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Two-Year Effects of Reducing the Duration of Untreated Psychosis

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

Arch Gen Psychiatry. 2008;65(6):634-640.

Background  The duration of untreated psychosis (DUP)—the time from onset of psychotic symptoms to the start of adequate treatment—is consistently correlated with better course and outcome, but the mechanisms are poorly understood.

Objective  To report the effects of reducing DUP on 2-year course and outcome.

Design  A total of 281 patients with a DSM-IV diagnosis of nonorganic, nonaffective psychosis coming to their first treatment during 4 consecutive years were recruited, of which 231 participated in the 2-year follow-up. A comprehensive early detection (ED) system, based on public information campaigns and low-threshold-psychosis–detecting teams, was introduced in 1 health care area (ED area), but not in a comparable area (no-ED area). Both areas ran equivalent 2-year treatment programs.

Results  First-episode patients from the ED area had a significantly lower DUP, better clinical status, and milder negative symptoms at the start of treatment. There were no differences in treatment received for the first 2 years between the groups. The difference in negative symptoms was maintained at the 1-year follow-up. There was a statistically significant difference in the Positive and Negative Syndrome Scale negative component, cognitive component, and depressive component in favor of the ED group at the 2-year follow-up. Multiple linear regression analyses gave no indication that these differences were due to confounders.

Conclusion  Reducing the DUP has effects on the course of symptoms and functioning, including negative symptoms, suggesting secondary prevention of the negative psychopathologies in first-episode schizophrenia.

Author Affiliations: Institute of Psychiatry, Faculty of Medicine (Drs Melle, Friis, and Opjordsmoen), Institute of Psychology, Faculty of Social Sciences (Dr Rund), and the Department of Behavioral Sciences in Medicine (Dr Vaglum), University of Oslo, Norway; Department of Psychiatry, Ullevål University Hospital, Oslo, Norway (Drs Melle, Friis, and Opjordsmoen); Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway (Drs Larsen and Johannesen); Department of Clinical Medicine, Psychiatry Section, University of Bergen, Norway (Dr Larsen); Psychiatric Research Unit, Zealand Region Psychiatry, Roskilde, Denmark (Drs Haahr and Simonsen); Asker and Bærum Hospital Trust, Sandvika, Norway (Dr Rund); Institute of Psychiatry, University of Copenhagen, Denmark (Dr Simonsen); and Department of Psychiatry, Yale University, New Haven, Connecticut (Dr McGlashan).

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