Daniel Cavalcante1, Luccas Coutinho1, Bruno Ortiz1, Mariane Noto1, Quirino Cordeiro1, Vanessa Ota1, Sintia Belangeiro1, Rodrigo Bressan1, Ary Gadelha1, Cristiano Noto1; 1UNIVERSIDADE FEDERAL DE SÃO PAULO
The duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcome in psychosis. In low- and middle-income countries, despite the advances in the mental health assistance, there are still few studies addressing this issue. We aimed to verify if DUP can predict worse symptom severity and treatment response in a Brazilian cohort of antipsychotic naïve patients in first episode of psychosis (FEP). Our sample comprised 145 patients admitted to a psychiatric emergency service. Diagnosis was established according to the Structured Clinical Interview for DSM-IV (SCID). Symptom severity was measured with the Positive And Negative Symptoms Scale (PANSS) considering five dimensions (positive, negative, depressive, disorganized and excitement), and the functionality was assessed with the Global Assessment of Functioning Scale (GAF). We performed multivariated linear regressions using DUP to predict the treatment outcomes, controlling for possible confounders as sex, age, income and living arrangement. All patients were treated with risperidone and 79 patients were reassessed after 10 weeks of treatment. The DUP’s median was 61 days (interquartile range: 170; min=0; max=1770). At baseline, we have not found a significant prediction, but after 10 weeks, DUP predicted worse scores on positive dimension (p<0.001, R²=0.279, β=0.012), negative dimension (p=0.001, R²=0.262, β=0.012), functionality (p=0.005, R²=0.175, β=1.848) and response to treatment (p<0.001, R²=0.325, β=0.042). Our findings indicate that DUP does not influence the baseline status of the patients, but can predict the treatment outcomes in a short-term follow-up, even accounting for premorbid clinical and sociodemographic factors.
