Academic journal article Indian Journal of Psychiatry

Effects of Duration of Untreated Psychosis on Long-Term Outcome of People Hospitalized with First Episode Schizophrenia

Academic journal article Indian Journal of Psychiatry

Effects of Duration of Untreated Psychosis on Long-Term Outcome of People Hospitalized with First Episode Schizophrenia

Article excerpt

Byline: Amresh. Shrivastava, Nilesh. Shah, Megan. Johnston, Larry. Stitt, Meghana. Thakar, Gurusamy. Chinnasamy

Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome. Thus, this study found that DUP alone does not determine outcome status confirming the role of psychopathological heterogeneity.


Outcome of schizophrenia has been repeatedly demonstrated to be 'good' and 'favorable,' which generally implies that most of the patients treated adequately are able to maintain a reasonable quality of life, remain free from distressing symptoms, can function at a moderate level and live a life outside psychiatric institutions in the community.[sup] [1],[2],[3],[4],[5]

A number of reasons have been cited for this premise, which of course has currently come under some scrutiny.[sup] [6],[7] There has been intense interest in duration of untreated psychosis (DUP) because of the proposal that psychosis is somehow neurologically toxic.[sup] [8] If this is true that delay in treating people with psychosis could impair prognosis, while reducing delay could improve it.[sup] [9] However, despite the blossoming of early intervention services, there is continuing disagreement over whether there is a real association between DUP and outcome. Several conflicting evidence have been reported.[sup] [10],[11],[12]

Although DUP has been reported as an independent marker of outcome, measurement errors and variability in DUP in terms of heterogeneity have also been reported and caution advised.[sup] [13],[14] The strength of association between DUP and outcome has been found to be only 'moderately strong' based upon the available data, accounting for approximately 13% of variance or one-third to one-fourth of those who did not achieve remission.[sup] [15] Until now, very few long-term studies have examined this association. Long-term outcome of schizophrenia is multifactorial in nature; it not clearly known if a short DUP is a strong determinant of long-term outcome.[sup] [16] The present study examines the effects of DUP on clinical and social outcome in a 10-year, long-term follow-up in a cohort of first episode psychosis.

Materials and Methods

Design This study is a naturalistic, prospective, longitudinal follow-up study conducted at Mumbai, India. Assessments were conducted at the baseline and at the end of 10 years, follow-up, by trained and experienced clinical research staff. Inter-rater reliability was established for quantification of outcome.

Sample and settings Two hundred patients admitted with first episode psychosis were recruited as per inclusion criteria, and 101 were available at the end point. Wherever necessary patients were traced, contacted and assessed. The study was carried out in a non-governmental, psychiatric hospital certified as a psychiatric facility by the State Government as per Indian Mental Health Act 1983 from a period of 1993 to 2007. The Independent Ethics Commission of Mumbai approved the study.

All patients and their relatives were explained the nature and purpose of study and an informed consent was obtained at the beginning of the study as well as at the end of the follow up for repeat assessment.

Inclusion and exclusion criteria Baseline inclusion criteria included: hospitalization, availability of key relatives, confirmed diagnosis of psychotic disorder- non-affective as per Diagnostic and Statistical Manual (DSM-III-R) criteria; between the ages of 18-45 years, informed consent for participation in the study. …

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