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The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis

Published online by Cambridge University Press:  30 April 2008

P. Jeppesen ,
L. Petersen ,
A. Thorup ,
M.-B. Abel ,
J. Øhlenschlæger ,
T. Ø. Christensen ,
G. Krarup ,
P. Jørgensen  and
M. Nordentoft
P. Jeppesen*
Affiliation:
Psychiatric Centre Bispebjerg, Copenhagen NV, Denmark
L. Petersen
Affiliation:
Psychiatric Centre Bispebjerg, Copenhagen NV, Denmark
A. Thorup
Affiliation:
Psychiatric Centre Bispebjerg, Copenhagen NV, Denmark
M.-B. Abel
Affiliation:
Psychiatric Centre Bispebjerg, Copenhagen NV, Denmark
J. Øhlenschlæger
Affiliation:
Psychiatric Centre Sct Hans, Roskilde, Denmark
T. Ø. Christensen
Affiliation:
Psychiatric Hospital Risskov, Risskov, Denmark
G. Krarup
Affiliation:
Psychiatric Hospital Risskov, Risskov, Denmark
P. Jørgensen
Affiliation:
Psychiatric Hospital Risskov, Risskov, Denmark
M. Nordentoft
Affiliation:
Psychiatric Centre Bispebjerg, Copenhagen NV, Denmark
*
*Address for correspondence: P. Jeppesen, M.D., Ph.D., Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. (Email: [email protected])
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Abstract

Background

The association between the duration of untreated psychosis (DUP) and outcome of schizophrenia may be confounded by other factors such as poor pre-morbid adjustment. The aim of the present study was to examine the independent contributions of DUP and of pre-morbid adjustment to the clinical and social outcomes of schizophrenia.

Method

A longitudinal, prospective, 2-year follow-up study of 423 patients with first-episode schizophrenia-spectrum psychosis was conducted. Patients were comprehensively assessed at entry, 1-year and 2-year follow-up. At entry, DUP was measured by IRAOS (an instrument for the assessment of onset and early course of schizophrenia) and pre-morbid adjustment was measured by the Pre-morbid Adjustment Scale (PAS) as ‘pre-morbid social adaptation’ and ‘pre-morbid school adaptation’. Outcome measures included the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Social Network Schedule and social information. Multiple linear regression models were used for data analysis.

Results

The median DUP was 48 weeks, which is long compared to other studies. Longer DUP was independently associated with more psychotic symptoms at entry, 1-year and 2-year follow-up. Poorer pre-morbid social adaptation was independently associated with more negative symptoms and smaller social network at entry and 1-year follow-up. Poorer pre-morbid school adaptation was independently associated with poor vocational outcome at 1-year and 2-year follow-up.

Conclusions

Longer DUP is associated with poorer 2-year outcome of psychosis in schizophrenia-spectrum disorders, when pre-morbid functioning and other prognostic factors are controlled for. Impaired pre-morbid development is independently associated with more negative symptoms and poorer social outcome.

Keywords

Duration of untreated psychosisfirst-episode psychosispremorbid adjustmentschizophreniatreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1157 - 1166
Copyright
Copyright © 2008 Cambridge University Press

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