Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders

Menculini, Giulia; Verdolini, Norma; Gobbicchi, Chiara; Bello, Valentina Del; Serra, Raffaella; Brustenghi, Filippo; Armanni, Margherita; Spollon, Giulio; Cirimbilli, Federica; Brufani, Francesca; Pierotti, Valentina; Buò, Agata Di; Giorgi, Filippo De; Sciarma, Tiziana; Moretti, Patrizia; Vieta, Eduard; Tortorella, Alfonso

doi:10.1016/j.euroneuro.2022.06.004

Cited by 8 publications

(4 citation statements)

References 68 publications

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“…Depressive symptoms were modifiable, illness-related MCPs of relapse not only in depressive, but also in bipolar and substance use disorders. In bipolar disorder, depressive symptoms are commonly responsible for the largest proportion of non-euthymic mood states [ 52 ], and are also responsible for longer duration of untreated illness [ 52 ], and inter-episodic impairment in functioning [ 53 ]. A factor contributing to inappropriate treatment of bipolar disorder is a misdiagnosis leading to use of antidepressants [ 54 ], as opposed to using other effective treatments, including quetiapine or lurasidone among others [ 55 , 56 ], or poor adherence to medications, which in turn is associated with depressive symptoms [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

Solmi,

Cortese,

Vita

et al. 2023

Mol Psychiatry

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We aimed to identify diagnosis-specific/transdiagnostic/transoutcome multivariable candidate predictors (MCPs) of key outcomes in mental disorders. We conducted an umbrella review (protocol link), searching MEDLINE/Embase (19/07/2022), including systematic reviews of studies reporting on MCPs of response, remission, recovery, or relapse, in DSM/ICD-defined mental disorders. From published predictors, we filtered MCPs, validating MCP criteria. AMSTAR2/PROBAST measured quality/risk of bias of systematic reviews/individual studies. We included 117 systematic reviews, 403 studies, 299,888 individuals with mental disorders, testing 796 prediction models. Only 4.3%/1.2% of the systematic reviews/individual studies were at low risk of bias. The most frequently targeted outcome was remission (36.9%), the least frequent was recovery (2.5%). Studies mainly focused on depressive (39.4%), substance-use (17.9%), and schizophrenia-spectrum (11.9%) disorders. We identified numerous MCPs within disorders for response, remission and relapse, but none for recovery. Transdiagnostic MCPs of remission included lower disease-specific symptoms (disorders = 5), female sex/higher education (disorders = 3), and quality of life/functioning (disorders = 2). Transdiagnostic MCPs of relapse included higher disease-specific symptoms (disorders = 5), higher depressive symptoms (disorders = 3), and younger age/higher anxiety symptoms/global illness severity/ number of previous episodes/negative life events (disorders = 2). Finally, positive trans-outcome MCPs for depression included less negative life events/depressive symptoms (response, remission, less relapse), female sex (response, remission) and better functioning (response, less relapse); for schizophrenia, less positive symptoms/higher depressive symptoms (remission, less relapse); for substance use disorder, marital status/higher education (remission, less relapse). Male sex, younger age, more clinical symptoms and comorbid mental/physical symptoms/disorders were poor prognostic factors, while positive factors included social contacts and employment, absent negative life events, higher education, early access/intervention, lower disease-specific and comorbid mental and physical symptoms/conditions, across mental disorders. Current data limitations include high risk of bias of studies and extraction of single predictors from multivariable models. Identified MCPs can inform future development, validation or refinement of prediction models of key outcomes in mental disorders.

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Section: Discussionmentioning

confidence: 99%

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

Solmi,

Cortese,

Vita

et al. 2023

Mol Psychiatry

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“…Given that longer DUI has been associated with negative outcomes in other psychiatric disorders, 13 – 15 but has not been investigated much in gambling disorder, we examined DUI in a large sample of people with this condition. The dataset combined participants, who reported that they had never previously received treatment for gambling disorder, from eight double-blind, placebo-controlled pharmacological trials 16 …”

Section: Introductionmentioning

confidence: 99%

Duration of untreated illness in gambling disorder

Grant,

Chamberlain

2023

CNS Spectr.

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Objective Gambling disorder is common, affects 0.5–2% of the population, and is under-treated. Duration of untreated illness (DUI) has emerged as a clinically important concept in the context of other mental disorders, but DUI in gambling disorder, has received little research scrutiny. Methods Data were aggregated from previous clinical trials in gambling disorder with people who had never previously received any treatment. DUI was quantified, and clinical characteristics were compared as a function of DUI status. Results A total of 298 individuals were included, and the mean DUI (standard deviation) was 8.9 (8.4) years, and the median DUI was 6 years. Longer DUI was significantly associated with male gender, older age, earlier age when the person first started to gamble, and family history of alcohol use disorder. Longer DUI was not significantly associated with racial-ethnic status, gambling symptom severity, current depressive or anxiety severity, comorbidities, or disability/functioning. The two groups did not differ in their propensity to drop out of the clinical trials, nor in overall symptom improvement associated with participation in those trials. Conclusions These data suggest that gambling disorder has a relatively long DUI and highlight the need to raise awareness and foster early intervention for affected and at-risk individuals. Because earlier age at first gambling in any form was strongly linked to longer DUI, this highlights the need for more rigorous legislation and education to reduce exposure of younger people to gambling.

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“…Many studies have assessed the DUI in patients with psychoses, and an increasing number of reports consider it a potential predictor of disease outcome. Prolonged DUIs may increase the disease burden, lead to a complex disease course and severe symptoms, and affect outcomes [3]. A shortened DUI, in contrast, may prevent disease recurrence or chronicity [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics, Metabolic Parameters, and Risk Factors for Suicide Attempts Vary with Untreated Major Depressive Disorder Duration

Tong,

Shi,

Yang

et al. 2023

Depression and Anxiety

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Suicidal attempts (SAs) are common in major depressive disorder (MDD). However, only few studies have so far assessed how risk factors for SAs in patients with MDD might be related to the duration of untreated illness (DUI). We interviewed 1,718 drug-naive outpatients with MDD with first-episode SAs and divided them into groups that had and had not attempted suicide. DUI was used as an additional grouping criterion. The patients (20.14%; 346/1718) who had a history of SAs were older and had a longer DUI; lower educational level (middle school-educated only); more psychotic symptoms; higher scores on depression and anxiety scales; and higher BP, plasma BG, TC, and LDL-C levels, but lower HDL-C concentrations. Anxiety symptoms, high education level, and being unmarried were risk factors for SA in patients with MDD with DUIs of <3 months; anxiety symptoms, low BMI, high plasma TC, and low plasma HDL-C were risk factors for SA in the group with DUIs between 3 and 8 months; age, anxiety symptoms, and higher systolic blood pressure were risk factors for those with DUIs>8 months. This study was a single-center cross-sectional survey, and its limitations include a lack of outside validation. Patients with MDD with and without a SA history have different clinical characteristics and metabolic parameters, and risk factors for suicide vary across DUI stages. Anxiety was a general risk factor, suggesting that clinicians should strengthen their assessment of SA risk in patients with MDD during diagnosis and treatment.

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Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders

Cited by 8 publications

References 68 publications

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

Duration of untreated illness in gambling disorder

Clinical Characteristics, Metabolic Parameters, and Risk Factors for Suicide Attempts Vary with Untreated Major Depressive Disorder Duration

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