Variation in duration of untreated psychosis in an 18-year perspective (original) (raw)
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The British Journal of Psychiatry, 2005
BackgroundIt is unclear whether an early detection programme increases or decreases the number of patients with a long duration of untreated psychosis (DUP), and whether these differ from other patients with a long DUP.AimsTo investigate whether the number and characteristics of patients with a long DUP in the early detection programme differ from those with along DUP in the non-earlydetection programme.MethodWe compared the number and characteristics of patients with a DUP $2 years in an early detection area and a non-early detection area.ResultsThe early detection programme recruited slightly fewer patients with a long DUP than the non-early detection programme. The patients in the early detection programme had lower PANSS scores, but more frequently had a deteriorating course of premorbid social functioning.ConclusionsAn early detection programme does not seem to drain a pool of previously undetected patients with a long DUP. The patients in the early detection programme seem to ...
Effect of an early detection programme on duration of untreated psychosis
British Journal of Psychiatry, 2005
BackgroundIt is unclear whether an early detection programme increases or decreases the number of patients with a long duration of untreated psychosis (DUP), and whether these differ from other patients with a long DUP.AimsTo investigate whether the number and characteristics of patients with a long DUP in the early detection programme differ from those with along DUP in the non-earlydetection programme.MethodWe compared the number and characteristics of patients with a DUP $2 years in an early detection area and a non-early detection area.ResultsThe early detection programme recruited slightly fewer patients with a long DUP than the non-early detection programme. The patients in the early detection programme had lower PANSS scores, but more frequently had a deteriorating course of premorbid social functioning.ConclusionsAn early detection programme does not seem to drain a pool of previously undetected patients with a long DUP. The patients in the early detection programme seem to ...
Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial
Schizophrenia Bulletin Open, 2021
ObjectiveDuration of Untreated Psychosis (DUP) remains unacceptably long and limits effectiveness of care. To determine whether an early detection campaign (“Mindmap”) can reduce DUP in a US community setting.MethodsIn this nonrandomized controlled trial, Mindmap targeted the catchment of one specialty first-episode service or FES (STEP, Greater New Haven) from 2015 to 2019, while usual detection efforts continued at a control FES (PREP, Greater Boston). Mindmap targeted diverse sources of delay through mass & social media messaging, professional outreach & detailing, and rapid enrollment of referrals. Both FES recruited 16–35 years old with psychosis onset ≤3 years. Outcome measures included DUP-Total (onset of psychosis to FES enrollment), DUP-Demand (onset of psychosis to first antipsychotic medication), and DUP-Supply (first antipsychotic medication to FES enrollment).Results171 subjects were recruited at STEP and 75 at PREP. Mindmap was associated with an increase in the number...
Journal of Psychiatric Research, 2008
To assess the impact of duration of untreated psychosis (DUP) on baseline and 18-month follow-up characteristics controlling for relevant confounders in an epidemiological first-episode psychosis (FEP) cohort.The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 786 FEP patients from January 1998 to December 2000. Data were collected from medical files using a standardized questionnaire. Data from 636 patients were analyzed.Median DUP was 8.7 weeks. Longer DUP was associated with worse premorbid functioning (p < 0.001), higher rate of schizophrenia-spectrum disorders (p < 0.001), and younger age at onset of psychosis (p = 0.004). Longer DUP was not associated with baseline variables but with a lower rate of remission of positive symptoms (p < 0.001) and employment/occupation (p < 0.001), a higher rate of persistent substance use (p = 0.015), worse illness severity (p < 0.001) and global functioning (p < 0.001) at follow-up after controlling for relevant confounders, explaining approximately 5% of variance of remission of positive symptoms (p < 0.001) in the total sample and 3% in schizophrenia-spectrum disorders excluding bipolar I disorder (p = 0.002). Outcome was significantly worse when DUP exceeded 1–3 months.Avoiding pitfalls of non-epidemiological studies, DUP appears to be a modest independent predictor of prognosis in the medium-term. Results support the need for assertive early detection strategies.
Early Intervention in Psychiatry, 2013
Aim: Early intervention (EI) services for psychosis aim to reduce the duration of untreated psychosis (DUP) with intensive large-scale multi-focus initiatives, including public awareness campaigns. As a consequence of this approach, individuals with a very long DUP who might have otherwise remained undiagnosed may come to medical attention. The aim of this study was to investigate if an EI service detected additional cases of individuals with a first-episode psychosis (FEP) with a very long DUP and identify demographic and clinical characteristics associated with a very long DUP.
Duration of untreated psychosis predicts treatment outcome in an early psychosis program
Schizophrenia Research, 2001
For patients ®rst presenting with a non-affective psychotic disorder, the duration of untreated psychosis (DUP; the time between the onset of positive psychotic symptoms and the initiation of appropriate treatment) varies widely, from a few weeks to several years. A number of studies report that a longer DUP is associated with poorer clinical outcomes. We studied DUP and its association with clinical outcomes in a group of patients with schizophrenia and related psychotic disorders treated in the naturalistic clinical setting of an early psychosis program. DUP was determined for 19 patients with a non-affective psychotic disorder (schizophrenia, schizoaffective disorder or schizophreniform disorder) and no previous treatment for psychosis, by use of the IRAOS, a retrospective structured interview carried out with patients and their families. Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Function (GAF) ratings were available at baseline and 6 month follow-up. For analysis, patients were categorized into a short DUP (n 9) or long DUP (n 10) group. The median DUP (57 weeks) was used as the dividing point. At baseline, the two groups did not differ signi®cantly on positive symptoms or total PANSS ratings. However, negative symptoms were more severe in the long DUP group at baseline (P 0.029), and the long DUP group had a signi®cantly higher mean rating for the passive/apathetic social withdrawal item of the PANSS (P 0.024). At 6 month followup, the long DUP group had signi®cantly higher ratings for positive symptoms (P 0.028) and had lower GAF scores (P 0.044). Signi®cantly more (P 0.033) long DUP patients had enduring positive psychotic symptoms. The results con®rm both the wide range of DUP among patients ®rst presenting with schizophrenia and related psychotic disorders and the association of long DUP, de®ned as greater than approximately 1 year, with a poorer clinical outcome. This study highlights the importance of collecting data regarding DUP and supports the view that patients with a long DUP are likely to be less responsive to treatment in general and will require greater resources and more intensive interventions. q
Early detection of psychosis: positive effects on 5-year outcome
Psychological Medicine, 2010
Background. During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome. This study reports the effects of reducing DUP on 5-year course and outcome. Method. During 1997-2000 a total of 281 consecutive patients aged >17 years with first episode non-affective psychosis were recruited, of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) programme with public information campaigns and low-threshold psychosis detection teams was established in one healthcare area (ED-area), but not in a comparable area (no-ED area). Both areas ran equivalent treatment programmes during the first 2 years and need-adapted treatment thereafter. Results. At the start of treatment, ED-patients had shorter DUP and less symptoms than no-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modelling showed better scores for the ED group on the Positive and Negative Syndrome Scale negative, depressive and cognitive factors and for global assessment of functioning for social functioning at 5-year follow-up. The ED group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders. Conclusions. Early treatment had positive effects on clinical and functional status at 5-year follow-up in first episode psychosis.