Citation

Melle I, Larsen TK, Haahr U, Friis S, Johannesen JO, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T. Arch. Gen. Psychiatry 2008; 65(6): 634-640.

Copyright

(Copyright © 2008, American Medical Association)

DOI

10.1001/archpsyc.65.6.634

PMID

18519821

Abstract

BACKGROUND: The duration of untreated psychosis (DUP)-the time from onset of psychotic symptoms to the start of adequate treatment--is consistently correlated with better course and outcome, but the mechanisms are poorly understood.
OBJECTIVE: To report the effects of reducing DUP on 2-year course and outcome.
DESIGN: A total of 281 patients with a DSM-IV diagnosis of nonorganic, nonaffective psychosis coming to their first treatment during 4 consecutive years were recruited, of which 231 participated in the 2-year follow-up. A comprehensive early detection (ED) system, based on public information campaigns and low-threshold-psychosis-detecting teams, was introduced in 1 health care area (ED area), but not in a comparable area (no-ED area). Both areas ran equivalent 2-year treatment programs.
RESULTS: First-episode patients from the ED area had a significantly lower DUP, better clinical status, and milder negative symptoms at the start of treatment. There were no differences in treatment received for the first 2 years between the groups. The difference in negative symptoms was maintained at the 1-year follow-up. There was a statistically significant difference in the Positive and Negative Syndrome Scale negative component, cognitive component, and depressive component in favor of the ED group at the 2-year follow-up. Multiple linear regression analyses gave no indication that these differences were due to confounders.
CONCLUSION: Reducing the DUP has effects on the course of symptoms and functioning, including negative symptoms, suggesting secondary prevention of the negative psychopathologies in first-episode schizophrenia.

Language: en

Keywords

Adult; Antipsychotic Agents; Combined Modality Therapy; Delusions; Denmark; Depression; Early Diagnosis; Female; Follow-Up Studies; Hallucinations; Humans; Male; Norway; Patient Care Team; Patient Readmission; Prognosis; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Suicide, Attempted