Duration of no treatment: impact on clinical picture and short-term outcome

Background
The duration of untreated illness (DUI) represents a modifiable parameter, the reduction of which may positively influence the outcome and long-term course of related mental conditions. It has been suggested that a long duration of untreated psychosis (DUP) has a neurotoxic effect with expected consequent cognitive dysfunction.
Aim
The aim is to examine the clinical and cognitive effects of DUP and DUI on the 2-year clinical outcome of drug-naive patients having their first-episode psychosis.
Patients and methods
This prospective study was carried out at the Psychological Medicine Hospital, State of Kuwait, and consisted of two parts: (a) baseline assessment, in which all patients with first-contact psychosis were clinically and psychometrically assessed by DSM-I and SCID-I, Positive and Negative Syndrome Scale, Hamilton Depression Rating Scale, Young Mania Rating Scale, Subtests of Wechsler Memory Scale (3rd ed.), and Wechsler Adult Intelligence Scale (WAIS; 3rd ed.) and (b) end of a 2-year follow-up, in which patients who continued 2 years of follow-up were reassessed by all the clinical and psychometric studies used at baseline.
Results
Ninety patients were followed up, of whom 54.5% were nonaffective patients, 23.33% had bipolar psychosis, and 22.22% had depressive psychosis. In the schizophrenia spectrum, although improvement in neuropsychological and cognitive status was observed after treatment, persistent cognitive deficits and negative symptoms were still observed in clinically stable individuals. DUP was found to be related to current age, number of rehospitalizations, negative symptoms, and trail make A, and inversely related to memory subtest scores. In bipolar and depressive psychosis, DUI was significantly related to current age, rehospitalization, age at onset, and total positive symptoms. DUI also had a highly significant inverse relation to performance test and total WAIS (=0.000 and 0.000) and a significant direct relation to speed and processing (trail make A) and with reasoning (trail make B) (=0.006 and 0.006). After 2 years, DUI was significantly inversely related to the performance test of WAIS (=0.026).
Conclusion
Long DUP is associated with lower levels of symptomatic and cognitive recovery. Therefore, early detection programs are required to decrease the period between illness onset, diagnosis, and treatment in first-episode psychotic patients, which could lead to improved therapeutic strategies and public health initiatives.