عوامل موثر بر مدت زمان ابتلا به روان پریشی درمان نشده

Background Shortening the duration of untreated psychosis (DUP) – with the aim of improving the prognosis of psychotic disorders – requires an understanding of the causes of treatment delay. Current findings concerning several candidate risk factors of a longer DUP are inconsistent. Our aim was to identify factors contributing to DUP in a large sample that represents the treated prevalence of non-affective psychotic disorders. Method Patients with a non-affective psychotic disorder were recruited from mental health care institutes from 2004 to 2008. Of the 1120 patients enrolled, 852 could be included in the present analysis. Examined candidate factors were gender, educational level, migration status, premorbid adjustment and age at onset of the psychotic disorder. DUP was divided into five ordinal categories: less than one month, one month to three months, three months to six months, six months to twelve months and twelve months and over. An ordinal logistic regression analysis was used to identify the risk factors of a longer DUP. Results Median DUP was less than one month (IQR 2). The factors migration status (p = 0.028), age at onset of the psychotic disorder (p = 0.003) and gender (p = 0.034) were significantly associated with DUP in our analysis. Conclusion First generation immigrant patients, patients with an early onset of their psychotic disorder and male patients seem at risk of a longer DUP. These findings can assist in designing specific interventions to shorten treatment delay.

The duration of untreated psychosis (DUP) is defined as the time from the emergence of the first psychotic episode to the initiation of adequate treatment. DUP can last days, months or even years (Marshall et al., 2005). A longer DUP is associated with worse short-term (Marshall et al., 2005 and Perkins et al., 2005) and long-term outcomes (Bottlender et al., 2003, Crumlish et al., 2009 and Boonstra et al., 2012a). The potential of DUP being modifiable raises the possibility of improving outcome by shortening DUP. In designing interventions to shorten DUP, it is important to identify factors contributing to DUP. Factors previously associated with a longer DUP include stigma-related concerns (Corrigan, 2004 and Tanskanen et al., 2011), an insidious mode of onset (Morgan et al., 2006 and Compton et al., 2008) and a diagnosis of non-affective psychosis compared with affective psychosis (Morgan et al., 2006, Bechard-Evans et al., 2007 and Schimmelmann et al., 2008). Inconsistent results have been reported for the association between DUP and several other factors. Concerning gender, even though studies continue to show that men have (a tendency for) a longer DUP compared with women (Chang et al., 2011 and Fridgen et al., 2012), a review could not confirm the association (Cascio et al., 2012). Also inconsistent are the findings with respect to the association between DUP and educational level: longer DUP was found to be associated with a higher level (Chong et al., 2005), a lower level (Verdoux et al., 1998) and not with educational level at all (Morgan et al., 2006, Bechard-Evans et al., 2007, Compton et al., 2008 and Compton et al., 2011). Most studies did not find an association between DUP and ethnicity (Anderson et al., 2013). Interestingly however, three recent studies reported an association between DUP and migration status (Sterk et al., 2010, Boonstra et al., 2012b and Nerhus et al., 2013). Furthermore, inconsistent results have been reported with respect to the association between DUP and overall premorbid adjustment (Chen et al., 2005; versus Harrigan et al., 2003 and Schimmelmann et al., 2008) and the association between DUP and age at onset of the psychotic disorder (Bechard-Evans et al., 2007 and Schimmelmann et al., 2008; versus Drake et al., 2000 and Morgan et al., 2006). Notably, many previous studies examining DUP had relatively small sample sizes, a mixed sample of patients with affective and non-affective psychotic disorders and a substantial variation in definition of DUP. Given the importance of knowledge concerning the factors associated with DUP, the inconsistency of previous findings and the limitations of previous research, the association between DUP and candidate risk factors needs further elucidation. The aim of this study was to identify risk factors of a longer DUP in a large sample that represents the treated prevalence of non-affective psychotic disorders. Specifically, we aimed to test the hypothesis that being an immigrant, having a poor premorbid adjustment and having an earlier age at onset of the psychotic disorder are associated with a longer DUP. Furthermore, we hypothesized that gender and educational level are not associated with DUP.