Shorter Duration Of Untreated Psychosis Research Articles

Subtyping first-episode non-affective psychosis using four early-course features: potentially useful prognostic information at initial presentation.

Heterogeneity of symptoms, course and outcomes in primary psychotic disorders complicates prognosis, treatment and diverse aspects of research. This study aimed to identify interpretable subtypes of first-episode non-affective psychosis based on four early-course features (premorbid academic functioning, premorbid social functioning, duration of the prodrome and age at onset of psychosis). Data from 200 well-characterized patients hospitalized in public-sector inpatient units for first-episode non-affective psychosis were used in latent profile analyses. Derived subtypes were then compared along a number of clinical dimensions using analyses of variance. Using four early-course features, three classes were derived. A good premorbid/short prodrome subtype was characterized by a lower severity of positive symptoms, better social/occupational/global functioning, and a shorter duration of untreated psychosis; a poor premorbid/early onset subtype demonstrated greater negative and preoccupation symptoms, as well as greater psychosocial problems; and a long prodrome/late onset subtype was characterized by greater dysphoric symptoms. Findings indicate a need for further research with first-episode samples on the utility of subtyping based on early-course (premorbid, prodromal and onset-related) characteristics. Such efforts could enhance the parsing of heterogeneity, thereby advancing clinical practice and research.

Mismatch Negativity and Cognitive Performance for the Prediction of Psychosis in Subjects with At-Risk Mental State

BackgroundA shorter duration of untreated psychosis has been associated with better prognosis in schizophrenia. In this study, we measured the duration mismatch negativity (dMMN), an event-related potential, and cognitive performance in subjects with at-risk mental state (ARMS), patients with first-episode or chronic schizophrenia, and healthy volunteers. The main interest was to determine if these neurocognitive measures predict progression to overt schizophrenia in ARMS subjects.Methodology/Principal FindingsSeventeen ARMS subjects, meeting the criteria of the Comprehensive Assessment of At-Risk Mental State, 31 schizophrenia patients (20 first-episode and 11 chronic) and healthy controls (N = 20) participated in the study. dMMN was measured by an auditory odd-ball paradigm at baseline. Neuropsychological performance was evaluated by the Japanese version of the Brief assessment of cognitive function of schizophrenia (BACS-J). The first-episode schizophrenia group showed significantly smaller amplitudes at frontal electrodes than did control subjects whereas chronic patients elicited smaller amplitudes at frontal and central electrodes, consistent with previous reports. During the follow-up period, 4 out of the 17 ARMS subjects transitioned to schizophrenia (converters) while 13 did not (non-converters). Specifically, dMMN amplitudes of non-converters did not differ from those of healthy controls, while converters showed significantly smaller dMMN amplitudes at some electrodes compared to control subjects. Converters performed significantly worse on tests of working memory, verbal fluency, and attention/information processing than did non-converters. There was a significant positive correlation between dMMN amplitudes at the frontal electrodes and verbal fluency, as measured by the BACS, in the AMRS subjects as a whole.Conclusions/SignificanceARMS subjects who later developed schizophrenia elicited smaller dMMN amplitudes to begin with, compared to non-converters. Notably, we have provided the first evidence for the ability of verbal fluency to predict dMMN amplitudes in ARMS subjects. These findings are expected to add to the efforts for early diagnosis and intervention of schizophrenia.

Remission in Schizophrenia: Critical and Systematic Review

In 2005, the Remission in Schizophrenia Working Group published consensus criteria to define remission. These criteria have been widely accepted and utilized and have provided further insights about schizophrenia management and prognosis. We systematically reviewed studies that utilized these criteria, with the aim of assessing the remission rate in follow-up studies and the variables predicting or associated with remission. Remission has a reported rate of 17% to 78% (weighted mean = 35.6%) in first-episode schizophrenia and 16% to 62% (weighted mean = 37%) in multiple-episode patients, with no statistical difference between the two weighted means (p = .79). Patients who were treated with long-acting injectable risperidone showed high maintenance of remission status. Studies comparing second-generation antipsychotics versus haloperidol showed higher remission rates for the former. The variables most frequently associated with remission were better premorbid function, milder symptoms at baseline (especially negative symptoms), early response to treatment, and shorter duration of untreated psychosis. Variability in the length and frequency of follow-ups, as well as differences in dropout rates, could partially explain the differences in reported rates. Rates of symptomatic remission exceeded reported rates for functional recovery. Moreover, the majority of studies used Remission in Schizophrenia Working Group severity criteria only, neglecting duration. To enhance comparison between future research findings, we suggest further specifiers of the working group's criteria, to better define frequency and duration of follow-up, and proxy measures of remission.

Social capital, pathway to care and duration of untreated psychosis: Findings from a low- and middle-income country context

Background. Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis (FEP). Objective. To determine the relationship between individual- and neighbourhood-level socio-environmental factors (household income and rated measures of neighbourhood social capital) and duration of untreated psychosis (DUP) in South Africa. Methods. We obtained data regarding sociodemographics, evolution of symptoms and pathway to care from interviews with 54 consecutively admitted FEP patients at Town Hill Hospital. Caregivers and clinical notes were also consulted. A population-based survey of social capital was conducted in the residential neighbourhood of each patient at onset. Cox regression analyses were used to test whether socioeconomic factors and overall neighbourhood social capital scores and sub-scores were associated with DUP. Results. After controlling for age at onset, gender and income, a shorter DUP was independently associated with police involvement in pathways to care, while non-black ethnicity and greater levels of total social capital were associated with a longer DUP. Community participation, neighbourhood connectedness, and trust and safety were specifically associated with a longer DUP. Conclusions . Individual factors including greater age at onset and police involvement in the care pathway were significantly associated with shorter DUP in this middle-income setting. Paradoxically, aspects of social capital pertaining to greater community involvement were associated with delays in pathways to appropriate care. It is possible that community members opted to care for individuals with early psychosis longer before sending them to formal health services. This is especially likely in contexts where mental health services are scarce and inaccessible, which has important implications for mental health education campaigns.

Social capital, pathway to care and duration of untreated psychosis: Findings from a low- and middle-income country context

<p><strong>Background.</strong> Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis (FEP).</p><p><strong>Objective.</strong> To determine the relationship between individual- and neighbourhood-level socio-environmental factors (household income and rated measures of neighbourhood social capital) and duration of untreated psychosis (DUP) in South Africa.</p><p><strong> Methods.</strong> We obtained data regarding sociodemographics, evolution of symptoms and pathway to care from interviews with 54 consecutively admitted FEP patients at Town Hill Hospital. Caregivers and clinical notes were also consulted. A population-based survey of social capital was conducted in the residential neighbourhood of each patient at onset. Cox regression analyses were used to test whether socioeconomic factors and overall neighbourhood social capital scores and sub-scores were associated with DUP.</p><p><strong>Results.</strong> After controlling for age at onset, gender and income, a shorter DUP was independently associated with police involvement in pathways to care, while non-black ethnicity and greater levels of total social capital were associated with a longer DUP. Community participation, neighbourhood connectedness, and trust and safety were specifically associated with a longer DUP.</p><p><strong>Conclusions</strong>. Individual factors including greater age at onset and police involvement in the care pathway were significantly associated with shorter DUP in this middle-income setting. Paradoxically, aspects of social capital pertaining to greater community involvement were associated with delays in pathways to appropriate care. It is possible that community members opted to care for individuals with early psychosis longer before sending them to formal health services. This is especially likely in contexts where mental health services are scarce and inaccessible, which has important implications for mental health education campaigns.</p>

Cannabis use and Duration of Untreated Psychosis: A Systematic Review and Meta-Analysis

Duration of untreated psychosis (DUP) is an important predictor of outcome in first-episode psychosis (FEP). Cannabis use is highly prevalent in FEP patients and it is important to evaluate the potential impact of cannabis use on DUP. A systematic review of the literature was conducted to identify articles reporting DUP in FEP cannabis users (CU+) and nonusers (CU-) respectively. Studies meeting inclusion criteria were entered into a meta-analysis. In addition, a comparative review was conducted of the relationship between substance use and DUP. Nine studies were identified reporting DUP in CU+ versus CU- patients. Of the pooled sample of 1726 FEP patients, 39% were cannabis users. Although in most studies DUP was shorter in cannabis using patients, meta-analysis did not detect a significant relationship between DUP and cannabis use. A trend towards shorter DUP in substance users was also apparent in the comparative review; although in none of the studies did this association reach statistical significance. This review and meta-analysis suggests a trend association between shorter DUP and cannabis use in FEP; especially when cannabis use is defined in terms of current or recent use (rather than lifetime use.) Further research should aim to clarify the relative effects of longstanding versus recent onset cannabis use on neurobiology, pathway to care and outcome in FEP.

Which came first, delusions or hallucinations? An exploration of clinical differences among patients with first-episode psychosis based on patterns of emergence of positive symptoms

Remarkably little is known about patterns of emergence of specific symptoms in the early course of nonaffective psychotic disorders. Some 159 well-characterized first-episode psychosis patients were categorized into those with: (1) delusions only (n=29, 18.2%); (2) delusions that emerged at least 1 month before hallucinations (n=31, 19.5%); (3) hallucinations that began at least 1 month before delusions (n=26, 16.4%); and (4) delusions and hallucinations that emerged concomitantly, within the same month (n=73, 45.9%). These four groups were compared across a number of clinical features, including duration of untreated psychosis, symptom severity, insight, and functioning, while controlling for potential confounders. Patients with delusions and hallucinations emerging within the same month had a shorter duration of untreated psychosis than those in whom one psychotic symptom emerged greater than one month before the other. The delusions-only group had significantly less severe positive, negative, and general psychopathology symptom scores, as well as better social and occupational functioning. Replication and further elucidation of specific patterns of symptom emergence would deepen the field's understanding of early-course phenomenology, and may inform efforts to improve upon nosology, prognostication, and treatment selection.

Does duration of untreated psychosis predict very long term outcome of schizophrenic disorders? results of a retrospective study

BackgroundStudies performed to assess the relevance of duration of untreated psychosis (DUP) as a predictor of long-term outcome (i.e. follow-ups of ten years or more) are somewhat limited. The aim of this study was to evaluate the potential association between DUP and very long-term outcome (16-33 yrs) of schizophrenia by means of a retrospective design.MethodsRetrospective data obtained from clinical records were collected regarding DUP and outcome variables (number of hospitalizations; number of attempted suicides; course of illness; GAF scores at last observation) for a cohort of 80 outpatients (52 Males, 28 Females, mean age 51.0+/-11.58 years) affected by schizophrenia according to DSMIVTR attending a university community mental health centre.ResultsMean duration of follow up was 25.2 +/- 8.68 years; mean duration of untreated psychosis was 49.00 months (range 1-312 mo), with no significant difference according to gender. Patients with a shorter DUP (=/< 1 year) displayed more frequent “favourable” courses of illness (28.9% vs 8.6%) (p = 0.025), more frequent cases with limited (=/< 3) number of hospital admissions (85.7% vs 62.1%) (p = 0.047) and a better functioning (mean GAF score = 50.32+/-16.49 vs 40.26+/-9.60, p = 0.002); regression analyses confirmed that shorter DUP independently predicted a more positive outcome in terms of number of hospital admissions, course of illness, functioning (GAF scores).ConclusionA shorter DUP appears to act as a significant predictor of better outcome in schizophrenia even in the very long-term.

Predictors of disengagement from treatment in an early psychosis program

BackgroundDisengagement from treatment is a major concern in psychiatry. This is of particular concern for those presenting for care at their first episode of psychosis (FEP). The purpose of this study is to determine the rate of disengagement from a three year FE treatment program and the predictors of disengagement. MethodWe used a longitudinal cohort design. The cohort consisted of 286 FEP individuals. Measures included assessments of positive and negative symptoms, depression, substance use, premorbid and current functioning, cognition and duration of untreated psychosis. Disengagement from treatment was defined as leaving the program before the 30months. ResultsAt 30months after treatment, the estimated rate of disengagement from treatment was 31%. Predictors of disengagement were examined via Cox proportional hazards models which revealed that lower ratings on negative symptom scores at baseline (HR=0.946; CI=0.909–0.985), a shorter duration of untreated psychosis (HR=0.997; CI=0.994–0.999), and not having a family member involved in the program (HR=0.310; CI=0.196–0.490) contributed significantly to predicting disengagement from treatment. An examination of those who dropped out at different times revealed that those who dropped out prior to 6months had significantly greater cannabis (p<0.05) and other drug use (p<0.01). ConclusionsEngagement in early services may be helped by attending carefully to substance use to prevent early dropout, to those who may have had a short duration of untreated psychosis and to working with families to engage families in the program.

Prediction of remission and recovery in young people presenting with first-episode psychosis in Hong Kong: A 3-year follow-up study

The aim of the current study was to investigate the rates and predictors of symptomatic remission and recovery in patients presenting with first-episode psychosis 3 years after treatment initiation. Seven hundred participants aged 15-25 years consecutively enrolled in a territory-wide early intervention programme in Hong Kong from July 2001 to August 2003 fulfilled study inclusion criteria, with 539 completing 3-year follow-up. Baseline and follow-up variables were collected via systematic medical file review. The operational criteria for recovery were based on clinical definition incorporating both symptom and functional dimensions. By the end of 3-year follow-up, 58.8% (n = 317) and 17.4% (n = 94) of participants met criteria for symptomatic remission and recovery, respectively. Around half (51.2%, n = 276) were not remitted either symptomatically or functionally in the last 12 months of follow-up. Of those who achieved sustained symptomatic remission, only 43.1% were also in functional remission. Patients in symptomatic remission had lower rate of admissions, shorter duration of hospitalisations and more favourable psychosocial functioning than non-remitted counterparts. Logistic regression analysis revealed that female sex, older age of onset of psychosis, shorter duration of untreated psychosis (DUP) and early symptom resolution predicted symptomatic remission at the end of follow-up. Higher educational attainment, superior baseline occupational status and shorter DUP were found to be predictive of recovery. In a large representative cohort of Chinese young people presenting with first-episode psychosis, although more than half achieved symptomatic remission 3 years after service entry, the rates of functional remission and recovery were low. More intensive psychosocial interventions may be required to further improve patients' functional outcome.

Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Can insight be predicted in first-episode psychosis patients? A longitudinal and hierarchical analysis of predictors in a drug-naïve sample

Poor insight is a ubiquitous phenomenon in psychosis with great repercussions on clinical practise and the outcomes of patients. Poor insight comprises “state” and “trait” components. This paper targeted predictors of global insight and insight dimensions at baseline in the drug-naïve status of first-episode psychosis patients and during a 6-month follow up after episode remission.Seventy-seven consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders (FESSD) completed baseline and 6-month insight, premorbid, symptomatological and neuropsychological assessments. Insight measures served as dependent variables for a set of hierarchical multiple regression models.Premorbid personality abnormalities and duration of untreated psychosis (DUP) significantly predicted ‘state’ and ‘trait’ insight global scores. Duration of untreated psychosis (DUP) significantly predicted ‘state’ insight, measured as refusal of treatment at baseline. Moreover, premorbid personality abnormalities and DUP with minor contributions of demographic variables, cognitive functioning and psychopathological dimensions predicted ‘trait insight’, defined as insight after remission of the psychosis episode‘Insight improver’ FESSD patients showed better late adolescent premorbid adjustment, lower personality disturbances (sociopathic, schizoid and schizotypy dimensions), shorter DUP, and lower positive, negative and disorganisation symptoms and better cognitive performance on the Trail Making B test at the 6-month follow-up assessment.Premorbid personality abnormalities and DUP were predictors of ‘state’ and ‘trait’ insight, both at global scores and dimension levels. Moreover, insight improvement in patients with FESSD was related to premorbid abnormalities (in both adjustment and personality), shorter DUP, fewer positive and negative symptoms and better performance in cognitive tests at the 6-month follow up.

S01-01 - Early Detection in Psychosis: 5 year Outcome in the Scandinavian Tips-Study

BackgroundDuring the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long term outcome. This study reports the effects of reducing DUP on 5-year course and outcome.MethodsDuring 1997-2000 a total of 281 consecutive patients aged &gt; 17 years with first episode non-affective psychosis were recruited of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) program with public information campaigns and low-threshold psychosis detection teams was established in one health-care area (ED-area), but not in a comparable area (No-ED area). Both areas ran equivalent treatment programs during the first 2 years and need-adapted treatment thereafter.ResultsAt the start of treatment ED-patients had shorter DUP and less symptoms than No-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modeling showed better scores for the ED-group on PANSS negative, depressive and cognitive factors and for GAF social functioning at 5 year follow-up. The ED-group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders.ConclusionsEarly treatment had positive effects on clinical and functional status at 5 year follow-up in first episode psychosis.

Predictors of response and remission in the acute treatment of first-episode schizophrenia patients — Is it all about early response?

Background To evaluate the predictive validity of early response compared to other well-known predictor variables in acutely ill first-episode patients. Methods 112 patients were treated with a mean dosage of 4.14 mg (± 1.70) haloperidol and 112 patients with a mean dosage of 4.17 mg (± 1.55) risperidone for a mean inpatient treatment duration of 42.92 days (± 16.85) within a double-blind, randomized controlled trial. Early response was defined as a ≥ 30% improvement in the PANSS total score by week 2, response as a ≥ 50% reduction in the PANSS total score from admission to discharge and remission according to the consensus criteria. Univariate tests and logistic regression models were applied to identify significant predictors of response and remission. Results 52% of the patients were responders and 59% remitters at discharge. Non-remitters at discharge were hindered from becoming remitters mainly by the presence of negative symptoms. Univariate tests revealed several significant differences between responders/non-responders and remitters/non-remitters such as age, severity of baseline psychopathology as well as the frequency of early response. Both early response (p < 0.0001) and a higher PANSS positive subscore at admission (p = 0.0002) were identified as significant predictors of response at discharge, whereas a shorter duration of untreated psychosis (p = 0.0167), a lower PANSS general psychopathology subscore (p < 0.0001), and early treatment response (p = 0.0002) were identified as significant predictors of remission. Conclusion Together with the finding that early response is a significant predictor of response and remission, the relevance and predictive validity of negative and depressive symptoms for outcome is also highlighted.

Cannabis use predicts shorter duration of untreated psychosis and lower levels of negative symptoms in first-episode psychosis: a South African study

Cannabis use/abuse is a common co-morbid problem in patients experiencing a first episode of psychotic illness (FEP). The relationship between the clinical presentation of FEP and cannabis abuse is complex and warrants further investigation, especially within the South African context. We tested associations between recent/current cannabis use and duration of untreated psychosis (DUP), age of onset (AO), PANSS-rated (Positive and Negative Syndrome Scale) positive, negative and general psychopathology symptoms and depressive symptoms (Calgary Depression Scale for Schizophrenia) in a sample of 54 patients with FEP. Mean DUP was 34.4 weeks, while mean AO was 24.7 years. Co-morbid cannabis use occurred in 35% of the sample and was significantly associated with shorter DUP (Mann-Whitney U, p=0.026). While not significant, there was also a trend association between cannabis use and lower negative symptoms (Mann-Whitney U, p=0.051). Current/recent cannabis use was associated with clinical features of psychosis onset that previously have been associated with better outcome. Medium and long-term outcome for cannabis users however, is likely to depend on whether or not cannabis use is ongoing.

Prognostic value of duration of untreated psychosis in long-term outcome of schizophrenia

SummaryBackgroundThe goal of this prognostic study was to investigate whether the duration of untreated psychosis (DUP) may have a prognostic value with regard to the further course of the illness.Material/MethodsFifty-eight patients (77% of the original study group) diagnosed with DSM III schizophrenia and later re-diagnosed with DSM IV T-R were assessed at 4 time points. Number of relapses, average time of inpatient treatment, number of inpatient readmissions, and severity of psychopathological symptoms were assessed at 1-, 3-, 7- and 12-year follow-ups. DUP information was obtained by clinical interview with patients and their families. The severity of symptoms was assessed using BPRS-SA, UCLA version.ResultsIncreases in the number of relapses at follow-ups were more prominent in the group with a longer DUP (p<0.001). Decreases in the results of BPRS (symptom improvement) were more prominent in patients with a shorter DUP. The latter had significantly lower results than patients with a long DUP at each assessment except the index hospitalization (p equalled, respectively: 0.449; 0.002; 0.012; 0.034 and 0.014). Decreases in positive symptoms were greater in patients with a short DUP – significant at all except the 7-year follow-up (p equalled respectively: 0.230; <0.001; 0.011; 0.214; <0.001).Conclusions1) A positive correlation was found between DUP and the dynamics of general and positive symptoms and the number of relapses. 2) There was no significant relationship between DUP and the dynamics of negative symptoms, whereas the relationship between the time and number of re-hospitalizations was marginally significant.

Diagnostic stability of first-episode psychosis and predictors of diagnostic shift from non-affective psychosis to bipolar disorder: A retrospective evaluation after recurrence

Diagnostic changes during follow-up are not uncommon with a first-episode psychosis (FEP). This study aimed to evaluate the diagnostic stability of the FEP and to identify factors associated with a diagnostic shift from non-affective psychosis to bipolar disorder. Considering that the diagnosis of FEP is frequently more definite after recurrence in many clinical settings, a retrospective evaluation after recurrence was preformed. Subjects were 150 patients with psychotic disorders who had been admitted to a psychiatric ward both for first episode and recurrence of their psychosis. Consensus diagnosis was made for each episode through a review of hospital records. Patients diagnosed with non-affective psychoses at the first episode were included in the analysis of predictive factors of a diagnostic shift to bipolar disorder. First-episode diagnoses were revised upon recurrence in 20.7% of patients. The most common change was to bipolar disorder accounting for more than half of all diagnostic changes. Schizophrenia exhibited the highest prospective and retrospective diagnostic consistencies. Female gender, short duration of untreated psychosis, high level of premorbid functioning, and several symptoms including lability, mood elation, hyperactivity, and delusions with religious or grandiose nature were identified as predictive factors for a diagnostic shift from non-affective psychosis to bipolar disorder. Clinical features of psychoses seem to evolve during the disease course resulting in diagnostic changes upon recurrence in a significant portion of FEP. Special consideration on a diagnostic shift to bipolar disorder is required in patients exhibiting the predictive factors identified in the current study.

Early detection of psychosis: positive effects on 5-year outcome

During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome. This study reports the effects of reducing DUP on 5-year course and outcome. During 1997-2000 a total of 281 consecutive patients aged >17 years with first episode non-affective psychosis were recruited, of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) programme with public information campaigns and low-threshold psychosis detection teams was established in one healthcare area (ED-area), but not in a comparable area (no-ED area). Both areas ran equivalent treatment programmes during the first 2 years and need-adapted treatment thereafter. At the start of treatment, ED-patients had shorter DUP and less symptoms than no-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modelling showed better scores for the ED group on the Positive and Negative Syndrome Scale negative, depressive and cognitive factors and for global assessment of functioning for social functioning at 5-year follow-up. The ED group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders. Early treatment had positive effects on clinical and functional status at 5-year follow-up in first episode psychosis.

Association between duration of untreated psychosis and brain morphology in schizophrenia within the Northern Finland 1966 Birth Cohort

Background Duration of untreated psychosis (DUP) has been linked with poor prognosis and changes in the brain structure in schizophrenia at least at the beginning of the disease, but it is still unknown whether DUP relates to brain morphometry in the longer term. Our aim was to analyze the relation between DUP and the brain structure in schizophrenia in the general population, after several years of illness. Methods Brains of subjects with psychosis from the Northern Finland 1966 Birth Cohort (NFBC 1966) were scanned with MRI during 1999–2001 after an 11-year follow-up. DUP was assessed from medical records and regressed against global and local tissue density measurements. The brain morphometric and the DUP information were available for 46 subjects with DSM-III-R schizophrenia. Results The DUP did not correlate with volumes of the total gray or white matter or the cerebrospinal fluid. The length of DUP associated positively with reduced densities of the right limbic area and the right hippocampus. Conclusions Long DUP was slightly associated with reductions of gray matter densities in the limbic area and especially the hippocampus after several years follow-up, supporting the hypothesis that, compared to short DUP, long DUP might be a marker of different disease trajectories including subtle morphometric changes.

The influencing factors of duration of untreated psychosis and the relationship between DUP and treatment outcome in epidemiological first episode schizophrenia

Objective To explore the influencing factor of duration of untreated psychosis(DUP) and the relationship between duration of untreated psychosis and treatment outcome in epidemiological first-episode schizophrenia. Methods 912 medical records of the first episode schizophrenia patients were recruited in the study for epidemiological survey . The general medical data, clinical diagnosis, and treatment outcome were collected. DUP was determined refer to symptom onset for schizophrenia (SOS) scale. Patients were divided into short DUP and long DUP groups according to the median values of DUP values. Results Between short DUP and long DUP groups, the difference in marriage was significant ( P < 0. 05). The unmarried patients in the short DUP group (63.7% ) was higher than the long DUP group (52.6% ), the variance was significant (λ2 =5.990, P<0.05). The divorce in the short DUP group (0.6% ) was lower than the long DUP group (4.4% ) , the variance was significant (λ2 =5.079, P<0.01).The simple schizophrenia in the short DUP group (1.5%) was lower than the long DUP group (4. 1% ) , the variance was significant (λ2 =5.868, P<0.05). The treatment outcomes between the two groups had a significant variance ( λ2 =36.093, P < 0.01) , and the Ridit analysis of treatment outcomes between the two groups showed significant difference ( u = 5.183, P<0.01). The marriage,age of onset and clinical diagnosis were significantly correlated with DUP in multiple factor Logistic regression analysis. Conclusion The marriage,age of onset and clinical diagnosis are significantly correlated with DUP in the first episode schizophrenia patients,the longer of DUP and the worse of treatment outcome. Key words: Duration of untreated psychosis; First episode schizophrenia