role of cannabis in relationship to DUB is unclear. The aim of the present study is to examine the associations between DUB and key clinical outcomes at baseline in BD I, and at one year follow-up, and to evaluate the influence of cannabis use. Patients with first-treatment BD I (N=62) completed comprehensive clinical evaluations, which included both DUB and the number of previous episodes. There were no significant associations between DUB and key clinical outcomes. Longer duration from first manic episode to treatment was associated with risk of starting excessive cannabis use after onset of the bipolar disorder. The main finding is the lack of significant associations between features of previous illness episodes and clinical outcomes. Long duration of untreated mania seems to increase the risk for later cannabis use.
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Affiliation(s)
- Levi Røstad Kvitland
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | | | - Sofie Ragnhild Aminoff
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway; Division of Mental Health Services, Department of Specialized Inpatient Treatment, Akershus University Hospital, Akershus, Norway.
| | - Christine Demmo
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Tone Hellvin
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Trine Vik Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ole Andreas Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
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Oguchi Y, Nakagawa A, Sado M, Mitsuda D, Nakagawa Y, Kato N, Takechi S, Hiyama M, Mimura M. Potential predictors of delay in initial treatment contact after the first onset of depression in Japan: a clinical sample study. Int J Ment Health Syst 2014; 8:50. [PMID: 25530800 PMCID: PMC4271502 DOI: 10.1186/1752-4458-8-50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample. Methods Ninety-five patients with depression with longer (>12 months) and shorter DUI (≤12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed. Results Of the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th–75th percentile, 2–13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance. Conclusions Our findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.
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Affiliation(s)
- Yoshiyo Oguchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan ; Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan ; Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan ; Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Dai Mitsuda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yuko Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Noriko Kato
- Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Sayuri Takechi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan ; Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Mitsunori Hiyama
- Department of Psychiatry, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
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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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