The "Doses" of Initial, Untreated Hallucinations and Delusions: A Proof-of-Concept Study of Enhanced Predictors of First-Episode Symptomatology and Functioning Relative to Duration of Untreated Psychosis

Objective: A prominent limitation of literature on duration of untreated psychosis (DUP) is that researchers have studied only unidimensional duration as an early-course predictor, neglecting potential effects of frequency/severity of initial, untreated psychosis. This study demonstrates utility of the concept of “doses” of initial, untreated hallucinations and delusions—representing more complete measures of “exposure”—as enhanced predictors of symptomatology/functioning relative to DUP alone.

Method: 109 first-episode patients with a psychotic disorder based on Structured Clinical Interview for DSM-IV Axis I Disorders criteria were assessed at 3 public-sector psychiatric units serving an urban, socially disadvantaged, predominantly African American community between July 2004 and June 2008. Dependent variables included negative symptoms, general psychopathology, insight, and global functioning at initial hospitalization.

Results: When added to a baseline model (age, gender, and premorbid academic and social functioning), DUP predicted current negative symptoms (P = .02, model R2 = 0.20), though dose of hallucinations and dose of delusions did not. However, regarding general psychopathology symptoms, DUP was not predictive, though dose of delusions was, when controlling for the other 5 variables (P = .02, model R2 = 0.15). DUP was not a significant predictor of insight, though dose of hallucinations was, such that a greater dose of initial, untreated hallucinations was associated with better insight at initial hospitalization (P < .01, model R2 = 0.20). DUP was associated with global functioning (P = .05), and dose of delusions added significantly to this prediction (P = .04; model R2 = 0.13).

Conclusions: Doses of initial, untreated hallucinations and delusions add substantively, though differentially, to the prediction of early-course symptomatology and functioning. Findings suggest a need for focused research on frequency/severity of pretreatment psychotic symptoms beyond duration measures.

J Clin Psychiatry

Submitted: November 19, 2009; accepted May 3, 2010.

Online ahead of print: January 11, 2011 (doi:10.4088/JCP.09m05841yel).

Corresponding author: Michael T. Compton, MD, MPH, The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, 2150 Pensylvania Ave, N.W., Room #8-429, Washington, DC 20037 (mcompton@mfa.gwu.edu).