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Schizophrenia Bulletin 2003 29(4):757-769;
© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

Prolonged Untreated Illness Duration From Prodromal Onset Predicts Outcome in First Episode Psychoses

Matcheri S. Keshavan, M.D., Professor, Gretchen Haas, ph.D., Associate Professor, Jean Miewald, B.A., Associate Professor, Debra M. Montrose, ph.D., Associate Professor, Ravinder Reddy, M.D., Associate Professor, Nina R. Schooler, ph.D., Professor of Psychiatry and John A. Sweeney, ph.D., Professor of Psychiatry
University of Pittsburgh School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic Pittsburgh, PA
Long Island Jewish Medical Center, Hillside Hospital Glen Oaks, NY
University of Illinois at Chicago, Department of Psychiatry Chicago, IL

Send reprint requests to Dr. M.S. Keshavan, UPMC Health System-Western Psychiatric Institute and Clinic, Room 441, 3811 O'Hara Street, Pittsburgh, PA 15213; e-mail: keshavanms{at}upmc.edu

Several, although not all, studies suggest that prolonged duration of untreated illness (DUI) predicts poor outcome in psychotic disorders such as schizophrenia. It is unclear whether this association can be explained by factors such as baseline deficits or poor premorbid adjustment. First episode psychotic patients were evaluated at 1 and 2 years following baseline evaluations. Predictive measures showing significant correlations with outcome were entered in multiple regression analyses with Strauss-Carpenter scale (SC) and Global Assessment of Functioning scale (GAF) outcome scores as dependent variables. Illness duration computed from the onset of the prodrome (DUI-pro), used both as a dichotomous and as a continuous measure, highly significantly predicted both GAF and SC scores at 2 years. On the other hand, baseline functioning significantly predicted the 1-year but not the 2-year outcome. When Premorbid Adjustment Scale (PAS) scores were additionally entered into the analyses in a smaller subset, the relation between DUI-pro and the 2-year outcome scores remained significant. Significant associations were also seen between outcome and baseline neuropsychological deficits involving attention and memory. Further research is needed to examine whether prolonged untreated illness is simply associated with poor outcome or plays a causal role in relation to outcome. The latter, if true, would strongly support therapeutic intervention efforts in the prodromal and early psychotic phases of schizophrenia.

Keywords: Prodrome / psychosis / illness duration / outcome / schizophrenia


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