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Effects on Clinical Presentation

Ingrid Melle, MD; Tor K. Larsen, MD; Ulrik Haahr, MD; Svein Friis, MD; Jan Olav Johannessen, MD; Stein Opjordsmoen, MD; Erik Simonsen, MD; Bjørn Rishovd Rund, PhD; Per Vaglum, MD; Thomas McGlashan, MD

Arch Gen Psychiatry. 2004;61:143-150.

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 for 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.

From the Division of Psychiatry, Ullevaal University Hospital (Drs Melle, Friis, and Opjordsmoen), and the Institute of Psychology (Dr Rund) and Department of Behavioral Medicine (Dr Vaglum), University of Oslo, Oslo, Norway; Rogaland Psychiatric Hospital, Stavanger, Norway (Drs Larsen and Johannesen); Roskilde Psychiatric University Hospital Fjorden, Roskilde, Denmark (Drs Haahr and Simonsen); and Department of Psychiatry, Yale University School of Medicine, New Haven, Conn (Dr McGlashan).

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