Duration of untreated psychosis: predictors and clinical consequences

Apeldoorn, S. (2013) Duration of untreated psychosis: predictors and clinical consequences. thesis, Medicine.

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Abstract

Background: Effectively shortening the duration of untreated psychosis (DUP) - with the aim to improve the prognosis of psychotic disorders - requires an understanding of the causes of treatment delay. Findings concerning predictors of DUP are inconsistent and many previous studies have important limitations, e.g. small or non-representative samples. Therefore the association between DUP and predictors needs further elaboration. Furthermore, longer DUP is often associated with the outcomes remission and the severity of symptoms. However, several previous results may be biased by limitations of the three-factor Positive and Negative Syndrome Scale (PANSS) model that is often used and by the failing to control adequately for potential confounders. Therefore the association between DUP and remission and symptom severity deserves further elaboration as well. Aims: 1) to examine whether there is an association between DUP and the predictor variables gender, educational degree, migration status, premorbid adjustment and age at onset of the psychotic disorder; 2) to examine whether there is an association between DUP and the outcome variables remission and symptom severity. Method: The present study is part of the Genetic Risk and Outcome of Psychosis (GROUP) project: a naturalistic cohort study. From 2004 to 2008 patients with a non-affective psychotic disorder were recruited from mental health care institutes in The Netherlands and Belgium. The present study included 852 patients. To determine symptom severity a five-factor PANSS model was used, which consists of a positive symptoms, negative symptoms, disorganization, excitement and emotional distress subscale. Analyses concerning DUP and its predictors were performed by a Zero-inflated Negative Binomial model; a regression model that deals with an excess of zero counts within a data set. For analyses concerning DUP and its outcomes, DUP was dichotomized and logistic and multiple linear regressions were applied. The associations were adjusted for the potential confounders gender, premorbid adjustment and age at onset of the psychotic disorder. Results: Mean DUP was 4.4 months and median DUP was 0 months. Longer DUP was predicted by being a first generation immigrant (p = 0.035), but not by being a second generation immigrant, gender, educational degree, premorbid adjustment or age at onset of the psychotic disorder. After adjustment for potential confounders, longer DUP predicted less achievement of remission (p = 0.029) and a higher severity of positive symptoms (p = 0.011). No association was found between DUP and the severity of negative symptoms, disorganization, excitement or emotional distress. Conclusions: 1) for first generation immigrant patients average DUP was longer than for native-born patients. This may be of major importance in a country like The Netherlands, were immigrants are more than one fifth of the population; 2) gender, educational degree, premorbid adjustment and age at onset of the psychotic disorder were no significant predictors of DUP; 3) patients with a longer DUP less often achieved remission and had a higher severity of positive symptoms. This supports the importance of early detection and treatment of patients with psychotic disorders; 4) DUP was not significantly associated with the severity of negative symptoms, disorganization, excitement or emotional distress.

Item Type:	Thesis (Thesis)
Supervisor name:	Bruggeman, Dr. R. and Rob Giel Onderzoekcentrum
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:43
Last Modified:	25 Jun 2020 10:43
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/481

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