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Early detection of psychosis: positive effects on 5-year outcome

Published online by Cambridge University Press:  14 October 2010

T. K. Larsen ,
I. Melle ,
B. Auestad ,
U. Haahr ,
I. Joa ,
J. O. Johannessen ,
S. Opjordsmoen ,
B. R. Rund ,
J. I. Rossberg  and
E. Simonsen
...Show all authors
T. K. Larsen*
Affiliation:
Stavanger University Hospital, Psychiatric Clinic, Stavanger, Norway Department of Clinical Medicine, Section Psychiatry, University of Bergen, Norway
I. Melle
Affiliation:
Oslo University Hospital, Oslo, Norway Institute of Psychiatry, University of Oslo, Norway
B. Auestad
Affiliation:
Faculty of Science and Technology, University of Stavanger, Norway
U. Haahr
Affiliation:
Psychiatric Research Unit and University of Copenhagen, Zealand Region Psychiatry Roskilde, Denmark
I. Joa
Affiliation:
Stavanger University Hospital, Psychiatric Clinic, Stavanger, Norway
J. O. Johannessen
Affiliation:
Stavanger University Hospital, Psychiatric Clinic, Stavanger, Norway
S. Opjordsmoen
Affiliation:
Oslo University Hospital, Oslo, Norway Institute of Psychiatry, University of Oslo, Norway
B. R. Rund
Affiliation:
Vestre Viken Hospital Trust/Department of Psychology, University of Oslo, Norway
J. I. Rossberg
Affiliation:
Oslo University Hospital, Oslo, Norway Institute of Psychiatry, University of Oslo, Norway
E. Simonsen
Affiliation:
Psychiatric Research Unit and University of Copenhagen, Zealand Region Psychiatry Roskilde, Denmark
P. Vaglum
Affiliation:
Department of Behavioral Sciences in Medicine, University of Oslo, Norway
S. Friis
Affiliation:
Oslo University Hospital, Oslo, Norway Institute of Psychiatry, University of Oslo, Norway
T. McGlashan
Affiliation:
Yale University School of Medicine, New Haven, Connecticut, USA
*
*Address for correspondence: T. K. Larsen, M.D., Stavanger University Hospital, Division of Psychiatry, Armauer Hansensv 20, p.b. 8100, N-4068 Stavanger, Norway. (Email: [email protected])
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Abstract

Background

During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome. This study reports the effects of reducing DUP on 5-year course and outcome.

Method

During 1997–2000 a total of 281 consecutive patients aged >17 years with first episode non-affective psychosis were recruited, of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) programme with public information campaigns and low-threshold psychosis detection teams was established in one healthcare area (ED-area), but not in a comparable area (no-ED area). Both areas ran equivalent treatment programmes during the first 2 years and need-adapted treatment thereafter.

Results

At the start of treatment, ED-patients had shorter DUP and less symptoms than no-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modelling showed better scores for the ED group on the Positive and Negative Syndrome Scale negative, depressive and cognitive factors and for global assessment of functioning for social functioning at 5-year follow-up. The ED group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders.

Conclusions

Early treatment had positive effects on clinical and functional status at 5-year follow-up in first episode psychosis.

Keywords

Early interventionfirst-episode psychosisoutcome
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 7 , July 2011 , pp. 1461 - 1469
Copyright
Copyright © Cambridge University Press 2010

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References

Bentsen, H, Munkvold, OG, Notland, TH (1996). The interrater reliability of the Positive and Negative Syndrome Scale. International Journal of Methods in Psychiatric Research 6, 1–9.3.3.CO;2-A>CrossRefGoogle Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2008). Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65, 762–771.CrossRefGoogle ScholarPubMed
Bosanac, P, Patton, GC, Castle, DJ (2010). Early intervention in psychotic disorders: faith before facts? Psychological Medicine 40, 353–358.CrossRefGoogle ScholarPubMed
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.CrossRefGoogle ScholarPubMed
Drake, RE, Osher, FC, Noordsy, DL, Hurlbut, SC, Teague, GB, Beaudett, MS (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin 16, 57–67.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1995). The Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID I/P, version 2.0). New York State Psychiatric Institute Biometrics Research Department: New York.Google Scholar
Friis, S, Larsen, TK, Melle, I, Opjordsmoen, S, Johannessen, JO, Haahr, U, Simonsen, E, Rund, BR, Vaglum, P, McGlashan, T (2003). Methodological pitfalls in early detection studies – the NAPE Lecture 2002. Nordic Association for Psychiatric Epidemiology. Acta Psychiatrica Scandinavica 107, 3–9.CrossRefGoogle ScholarPubMed
Gueorguieva, R, Krystal, JH (2004). Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Archives of General Psychiatry 61, 310–317.CrossRefGoogle ScholarPubMed
Haahr, U, Friis, S, Larsen, TK, Melle, I, Johannesen, JO, Opjordsmoen, S, Simonsen, E, Rund, BR, Vaglum, P, McGlashan, T (2008). First episode psychosis: diagnostic stability over one and two years. Psychopathology 41, 322–329.CrossRefGoogle ScholarPubMed
Joa, I, Johannessen, JO, Auestad, B, Friis, S, McGlashan, T, Melle, I, Opjordsmoen, S, Simonsen, E, Vaglum, P, Larsen, TK (2008). The key to reducing duration of untreated first psychosis: information campaigns. Schizophrenia Bulletin 34, 466–472.CrossRefGoogle ScholarPubMed
Johannessen, JO, McGlashan, TH, Larsen, TK, Horneland, M, Joa, I, Mardal, S, Kvebaek, R, Friis, S, Melle, I, Opjordsmoen, S, Simonsen, E, Ulrik, H, Vaglum, P (2001). Early detection strategies for untreated first-episode psychosis. Schizophrenia Research 51, 39–46.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Larsen, TK, Friis, S, Haahr, U, Johannessen, JO, Melle, I, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, PV, McGlashan, TH (2004). Premorbid adjustment in first-episode non-affective psychosis: distinct patterns of pre-onset course. British Journal of Psychiatry 185, 108–115.CrossRefGoogle ScholarPubMed
Larsen, TK, Melle, I, Auestad, B, Friis, S, Haahr, U, Johannessen, JO, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2006). Early detection of first-episode psychosis: the effect on 1-year outcome. Schizophrenia Bulletin 32, 758–764.CrossRefGoogle ScholarPubMed
Larsen, TK, Melle, I, Friis, S, Joa, I, Johannessen, JO, Opjordsmoen, S, Simonsen, E, Vaglum, P, McGlashan, TH (2007). One-year effect of changing duration of untreated psychosis in a single catchment area. British Journal of Psychiatry (Suppl.) 51, s128–s132.CrossRefGoogle Scholar
Lehman, AF (1988). A quality of life interview for the chronically mental ill. Evaluation and Program Planning 11, 51–62.CrossRefGoogle Scholar
McGlashan, TH (1999). Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biological Psychiatry 46, 899–907.CrossRefGoogle ScholarPubMed
McGlashan, TH, Hoffman, RE (2000). Schizophrenia as a disorder of developmentally reduced synaptic connectivity. Archives of General Psychiatry 57, 637–648.CrossRefGoogle ScholarPubMed
McGlashan, TH, Johannessen, JO (1996). Early detection and intervention with schizophrenia: rationale. Schizophrenia Bulletin 22, 201–222.CrossRefGoogle ScholarPubMed
McGorry, P, Johanessen, JO, Lewis, S, Birchwood, M, Malla, A, Nordentoft, M, Addington, J, Yung, A (2010). Early intervention in psychosis: keeping faith with evidence-based health care. Psychological Medicine 40, 399–404.CrossRefGoogle ScholarPubMed
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975–983.CrossRefGoogle ScholarPubMed
Melle, I, Haahr, U, Friis, S, Hustoft, K, Johannessen, JO, Larsen, TK, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2005). Reducing the duration of untreated first-episode psychosis – effects on baseline social functioning and quality of life. Acta Psychiatrica Scandinavica 112, 469–473.CrossRefGoogle ScholarPubMed
Melle, I, Johannesen, JO, Friis, S, Haahr, U, Joa, I, Larsen, TK, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2006). Early detection of the first episode of schizophrenia and suicidal behavior. American Journal of Psychiatry 163, 800–804.CrossRefGoogle ScholarPubMed
Melle, I, Larsen, TK, Haahr, U, Friis, S, Johannesen, JO, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2008). Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. Archives of General Psychiatry 65, 634–640.CrossRefGoogle ScholarPubMed
Pedersen, G, Hagtvedt, HA, Karterud, S (2007). Generalizability studies of the Global Assessment of Functioning – split version. Comprehensive Psychiatry 48, 88–94.CrossRefGoogle ScholarPubMed
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 1785–1804.CrossRefGoogle ScholarPubMed
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Ohlenschlaeger, J, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 602.CrossRefGoogle ScholarPubMed
Pinheiro, JC, Bates, DM (2000). Mixed Effect Models in S- and S-PLUS. Springer: New York.CrossRefGoogle Scholar
R Development Core Team (2005). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria (http://www.R-project.org/).Google Scholar