Duration of active psychosis and functional outcomes in first-episode non-affective psychosis

作者：Maria Pelayo Teran Jose; Gajardo Galan Virginia; Gomez Revuelta Marcos; Ortiz Garcia de la Foz Victor; Ayesa Arriola Rosa; Tabares Seisdedos Rafael; Crespo Facorro Benedicto

来源：European Psychiatry, 2018, 52: 29-37.

DOI：10.1016/j.eurpsy.2018.03.003

• Schizophrenia
• Early intervention
• Positive symptoms
• Prognosis
• Prospective study
• Neurotoxicity hypothesis

Background: The duration of untreated psychosis (DUP) has been associated with negative outcomes in psychosis; however, few studies have focused on the duration of active psychotic symptoms after commencing treatment (DAT). In this study, we aimed to evaluate the effect of DUP and DAT on functional long-term outcomes (3 years) in patients with early psychosis.
Methods: We evaluated the Scale for the Assessment of Positive Symptoms (SAPS) at frequent intervals for 3 years after presentation to determine the DAT for 307 individuals with first-episode psychosis together with DUP and clinical variables. The functional outcomes were assessed using the Disability Assessment Scale (DAS) at three years, and functional recovery was defined as minimal impairment and return to activity. Associated variables, DAT and DUP were included in logistic regression models to predict functional outcomes. Receiver operating characteristic curves and Youden's index were applied to assess the best cut-off values.
Results: DAT, (Wald: 13.974; ExpB: 1.097; p < 0.001), premorbid adjustment, initial BPRS score, gender, age of onset and schizophrenia diagnosis were significant predictors of social functioning, whereas only premorbid adjustment (Wald: 11.383; ExpB:1.009), DAT (Wald: 4.850; ExpB: 1.058; p = 0.028) and education were significant predictors of recovery. The optimal cut-off of DAT for predicting social functioning was 3.17 months for DAT (sensitivity: 0.68; specificity: 0.64; Youden's index: 0.314).
Conclusions: DAT is strongly related to functional outcomes independent of the DUP period or other variables. As a modifiable variable, the reduction of the DAT should be considered a main focus of intervention from the onset of the illness to improve long-term outcomes.

• 出版日期2018-8