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The duration of untreated psychosis (DUP) has been associated with negative outcomes in psychosis; however, few studies have focused on the duration of active psychotic symptoms after commencing treatment (DAT). In this study, we aimed to evaluate the effect of DUP and DAT on functional long-term outcomes (3 years) in patients with early psychosis.
We evaluated the Scale for the Assessment of Positive Symptoms (SAPS) at frequent intervals for 3 years after presentation to determine the DAT for 307 individuals with first-episode psychosis together with DUP and clinical variables. The functional outcomes were assessed using the Disability Assessment Scale (DAS) at three years, and functional recovery was defined as minimal impairment and return to activity. Associated variables, DAT and DUP were included in logistic regression models to predict functional outcomes. Receiver operating characteristic curves and Youden’s index were applied to assess the best cut-off values.
DAT, (Wald: 13.974; ExpB: 1.097; p < 0.001), premorbid adjustment, initial BPRS score, gender, age of onset and schizophrenia diagnosis were significant predictors of social functioning, whereas only premorbid adjustment (Wald: 11.383; ExpB:1.009), DAT (Wald: 4.850; ExpB: 1.058; p = 0.028) and education were significant predictors of recovery. The optimal cut-off of DAT for predicting social functioning was 3.17 months for DAT (sensitivity: 0.68; specificity: 0.64; Youden’s index: 0.314).
DAT is strongly related to functional outcomes independent of the DUP period or other variables. As a modifiable variable, the reduction of the DAT should be considered a main focus of intervention from the onset of the illness to improve long-term outcomes.
Hallucinations occur when sensations are perceived in the absence of environmental stimuli. They are generated by the brain under normal or abnormal situations, including drowsiness, sensory deprivation, use of or withdrawal from drugs or toxins, structural or metabolic brain disease, seizures or migraine, and psychiatric disorders such as schizophrenia. Hypnagogic and hypnopompic hallucinations (HH) are typically visual, but can be auditory, tactile or kinetic. Complex nocturnal visual hallucinations (CNVH) have somewhat different phenomenology and putative pathophysiology from HHs and can be seen in a variety of pathologic conditions. CNVH have similar phenomenology and represent a final common pathway for a variety of etiologies. The exploding head syndrome (EHS) is thought to be a benign condition characterized by an imagined very loud sound or explosion in the head at sleep onset or on waking during night.
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