Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India.
BACKGROUND
Longer duration of untreated psychosis (DUP) is known to be associated with poorer outcome of schizophrenia. DUP is also known to be longer in lower- and middle-income countries. Methodologically sound studies that have examined the association of DUP and outcome of schizophrenia in these countries are lacking.


OBJECTIVE
The aim was to evaluate the association between DUP and outcome of never-treated schizophrenia patients.


METHODS
This study was conducted at the National Institute of Mental Health and Neurosciences, Bangalore, using a prospective cohort design.


METHODS
119 patients with schizophrenia/schizophreniform disorder diagnosed using the computerized diagnostic interview schedule for DSM-IV (CDIS-IV) were further assessed for DUP with the interview for retrospective assessment of onset of schizophrenia (IRAOS). After a mean (SD) follow-up period of 55.9 (37.2) weeks, the social and occupational functioning and psychopathology of 93 (80.2% of the surviving patients) patients were assessed using the social and occupational functioning scale (SOFS) and the positive and negative syndrome scale (PANSS), by raters blind to the DUP data. Spearman's correlation and Kendall's tau-B test were used to analyze the relationship between DUP and the outcome variables.


RESULTS
The mean DUP was 90.2 (median=30.1; SD=121.9) weeks. SOFS and PANSS scores at follow-up were statistically significantly associated with DUP, but not with other baseline variables (SOFS: rho=0.22, P=0.03; PANSS: rho=0.23, P=0.03). Among those with the shortest DUP (<16 weeks; n=33), 45.5%, 30.3%, and 24.2% had no impairment, mild-moderate impairment, and severe impairment, respectively. In contrast, 19.4%, 38.7%, and 41.9% of those with the longest DUP (>72 weeks; n=31) had no, mild-moderate, and severe impairment, respectively (Kendall's Tau-b=0.194; P=0.025).


CONCLUSIONS
The delay in accessing treatment among patients with psychosis is considerable in India, a lower- to middle-income country. Longer DUP is associated with poorer psychopathological and functional outcomes in persons with schizophrenia/schizophreniform disorder.
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. jagatth@yahoo.com
Jagadisha
J
Thirthalli
Naveen Kumar
NK
Channaveerachari
Doddaballapura K
DK
Subbakrishna
Linda B
LB
Cottler
Mathew
M
Varghese
Bangalore N
BN
Gangadhar