Association between duration of Untreated Psychosis and severer symptoms and poorer quality of life: study in First-Episode Psychosis patients

Abstract

Introduction

The First Episode Psychosis (FEP) Inpatient Unit is specialized in early assessment/intervention in patients with Psychotic Disorders. Duration of Untreated Psychosis/DUP has a key role in the prognosis of those patients. Longer DUP is associated with poorer treatment response and greater risk of relapse. Some studies also suggest an association between DUP and the severity of negative symptoms, but further research is needed.

Objectives

The objectives of this study were to analyze the relationship between DUP and psychotic symptoms, duration of admission, medication, and quality of life, after inpatient intervention.

Methods

This is a retrospective study of a cohort (N=25) admitted to the unit. Sociodemographic and clinical variables (number of days of hospitalization, DUP, and Defined Daily Dose/DDD of antipsychotics) were evaluated. Psychometric instruments (PANSS/Positive and Negative Syndrome Scale and WHOQOL-BREF/World Health Organization Quality Of Life) were applied at admission and at discharge. We used a Spearman correlation test to measure the degree of association between the variables.

Results

Longer DUP correlated with more days of hospitalization, higher negative PANSS scores, and poorer social relationships domain of the WHOQOL at admission (p<0.05). At discharge, DUP presented positive and significant correlations with all subscales of the PANSS (positive, negative, and general; p<0.05) and DDD (p<0.01).

VARIABLES	DUP
WHOQOL_SOCIAL RELATIONSHIPS DOMAIN_ADMISSION	rs =-.448*p=0.018
PANSS_NEGATIVE_ ADMISSION	rs =.424*p=0.035
PANSS_NEGATIVE_ DISCHARGE	rs =.638**p=0.001
PANSS_POSITIVE_ DISCHARGE	rs =.455*p=0.022
PANSS_GENERAL_ DISCHARGE	rs =.518**p=0.008
PANSS_TOTAL_ DISCHARGE	rs =.564**p=0.003
DDD_ DISCHARGE	rs=.539**p=0.005
DAYS OF HOSPITALIZATION	rs=.429**p=0.032

Conclusions

Our results are in line with the current literature on DUP, showing it leads to a worse prognosis, with a more severe clinical course, with the need for extended hospitalizations, a worsening of social relationships, and a higher dosage of medication.

Thus, DUP may be a potentially modifiable prognostic factor. It is possible that FEP patients with negative symptoms dominance may have a more insidious onset and, therefore, the search for treatment may be delayed. Conversely, if there is a mechanism by which DUP influences the symptom profile, its knowledge may lead to a better understanding of psychosis and improved treatment options.

Importantly, DUP showed stronger correlations with the severity of the clinical picture at discharge than at admission, suggesting that longer untreated psychosis may also predict poorer treatment response.

Disclosure of Interest

None Declared