Reducing the duration of untreated psychosis and changing help-seeking behaviour in Singapore

AIM: This study was conducted to examine the impact of early detection strategies of an early psychosis intervention programme on the duration of untreated psychosis (DUP) and the pattern of help-seeking behaviour. METHOD: Patients with first-episode psychosis were compared before and after the initiation of a programme of public education and networking with primary health care providers. These two groups were compared on the DUP and the change in the pattern of help-seeking. RESULTS: The DUP was significantly reduced from a median of 12 to median of 4 months (p=0.002, Mann-Whitney U-test). There was an increase in the proportion of self and family referrals, and a fall in the proportion of police referrals. CONCLUSION: Awareness campaigns which target multiple groups and use various modes of communication are effective in influencing the DUP and patterns of help-seeking.     

Cognitive deterioration and duration of untreated psychosis

Aim: To examine the relationship between cognitive deterioration and the duration of untreated psychosis (DUP) in a first‐episode psychosis sample. Method: We assessed a consecutive sample of first‐episode psychosis participants (N = 50) with measures of cognitive deterioration and DUP. Results: Using correlations and stepwise linear regressions, we found strong relationships between DUP and measures of cognitive deterioration. Conclusions: The length of DUP predicted cognitive deterioration. These results highlight a potential DUP grace period (>6 months) in which significant cognitive deterioration may be averted.     

Measurement and reporting of the duration of untreated psychosis

Aim: The aim of this study was to investigate the demographic, illness and methodological factors associated with mean and median duration of untreated psychosis (DUP). Methods: A systematic review and meta‐analysis of the published studies of DUP and an examination of available DUP distributions. Results: DUP was longer in samples with a higher proportion of patients with schizophrenia and was shorter in samples that included affective psychosis. Sex, age, and the methods of measuring the onset and end‐point of DUP and the type of service in which the studies were performed did not contribute to the heterogeneity of the mean or median DUP values. Mean DUP is significantly prolonged by a small number of patients, and the median DUP is a poor indicator of the rate at which patients present. Conclusions: The DUP of patients with affective and non‐affective psychosis should be examined separately in order to make measures of DUP more meaningful and comparable, and DUP should be reported using more comprehensive measures. We suggest a method of reporting DUP based on the rate of presentation of first‐episode psychosis patients rather than the length of DUP.     

Health beliefs link to duration of untreated psychosis and attitudes to later treatment in early psychosis

Background: Health beliefs influence health behaviours and have been shown to influence outcomes in a variety of illnesses, treatments and preventative interventions. Aims: We aimed to measure health beliefs in first episode psychosis with the hypotheses that their structure would resemble that in physical illness (diabetes) and would correlate with prior duration of untreated psychosis and later attitudes to treatment. Method: The Multidimensional Health Locus of Control scale was used in a sample of 50 people with schizophrenia during the first episode and at 18-month follow-up, 51 diabetic controls and 51 normal controls. Results: Schizophrenia patients, both at first episode and 18 months later, had a pattern of health beliefs that was similar to those of the patients with diabetes and significantly different to the normal controls. There were significant associations between internal locus of control score and short DUP, and between external locus of control score and a positive attitude to medication as measured by the Drug Attitudes Inventory. Conclusions: Health beliefs in first episode schizophrenia correlate with determinants of outcome. Accepted: 9 December 2002 Correspondence to Dr. Clifford Haley     

Is the duration of untreated psychosis temporally stable?

Although there is some evidence that duration of untreated psychosis (DUP) is geographically stable, few have examined whether the phenomenon is temporally stable. We examined DUP in two cohorts within two discrete time periods (1995-1999 and 2003-2005) spanning a decade in the same geographically defined community psychiatric service with no early intervention programme. Patients were diagnosed by Structured Clinical Interview for DSM (SCID) and we determined the DUP using the Beiser Scale. The DUP of the 240 participants did not differ significantly between study periods.     

Duration of untreated psychosis and pathways to care in patients with first-episode psychosis in Iran

Aim: This is the first study on the duration of untreated psychosis and pathways to care among patients with first‐episode psychosis in Iran as a developing country. Methods: Ninety‐one patients with a first episode of non‐organic psychosis admitted to a university‐affiliated psychiatric hospital in Iran were assessed for duration of untreated psychosis (DUP), pathways to care and mode of onset. Results: Median DUP was 11 weeks (mean = 52.3 weeks). Following the onset of psychosis, most patients were first seen by a psychiatrist (n = 23, 25.3%), a traditional healer (n = 21, 23.1%) or a general practitioner (n = 16, 17.6%). Most referrals to the psychiatric hospital were made by the family (n = 30, 33.1%), or health professionals (n = 29, 31.9%). Acute onset and rural place of residence were associated with shorter DUP in multivariate analysis. Conclusions: Median DUP was not long in an inpatient sample with first‐episode psychosis, which may be due to the preponderance of affective and acute psychoses in this sample and some help‐seeking or service variables.     

Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis

OBJECTIVE: This study examines 1year outcome in patients having first-episode non-affective psychosis, with emphasis on Duration of Untreated Psychosis (DUP) and premorbid functioning, in order to clarify how these factors interact. METHOD: Forty-three consecutively admitted patients were all rated on the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning Scale (GAF), both upon hospitalization and at 1year follow-up. In addition, premorbid functioning, DUP, duration of hospitalization, and social functioning were rated. RESULTS: Fifty-six per cent were in remission, 18% suffered multiple relapses and 26% were continuously psychotic at 1 year follow-up. Both poor premorbid functioning and long DUP are significantly correlated with more negative symptoms and poorer global functioning at follow-up. Long DUP is also significantly correlated with more positive symptoms. Even when we control for other factors, including premorbid functioning and gender, DUP is a strong predictor of outcome. To a limited degree premorbid functioning and DUP interact, but DUP has an independent influence on outcome. CONCLUSIONS: these findings strengthen the rationale for establishing health service programs for early detection and treatment of first-onset psychosis     

The key to reducing duration of untreated first psychosis: information campaigns

The TIPS early intervention program reduced the duration of untreated psychosis (DUP) in first-episode schizophrenia from 16 to 5 weeks in a health care sector using a combination of easy access detection teams (DTs) and a massive information campaign (IC) about the signs and symptoms of psychosis. This study reports what happens to DUP and presenting schizophrenia in the same health care sector when the IC is stopped. METHODS: Using an historical control design, we compare 2 cohorts of patients with first-episode Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, non-affective psychosis at admission to treatment. The first cohort (N = 108) was recruited from January 1997 to December 2000, using an IC to raise awareness about recognizing psychosis to the public, the schools, and to general practitioners. The second cohort (N = 75) was recruited from January 2002 to June 2004 with no-IC. Easy access DTs were available to both cohorts. RESULTS: In the no-IC period, DUP increased back up to 15 weeks (median) and fewer patients came to clinical attention through the DTs. No-IC patients were diagnosed less frequently with schizophreniform disorder, more Positive and Negative Syndrome Scale positive and total symptoms, and poorer Global Assessment of Functioning (symptom) Scale scores. CONCLUSIONS: Intensive education campaigns toward the general public, the schools, and the primary health care services appear to be an important and necessary part of an early detection program. When such a campaign was stopped, there was a clear regressive change in help-seeking behavior with an increase in DUP and baseline symptoms.     

First rank symptoms in first episode psychosis and their relationship to the duration of untreated illness

Most studies of First Rank Symptoms (FRS) are based on cross-sectional inpatient samples of people with schizophrenia at various stages of illness. We sought to examine the prevalence of FRS in a representative sample of first episode psychosis patients and compare those with and without FRS clinically and in terms of duration of untreated illness. Information was gathered from 158 consecutive cases of first episode psychosis presenting in a defined geographical region through semi-structured interview tools. Of this sample, 40.5% of cases received a diagnosis of schizophrenia. The prevalence of FRS among the entire group was 52.5%. After controlling for multiple testing, no FRS contributed significantly to predicting a diagnosis of schizophrenia. There was no significant relationship between the duration of untreated illness and FRS.