Effects of Prodromal Stage and Untreated Psychosis on Subsequent Psychopathology of Schizophrenia: A Path Analysis

Abstract

<b><i>Background:</i></b> To examine psychopathology present under prolonged antipsychotic treatment in schizophrenia and to analyse their relationship to both the duration of the prodromal stage (DPS; time between onset of first unspecific psychological symptoms and first schizophrenic symptoms) and the duration of untreated psychosis (DUP; time between the onset of psychosis and the initiation of antipsychotic treatment). <b><i>Methods:</i></b> The psychopathology of 93 patients was assessed cross-sectionally using the Scales for the Assessment of Negative and Positive Symptoms and the Brief Psychiatric Rating Scale. DPS and DUP were assessed by means of the patient records and the Interview for the Retrospective Assessment of the Onset and Course of Schizophrenia and Other Psychoses. A path analysis using maximum likelihood estimation was conducted with the program Analysis of Moment Structures for Windows. <b><i>Results:</i></b> The resulting path model indicated that DPS was predictive for a more severe negative symptomatology in schizophrenia, whereas DUP was associated with a more severe positive symptomatology in the long-term. Furthermore, DUP showed an inverse correlation with the age of the patients at the onset of both first unspecific psychological symptoms and first schizophrenic symptoms. <b><i>Conclusion:</i></b> A long prodromal stage suggests an increased risk of a long-term progression with negative symptoms in schizophrenia, whereas a delayed start of antipsychotic treatment could lead to an increased manifestation and severity of positive symptoms in the long term. These results underline the need to shorten the duration of the prodrome by an early detection and adequate intervention in patients with increased risk to develop psychosis.

Duration of Untreated Disorder and Cannabis Use: An Observational Study on a Cohort of Young Italian Patients Experiencing Psychotic Experiences and Dissociative Symptoms

“…The early stage of the disease is considered a critical period in determining its long-term outcome [ 4 ] in relation to personal, familiar, social, and clinical burdens. While the first-episode psychosis (FEP) refers to the first time someone experiences a psychotic episode, the duration of untreated psychosis (DUP) is the time that elapses between the first experience of psychosis and the initiation of antipsychotic treatment [ 5 ]. Current literature proposes a distinction between long and short DUP; however, a time cut-off has not been established for making such a distinction.…”

“…Current literature proposes a distinction between long and short DUP; however, a time cut-off has not been established for making such a distinction. Depending on the study, the time cut-off ranges from 3 [ 6 ] to 18 months [ 7 ], and includes 6 months [ 8 ], 9 months [ 5 ] and 12 months [ 9 ]. Several factors might contribute to longer DUP, such as: (i) low awareness of psychotic symptoms; (ii) dismissive attitude of patients and parents experiencing prominent negative symptoms and social withdrawal as opposed to positive symptoms; and (iii) health care providers’ failure to recognize psychosis [ 10 ].…”

Pathways to care in at‐risk mental states: A systematic review

“…The time between psychotic symptom onset and treatment in ARMS is described variously as the Duration of Untreated Attenuated Psychotic Symptoms (DUAPs), Duration of Untreated Illness (DUI), and Duration of Untreated Prodromal Symptoms (DUPrS). A growing body of research suggests longer DUAPs are predictive of less favourable outcomes, including increased transition rates (Nelson et al, 2016), reduced scores on the Global Assessment of Functioning (Fusar‐Poli et al, 2009; Zhang et al, 2019), poorer social functioning (Burton et al, 2019; Carrión et al, 2016), and, in those who transition, increased risk of negative symptoms (Gebhardt et al, 2019).…”