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.
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.
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.
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.
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.