Early intervention in schizophrenia may not actually slow or stop a patient’s mental decline, despite a common belief that it will, researchers reported in The American Journal of Psychiatry online.
“Our finding is somewhat counterintuitive. There has been a good amount of evidence suggesting that if you get people who are having their first psychotic episode into treatment as soon as possible, you can avert irreversible declines,” said study lead author Katherine Jonas, PhD, postdoctoral fellow in the psychiatry department at Stony Brook University, Stony Brook, New York.
“We found that if you compare people who got into treatment early with those who did not, the early treatment group only appears to have better outcomes because they are often younger and haven't been sick as long.”
Dr. Jonas and colleagues evaluated the duration of untreated psychosis, or the timespan between psychosis onset and treatment initiation, in 287 people with schizophrenia or schizoaffective disorder. The data included patient observations that spanned from childhood to 20 years after first hospital admission.
Whether the duration of untreated psychosis was long or short, patients experienced similar declines in psychosocial functioning, according to the study. Patients with a long duration of untreated psychosis experienced most of their declines before their first psychiatric hospitalization, while patients with a short duration of untreated psychosis experienced the bulk of their declines after their first hospitalization.
However, when researchers looked at psychosocial function relative to psychosis onset only, they found duration of untreated psychosis did not predict the course of illness.
“The association between duration of untreated psychosis and psychosocial function may be an artifact of early detection, creating the illusion that early intervention is associated with improved outcomes,” researchers concluded. “In other words, duration of untreated psychosis may be better understood as an indicator of illness stage than a predictor of course.”
Jonas KG, Fochtmann LJ, Perlman G, et al. Lead-time bias confounds association between duration of untreated psychosis and illness course in schizophrenia. The American Journal of Psychiatry. 2020 February 12;[Epub ahead of print].