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Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients.
J Clin Psychiatry. 2011 Feb; 72(2):225-32.JC

Abstract

OBJECTIVE

Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators.

METHOD

Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders.

RESULTS

The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r = 0.23, P = .02), and poorer insight was associated with longer DUI (r = -0.24, P = .01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems.

CONCLUSIONS

There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges.

Authors+Show Affiliations

Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 49 Jesse Hill Jr Drive, SE, Room #333, Atlanta, GA 30303, USA. mcompto@emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

21382306

Citation

Compton, Michael T., et al. "Patient-level Predictors and Clinical Correlates of Duration of Untreated Psychosis Among Hospitalized First-episode Patients." The Journal of Clinical Psychiatry, vol. 72, no. 2, 2011, pp. 225-32.
Compton MT, Gordon TL, Goulding SM, et al. Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients. J Clin Psychiatry. 2011;72(2):225-32.
Compton, M. T., Gordon, T. L., Goulding, S. M., Esterberg, M. L., Carter, T., Leiner, A. S., Weiss, P. S., Druss, B. G., Walker, E. F., & Kaslow, N. J. (2011). Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients. The Journal of Clinical Psychiatry, 72(2), 225-32. https://doi.org/10.4088/JCP.09m05704yel
Compton MT, et al. Patient-level Predictors and Clinical Correlates of Duration of Untreated Psychosis Among Hospitalized First-episode Patients. J Clin Psychiatry. 2011;72(2):225-32. PubMed PMID: 21382306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients. AU - Compton,Michael T, AU - Gordon,Tynessa L, AU - Goulding,Sandra M, AU - Esterberg,Michelle L, AU - Carter,Tandrea, AU - Leiner,Amy S, AU - Weiss,Paul S, AU - Druss,Benjamin G, AU - Walker,Elaine F, AU - Kaslow,Nadine J, PY - 2009/09/17/received PY - 2009/12/14/accepted PY - 2011/3/9/entrez PY - 2011/3/9/pubmed PY - 2011/5/4/medline SP - 225 EP - 32 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 72 IS - 2 N2 - OBJECTIVE: Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators. METHOD: Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS: The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r = 0.23, P = .02), and poorer insight was associated with longer DUI (r = -0.24, P = .01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems. CONCLUSIONS: There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/21382306/Patient_level_predictors_and_clinical_correlates_of_duration_of_untreated_psychosis_among_hospitalized_first_episode_patients_ L2 - http://www.psychiatrist.com/jcp/article/pages/2011/v72n02/v72n0212.aspx DB - PRIME DP - Unbound Medicine ER -