Does treatment delay predict occupational functioning in first-episode psychosis?

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Abstract

Although duration of untreated psychosis (DUP) predicts treatment outcome as assessed by symptoms in first-episode psychosis, there is much less evidence concerning its relation to social functioning. We present the results of a prospective study of 163 first-episode psychosis patients examining occupational activity at three years, after initiation of treatment. Both shorter DUP and higher social support were significantly associated with more full time occupational activity at follow-up. The findings suggest the importance of reducing treatment delay and increasing social support in order to improve occupational outcomes for those with first-episode psychosis.

Introduction

It has been hypothesized that a longer duration of untreated psychosis (DUP) results in less symptomatic and functional recovery once treatment for a psychotic disorder is initiated (McGlashan, 1996, Wyatt, 1991). There is evidence of a correlation between DUP and symptom reduction over the first year or two of treatment (Norman et al., 2005a, Perkins et al., 2005), but there is less evidence concerning DUP and indices of functioning (Bottlender and Moller, 2003, Malla and Payne, 2005, Norman et al., 2005a, Perkins et al., 2005). Studies which assess functioning in relation to DUP have typically used summary measures of functioning (e.g. Addington et al., 2003, Harris et al., 2005) which may be less informative than self-explanatory measures such as employment, financial support, nature of housing etc. (Tulloch et al., 2006).

In this report, we test the hypothesis that DUP is an independent predictor of full time occupational activities at three years after initiation of treatment. The independence of DUP is assessed in relation to other predictors such as gender, age of onset, premorbid adjustment, education level and rated capacity for full time work at presentation for treatment, social support, substance use and adherence to treatment.

Section snippets

Participants

Participants were patients who entered in the Prevention and Early Intervention Program for Psychosis (PEPP) in London, Ontario, Canada between March 1997 and July 2003. The assessment and treatment protocols utilized by PEPP are described elsewhere (Malla et al., 2003; or www.PEPP.ca). Patients provided informed consent as approved by the University of Western Ontario Ethics Board for Health Sciences Research.

265 previously untreated individuals consented and engaged in treatment during the

Sample

Table 1 shows the characteristics. There were no significant differences between these patients and those who were not available at three year on the characteristics in Table 1, with the exception of diagnosis. There was a significantly greater likelihood of diagnosis of schizophrenia or schizoaffective disorder among those with 3-year outcome data (79.8%) than for those lost to follow-up (53.4%) (χ2 = 20.7, df = 1, p < .001).

Prediction of occupational activity

At 3 years, 44% of patients had no weeks of full time occupation and 28.2%

Discussion

These prospective data indicate that treatment delay predicts subsequent full time occupational activities. Two retrospective studies have failed to find DUP significantly related to employment outcomes (de Haan et al., 2003, Tirupati et al., 2004), although the latter does report a trend in the direction of longer DUP being associated with less employment during the first year of treatment. Possible explanations of the discrepancies in findings are that we used a longer term follow-up; and the

Acknowledgment

This research was supported by grant number 57925 from Canadian Institutes of Health Research.

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