Thomas McGlashan, M.D., professor of psychiatry at Yale School of Medicine, said the length of time between the onset of psychosis and detection and treatment can stretch from several weeks to several years. This time span is a concern because the patient is sick and untreated and because there is some indication that the untreated psychotic state itself may increase the risk of a poor outcome.
"It looks like the longer the period of time before treatment, the worse off the patients are not only when they come into treatment, but how they respond to treatment," McGlashan said.
In a study published this month in the Archives of General Psychiatry, McGlashan looked at 281 patients in four Scandanavian health sectors with equivalent treatment programs. Two of the four sectors had early detection programs and two did not. Those that did have programs educated residents, school counselors, and health care workers about psychotic symptoms such as increasing isolation, responding to voices no one else hears, delusional thinking, irritability, difficulty sleeping, and overall marked reduction in the ability to cope with life's daily stresses.
Participants were followed up after three months, one year and two years. This study compares the patients' clinical state at admission and at the three month follow up. The researchers found that the duration of untreated patient psychosis in the two health sectors with early detection programs was significantly shorter -- one month as compared to four months.
"All factors being equal, early detection efforts will bring people into treatment at lower symptom levels," McGlashan said. "Patients who began treatment earlier tended to be younger, less symptomatic, and more responsive to treatment."
He said there will be a follow up after one, two , five and 10 years to see if the early detection and intervention has a lasting effect.
Co-authors included Ingrid Melle, M.D., Svein Friis, M.D., Stein Opjordsmoen, M.D., Bjorn Roshovd Rund, Per Vaglum, M.D., Tor Larsen, M.D., Jan Olav Johannessen, M.D., Ulrik Haahr, M.D., and Erik Simonsen, M.D.
Citation: Archives of General Psychiatry, 61:143-150.
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