RESEARCH WEEKLY: Duration of Untreated Psychosis and Genetics
By Elizabeth Sinclair Hancq
(June 1, 2022) The duration of untreated psychosis, the time from when psychotic symptoms first manifest to when adequate treatment is achieved, is a clinically meaningful measure and is associated with both the short-term and long-term outcomes of schizophrenia. For example, previous research has suggested that a longer duration of untreated psychosis is associated with an increased risk for suicide, violent behavior and worse overall prognosis. This is in part due to the physical damages that untreated psychosis can have on the brain.
It is for these reasons there has been a large investment into early psychosis treatment programs, as the scientific community and social service providers recognize that the earlier someone with psychosis is receiving treatment, the better their overall prognosis and response to treatment will be. Most developed countries have robust early psychosis treatment programs, such as coordinated specialty care programs. In the United States, states are required to utilize 10% of their mental health funding from the Substance Abuse and Mental Health Services Administration toward early psychosis treatment programs.
However, in evaluations of first-episode psychosis programs, researchers found that the programs have not had large impacts on the duration of untreated psychosis of individuals enrolled. Therefore, researchers have speculated that the duration of untreated psychosis is more due to illness severity or nonmodifiable factors rather than something that can be prevented. This includes a potential biological impact on duration of untreated psychosis, specifically genetics.
Results of genetic variants and time to treatment
The EU-GEI group, a European coalition of researchers working to study gene-environment interactions in schizophrenia, sought to examine the relationship between genetics and the duration of untreated psychosis. The researchers conducted a genetic analysis on individuals with first-episode psychosis from six different countries and across 17 different research sites between May 2010 and April 2015 to understand if genetics can partly explain variations in duration of untreated psychosis among individuals with first-episode psychosis.
Polygenic scores were utilized to categorize individual’s genetic variations into groups of diagnoses, including schizophrenia, bipolar disorder and major depression. Polygenic scores are a way to capture the variation in genetics that influence the propensity for a particular disease. Rather than the result of one or two genes, these disorders are much more multifactorial, with multiple genetic variants with small effects impacting an individual’s risk for developing the illness. This type of analysis allows for the examination of the role of genetics in influencing particular outcomes without the need to focus on one or two particular genes.
Publishing their work in Schizophrenia Bulletin, the researchers found no effect of the genetic polygenic scores on duration of untreated psychosis. Specifically, the higher the polygenic score, which indicates a higher risk of disease and has previously been shown to be associated with increased symptoms, had no correlation with the time between an individual’s illness onset and the beginning of meaningful treatment.
The results mean that genetics likely do not play a role in the duration of untreated psychosis. Rather, structural barriers to treatment, mental health system accessibility or other modifiable factors are more important in determining how long an individual goes from the onset of symptoms to actually receiving treatment.
These results underscore the importance of education about the signs and symptoms of severe mental illness and early identification and treatment of these individuals by the mental healthcare system. Further work is needed to educate the public about the first onset of psychotic disorders as well as providing resources to education and healthcare professionals who may encounter individuals when they are first developing symptoms.
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