Duration of untreated psychosis & Long-term outcome of First episode, hospitalized schizophrenia: Search for a missing link in a linear correlation

Duration of untreated psychosis & Long-term outcome of First episode, hospitalized schizophrenia: Search for a missing link in a linear correlation Amresh Shrivastavaa,*, Nilesh Shahb, Meghana Thakarc, Larry Stittd, Gurusamy Chinnasamye \t a Excecutive Director , Mental Health Foundation of India (PRERANA Charitable trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602, Currently: Assistant Professor of Psychiatry, The University of western Ontario, & associate Scientist, Lawson Health Research Institute, London, Ontario,Canada, E Mail : amresh.edu@gmail.com b Professor of Psychiatry LTMG Hospital, University of Mumbai, Sion, Mumbai, Maharashtra, India 400 022 c Clinical psychologist, Silver Mind Hospital, Mumbai,India d Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5C1 e Research Office, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5C1 *Corresponding author. Tel.: +1-519-631-8510; Fax: +1-519-631-2512. E-mail address: dr.amresh@gmail.com (A. Shrivastava). Present address: Regional Mental Health Care, 467 Sunset Drive, St. Thomas, Ontario, Canada N5H 3V9. Background: Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome and provides credence to development of early intervention services. While long-term outcome of schizophrenia is multifactorial in nature, it is difficult to argue that DUP is an independent determinant of outcome. Most likely several other factors together with short DUP determine a ‘good outcome’. The present study examines effect of differential periods of DUP on clinical and social outcome in ten year’s long-term follow up. Method: we conducted a ten years follow up study of first episode hospitalized DSM III-R schizophrenia and correlated multiple outcome criteria with DUP at Mumbai. We carefully determined onset of psychosis using criteria for appearance of positive symptoms, negative symptoms or significant social decline. Data was analyzed using SAS. Results: : we analyzed 101 patients available at ten years. We found that mean DUP was higher for group, which showed Clinical recovery on GCIS [14.0(SD=8.0) months for recovered & 10.8 (SD=5.7) months in nonrecovered group p=0.091]. There is a significant difference between those with DUP≤6 months compared to those with DUP>6 months in terms of subscales of PANSS, positive symptoms (p=.013), negative symptoms (p=.010), and General psychopathology (p=.004) with those with ≤ 6 months DUP having more positive symptoms, more negative symptoms and a lower GP. DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome. Conclusion: We find that DUP alone does not indicate and determine outcome status in first episode. Psychopathological heterogeneity in longitudinal course in early phase needs to be considered as one such factor. Further it is also not clear how early should the intervention be done for the benefit of early intervention.. More research is needed in this field

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