OBJECTIVES: A long duration of untreated psychosis (DUP) is known to be associated with a poorer prognosis and with worse symptomatic and functional outcome. The aim of the study was to test the hypothesis that early detection and treatment with antipsychotics in the prodromal phase of the illness improves the outcome; to compare short and long-term outcome in patients with DUP longer than 1 year (group 1) with patients that were treated already in the prodromal phase of the disease (group 0).
DESIGN AND SETTING: Eighty-seven patients with schizophrenia were included to the retrospective study, 37 patients to group 0 and 50 patients to group 1. The course and outcome of the disease was studied in the two groups. The severity of schizophrenia was evaluated by measuring several outcome parameters. The symptom severity was evaluated using a check list developed from CAARMS inventory; the average daily dose of antipsychotics was calculated as well as the number and duration of hospital admissions. Groups were compared during the acute psychosis of first episode (t1) and at the conclusion of the study (t2).
RESULTS: More symptoms of greater intensity were present during the first and second evaluations in group 1 as compared to group 0 patients. The patients in group 0 needed lower dosages of antipsychotics even several years after treatment had been initiated. This effect persisted until the final evaluation; 11% were without antipsychotics at the conclusion of the study. Patients in group 1 were hospitalized more frequently; they needed more hospitalizations and these were of longer duration. Only 38% of patients in group 0 were treated in the hospital, 27% were hospitalized only once.
CONCLUSIONS: Better outcome can be achieved with early antipsychotic treatment. Patients with long DUP differ from patients who were treated already in the prodromal phase in several outcome measures.