Is duration of illness really influencing outcome in major psychoses?

Abstract

Background: An increasing number of studies identifies the duration of illness (DI) as an important predictor of outcome in patients affected by major psychoses (MP). The aim of the present paper was to revise medical literature about DI and its effects on MP, focusing in particular on the relationship between DI and outcome with particular reference to treatment response, suicidal risk, cognitive impairment and social functioning. Methods: A search in the main database sources has been performed to obtain a comprehensive overview. Studies with different methodologies (open and double-blinded) have been included, while papers considering other variables such as duration of untreated episode/illness were excluded. MP included the diagnoses of schizophrenia, bipolar disorder and major depressive disorder. Results: Available data show that DI influences treatment response, suicidal risk and loss of social functioning in schizophrenic patients, while results are more controversial with regard to cognitive impairment. In bipolar disorder, a long DI has been associated with less treatment response, more suicidal risk and cognitive impairment, but more data are needed to draw definitive conclusions. Finally, studies, regarding DI of illness and its predictive value of outcome in major depressive disorder show contradictory results. Conclusions: DI appears a negative outcome factor particularly for schizophrenia, while with regard to mood disorders, more data are needed to draw definitive sound conclusions.

• Duration of illness (DI)
• Major psychoses (MP)
• Outcome

Declaration of interest: Prof. Altamura has served as Merck and Astra Zeneca consultant, and Sanofi, Lilly and Pfizer speaker bureau. Dr Buoli has served as Roche consultant. Dr Serati does not have any affiliation with or financial interest in any organization that might pose a conflict of interest with the present article. The authors alone are responsible for the content and writing of the paper.