TY - JOUR
T1 - Reducing the duration of untreated first-episode psychosis
T2 - Effects on Clinical Presentation
AU - Melle, Ingrid
AU - Larsen, Tor K.
AU - Haahr, Ulrik
AU - Friis, Svein
AU - Johannessen, Jan Olav
AU - Opjordsmoen, Stein
AU - Simonsen, Erik
AU - Rund, Bjorn Rishovd
AU - Vaglum, Per
AU - McGlashan, Thomas
PY - 2004/2/1
Y1 - 2004/2/1
N2 - Context: Most studies on first-episode psychosis show an association between a long duration of untreated psychosis (DUP) and poorer short-term outcome, but the mechanisms of this relationship are poorly understood. Objective: To determine whether it is possible to reduce the DUP fo r first-episode patients in a defined health care area through the introduction of an early detection (ED) program, compared with parallel health care areas without an ED program (No-ED). Setting and Patients: We included consecutive patients with a DSM-IV diagnosis of nonorganic, nonaffective psychosis coming to their first treatment in the study health care areas between January 1, 1997, and December 31, 2000. A total of 281 patients (76% of the total) gave informed consent. Interventions: The ED and No-ED health care areas offered an equivalent assessment and treatment program for first-episode psychosis. The ED area also carried out an intensive ED program. Results: The DUP was significantly shorter for the group of patients coming from the ED area, compared with patients from the No-ED areas (median, 5 weeks [range, 0-1196 weeks] vs 16 weeks [range, 0-966 weeks]). Clinical status measured by the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale was significantly better for patients from the ED area at start of treatment and, with the exception of Positive and Negative Syndrome Scale positive subscale, at 3 months. Multiple linear regression analyses gave no indication that confounders were responsible for these differences. Conclusions: It is possible to reduce the DUP through an ED program. The reduction in DUP is associated with better clinical status at baseline that is maintained after 3 months.
AB - Context: Most studies on first-episode psychosis show an association between a long duration of untreated psychosis (DUP) and poorer short-term outcome, but the mechanisms of this relationship are poorly understood. Objective: To determine whether it is possible to reduce the DUP fo r first-episode patients in a defined health care area through the introduction of an early detection (ED) program, compared with parallel health care areas without an ED program (No-ED). Setting and Patients: We included consecutive patients with a DSM-IV diagnosis of nonorganic, nonaffective psychosis coming to their first treatment in the study health care areas between January 1, 1997, and December 31, 2000. A total of 281 patients (76% of the total) gave informed consent. Interventions: The ED and No-ED health care areas offered an equivalent assessment and treatment program for first-episode psychosis. The ED area also carried out an intensive ED program. Results: The DUP was significantly shorter for the group of patients coming from the ED area, compared with patients from the No-ED areas (median, 5 weeks [range, 0-1196 weeks] vs 16 weeks [range, 0-966 weeks]). Clinical status measured by the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale was significantly better for patients from the ED area at start of treatment and, with the exception of Positive and Negative Syndrome Scale positive subscale, at 3 months. Multiple linear regression analyses gave no indication that confounders were responsible for these differences. Conclusions: It is possible to reduce the DUP through an ED program. The reduction in DUP is associated with better clinical status at baseline that is maintained after 3 months.
UR - http://www.scopus.com/inward/record.url?scp=9144268278&partnerID=8YFLogxK
U2 - 10.1001/archpsyc.61.2.143
DO - 10.1001/archpsyc.61.2.143
M3 - Article
C2 - 14757590
AN - SCOPUS:9144268278
SN - 0003-990X
VL - 61
SP - 143
EP - 150
JO - Archives of General Psychiatry
JF - Archives of General Psychiatry
IS - 2
ER -