Access and latency to first antipsychotic treatment in Italian patients with schizophrenia and other schizophrenic spectrum disorders across different epochs

Abstract

Schizophrenic patients showed earlier onset and longer DUI compared with patients with other SSDs. Data on the total sample showed a later age of onset and a reduced DUI across epochs.

Italian patients with more recent onset of Major Depressive Disorder have a shorter duration of untreated illness

“…More in detail, the questionnaire includes a preliminary part, collecting patient's socio-demographic features (ie, age, gender, occupational and marital status, family history for psychiatric disorders), and two sections, respectively, focused on psychopathological onset (section 1) and first psycho-pharmacological treatment (section 2). [24][25][26] In particular, the DUI was considered as the time (measured in months) elapsing between the psychopathological onset and the administration-in compliant patients-of the first psycho-pharmacological treatment, at appropriate dosage and for an adequate period of time, 24 according to the most recently updated International treatment guidelines. In respect to stressful life events, we considered any condition disrupting personal life, exceeding the adaptive capacity of the individual (ie, trauma, abuse, mourning, physical illness, work and family stressors).…”

“…29 The above-mentioned questionnaire was specifically designed to investigate and collect variables potentially influencing the psychopathological onset and the latency to first psycho-pharmacological treatment in psychiatric patients and it has been already used in recent studies in the field. [24][25][26] In particular, the DUI was considered as the time (measured in months) elapsing between the psychopathological onset and the administration-in compliant patients-of the first psycho-pharmacological treatment, at appropriate dosage and for an adequate period of time, 24 according to the most recently updated International treatment guidelines. 30 The psychopathological onset was considered as the outbreak of first symptoms causing an impaired functioning in at least one major area of daily life (eg, work, familial, social), recognised by the patient or his/her caregiver as debilitating and, thus, a clinical condition suitable for proper diagnosis and pharmacological treatment.…”

“…14 Finally, from the neuroimaging perspective, a longer DUI has been associated with hippocampal volume reduction, 15 with antidepressant treatment apparently having a protective effect. 24 In addition, recent studies have stressed that the epoch of onset, in turn, significantly influences the DUI of different psychiatric disorders, 25 including schizophrenia spectrum disorders, 26 with an overall reduction in its estimates throughout time. 20,21 Moreover, identifying reasons for delay in consulting a clinician, particularly a psychiatrist, and obtain a diagnosis, which may include secretiveness, social stigma and difficult access to psychiatric services, could provide a valuable contribution to ameliorate strategies for early diagnosis and treatment.…”

“…6 For instance, along with its closely related variables (ie, age of onset and age of first treatment), other parameters related to the psychopathological onset (eg, nature of first symptoms, occurrence of stressful events before onset, presence of family members and caregiver) and first therapist/setting (eg, psychiatrist vs other clinician, outpatient/inpatient) have been investigated and found to differ in relation to DUI among patients with different psychiatric disorders. 24 In addition, recent studies have stressed that the epoch of onset, in turn, significantly influences the DUI of different psychiatric disorders, 25 including schizophrenia spectrum disorders, 26 with an overall reduction in its estimates throughout time.…”

Diagnostic delay in ADHD: Duration of untreated illness and its socio‐demographic and clinical predictors in a sample of adult outpatients

“…This delay is a relevant item for ADHD (Shaw et al, 2012), as well as for other psychiatry disorders. In particular, over the past 30 years increasing attention was paid to the duration of untreated psychosis-that is, the period between the onset of psychotic symptoms and the initiation of pharmacological treatment-and the duration of untreated illness or DUI-that is, the interval between the onset of a specific psychiatric disorder and the administration of the first appropriate pharmacological treatment (Altamura et al, 2015;Dell'Osso et al, 2016;Murru & Carpiniello, 2018)-to underline the impact of early pharmacological intervention on the distinctive functional and cognitive deterioration of schizophrenia spectrum disorders (Murru & Carpiniello, 2018;Palazzo et al, 2016). More recently, some authors have applied the concept of DUI from schizophrenia to other psychiatric disorders , studying the impact of late recognition and treatment on the most important disorder-specific outcomes (Albert et al, 2019;Altamura et al, 2015;Fritz et al, 2017).…”