Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: a naturalistic study

Abstract

This study was designed to investigate and compare demographic and clinical features with specific emphasis on age at onset, age at first treatment and, in particular, on duration of untreated illness (DUI), in patients with different mood and anxiety disorders. Study sample included 729 outpatients with the following diagnoses: major depressive disorder (n=181), bipolar disorder type I (BD I, n=115) and II (BD II, n=186), generalized anxiety disorder (n=100), panic disorder (n=96), and obsessive-compulsive disorder (n=51). Main demographic and clinical variables of the sample were compared among the diagnostic groups using one-way analysis of variance or chi tests. The diagnostic groups showed significant differences in relation to age at onset and age at first pharmacological treatment and in relation to latency to treatment. In particular, patients with major depressive disorder showed the shortest DUI (39.08 months), whereas patient with BD II showed the longest DUI (97.2 months) in comparison with the other groups. Within the group with anxiety disorders (F=7.512, P<0.001), patients with panic disorder showed the shortest DUI (44.35 months), whereas patients with obsessive-compulsive disorder showed the longest DUI (90.57 months). The present findings suggest that patients with different mood and anxiety disorders show significant differences in terms of age at onset, age at first treatment and, consequently, DUI, which potentially reflect different reasons influencing treatment delay.

Can Long-Term Outcomes Be Improved by Shortening the Duration of Untreated Illness in Psychiatric Disorders? A Conceptual Framework

“…Finally, studies of anxiety disorders in relation to DUI have recently been reported, showing significant differences in the mean DUI among various conditions (i.e., almost 4 years in patients with panic disorder and more than 8 years in subjects with obsessive-compulsive disorder) [45] as well as peculiar associations with a worse outcome. In particular, a longer DUI was found to be related to a worse response to pharmacological treatment in both obsessive-compulsive disorder [25] and generalized anxiety disorder [24], to more frequent depressive comorbidity in panic disorder [22] and to an earlier age at onset, longer duration of illness and higher rates of comorbidity in generalized anxiety disorder [24].…”

“…However, even though a relationship between anxiety and neurobiological alterations in specific brain areas has been shown [42,43,44], the hypothesis that prolonged latency to treatments correlates with a poor outcome on the basis of cerebral modifications occurring with the progression of the disease is speculative. Nevertheless, it is well-established that a chronic and untreated state of anxiety is related to significant disability and, as a consequence, to poorer quality of life [45]. …”

First‐episode types in bipolar disorder: predictive associations with later illness

“…Patients diagnosed with BD-II were most likely to present initially in depression (77.5%), and in BD-I cases, there was also prominent initial depression (46.4%) as well as psychosis or mania (13.3-22.4%; Table 1). It may also be significant that the latency from onset of BD to systematic diagnostic assessment and enrollment in regular and sustained treatment at the study centers was nearly 3 years longer among patients diagnosed BD-II than BD-I, and 11 years overall; this delay may reflect the severity of mania among BD-I cases requiring early intervention as well as delay in differentiating BD-II from recurrent depression (31)(32)(33)(34). It is also noteworthy that overall morbidity differed only moderately by onset type, with high values following hypomania and low values after initial anxiety (Table 3, Fig.…”

Staging bipolar disorder: Clinical framework, biomarkers and interventions

“…Zbog toga ne čudi da je dijagnostikovanje bipolarnog poremećaja, kao oboljenja sa više faza (manična, depresivna, mešovita) i aspecifičnim početkom (najčešće depresivna epizoda) otežano te dovodi do odlaganja adekvatnog terapijskog tretmana (stabilizator raspoloženja), produženja perioda nelečenosti i posledično lošijeg ishoda, ali i teže klasifikacije stadijuma razvoja [9,10,13,14,15].…”