Longer Duration Of Untreated Illness Research Articles

Potential predictors of delay in initial treatment contact after the first onset of depression in Japan: a clinical sample study.

BackgroundA growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample.MethodsNinety-five patients with depression with longer (>12 months) and shorter DUI (≤12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed.ResultsOf the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th–75th percentile, 2–13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance.ConclusionsOur findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.

P.1.e.001 Have sex hormones a role in the pathogenesis of psychotic symptoms in major psychoses?

Purpose of the Study: Sex hormones act as modulators of neurotransmitters in the brain and appear to be implicated in the pathogenesis and prognosis of mood disorders and schizophrenia. Preliminary data would indicate high levels of progesterone to be protective against psychotic symptoms [1,2], while, with regard to dehydroepiandrosterone (DHEA), results are discordant. If in one study DHEA appeared to protect bipolar patients against paranoid delusions, in another this hormone was found to be higher in schizophrenia patients compared with healthy controls [2,3]. Aim of this study is to compare the levels of progesterone and DHEA between patients with different diagnosis and in relation to the presence of psychotic symptoms. Methods: Fifty-five male patients, consecutively hospitalized in our patients’ clinic, were included into the study. Inclusion criteria consisted of: (1) a diagnosis of a mood or psychotic disorder and (2) lack of clinical conditions affecting hormonal plasma concentrations. Progesterone and DHEA plasma dosages were always measured at the admission in the morning and patients had to be drug free for at least two weeks Two analyses of variance (ANOVAs) were performed: in the first one plasma progesterone and DHEA plasma levels were compared according to diagnostic subgroups (schizophrenia, mood disorders, substance induced psychosis); in the second one the plasma levels of the two hormones were compared according to the presence of psychotic symptoms. Finally a binary logistic regression was performed to find if clinical variables were associated with abnormal plasma levels of DHEA or progesterone. In particular, age at onset, duration of illness, duration of untreated illness, BPRS mean total score, BPRS (unusual thought content) mean score, BPRS (hallucinations) mean score and the sum of mean scores of the two BPRS items were considered as independent variables, while the presence of abnormal DHEA/progesterone plasma levels as the dependent variable. Results: 20% of total sample (N= 55) presented abnormal values of DHEA and 32.7% of progesterone. Higher plasma levels of DHEA were found in patients with a history of psychotic symptoms (F = 8.454, p = 0.005), and plasma levels of progesterone showed only a trend (F = 3.772, p = 0.058). In contrast no significant differences of the plasma levels of the two hormones emerged between diagnostic groups (F = 0.859, p = 0.43). A longer duration of untreated illness was found to be positively associated with abnormal plasma levels of DHEA (OR= 1.193, p = 0.032), while a significant negative association was found between BPRS (unusual thought content) scores and abnormal plasma levels of DHEA (OR= 0.544, p = 0.04). Conclusions: Higher plasma levels of DHEA appear to be associated with the occurrence of psychotic symptoms, but less prominent delusional symptoms in acute phase. These results could indicate that high plasma levels of DHEA would be an index of chronicity independently from the diagnosis, but they could be protective against the acute psychotic exacerbation. Previous conflicting data can be explained on the basis of these findings.

Poster #M262 ACUTE MEDICAL CARE UTILISATION IN PSYCHIATRIC INPATIENTS

Expressed emotion (EE) was examined in a large sample of families of patients with either first-episode psychosis (FEP) within the schizophrenia spectrum, or who met the criteria for ultra high-risk (UHR) of psychosis. The aim of our study was to determine the patterns and relationship of EE with the duration of untreated illness (DUI) or of untreated psychosis (DUP), as well as with illness severity. The sample used in our study included 77 FEP and 66 UHR families. The Camberwell Family Interview was used to assess EE.In both samples, about one-third of patients’ families were classified as high EE, with emotional over-involvement (EOI) being the most frequent reason for a family to be classified as high EE. In FEP, higher EE correlated with longer DUI, and higher paternal EOI with longer DUP. DUI, however, was not found to correlate to EE in UHR patients. Severity of illness at the initial assessment did not relate to EE in either FEP or UHR families. Families of FEP and UHR patients were not found to differ in terms of the prevalence of a high EE rating, or of any of its subcomponents.The results of this study only partially support the hypothesis that high EE develops as a reaction to patient status. Patients from families with high EE could possibly benefit from interventions that are targeted at improving their resilience when dealing with problematic family environments.

EPA-0773 – Duration of untreated illness, duration of illness and severity of illness in obsessive compulsive disorder and main subtypes

Introduction Obsessive-compulsive disorder (OCD) symptoms are remarkably diverse, as regards both clinical presentation and severity 1 . Studies are conflicting about whether any specific phenotype of OCD is easier to treat or likely to benefit from a particular treatment. Duration of untreated illness (DUI) represents a modifiable parameter, whose reduction may positively influence the outcome and long-term course of specific psychiatric disorders 2 . The aim of this study was to evaluate possible differences concerning severity, duration of illness (DI) and DUI among OCD subtypes in a sample of OCD patients. Methods 114 OCD outpatients were recruited and assessed using the Y-BOCS. The main OCD phenotypes were identified through the YBOCS- Symptom Checklist. A one-way ANOVA test was performed to compare DUI, DI and Y-BOCS scores in the sample. Results Subjects were categorized into 4 clinical phenotypes,: aggressive/checking (n=31), contamination/cleaning (n=37), simmetry/ordering (n=32) and multiple phenotypes (n=14). DUI, DI and YBOCS scores were found significantly higher in aggressive/checking subgroup, compared to other subgroups (One Way ANOVA: F=3.58 p Conclusions DUI and DI resulted significantly higher in the aggressive/checking subgroup, compared to the other subgroups. YBOCS scores resulted significantly higher in the aggressive/checking subgroup compared to the others, showing that longer DUI and DI may condition a worse clinical outcome in this subgroup. Of note, within the total sample half of the whole DI was spent untreated.

Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy

This study set out to investigate the patterns of referral in a sample (n=206) of patients having first-time access to an Italian comprehensive program that targets the early detection of and early intervention on subjects at the onset of psychosis. The primary goal of the study was to investigate the duration of untreated illness (DUI) and/or the duration of untreated psychosis (DUP) in the sample since the implementation of the program. Data on pathways of referrals prospectively collected over a 11-year period, from 1999 to 2010; data referred to patients from a defined catchment area, and who met ICD-10 criteria for a first episode of a psychotic disorder (FEP) or were classified to be at ultra-high risk of psychosis (UHR) according to the criteria developed by the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne. Changes over time in the DUI and DUP were investigated in the sample. Referrals increased over time, with 20 subjects enrolled per year in the latter years of the study. A large majority of patients contacted a public or private mental health care professional along their pathway to treatment, occurring more often in FEP than in UHR patients. FEP patients who had contact with a non-psychiatric health care professional had a longer DUP. Over time, DUP and DUI did not change in FEP patients, but DUI increased, on average, in UHR patients. The establishment of an EIP in a large metropolitan area led to an increase of referrals from people and agencies that are not directly involved in the mental health care system; over time, there was an increase in the number of patients with longer DUI and DUP than those who normally apply for psychiatric services.

General Medical Conditions Are Associated With Delay to Treatment in Patients with Bipolar Disorder

Bipolar disorder (BPD) is associated with worse physical health. Indeed patients with BPD more frequently suffer from medical conditions such as cardiovascular illness, hypertension, diabetes, hypothyroidism, respiratory disease, liver disease, peptic ulcer, and arthritis. Since some clinical characteristics have been associated with worse course and outcome of BPD, it is possible that they might also bring to an increased medical burden in patients with BPD. The aim of the present report is to assess the prevalence of medical conditions in patients with BPD, and to determine the clinical variables associated with the presence of a medical condition. Charts of patients with BPD I and II were reviewed: socio-demographic and clinical information were collected. Medical conditions were classified by the ICD-10 and grouped according to the Cumulative Illness Rating Scales in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The associations between the presence of medical conditions and demographic/clinical variables of BPD were then analyzed. Charts of 309 patients were included in the study. 170 (55%) patients had at least one medical condition. The most common were endocrine/metabolic disease (23%), and vascular disease (21%). Having a medical condition was associated with longer duration of untreated illness and female gender. Patients with BPD have high rates of medical conditions, especially hypertension and metabolic disorders. A longer duration of untreated illness is associated with having a medical condition, probably due to the long-lasting adoption on unhealthy lifestyles not counterbalanced by treatment and psychoeducation.

Duration of untreated illness and duration of illness in anxiety disorders: assessment and influence on outcome.

Anxiety disorders are disabling and generally chronic conditions, with a lifetime prevalence of 15-20% in the general population. These disorders are usually associated with early onset and often remain untreated for several years with important consequences on patients' functioning and quality of life. From this perspective, recent literature has considered duration of illness (DI) and duration of untreated illness (DUI), two important variables influencing outcome in many psychiatric conditions including anxiety disorders. The DUI has been defined as the interval between the onset of a specific psychiatric disorder and the subsequent administration of the first adequate pharmacological treatment given at standard dosages and for an adequate period of time in compliant subjects. The DI can be defined as the time elapsing between the onset of a psychiatric disorder and the recovery from the illness. The two variables are likely interrelated, with a longer DUI being a major contributor to a longer DI. A significant body of evidence has shown that prolonged DI and DUI are associated with structural and functional brain abnormalities as well as with poor treatment response, particularly in schizophrenia. More recently, an increasing number of studies have been pointing toward a similar conclusion in affective disorders. As a consequence, the assessment of the latency to treatment (DUI) may represent one of the first steps in order to plan early interventions and reduce the overall DI. The present chapter highlights the role of the DI and latency to treatment in anxiety disorders, focusing on epidemiologic, neuropathological, clinical and prognostic issues.

Duration of untreated illness (DUI) and schizophrenia sub-types: A collaborative study between the universities of Milan and Moscow

Several studies show an association between a long duration of untreated illness (DUI) and poor outcome in schizophrenic patients. DUI, in turn, may be influenced by different variables including specific illness-related factors as well as access to local psychiatric services. The purposes of the present study were to detect differences in terms of DUI among schizophrenics coming from different geographic areas and to evaluate differences in DUI across diagnostic sub-types. One hundred and twenty-five (125) schizophrenic patients of the Psychiatric Clinic of Milan (n = 51) and Moscow (n = 74) were enrolled. SCID-I was administered to all patients and information about DUI was obtained by consulting clinical charts and health system databases, and by means of clinical interviews with patients and their relatives. DUI was defined as the time between the onset of illness and the administration of the first antipsychotic drug. One-way analyses of variance (ANOVAs) were performed to find eventual differences in terms of DUI across diagnostic sub-types. Italian patients showed a longer DUI (M = 4.14 years, SD = 4.95) than Russians (M = 1.16 years, SD = 1.43) (F = 24.03, p < .001). DUI was found to be longer in paranoid schizophrenics (M = 3.47 years, SD = 4.19) compared to catatonic patients (M = 0.96 years, SD = 0.94) (F = 3.56, p = .016). The results of the present study suggest that the different schizophrenic sub-types may differ in terms of DUI, likely due to different clinical severity and social functioning. Studies with larger samples are needed to confirm the data of the present study.

2012 Wayne Fenton Award for Exceptional Clinical Care: Dr. Eadbhard O'Callaghan

2012 Wayne Fenton Award for Exceptional Clinical Care: Dr. Eadbhard O'Callaghan

Family history of psychosis negatively impacts age at onset, negative symptoms, and duration of untreated illness and psychosis in first-episode psychosis patients

Family history (FH) of psychosis has been a focus of investigations attempting to explain the heterogeneity in schizophrenia. Previous studies have demonstrated that FH is associated with earlier age at onset, severity of positive and negative symptoms, and the duration of untreated illness (DUI). The current study examined the impact of FH on the clinical presentation and help-seeking behaviors of a well-characterized, first-episode sample. The present study utilized the Symptom Onset in Schizophrenia (SOS) Inventory, the Positive and Negative Syndrome Scale (PANSS), and structured interviews on FH to examine these relationships in a large (n=152) sample of predominantly African American patients. Results showed that patients with a first-degree FH of psychosis had a younger age at onset of both the prodrome and psychosis, but did not differ in duration of prodromal period. Furthermore, FH and sex interacted to influence severity of negative, but not positive symptoms. Finally, FH interacted with sex to influence both the DUI and DUP in that only males with FH had longer DUI and DUP. The findings have implications for understanding the impact of specific family-related mechanisms on both clinical and help-seeking factors, as well as for informing future family-based intervention efforts.

P-474 - Duration of untreated illness and long-term outcome in major depressive disorder

Introduction A number of studies of a possible relationship between duration of untreated illness (DUI) and various psychiatric disorders shown the possible role of DUI as negative prognostic factor in schizophrenia and psychotic disorders. On the other hand few data evaluate the role of DUI in the clinical outcome of major depressive disorder. Objectives Analyze the duration of untreated illness and evaluate long-term outcomes in major depressive disorder. Method Sample of 73 subjects (53F and 20M) with major depressive disorder according to DSM-IV-TR. We collected demographic, clinical and outcome data: age, sex, family history, age at onset of illness, age of first antidepressant treatment and dosage, possible comorbidity with other diagnoses and substance abuse, number of depressive episodes before and after treatment, number of hospitalizations and suicide attempts. Results Results show that the DUI is longer in the male than in the female sample (p = 0.049) and long DUI is related to an onset disorder at a younger age (p = 0.040) and with a longer duration of illness (p = 0.006). It was also demonstrated that the number of depressive episodes prior to the first antidepressant treatment is higher in the sample of patients with a longer DUI (p = 0.006). Discussion These results show that the duration of untreated illness is longer in the male sample; other results are consistent with previous studies and show a better outcome of depression in patients with a short duration of untreated illness.

P-1217 - Duration of untreated illness (DUI) in the different schizophrenic subtypes: a collaborative study milan-moscow

Several studies show as a long duration of untreated illness (DUI) is associated with poor outcome in schizophrenic patients. Purpose of the present study was to evaluate eventual differences in terms of DUI between the diagnostic subtypes in a sample of schizophrenics coming from different geographic areas. One hundred twenty-five schizophrenic patients of the Psychiatric Clinic of Milan (n = 51) and Moscow (n = 74) were enrolled. SCID-I was administered to all patients and information about DUI were obtained consulting clinical charts, health system databases, and performing interviews with patients and their relatives. DUI was defined as the time between the onset of symptoms and the administration of first antipsychotic. One-way ANOVAs were performed to find eventual differences in terms of DUI between the diagnostic subtypes. Italian patients showed a longer DUI (4.14 years ± 4.95) in comparison with the Russian ones (1.16 years ±1.43). DUI was found to be longer in paranoid schizophrenics (3.47 years ± 4.19) respect to catatonic ones (0.96 years ± 0.94) (F = 3.56, p = 0.016). The results of the present study show as the different schizophrenic subtypes can have a different DUI perhaps for the dissimilar clinical severity and social functioning. Studies with larger samples are warranted to confirm the data of the present study.

Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles.

In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention. The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes. Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.

Duration of untreated illness in schizophrenia is not associated with 5-year brain volume change

ObjectivesEvidence for an association between duration of untreated illness (DUI) with clinical and functional outcome or brain volume (change) in schizophrenia patients is inconclusive. We aimed to investigate the relationship between DUI, outcome and brain volume at illness onset or brain volume change during the first five years of the illness in first-episode patients. MethodsMagnetic resonance images were acquired at baseline (T0) and after 5-year (T5) of 57 schizophrenia patients. Correlations were calculated in patients between brain volume (change), DUI and outcome variables. ResultsWe found no significant correlation between DUI and brain volume (change) in schizophrenia patients. A longer DUI was significantly correlated with higher PANSS scores at T0 and T5, and with higher scores on the Camberwell Assessment of Need scale at T5. Baseline volume of the cerebrum and lateral ventricles, and cerebellum volume (change) were associated with PANSS scores at T0 and T5. ConclusionAlthough clinical outcome is associated with both brain volume (change) and DUI, we found no evidence for a relationship between DUI and brain volume (change). DUI and baseline brain volume or 5-year brain volume (change) seem to explain different parts of the variation in clinical outcome.

Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care

To provide an update of the recent studies on the age of onset of the major mental illnesses, with a special focus on the prospects for prevention and early intervention. The studies reviewed here confirm previous reports on the age of onset of the major mental disorders. While the behaviour disorders, and certain anxiety disorders, emerge during childhood, most of the high prevalence disorders (anxiety, mood and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early age of onset has been shown to be associated with a longer duration of untreated illness and poorer clinical and functional outcomes. Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. Although there is increasing evidence to suggest that intervention during the early stages of a disorder may help reduce the severity and/or the persistence of the initial or primary disorder and prevent secondary disorders, additional research is needed into appropriate treatment for early stage cases as well as the long-term effects of early intervention, and to appropriate service design for those in the early stages of a mental illness. This will mean not only the strengthening and re-engineering of existing systems but also, crucially, the construction of new streams of care for young people in transition to adulthood.

Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: Results from the Programma2000 (Milan, Italy)

Expressed emotion (EE) was examined in a large sample of families of patients with either first-episode psychosis (FEP) within the schizophrenia spectrum, or who met the criteria for ultra high-risk (UHR) of psychosis. The aim of our study was to determine the patterns and relationship of EE with the duration of untreated illness (DUI) or of untreated psychosis (DUP), as well as with illness severity. The sample used in our study included 77 FEP and 66 UHR families. The Camberwell Family Interview was used to assess EE. In both samples, about one-third of patients’ families were classified as high EE, with emotional over-involvement (EOI) being the most frequent reason for a family to be classified as high EE. In FEP, higher EE correlated with longer DUI, and higher paternal EOI with longer DUP. DUI, however, was not found to correlate to EE in UHR patients. Severity of illness at the initial assessment did not relate to EE in either FEP or UHR families. Families of FEP and UHR patients were not found to differ in terms of the prevalence of a high EE rating, or of any of its subcomponents. The results of this study only partially support the hypothesis that high EE develops as a reaction to patient status. Patients from families with high EE could possibly benefit from interventions that are targeted at improving their resilience when dealing with problematic family environments.

Patient-Level Predictors and Clinical Correlates of Duration of Untreated Psychosis Among Hospitalized First-Episode Patients

Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators. Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders. The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r = 0.23, P = .02), and poorer insight was associated with longer DUI (r = -0.24, P = .01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems. There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges.

Global assessment of psychosocial functioning and predictors of outcome in schizophrenia

Objective. This study identified predictors of psychosocial outcome in schizophrenia. Method. A mixed group of patients diagnosed with schizophrenia were assessed as part of a routine clinical evaluation. A linear regression analysis was conducted in order to examine the effect of duration of untreated illness, number of previous hospitalisations, history of psychotic episodes and age at illness onset on patients’ functioning, as assessed with the Global Assessment of Functioning (GAF) scale. Results. Number of previous psychotic episodes as well as duration of untreated illness were the strongest predictors of patients’ levels of functioning amongst all main outcome measures. Older age at illness onset also predicted poorer functioning. Limitations. A principal limitation of our study is that our sample included predominantly Caucasian males; therefore, any extrapolation to other groups may remain speculative. Conclusions. Our preliminary results suggest that psychosocial outcome in schizophrenia may be affected by different factors. Longer history of psychotic episodes emerged as the most significant determinant of poorer outcome while longer duration of untreated illness and older age at illness onset were also associated with detrimental effects. Our findings may reflect the combined influences of neurodevelopmental abnormalities, exposure to psychotropic medication and psychosocial interventions as well as the vicissitudes of natural aging processes embedded in a chronic mental illness.

Duration of untreated illness and suicide in bipolar disorder: a naturalistic study

The aim of this naturalistic study was to evaluate the potential influence of the duration of untreated illness (DUI)--defined as the time elapsed between the occurrence of the first mood episode and the first adequate pharmacological treatment with mood stabilizers--on the clinical course of bipolar disorder (BD). Three hundred and twenty outpatients (n = 320) with a DSM-IV diagnosis of BD--either Type I or Type II--were interviewed; their clinical features were collected and they were naturalistically followed-up for 5 years. At the end of the follow-up observation, the sample was subdivided into two groups: one group with a DUI < or =2 years (n = 65) and another group with a DUI >2 years (n = 255). The main demographic and clinical variables were analyzed and compared between the two subgroups of patients using chi-square tests for dichotomous variables or Mann-Whitney U tests for continuous variables. Patients with a longer DUI showed a higher frequency of suicide attempts (Z = -2.11, P = 0.035), a higher number of suicide attempters (chi(2) = 4.13, df = 1, P = 0.04), and a longer duration of illness (Z = -6.79, P < 0.0001) when compared to patients with a shorter DUI. Moreover, patients with a longer DUI had a depressive first episode more frequently than patients with a shorter DUI (chi(2) = 11.28, df = 2, P = 0.004). A further analysis performed dividing the total sample into two subgroups on the basis of a DUI of 6 years (corresponding to the median value of the DUI in the study sample) confirmed prior findings. Results indicate a potential association between a longer DUI and a worse outcome in BD, particularly in terms of suicidality, and confirm the clinical relevance of early diagnosis and pharmacological intervention with mood stabilizers in BD.

Duration of Untreated Illness as a Predictor of Treatment Response and Clinical Course in Generalized Anxiety Disorder

The aim of the present study was to investigate the impact of the duration of untreated illness (DUI)-defined as the time elapsing between the onset of generalized anxiety disorder (GAD) and the first adequate pharmacologic treatment-on treatment response and clinical course in a sample of subjects with GAD. One hundred patients with GAD, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria, were enrolled and their main demographic and clinical features collected. Patients were then treated with selective serotonin reuptake inhibitors or venlafaxine for 8 weeks in open-label conditions. Treatment response and other clinical variables were analyzed after dividing the sample into two groups according to DUI (DUI <or=12 months and DUI >12 months). When the DUI was computed with respect to the first antidepressant treatment (DUI-AD), a higher improvement (Clinical Global Impressions-Severity of Illness scale) after the pharmacologic treatment was found in the group with a shorter DUI (analysis of variance with repeated measures: time effect F=654.975, P<.001; group effect: F=4.369, P=.039). When computed with respect to the first treatment with benzodiazepines (DUI-BDZ), the two groups did not show any significant difference in treatment response (time effect: F=652.183, P<.001; group effect: F=0.009, P=.924). In addition, patients with a longer DUI (DUI-BDZ or DUI-AD) showed an earlier age at onset, a longer duration of illness and a higher rate of comorbid psychiatric disorders with onset later than GAD. Results from this preliminary study seem to suggest that a shorter DUI-AD may determine a better response to pharmacologic treatment in patients with GAD, and that a longer DUI (DUI-BDZ and DUI-AD) may be associated to a worse clinical course. Further investigation on the relationship between DUI and GAD is needed.