Delay in treating psychosis has major long-term impact

A delay in treating psychosis can lead to a worsening of symptoms and quality of life, and this can remain evident for at least two decades after a patient first experiences illness, a new Irish study has found.

An estimated one in 100 people will experience an episode of psychosis in their lifetime. Symptoms can include irrational beliefs, impairments in thought processes, impairment in motivation and abnormal sensory experiences.

A longitudinal study - one of the longest running studies of its kind to be undertaken globally - was led by researchers at the DETECT Early Intervention in Psychosis Service and RCSI University of Medicine and Health Sciences.

It involved 171 people who first presented with psychosis to Cluain Mhuire Mental Health Service or St John of God Hospital in Dublin between 1995 and 1999. They were then studied again at 6 months and then four, eight, 12 and 20 years later. The participants’ psychotic symptoms, functioning and quality of life were assessed at each time point.

The researchers found that those who experienced longer delays in treatment had worse outcomes 20 years later in terms of their symptoms such as hallucinations and social withdrawal, functioning such as employment status and quality of life such as having satisfying interpersonal relationships.

While associations between delayed treatment and worse long-term outcomes can vary depending on what outcome is measured, the researchers found that they are sustained across decades in a way that could not be explained by other factors.

They said that while the importance of early detection and treatment for physical health conditions, such as cancer and heart disease, is now seen as “conventional wisdom”, this study suggests that this is also the case for psychosis.

The longer a person experiences untreated psychosis, the poorer their outcome for at least 20 years after the initial diagnosis.

“We found that a longer delay between when a person first experiences psychosis and is treated influences the extent of their recovery in the short, medium and long term. While psychosis typically occurs in early adulthood, it can also occur at any stage in a person’s life therefore everyone needs to be aware of how to identify it,” commented research psychologist and the study’s lead author, Dr Donal O’Keeffe.

According to consultant psychiatrist and one of the study’s senior authors, Prof Mary Clarke, these results “highlight the importance of ensuring that those with a diagnosis of psychosis have timely access to evidence-based treatments”.

“The findings from this study also underscore the importance of investing in research that aims to improve the outcome of psychotic illnesses,” she noted.

The researchers pointed out that like some physical symptoms, initial psychological symptoms can be subtle.

“It is always better that such concerns are discussed with someone, such as one’s GP, rather than neglected and potentially leading to more serious illness,” added another of the study’s senior authors, Prof John Waddington.

The study is published in The American Journal of Psychiatry and can be viewed here.