[Understanding the role of the duration of untreated illness in psychiatric disorders: a narrative review].

Dipartimento di Salute Mentale, UniversitĂ  di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
Rivista di Psichiatria (Impact Factor: 0.28). 01/2010; 45(4):197-208.
Source: PubMed

ABSTRACT 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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    ABSTRACT: AIM: The latency to first pharmacological treatment (duration of untreated illness or 'DUI') is supposed to play a major role in terms of outcome in psychotic conditions. Interest in the field of affective disorders and, in particular, of duration of untreated anxiety, has been recently registered as well. However, a preliminary epidemiologic investigation of the phenomenon is necessary. The present study was aimed to investigate and compare age at onset, age at first pharmacological treatment and DUI in a sample of patients affected by different anxiety disorders. DUI was defined as the interval between the onset of the specific anxiety disorder and the administration of the first adequate pharmacological treatment in compliant subjects. METHODS: Study sample included 350 patients, of both sexes, with a DSM-IV-TR diagnosis of panic disorder (n = 138), generalized anxiety disorder (n = 127) and obsessive-compulsive disorder (n = 85). RESULTS: Panic disorder was associated with the shortest DUI (39.5 months), whereas obsessive-compulsive disorder was associated with the longest latency to treatment (94.5 months) (F = 13.333; P < 0.0001). Patients with generalized anxiety disorder showed a mean DUI of 81.6 months. CONCLUSION: Present results indicate that patients with different anxiety disorders may wait for years (from 3 up to 8) before receiving a first adequate pharmacological treatment. Differences in terms of age at onset, age at the first pharmacological treatment and, ultimately, in DUI in specific anxiety disorders may depend on multiple clinical and environmental factors. Latency to non-pharmacological interventions (e.g. psychoeducation and different forms of psychotherapy) needs to be addressed and correlated with DUI in future studies.
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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.
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