Understanding the role of the duration of untreated illness in psychiatric disorders: A narrative review

Dipartimento di Salute Mentale, Università di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
Rivista di Psichiatria (Impact Factor: 0.72). 07/2010; 45(4):197-208.
Source: PubMed


The duration of untreated illness (DUI) is defined as the interval between the onset of a psychiatric disorder and the administration of the first pharmacological treatment.
The aim of the present article is to analyze the relationship between the DUI or the duration of untreated psychosis (DUP) and some clinical parameters in different psychiatric disorders, like major psychoses, mood disorders and anxiety disorders. Another objective is to analyze - according to the available literature - the relationship between a long DUI and neurobiological modifications occurring with the progression of the disorder and related to the clinical outcome. Finally, given that the DUI is a modifiable prognostic factor, different intervention programs aimed to reduce this variable are presented and discussed.
An updated review of the current literature was conducted through PubMed in order to compare different studies focused on DUI in major psychoses, depressive and anxiety disorders.
A significant body of evidence shows that a prolonged DUI represents a negative prognostic factor particularly in schizophrenia. Nevertheless, an increasing number of studies points toward a similar conclusion in mood and anxiety disorders as well, even though fewer studies have been published in this field.
Given the relationship between a longer DUI and a worse outcome--not only in major psychoses but also in mood and anxiety disorders--specific intervention programs aimed to reduce the latency to treatment are definitely envisaged.

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    • "Indeed, a longer DUP has been associated with a worse clinical and psychosocial outcome, frequently interpreted as a consequence of a more intense and rapid progression of the neurodegenerative process in the first years of untreated illness. This findings lends support to the importance of the early treatment of schizophrenia, repeatedly associated with a better prognosis [25-28]. However, the predictive value of DUP has been acknowledged mainly for cases at onset and with regard to the short- and medium-term periods [29], whilst its role in predicting long-term prognosis remains to be clarified [30]. "
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    ABSTRACT: Studies performed to assess the relevance of duration of untreated psychosis (DUP) as a predictor of long-term outcome (i.e. follow-ups of ten years or more) are somewhat limited. The aim of this study was to evaluate the potential association between DUP and very long-term outcome (16-33 yrs) of schizophrenia by means of a retrospective design. Retrospective data obtained from clinical records were collected regarding DUP and outcome variables (number of hospitalizations; number of attempted suicides; course of illness; GAF scores at last observation) for a cohort of 80 outpatients (52 Males, 28 Females, mean age 51.0+/-11.58 years) affected by schizophrenia according to DSMIVTR attending a university community mental health centre. Mean duration of follow up was 25.2 +/- 8.68 years; mean duration of untreated psychosis was 49.00 months (range 1-312 mo), with no significant difference according to gender. Patients with a shorter DUP (=/< 1 year) displayed more frequent "favourable" courses of illness (28.9% vs 8.6%) (p = 0.025), more frequent cases with limited (=/< 3) number of hospital admissions (85.7% vs 62.1%) (p = 0.047) and a better functioning (mean GAF score = 50.32+/-16.49 vs 40.26+/-9.60, p = 0.002); regression analyses confirmed that shorter DUP independently predicted a more positive outcome in terms of number of hospital admissions, course of illness, functioning (GAF scores). A shorter DUP appears to act as a significant predictor of better outcome in schizophrenia even in the very long-term.
    Annals of General Psychiatry 08/2012; 11(1):21. DOI:10.1186/1744-859X-11-21 · 1.40 Impact Factor
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    ABSTRACT: The aim of the paper was to evaluate rates of clinical remission and recovery according to gender in a cohort of chronic outpatients attending a university community mental health center who had been diagnosed with schizophrenia and schizoaffective disorder according to DSM-IV-TR. A sample of 100 consecutive outpatients (70 males and 30 females) underwent comprehensive psychiatric evaluation using the Structured Clinical Interview for Diagnosis of Axis I and II DSM-IV (SCID-I and SCID-II, Version R) and an assessment of psychopathology, social functioning, clinical severity, subjective wellbeing, and quality of life, respectively by means of PANSS (Positive and Negative Syndrome Scale), PSP (Personal and Social Performance), CGI-SCH (Clinical Global Impression-Schizophrenia scale), SWN-S (Subjective Well-being under Neuroleptics-scale), and WHOQOL (WHO Quality of Life). Rates of clinical remission and recovery according to different criteria were calculated by gender. Higher rates of clinical remission and recovery were generally observed in females than males, a result consistent with literature data. Overall findings from the paper support the hypothesis of a better outcome of the disorders in women, even in the very long term.
    01/2012; 2012(5):576369. DOI:10.1155/2012/576369
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    ABSTRACT: BACKGROUND: Several studies show an association between a long duration of untreated illness (DUI) and poor outcome in schizophrenic patients. DUI, in turn, may be influenced by different variables including specific illness-related factors as well as access to local psychiatric services. AIMS: The purposes of the present study were to detect differences in terms of DUI among schizophrenics coming from different geographic areas and to evaluate differences in DUI across diagnostic sub-types. METHOD: One hundred and twenty-five (125) schizophrenic patients of the Psychiatric Clinic of Milan (n = 51) and Moscow (n = 74) were enrolled. SCID-I was administered to all patients and information about DUI was obtained by consulting clinical charts and health system databases, and by means of clinical interviews with patients and their relatives. DUI was defined as the time between the onset of illness and the administration of the first antipsychotic drug. One-way analyses of variance (ANOVAs) were performed to find eventual differences in terms of DUI across diagnostic sub-types. RESULTS: Italian patients showed a longer DUI (M = 4.14 years, SD = 4.95) than Russians (M = 1.16 years, SD = 1.43) (F = 24.03, p < .001). DUI was found to be longer in paranoid schizophrenics (M = 3.47 years, SD = 4.19) compared to catatonic patients (M = 0.96 years, SD = 0.94) (F = 3.56, p = .016). CONCLUSIONS: The results of the present study suggest that the different schizophrenic sub-types may differ in terms of DUI, likely due to different clinical severity and social functioning. Studies with larger samples are needed to confirm the data of the present study.
    International Journal of Social Psychiatry 10/2012; 59(8). DOI:10.1177/0020764012456807 · 1.15 Impact Factor
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