The duration of untreated psychosis (DUP) is the time between the onset of psychotic symptoms and the start of adequate treatment. DUP can vary considerably in patients having their first episode of psychosis. Having psychotic symptoms for months or years can have a negative effect on social, occupational and personal functioning, and studies on first-episode psychosis show an association between a long DUP and poorer short-term outcomes.
Ingrid Melle, M.D., of Ullevaal University Hospital, Oslo, Norway, and colleagues studied whether it is possible to reduce the DUP for first episode patients by introducing an early detection (ED) program in a defined health care area compared to a similar health care area without an early detection program (No-ED). The study was carried out in four Scandinavian health care sectors in Norway and Denmark. Two sectors implemented the ED program, and two did not.
The early detection program consisted of educational campaigns about psychotic symptoms and their treatment aimed at the general population through newspaper, radio and cinema advertisements, and information campaigns directed at general practitioners, social workers and high school health personnel. The advertisements and campaigns also promoted a telephone hotline number. The study included 281 patients diagnosed with psychotic disorders coming to their first treatment in the two study areas between January 1, 1997 and December 31, 2000.
The researchers found that the DUP was significantly shorter for patients coming from the ED area compared with patients from the No-ED area (median, 5 weeks vs. 16 weeks). Clinical status was also better for patients in the ED area at the start of treatment, and at three months after treatment.
"The study's main finding is that with all other factors being equal, early detection efforts will bring people into treatment at lower symptom levels," the authors write. "It is thus reasonable to conclude that the threshold for seeking and/or entering treatment appears to have been lowered by the ED program…"
(Arch Gen Psychiatry. 2004;61:143-150. Available post-embargo at htt://www.archgenpsychiatry.com).
Editor's Note: This study was supported by a grant from the Norwegian National Research Council (Oslo); the Norwegian Department of Health and Social Affairs (Oslo); a grant from the National Council for Mental Health/Health and Rehabilitation (Oslo); Rogaland County (Stavanger, Norway) and Oslo County (Oslo) (Drs. Vaglum, Johannessen, Friis, Larsen, Melle, and Opjordsmoen); the Theodore and Vada Stanley Foundation (Bethesda, Md.); the Regional Health Research Foundation for Eastern Region (Hilleroed, Denmark); Roskilde County (Roskilde, Denmark); Helsefonden Lundbeck Pharma (Hellerup, Denmark); Eli Lilly Denmark (Lyngby); Janssen-Cilag Pharmaceuticals Denmark (Birkeroed) (Drs. Simonsen and Haahr); a National Alliance for Research on Schizophrenia and Depression (NARSAD) Distinguished Investigator Award (Great Neck, N.Y.); a grant from the National Institute of Mental Health (Rockville, Md.) (Dr. McGlashan); and a Young Investigator Award from NARSAD (Dr. Larsen).
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org.
To contact Ingrid Melle, M.D., e-mail Ingrid.melle@psykiatri.uio.no.
Journal
Archives of General Psychiatry