DOES DUP IMPACT ON THE CLINICAL OUTCOME? Harris K., Chilale Saint John of God Community Services

In Mzuzu a study was conducted to examine the extent of the Duration of Untreated Psychosis (DUP) It was found that the mean DUP was 51.7 months which is longer than the findings in the developed countries (12-24 months) The same subjects were followed-up for 18 months after commencing effective treatment Introduction

This mean DUP (51.7) in Mzuzu triggered the question: Does DUP impact on the clinical outcome after commencement of effective treatment? To answer this question, follow up data were analysed and compared with the findings at the initial assessment. Introduction

Clinical Outcome: was defined as an improvement in symptoms (both positive and negative, as measured by Scale of the Assessment of Negative and Positive Symptoms-SANS and SAPS) and improvement in social functioning as measured by the Global Assessment of Functioning (GAF). Definition of Terms

Effective Treatment: – Treatment of up to mg equivalents/ day of chlorpromazine for 4-6 weeks with adequate adherence – Comprehensive psycho-education on biological causes of psychosis and its treatment – Basic counselling Definitions Cont’d

The results are presented in this order: 1)Mean SAPS, SANS, and GAF at Initial Assessment and at Follow-up were compared to show changes ( improvements). 2)Paired sample T-test was used to show whether the changes (improvements) are statistically significant. 3)Does DUP impact on Time to Treatment Response?- independent sample, and Pearson Chi-square tests to show that it does not. Results (overview)

The results raised new questions as follows: Does DUP impact on Time to Treatment Response?- Independent sample, and Pearson Chi-square tests was performed to show that it does not or does’nt. Results cont

SAPS1 denotes SAPS at Initial Assessment SAPS2 denotes SAPS at Follow-up SANS1 denotes SANS at Initial Assessment SANS2 denotes SANS at Follow-up GAF1 denotes GAF at Initial Assessment GAF2 denotes GAF at Follow-up TTTR denotes Time to Treatment Response Notation

VariableMeanSample sizeStd deviation Std error of mean SAPS SAPS SANS SANS GAF GAF Mean SAPS, SANS, and GAF at Initial Assessment and at Follow-up

The mean score of SAPS1 is higher than the mean score of SAPS2; The mean score of SANS1 is higher than the mean score of SANS2; The mean score of GAF1 is lower than the mean score of GAF2. These mean differences show that there were changes (improvement) but were these changes significant? Mean SAPS, SANS, and GAF at Initial Assessment and at Follow-up

Paired differences Mean of the differences ± Std deviation T-test value dfP-value SAPS 1-SAPS ± SANS 1-SANS ± GAF 2-GAF ± Paired Sample T-test for SAPS, SANS, and GAF

The paired sample T-test shows that there were significant changes (improvements) in SAPS, SANS, and GAF of the subjects at Follow-up. It was thought that may be DUP had an impact on the rate at which the subjects improved Therefore, DUP was examined whether or not it impacted on Time to Treatment Response. Paired Sample T-test for SAPS, SANS, and GAF

It was found that, on average, subjects responded to treatment after 9.24 months. Moreover, 25% responded in 5 months, 50% responded in 8 months and 75% responded in 12 months. It follows that only 25% responded to treatment after one year and 75% responded to treatment in within one year. Time to Treatment Response (TTTR)

Did DUP have an impact on the TTTR of the subjects? An independent sample test for the equality of TTTR means between DUP ≤ 5 months and DUP ≥ 6 months would answer this question. DUP in months and TTTR in months T-ValuedfSig. (2-tailed)Mean Difference Std. Error Difference

The value Sig. (2-tailed)=.165 > 0.05, indicates that we can not reject the null hypothesis that the two TTTR means are the same. Therefore there is enough evidence at 5% significance level that the mean TTTR for both DUP groups is the same. We conclude that DUP does not impact on Time to Treatment Response (TTTR). DUP in months and TTTR in months

Time to Treatment Response (TTTR)-in Months Total DUP in Months <= Total DUP in months and TTTR in months

Again this relationship is also not statistically significant as shown by the Pearson Chi-Square test with (Chi-square value=5.825, df=2, P=0.054). DUP does not impact on Time to Treatment Response (TTTR) and, therefore, it does not impact on Clinical Outcome. DUP in months and TTTR in months

Changes in the GAF in relation to DUP

It has been shown that the subjects improved significantly within 18 months in their level of social functioning, as measured by GAF, after an effective treatment was administered. Now we examine how the GAF changed in relation to DUP. GAF1 stands for GAF score at initial assessment, while GAF2 stands for GAF score at Follow-up. Introduction

Positive change in GAF Scale for Short DUP Subjects (DUP of 0-5 months)

There was a significant improvement in social functioning for subjects with short DUP. changes in GAF Scale (DUP of 0-5 months)

GAF Scale for Subjects with (DUP of 6+ months)

There is a significant improvement in social functioning for subjects with long DUP but with seemingly some drops in the social function. We separately examine changes in GAF scale for subjects with DUP of 6-47 months and those with DUP of 48 and above months. We do this to observe what is happening within subjects with long DUP. change in GAF Scale (DUP of 6+ months)

Positive change in GAF Scale for Subjects with Long DUP (DUP of 6-47 months)

There is minimal improvement in social functioning for subjects with DUP from 6-47 months but with seemingly a mild frequency of drops in social function probably due to relapses. change in GAF Scale (DUP of 6-47 months)

Positive change in GAF Scale for Subjects with Long DUP (DUP of months)

For subjects with DUP from 48 and above the improvement in social functioning is minimal but significant. change in GAF Scale (DUP of months)

Generally DUP does not impact on clinical outcome directly Long DUP (DUP of 6+ months) had minimal change in social functioning. That is, the longer the DUP the more likely the patient will have minimal or slow change in social functioning after effective treatment Conclusion