Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India

Abstract

Context:Longer duration of untreated psychosis (DUP) is known to be associated with poorer outcome of schizophrenia. DUP is also known to be longer in lower- and middle-income countries. Methodologically sound studies that have examined the association of DUP and outcome of schizophrenia in these countries are lacking.Aim:The aim was to evaluate the association between DUP and outcome of never-treated schizophrenia patients.Setting and Design:This study was conducted at the National Institute of Mental Health and Neurosciences, Bangalore, using a prospective cohort design.Materials and Methods:119 patients with schizophrenia/schizophreniform disorder diagnosed using the computerized diagnostic interview schedule for DSM-IV (CDIS-IV) were further assessed for DUP with the interview for retrospective assessment of onset of schizophrenia (IRAOS). After a mean (SD) follow-up period of 55.9 (37.2) weeks, the social and occupational functioning and psychopathology of 93 (80.2% of the surviving patients) patients were assessed using the social and occupational functioning scale (SOFS) and the positive and negative syndrome scale (PANSS), by raters blind to the DUP data. Spearman's correlation and Kendall's tau-B test were used to analyze the relationship between DUP and the outcome variables.Results:The mean DUP was 90.2 (median=30.1; SD=121.9) weeks. SOFS and PANSS scores at follow-up were statistically significantly associated with DUP, but not with other baseline variables (SOFS: rho=0.22, P=0.03; PANSS: rho=0.23, P=0.03). Among those with the shortest DUP (<16 weeks; n=33), 45.5%, 30.3%, and 24.2% had no impairment, mild-moderate impairment, and severe impairment, respectively. In contrast, 19.4%, 38.7%, and 41.9% of those with the longest DUP (>72 weeks; n=31) had no, mild-moderate, and severe impairment, respectively (Kendall's Tau-b=0.194; P=0.025).Conclusions:The delay in accessing treatment among patients with psychosis is considerable in India, a lower- to middle-income country. Longer DUP is associated with poorer psychopathological and functional outcomes in persons with schizophrenia/schizophreniform disorder.

Association of duration of untreated psychosis and functional level, in first episode of schizophrenia attendingan outpatient clinic in Sri Lanka

“…Since DUP is known to impair the prognosis in this mental disorder, the knowledge of DUP is vital for planning rehabilitation efforts for patients with schizophrenia in Sri Lanka 1 . The found value of 35.5 months for DUP is much higher compared to 14.1 months stated in a meta-analysis of mainly western studies and 20.7 months found by a retrospective assessment in a study done in neighbouring India 11,12 . But the association of longer DUP to lower functional scores were agreeing with many of the studies from west and India 1,2,11,12 .…”

Early intervention in schizophrenia in developing countries: Focus on duration of untreated psychosis and remission as a treatment goal

“…The study was limited, however, by the small sample size which precluded multivariate analyses. Lastly, Thirthalli et al (2011) prospectively studied DUP and outcome in a cohort of antipsychotic na ï ve schizophrenia patients in the south of India. The authors included patients with schizophrenia or schizophreniform disorder diagnosed using a computerized diagnostic interview schedule for DSM-IV.…”

Dependence on Cultural Contexts of the Factors Influencing Social Acceptance toward Schizophrenia: Evidence from Comparative Study between Japan and Vietnam

“…The main objective of medical professionals is early intervention. Several studies emphasize better outcomes for treating schizophrenia because of early medical intervention (Marshall et al, 2005;Primavera et al, 2012;Thirthalli et al, 2011).…”