Abstract
BackgroundLonger duration of untreated psychosis (DUP) predicts poor functional outcomes in patients with schizophrenia. The results are not so clear when addressing effects on specific dimensions of symptoms, which may be due to confounding effects of previous antipsychotic treatment. We investigated the association between DUP, specific dimensions and response to treatment in a 10-week follow up study of patients at First-Episode of Psychosis (FEP) with no previous antipsychotic use.MethodsWe assessed 158 antipsychotic naïve individuals with first-episode psychosis, admitted to a psychiatric emergency service. Diagnosis was established according to the Structured Clinical Interview for DSM-IV (SCID). Symptom severity was measured with the Positive And Negative Symptoms Scale (PANSS) and the Clinical Global Impressions Scale (CGI). Functionality was assessed with the Global Assessment of Functioning Scale (GAF). All patients were treated with risperidone and reassessed after 10 weeks of treatment. For analyses, we performed non-parametric correlation tests (Spearman’s correlation).ResultsAt baseline, we did not find a correlation between DUP and symptom severity and functionality. After the follow-up, DUP became significantly correlated to both symptomatic and functional outcomes. DUP showed significant association with PANSS positive score (r=0.282; p=0.008), PANSS negative score (r=0.295; p=0.005), PANSS total score (r=0.258; p=0.017), CGI total (r=0.305; p=0.003) and GAF (r=-0.294; p=0.004). We also found a negative correlation between DUP and response to treatment considering 30% of reduction of PANSS’ scores (r=-0.288; p=0.027).DiscussionOur findings support that DUP does not affect the severity of illness at baseline, but modifies the response to treatment and clinical severity after 10 weeks. This finding suggests that longer exposition to psychosis might be involved in biological abnormalities that modulate the response to antipsychotics, which could mediate poor response to treatment.
Highlights
Suicide is the second cause one of the leading causes of death in young individuals
The exact nature of the relationship between these two phenomena remains unclear, which is intensely debated nowadays. Given both the high complexity of suicidal ideation (SI) and behavior and the fact that its expression has a trans-diagnostic nature, a fruitful approach to gain new insights about its relationships with psychiatric symptoms might be the application of network analysis, which could be helpful to elucidate specific associations existing between Psychotic experiences (PE) and SI
Through a network analytic approach, our results add new insights to previous findings concerning the associations between psychotic experiences and suicidal ideation, suggesting that perceptual anomalies, social anxiety, and bizarre experiences are connected in a meaningful way to suicidal ideation in a network of symptoms in a sample of non-help-seeking adolescents
Summary
Longer duration of untreated psychosis (DUP) predicts poor functional outcomes in patients with schizophrenia. We investigated the association between DUP, specific dimensions and response to treatment in a 10-week follow up study of patients at First-Episode of Psychosis (FEP) with no previous antipsychotic use. Results: At baseline, we did not find a correlation between DUP and symptom severity and functionality. Discussion: Our findings support that DUP does not affect the severity of illness at baseline, but modifies the response to treatment and clinical severity after 10 weeks. This finding suggests that longer exposition to psychosis might be involved in biological abnormalities that modulate the response to antipsychotics, which could mediate poor response to treatment
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