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Yee A, Greene S, Weiss A, Chaudhry S, Steadman S. Hospitalization and help-seeking among first episode psychosis patients. Discov Ment Health 2024; 4:10. [PMID: 38568391 PMCID: PMC10992493 DOI: 10.1007/s44192-024-00064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To examine hospitalization as part of a complex pathway to care in first episode psychosis (FEP), exploring help-seeking episodes (HSE) and their relationship to hospitalization. METHODS Data from 66 patients at the Early Psychosis Intervention Clinic New Orleans (EPIC-NOLA), a coordinated specialty care (CSC) clinic, was obtained from Pathways to Care (PTC) assessments, which documents elements of help seeking. A chart review was performed identifying hospitalizations. RESULTS Most patients were hospitalized multiple times (n = 37, M = 2.98, SD = 2.14). On average, patients had more hospitalizations prior to starting treatment at EPIC-NOLA (M = 1.72, SD = 1.35) than after (M = 1.27, SD = 1.79). Patients whose first HSE resulted in intake at EPIC-NOLA were significantly less likely to be hospitalized after intake than patients with multiple HSE (F(1,52.3) = 12.9, p < .001). There was a significant correlation (N = 42) between HSE and hospitalizations after intake (τb = .327 p < .05); patients seeking help more often were more likely to be hospitalized after intake. No significant correlations were found between duration of untreated psychosis (DUP) and hospitalization. CONCLUSION While results are correlational, several key relationships were noted. Fewer hospitalizations occurred after intake into EPIC-NOLA. Starting treatment after the first HSE was related to fewer future hospitalizations, compared to intake after multiple HSEs. Intake into a CSC clinic after a single HSE may reduce hospitalization. Additionally, increased HSE, not DUP, impacted patients' likelihood of hospitalization. This prompts treatment engagement during a first HSE to reduce hospitalization.
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Affiliation(s)
- Anna Yee
- School of Medicine, Tulane University, New Orleans, LA, USA.
| | - Sarah Greene
- School of Medicine, Tulane University, New Orleans, LA, USA
| | - Ashley Weiss
- School of Medicine, Tulane University, New Orleans, LA, USA
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Murden R, Allan SM, Hodgekins J, Oduola S. The effectiveness of public health interventions, initiatives, and campaigns designed to improve pathways to care for individuals with psychotic disorders: A systematic review. Schizophr Res 2024; 266:165-179. [PMID: 38412687 DOI: 10.1016/j.schres.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/19/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Lengthy duration of untreated psychosis (DUP) and duration of untreated illness (DUI) in people at clinical high-risk for psychosis (CHR-P) and first episode psychosis (FEP) is associated with poorer outcomes. However, individuals with FEP often experience negative pathways to care involving contacts with police, crisis services and requiring compulsory admissions, and evidence suggests individuals with both FEP and CHR-P often experience lengthy delays to treatment. Early detection interventions, such as public health interventions, may be one way to reduce delays. This systematic review aimed to synthesise the available evidence on such interventions. METHODS The EMBASE, PsychINFO, CINAHL, and MEDLINE databases were searched. Studies were included if they compared an intervention designed to improve timely access to treatment for individuals with FEP or CHR-P to standard treatment provision. Interventions may be targeted at potential patients, their families, the general public, or non-healthcare professionals. Outcomes of interest were DUP or DUI, and/or characteristics of pathways to care. RESULTS Nineteen studies met the inclusion criteria. All consisted of FEP populations, none of CHR-P populations. Employing narrative synthesis, we found mixed results about the effectiveness of interventions at reducing DUP and interventions appeared to differentially impact groups. Pathways to care information was limited and mixed. CONCLUSION Findings on the effectiveness of interventions designed to improve timely access to treatment were inconclusive. More research is warranted to better understand where delays occur and factors which may influence this for both FEP and CHR-P populations which may help to develop targeted interventions to address delays.
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Affiliation(s)
- Rhiannon Murden
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; Birmingham and Solihull Mental Health NHS Foundation Trust, Uffculme Centre, 52 Queensbridge Road, Moseley, Birmingham B13 8QY, UK.
| | - Sophie M Allan
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Sheri Oduola
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
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Nkire N, Kinsella A, Russell V, Waddington JL. Duration of the psychosis prodrome and its relationship to duration of untreated psychosis across all 12 DSM-IV psychotic diagnoses: Evidence for a trans-diagnostic process associated with resilience. Eur Neuropsychopharmacol 2024; 80:5-13. [PMID: 38128335 DOI: 10.1016/j.euroneuro.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
While duration of the psychosis prodrome (DPP) attracts attention in relation to the developmental trajectory of psychotic illness and service models, fundamental issues endure in the context of dimensional-spectrum models of psychosis. Among 205 epidemiologically representative subjects in the Cavan-Monaghan First Episode Psychosis Study, DPP was systematically quantified and compared, for the first time, across all 12 DSM-IV psychotic diagnoses. DPP was also compared with duration of untreated psychosis (DUP) and each was then analysed in relation to premorbid features across three age ranges: <12, 12-15 and 16-18 years. For each diagnosis, medians for both DPP and DUP were shorter than means, indicating common right-skewed distributions. Rank orders for both DPP and DUP were longest for schizophrenia, intermediate for other schizophrenia-spectrum psychoses, psychotic depression and psychotic disorder not otherwise specified, and shortest for brief psychotic disorder, bipolar disorder and substance-induced psychotic disorder, though with overlapping right-skewed distributions. DPP was longer than DUP for all diagnoses except substance-induced psychotic disorder. Across functional psychotic diagnoses, longer DPP was predicted by higher premorbid intelligence and better premorbid adjustment during age 16-18 years. These findings indicate that, trans-diagnostically, DPP and DUP share right-skewed continuities, in accordance with a dimensional-spectrum model of psychotic illness, and may reflect a unitary process that has been dichotomized at a subjective threshold along its trajectory. Better premorbid functioning during age 16-18 years appears to confer resilience by delaying progression to overt psychotic symptoms and may constitute a particular target period for psychosocial interventions.
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Affiliation(s)
- Nnamdi Nkire
- Drumalee Primary Care Centre, Cavan-Monaghan Mental Health Service, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anthony Kinsella
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vincent Russell
- Drumalee Primary Care Centre, Cavan-Monaghan Mental Health Service, Cavan, Ireland; Department of Psychiatry, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
| | - John L Waddington
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psychiatric-Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
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McIlwaine SV, Mughal S, Ferrari M, Rosengard R, Malla A, Iyer S, Lepage M, Joober R, Shah JL. Pre-onset subthreshold psychotic symptoms are associated with differential treatment delays before a first episode of psychosis: Initial evidence and implications. Schizophr Res 2024; 264:549-556. [PMID: 38335764 DOI: 10.1016/j.schres.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Help-seeking and treatment delays are increasingly critical areas of study in mental health services. The duration of untreated psychosis (DUP), or the time between illness onset and initiation of treatment, is a predictor of symptom remission and functioning for a first episode of psychosis (FEP). The World Health Organization recommends that specialized treatment for psychosis be initiated within the first three months of FEP onset. As a result, research has focused on factors that are associated with threshold-level DUP, while the experience of subthreshold psychotic symptoms (STPS) prior to a FEP may also complicate and present barriers to accessing care for young people. We therefore examine the possibility that STPS can impact DUP and its components. METHOD Using a follow-back cross-sectional design, we sought to describe duration of untreated illness, length of prodrome, DUP, help-seeking delay, referral delay, and number of help-seeking contacts among FEP patients who did and did not have STPS prior to psychosis onset. RESULTS We found that patients who experienced STPS had a longer median duration of untreated illness, prodrome length, DUP, and help-seeking delay compared to patients who did not have such symptoms. Referral delay did not differ substantially between the two groups. Importantly, treatment delays were extremely lengthy for many participants. CONCLUSIONS Pre-onset STPS are associated with help-seeking delays along the pathway to care even during a FEP. Examining early signs and symptoms may help to improve and tailor interventions aimed at reducing treatment delays and ultimately providing timely care when the need arises.
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Affiliation(s)
- S V McIlwaine
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada.
| | - S Mughal
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - M Ferrari
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - R Rosengard
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - A Malla
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - S Iyer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - M Lepage
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada; Department of Psychology, McGill University, Canada
| | - R Joober
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - J L Shah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
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Venkataraman S, Hazan H, Li F, Ferrara M, Harper A, Ma J, Shah J, Musket C, Levine N, Keshavan MS, Srihari V. Role of Early Psychosis Detection in the Relationship Between Personal Income and Duration of Untreated Psychosis. Psychiatr Serv 2024:appips20230239. [PMID: 38204369 DOI: 10.1176/appi.ps.20230239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Prolonged duration of untreated psychosis (DUP) predicts poor outcomes of first-episode psychosis (FEP) and is often linked to low socioeconomic status (SES). The authors sought to determine whether patients' personal income, used as a proxy for SES, predicts length of DUP and whether personal income influences the effect of an early psychosis detection campaign-called Mindmap-on DUP reduction. METHODS Data were drawn from a trial that compared the effectiveness of early detection in reducing DUP across the catchment area of an FEP service (N=147 participants) compared with an FEP service with no early detection (N=75 participants). Hierarchical regression was used to determine whether personal income predicted DUP when analyses controlled for effects of age, race, and exposure to early psychosis detection. A group × personal income interaction term was used to assess whether the DUP difference between the early detection and control groups differed by personal income. RESULTS Lower personal income was significantly associated with younger age, fewer years of education, Black race, and longer DUP. Personal income predicted DUP beyond the effects of age, race, and early psychosis detection. Although Mindmap significantly reduced DUP across all income levels, this effect was smaller for participants reporting lower personal income. CONCLUSIONS Patients' personal income may be an important indicator of disparity in access to specialty care clinics across a wide range of settings. Early detection efforts should measure and target personal income and other SES indicators to improve access for all individuals who may benefit from FEP services.
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Affiliation(s)
- Shruthi Venkataraman
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Hadar Hazan
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Fangyong Li
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Maria Ferrara
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Annie Harper
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Jessica Ma
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Jai Shah
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Christie Musket
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Nina Levine
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Matcheri S Keshavan
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Vinod Srihari
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
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Sklar AL, Yeh FC, Curtis M, Seebold D, Coffman BA, Salisbury DF. Functional and structural connectivity correlates of semantic verbal fluency deficits in first-episode psychosis. J Psychiatr Res 2024; 169:73-80. [PMID: 38000187 PMCID: PMC10843642 DOI: 10.1016/j.jpsychires.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/31/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Semantic verbal fluency (SVF) impairments are debilitating and present early in the course of psychotic illness. Deficits within frontal, parietal, and temporal brain regions contribute to this deficit, as long-range communication across this functionally integrated network is critical to SVF. This study sought to isolate disruptions in functional and structural connectivity contributing to SVF deficits during first-episode psychosis in the schizophrenia spectrum (FESz). METHODS Thirty-three FESz and 34 matched healthy controls (HC) completed the Animal Naming Task to assess SVF. Magnetoencephalography was recorded during an analogous covert SVF task, and phase-locking value (PLV) used to measure functional connectivity between inferior frontal and temporoparietal structures bilaterally. Diffusion imaging was collected to measure fractional anisotropy (FA) of the arcuate fasciculus, the major tract connecting frontal and temporoparietal language areas. RESULTS SVF scores were lower among FESz compared to HC. While PLV and FA did not differ between groups overall, FESz exhibited an absence of the left-lateralized nature of both measures observed in HC. Among FESz, larger right-hemisphere PLV was associated with worse SVF performance (ρ = -0.51) and longer DUP (ρ = -0.50). DISCUSSION In addition to worse SVF, FESz exhibited diminished leftward asymmetry of structural and functional connectivity in fronto-temporoparietal SVF network. The relationship between theta-band hyperconnectivity and poorer performance suggests a disorganized executive network and may reflect dysfunction of frontal cognitive control centers. These findings illustrate an aberrant pattern across the distributed SVF network at disease onset and merit further investigation into development of asymmetrical hemispheric connectivity and its failure among high-risk populations.
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Affiliation(s)
- Alfredo L Sklar
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Fang-Cheng Yeh
- University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, PA, USA
| | - Mark Curtis
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Dylan Seebold
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Brian A Coffman
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Dean F Salisbury
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA.
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7
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Zhang T, Xu L, Wei Y, Tang X, Hu Y, Cui H, Tang Y, Wang Z, Liu H, Chen T, Li C, Wang J. Duration of untreated prodromal psychosis among individuals with clinical high risk for psychosis. Psychiatry Res 2023; 329:115522. [PMID: 37812943 DOI: 10.1016/j.psychres.2023.115522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023]
Abstract
The impact of the duration of untreated psychosis on the outcomes of schizophrenia has been extensively studied. However, there is a notable gap in the current understanding of the relationship between the duration of untreated prodromal symptoms (DUPrS) and the development of psychosis in individuals at clinical high risk (CHR). A sample of 704 individuals with CHR was identified through a structured interview, of who 145 (20.6 %) converted to psychosis (CHR-C) during the 3-year follow-up. The DUPrS was defined as the period between the onset of the first attenuated psychotic positive symptom and the commencement of professional assistance at mental health services. Quantile regression was applied for quantile levels between 0.1 and 0.9, and adjusted for age, sex, and education.The overall sample had a mean DUPrS of 7.1 months. No significant differences were observed in the DUPrS between the CHR-C and non-converter (CHR-NC) groups. Quantile regression analysis highlighted variations in the effects of the DUPrS on clinical variables across the different quantiles. We observed a positive association between DUPrS rank and positive symptoms below the 0.3 quantile, while a positive association between DUPrS rank and negative symptoms above the 0.3 quantile (except 0.7 and 0.9 quantile). A longer DUPrS (> 3 months) was associated with younger age (odds ratio [OR] = 0.948, p = 0.003), a higher proportion of women (OR = 1.474, p = 0.003), higher baseline global function (OR = 1.044, p = 0.003), lower previous global function (OR = 0.921, p < 0.001), and higher negative symptoms (OR = 1.061, p = 0.001). This study sheds light on the pivotal role of DUPrS as a potential intermediary factor in the complex pathway of psychosis.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Co., Ltd, Shanghai, PR China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Ontario, Canada; Senior Research Fellow, Labor and Worklife Program, Harvard University, Cambridge, MA, United States
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, PR China; Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China.
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Bansal P, Saini B, Sharma A, Bansal PD, Moria K, Saini S, Singh B. Short-term Clinical Outcome of Previously Untreated and Treated Schizophrenia and Impact of Duration of Untreated Psychosis. Indian J Psychol Med 2023; 45:366-373. [PMID: 37483578 PMCID: PMC10357906 DOI: 10.1177/02537176221141614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background Duration of untreated psychosis (DUP) is an important modifiable factor affecting schizophrenia outcomes. A dearth of research in India on untreated versus treated schizophrenia warrants further research. Methods This was a longitudinal study in a tertiary hospital over 2 years. Inpatients diagnosed with schizophrenia (N = 116), aged 18-45, were divided into untreated and treated groups. Diagnostic confirmation, severity assessment, and clinical outcome were done using ICD-10 criteria, Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) scale. Follow-up was done at 12 and 24 weeks. DUP was measured, and its association with the outcome was assessed. Results Final analysis included 100 patients, 50 each of previously untreated and treated. Untreated patients had lower age and duration of illness (DOI), but higher DUP (p < .001). Treated patients showed much improvement on CGI-I at 12 weeks (p = .029), with no difference at 24 weeks. PANSS severity comparison showed no difference, and both groups followed a declining trend. In untreated patients, age of onset (AoO) was negatively correlated with severity (except general symptoms at baseline) at all follow-ups ('r' range = -0.32 to -0.49, p < .05), while DOI showed a positive correlation with negative and general symptoms at 12 weeks (r ~ 0.3, p < .05). Treated patients showed inconsistent and lower negative correlation between AoO and PANSS, with no correlation between severity and DOI. The mean sample DUP was 17.9 ± 31.6 weeks; it negatively correlated with education (r = -0.25, p = .01) and positively with PANSS severity ('r' range = 0.22 to 0.30, p < .05) at all follow-ups, especially negative symptoms. Patients with no or minimal improvement on CGI at 24 weeks had higher DUP (Quade's ANOVA F[1,98] = 6.24, p = .014). Conclusion Illness variables in untreated schizophrenia affect severity, which has delayed improvement than treated schizophrenia. Higher DUP is associated with negative symptoms of schizophrenia.
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Affiliation(s)
- Priyanka Bansal
- Dept. of Psychiatry, Government Medical College, Patiala, Punjab, India
| | - Bhavneesh Saini
- Dept. of Psychiatry, Government Medical College, Patiala, Punjab, India
| | - Arvind Sharma
- Dept. of Psychiatry, GGSMCH, Faridkot, Patiala, Punjab, India
| | - Pir Dutt Bansal
- Dept. of Psychiatry, GGSMCH, Faridkot, Patiala, Punjab, India
| | | | - Sumit Saini
- Dept. of Psychiatry, GGSMCH, Faridkot, Patiala, Punjab, India
| | - Baltej Singh
- Dept. of Community Medicine, GGSMCH, Faridkot, Punjab, India
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MacDonald K, Mohan G, Pawliuk N, Joober R, Padmavati R, Rangaswamy T, Malla A, Iyer SN. Comparing treatment delays and pathways to early intervention services for psychosis in urban settings in India and Canada. Soc Psychiatry Psychiatr Epidemiol 2023; 58:547-558. [PMID: 36571623 PMCID: PMC10088896 DOI: 10.1007/s00127-022-02414-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Although extensively studied in high-income countries (HICs) and less so in low- and middle-income countries (LMICs), pathways to care and treatment delays in early psychosis have not been compared across contexts. We compared pathways to early intervention for psychosis in an HIC (Montreal, Canada) and an LMIC (Chennai, India). We hypothesised that the duration of untreated psychosis (DUP) would be longer in Chennai. METHODS The number of contacts preceding early intervention, referral sources, first contacts, and DUP and its referral and help-seeking components of first-episode psychosis patients at both sites were similarly measured and compared using chi-square analyses and t tests/one-way ANOVAs. RESULTS Overall and help-seeking DUPs of Chennai (N = 168) and Montreal (N = 165) participants were not significantly different. However, Chennai patients had shorter referral DUPs [mean = 12.0 ± 34.1 weeks vs. Montreal mean = 13.2 ± 28.7 weeks; t(302.57) = 4.40; p < 0.001] as the early intervention service was the first contact for 44% of them (vs. 5% in Montreal). Faith healers comprised 25% of first contacts in Chennai. Those seeing faith healers had significantly shorter help-seeking but longer referral DUPs. As predicted, most (93%) Montreal referrals came from medical sources. Those seeing psychologists/counsellors/social workers as their first contact had longer DUPs. CONCLUSION Differences in cultural views about mental illnesses and organizational structures shape pathways to care and their associations with treatment delays across contexts. Both formal and informal sources need to be targeted to reduce delays. Early intervention services being the first portal where help is sought can reduce DUP especially if accessed early on in the illness course.
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Affiliation(s)
- Kathleen MacDonald
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, 600 101, India
| | - Nicole Pawliuk
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, 600 101, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, 600 101, India
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Singh SP, Winsper C, Mohan M, Birchwood M, Chadda RK, Furtado V, Iyer SN, Lilford RJ, Madan J, Meyer C, Ramachandran P, Rangaswamy T, Shah J, Sood M; WIC Consortium. Pathways to care in first-episode psychosis in low-resource settings: Implications for policy and practice. Asian J Psychiatr 2023; 81:103463. [PMID: 36645973 DOI: 10.1016/j.ajp.2023.103463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Developing countries such as India face a major mental health care gap. Delayed or inadequate care can have a profound impact on treatment outcomes. We compared pathways to care in first episode psychosis (FEP) between North and South India to inform solutions to bridge the treatment gap. METHODS Cross-sectional observation study of 'untreated' FEP patients (n = 177) visiting a psychiatry department in two sites in India (AIIMS, New Delhi and SCARF, Chennai). We compared duration of untreated psychosis (DUP), first service encounters, illness attributions and socio-demographic factors between patients from North and South India. Correlates of DUP were explored using logistic regression analysis (DUP ≥ 6 months) and generalised linear models (DUP in weeks). RESULTS Patients in North India had experienced longer DUP than patients in South India (β = 17.68, p < 0.05). The most common first encounter in North India was with a faith healer (45.7%), however, this contact was not significantly associated with longer DUP. Visiting a faith healer was the second most common first contact in South India (23.6%) and was significantly associated with longer DUP (Odds Ratio: 6.84; 95% Confidence Interval: 1.77, 26.49). Being in paid employment was significantly associated with shorter DUP across both sites. CONCLUSIONS Implementing early intervention strategies in a diverse country like India requires careful attention to local population demographics; one size may not fit all. A collaborative relationship between faith healers and mental health professionals could help with educational initiatives and to provide more accessible care.
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Albert N, Hansen HG, Starzer M, Nordentoft M, Hjorthøj C. Functioning pre- and post-treatment in schizophrenia; further investigations into lead time bias and duration of untreated psychosis. Schizophr Res 2023; 252:287-293. [PMID: 36706472 DOI: 10.1016/j.schres.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The association between duration of untreated psychosis (DUP) and later outcome is not fully understood. Jonas et al. in their 20-year follow-up found that the association could be explained by lead-time bias. In this study we aimed to analyze the relationship between DUP, time since onset of psychosis and functional outcome using a similar statistical approach as the Jonas study. METHOD Using data from 496 participants with first-episode schizophrenia, DUP was assessed using the IRAOS and functioning at the baseline assessment and the subsequent follow-ups (1, 2, 5 and 10 years) was assessed using the GAF-F. For premorbid functioning, the Premorbid Assessment of Functioning Scale was used and rescaled to correspond to the GAF. RESULTS The model with the best fit of data included both a slope and a level change. This model of level of function over time had the inflection point at the time of first treatment. This model indicated a slow decline per year until first treatment, at which point there was a sharp decrease in functioning, and after which functioning gradually improved again. Both in this model and in models accounting for potential lead-time bias, however, longer DUP was associated with a decrease in function for each additional week of DUP. This is in contrast with the Jonas et al. study. CONCLUSION In this study, we did not find evidence of a lead-time bias, but rather found that onset of treatment occurs at the time when participants level of functioning was most impaired, and consequently was not at random.
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Affiliation(s)
- Nikolai Albert
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark; Mental Health Centre Amager, Copenhagen University Hospital, Digevej 110, 2300 Copenhagen, Denmark.
| | - Helene Gjervig Hansen
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
| | - Marie Starzer
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
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Ferrara M, Gallagher K, Yoviene Sykes LA, Markovich P, Li F, Pollard JM, Imetovski S, Cahill J, Guloksuz S, Srihari VH. Reducing Delay From Referral to Admission at a U.S. First-Episode Psychosis Service: A Quality Improvement Initiative. Psychiatr Serv 2022; 73:1416-1419. [PMID: 35652190 PMCID: PMC9715806 DOI: 10.1176/appi.ps.202100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Duration of untreated psychosis (DUP), the period between psychosis onset and entry into care, is a time of great vulnerability. Longer DUP predicts poorer outcomes, and delayed treatment access can limit the effectiveness of coordinated specialty care (CSC) services. This column details one component of a broader early detection campaign, a quality improvement intervention focusing on reducing the delay between confirmation of eligibility and admission to care within a benchmark period of 7 days. Median delay significantly fell (from 13.5 to 3 days), and the proportion of admissions that met the benchmark increased (from 33% to 71%) over 4 years. This intervention provides a sustainable model to reduce wait times at CSC services.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Keith Gallagher
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Laura A Yoviene Sykes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Philip Markovich
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Fangyong Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Jessica M Pollard
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Shannon Imetovski
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - John Cahill
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
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León-Ortiz P, Reyes-Madrigal F, Mondragón-Maya A, Mora-Durán R, González-Manríquez L, Menéndez-Manjarrez F, Solís-Vivanco R, de la Fuente-Sandoval C. Social cognition and its association with the duration and severity of psychosis in antipsychotic-naïve individuals at different stages of the schizophrenia spectrum disorders. Schizophr Res 2022; 248:180-182. [PMID: 36075128 DOI: 10.1016/j.schres.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/22/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Pablo León-Ortiz
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico
| | - Francisco Reyes-Madrigal
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico
| | - Alejandra Mondragón-Maya
- Faculty of Superior Studies Iztacala, Universidad Nacional Autónoma de México, Mexico City 54090, Mexico
| | - Ricardo Mora-Durán
- Emergency Department, Hospital Fray Bernardino Álvarez, Mexico City 14000, Mexico
| | - Luz González-Manríquez
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico
| | - Fernanda Menéndez-Manjarrez
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico
| | - Rodolfo Solís-Vivanco
- Laboratory of Cognitive and Clinical Neurophysiology, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico.
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City 14269, Mexico.
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Weiss A, Steadman S, Mercier HD, Hansel TC, Chaudhry S, Clark I. Pathways to Care: How Help-Seeking Behaviors Relate to Duration of Untreated Psychosis and Treatment Engagement. Psychiatr Q 2022; 93:473-482. [PMID: 34669120 DOI: 10.1007/s11126-021-09960-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 01/20/2023]
Abstract
While much research has focused on the relationship between duration of untreated psychosis (DUP) and clinical outcomes in the first episode psychosis (FEP) patient population, little is known about the individual help-seeking episodes (HSE) that patients undergo before receiving appropriate care. The purpose of this project is to better understand how early referral to FEP-specific care and support system differences affect patients' DUP and engagement with treatment. Data from 50 patients was analyzed at the Early Psychosis Intervention Clinic of New Orleans (EPIC-NOLA) using a modified version of the Pathways to Care Assessments and data captured during clinical care. Patients with their first HSE leading to a referral to EPIC-NOLA (M = 13.3, SD = 11.17) had shorter DUP compared to patients referred after two or more HSEs (M = 29.7, SD = 36. 7), t (38.6) = 2.31, p = .026, 95%CI = 2.0-30.7. One chi-square test revealed a significantly greater proportion of patients referred after one HSE stayed in treatment for 12 months or more. Cluster analysis and independent t-test analyses revealed that patients with hospital pathways (M = 35.00, SD = 39.36) had significantly longer DUP compared to those with self, other and hospital (M = 15.21, SD = 19.07) care pathways. This study supports existing literature that suggest early FEP treatment leads to shortened DUP and longer treatment engagement. Additionally, patients with support systems (people or services) assisting them with help-seeking reach EPIC-NOLA faster, have shorter DUP, and have better treatment engagement.
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Affiliation(s)
- Ashley Weiss
- Department of Psychiatry and Behavioral Services, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Spencer Steadman
- Department of Psychiatry and Behavioral Services, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hannah D Mercier
- Department of Psychiatry and Behavioral Services, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Serena Chaudhry
- Department of Psychiatry and Behavioral Services, Tulane University School of Medicine, New Orleans, LA, USA
| | - Isabel Clark
- Department of Psychiatry and Behavioral Services, Tulane University School of Medicine, New Orleans, LA, USA
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Albin K, Albin C, Jeffries CD, Perkins DO. Clinician Recognition of First Episode Psychosis. J Adolesc Health 2021; 69:457-464. [PMID: 33846053 DOI: 10.1016/j.jadohealth.2020.12.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE Psychotic disorders develop during mid-adolescence through early adulthood, with the initial few months a "critical period" offering the greatest promise for recovery. However, the duration of untreated psychosis is typically over a year. This study aimed to identify aspects of care episodes contributing to delays in diagnosis of a first psychotic episode. METHODS Study subjects included 161 adolescents and young adults referred to a first episode psychosis treatment program. We captured the various ways that people who experience a severe mental illness engage in treatment using standardized interviews with patients and informants (e.g., family member) and medical record review. RESULTS A psychotic disorder diagnosis was not given for 38% of subjects at their initial episode of care. Time to first care episode was virtually the same for subjects that did and did not receive a psychosis diagnosis; 50% within 1 month and 84% within 6 months. Compared to initial care episodes with a psychosis diagnosis, those without a psychosis diagnosis less often involved emergency services (80% vs. 38%, respectively; p value = 1 × 10-7) and more often outpatient primary care (6% vs. 18%; p value = .032) and mental health (32% vs. 49%; p value = .045) services. However, dangerousness indicators were similar (29% vs. 28%; p value = 1). Dangerousness indicators increased to 54% (p value = .002) by the time of eventual diagnosis for those requiring multiple care episodes. CONCLUSIONS Clinicians were important contributors to delays in diagnosis and treatment of psychosis. Interventions targeting outpatient health care providers may be fruitful in reducing the duration of untreated psychosis.
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Affiliation(s)
- Kathryn Albin
- Texas College of Osteopathic Medicine Student, Fort Worth, Texas
| | - Cameron Albin
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Clark D Jeffries
- Renaissance Computing Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.
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Ferrara M, Guloksuz S, Mathis WS, Li F, Lin IH, Syed S, Gallagher K, Shah J, Kline E, Tek C, Keshavan M, Srihari VH. First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1359-1369. [PMID: 33948678 PMCID: PMC8319102 DOI: 10.1007/s00127-021-02090-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care. METHODS Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview. RESULTS Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups. CONCLUSION Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA.
| | - Sinan Guloksuz
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, Maastricht, The Netherlands
| | - Walter S Mathis
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Fangyong Li
- Center for Science and Social Science Information, YCAS Yale University, PO Box 208111, New Haven, CT, 06520, USA
| | - I-Hsin Lin
- Center for Science and Social Science Information, YCAS Yale University, PO Box 208111, New Haven, CT, 06520, USA
| | - Sumaiyah Syed
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Keith Gallagher
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Jai Shah
- PEPP-Montreal, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Emily Kline
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cenk Tek
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vinod H Srihari
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
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Nkire N, Scully PJ, Browne DJ, Baldwin PA, Kingston T, Owoeye O, Kinsella A, O'Callaghan E, Russell V, Waddington JL. Systematic comparison of duration of untreated illness versus duration of untreated psychosis in relation to psychopathology and dysfunction in the Cavan-Monaghan first episode psychosis study (CAMFEPS). Eur Neuropsychopharmacol 2021; 47:20-30. [PMID: 33823369 DOI: 10.1016/j.euroneuro.2021.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/22/2023]
Abstract
This study systematically compared duration of untreated illness (DUI) with duration of untreated psychosis (DUP) in prediction of impairment at first-episode psychosis and investigated the extent to which these relationships are influenced by premorbid features. The Cavan-Monaghan First Episode Psychosis Study ascertained cases of first-episode psychosis in rural Ireland via all routes to care with limited variations in socioeconomic milieu. Cases were evaluated for DUI and DUP and assessed clinically for psychopathology, neuropsychology, neurology, insight and quality of life, together with premorbid features. Analyses then determined prediction of clinical assessments by DUI versus DUP. The study population consisted of 163 cases of first episode psychosis, among which 74 had a schizophrenia spectrum disorder. Shorter DUI but not DUP predicted less severe positive and general symptoms, while shorter DUP and particularly DUI predicted less severe negative symptoms; neither shorter DUP nor shorter DUI predicted less severe cognitive impairment or fewer neurological soft signs; shorter DUP and DUI predicted increased quality of life; shorter DUI but not DUP predicted greater insight. Only prediction of quality of life was weakened by consideration of premorbid features. Results were generally similar across the two diagnostic groupings. The present findings systematically delineate associations with DUI versus DUP across domains of impairment in first episode psychosis. They suggest that DUI may reflect a more insidious process than DUP and that reduction in DUI may be associated with more consistent and broader diminutions in impairment than for DUP.
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Affiliation(s)
- Nnamdi Nkire
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul J Scully
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Browne
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrizia A Baldwin
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tara Kingston
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Olabisi Owoeye
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anthony Kinsella
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Vincent Russell
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - John L Waddington
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric-Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
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18
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Oduola S, Craig TKJ, Morgan C. Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:931-941. [PMID: 32681277 PMCID: PMC8192380 DOI: 10.1007/s00127-020-01922-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is inconsistent evidence on the influence of ethnicity on duration of untreated psychosis (DUP). We investigated ethnic differences in DUP in a large epidemiological dataset of first episode psychosis patients in an inner city area of south London, UK. METHODS We analysed data on 558 first episode psychosis patients at the South London and Maudsley NHS Trust, between 2010 and 2012. We performed multivariable logistic regression to estimate the odds of a short DUP (≤ 6 months) by ethnic group, controlling for confounders. RESULTS There was no evidence that ethnicity is associated with duration of untreated psychosis. However, we found evidence that a short DUP was strongly associated with age, living circumstances, and pathways to care variables (involuntary admission, out of office hour contact, accident and emergency referral, criminal justice agency referral and family involvement in help-seeking). Conversely, a long DUP was associated with report of social isolation, living alone, being single and General Practitioner referral. CONCLUSION Our findings suggest that indicators of social isolation were associated with long DUP. Our data also show that pathways into care characteristics play significant role in DUP. Thus, the challenge of tackling the issue of timely access to EI under the new Access and Waiting Time standard for psychosis requires a multilevel approach, including joint working with communities, public awareness of psychosis, less restrictive referral pathways and adequate resourcing of early intervention for psychosis services. These will go a long way in addressing patients' needs rather than be determined by service structures.
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Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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Myaba J, Mwale CM, Jumbe VC. Clinical Predictors of Duration of Untreated Psychosis: Exploring Psychosocial and Clinical Predictors of Duration of Untreated Psychosis in First-Episode Psychotic Patients in Mzuzu, Malawi. Malawi Med J 2021; 33:23-29. [PMID: 35509991 PMCID: PMC9023032 DOI: 10.4314/mmj.v33is.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The duration of untreated Psychosis (DUP) is a modifiable factor in the management and outcome of patients with psychosis. However, its predictive factors have not been studied much in Malawi. Our study was aimed at determining the psychosocial and clinical predictors of DUP in first episode psychosis in Malawi. Method A quantitative cross-sectional study, using secondary data from an early intervention study project was done in Mzuzu, Malawi. We analysed 140 adult participants enrolled in early intervention project in 2010. Data was collected using abstraction sheet to target predictive factors. We conducted univariate and multivariate logistic regression at confidence interval of 95%. We described the mean DUP, and looked at relationship of clinical and psychosocial factors with DUP. Results Most participants were male (60%, n=84) and single (51.4%, n=72). The median age of male participants was 31 years (Range=18 to 60), lower than females 35 years (Range=18 to 65). (what were the numbers of females). The majority of the participants' highest education level was secondary school (63.6%, n=89), and most had DUP of ≥ 6 months (74%, n=103). We found mean DUP of 42 months (SD= ±71). Employment status, diagnosis of schizophrenia (OR=10.93, 95% C.I 3.08-38.89), and negative symptoms of psychosis were associated with DUP of ≥ 6 months. Public self-consciousness and social quality of life were associated with long DUP. Conclusion Our study shows psychosocial and clinical factors that predict long DUP in Malawi. This highlights the need to target these factors when working on first episode psychosis for a better outcome.
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Affiliation(s)
- Japhet Myaba
- Department of Mental Health, Kamuzu College of Nursing, University of Malawi/Kamuzu University of Health Sciences
| | | | - Vincent C Jumbe
- Department of Health Systems and Policy, College of Medicine, University of Malawi/Kamuzu University of Health Sciences
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20
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Hung CF, Wang LJ, Hsu CW, Huang YC, Lin PY, Lee Y, Lee IK, Chou WJ, Lee CT. Contemporary psychiatric intervention for chronic schizophrenia patients incarcerated in a religious asylum in Taiwan. J Formos Med Assoc 2021; 120:1620-1626. [PMID: 33593690 DOI: 10.1016/j.jfma.2021.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/27/2020] [Accepted: 01/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND/PURPOSE In 2017, Long-Fa Temple, an illegal religious asylum in Taiwan, was forced to shut down. Hundreds of chronic mentally ill patients were incarcerated there but provided with no modern psychiatric treatment. This study investigated the effectiveness of providing psychiatric intervention for patients subsequently transferred from Long-Fa Temple to a medical center. METHODS In total, 88 patients (mean age: 57.2 years, 52.3% male) who had been incarcerated at Long-Fa Temple were transferred to a southern medical center. The patients underwent comprehensive biological, psychological, and social treatment for 18 months. The patients were evaluated once a month in terms of their psychotic symptoms, self-care, nutrition status, cognitive function, occupational function, and family function. RESULTS Regarding the patients' length of stay, 18.2% were incarcerated in Long-Fa Temple for less than 10 years, 21.6% for 10-20 years, and 60.2% for more than 20 years. In terms of psychiatric diagnosis, 98.9% of the patients had been diagnosed with a schizophrenia spectrum disorder. During the 18-month treatment period, negative symptoms decreased significantly, while the patients' self-care ability, nutrition status, cognition, occupational function, and family function all significantly improved over time. Patients who had been incarcerated for less than 10 years demonstrated better improvements in psychotic symptoms, self-care, nutrition status, and cognitive function. CONCLUSION Contemporary psychiatric intervention is beneficial for chronically untreated mentally ill patients, and the patients who had a shorter duration of illness had a better reserve of recovery. These findings can serve as an important reference for psychiatric intervention in developing countries.
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Affiliation(s)
- Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ing-Kit Lee
- Department of Infection, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chien-Te Lee
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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21
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Howes OD, Whitehurst T, Shatalina E, Townsend L, Onwordi EC, Mak TLA, Arumuham A, O’Brien O, Lobo M, Vano L, Zahid U, Butler E, Osugo M. The clinical significance of duration of untreated psychosis: an umbrella review and random-effects meta-analysis. World Psychiatry 2021; 20:75-95. [PMID: 33432766 PMCID: PMC7801839 DOI: 10.1002/wps.20822] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The idea that a longer duration of untreated psychosis (DUP) leads to poorer outcomes has contributed to extensive changes in mental health ser-vices worldwide and has attracted considerable research interest over the past 30 years. However, the strength of the evidence underlying this notion is unclear. To address this issue, we conducted an umbrella review of available meta-analyses and performed a random-effects meta-analysis of primary studies. MEDLINE, Web of Science, PsycINFO and EMBASE were searched from inception to September 3, 2020 to identify relevant meta-analyses of studies including patients with schizophrenia spectrum disorders, first-episode psychosis, or affective and non-affective psychosis. Thirteen meta-analyses were included, corresponding to 129 individual studies with a total sample size of 25,657 patients. We detected potential violations of statistical assumptions in some of these meta-analyses. We therefore conducted a new random-effects meta-analysis of primary studies. The association between DUP and each outcome was graded according to a standardized classification into convincing, highly suggestive, suggestive, weak, or non-significant. At first presentation, there was suggestive evidence for a relationship between longer DUP and more severe negative symptoms (beta=-0.07, p=3.6×10-5 ) and higher chance of previous self-harm (odds ratio, OR=1.89, p=1.1×10-5 ). At follow-up, there was highly suggestive evidence for a relationship between longer DUP and more severe positive symptoms (beta=-0.16, p=4.5×10-8 ), more severe negative symptoms (beta=-0.11, p=3.5×10-10 ) and lower chance of remission (OR=2.16, p=3.0×10-10 ), and suggestive evidence for a relationship between longer DUP and poorer overall functioning (beta=-0.11, p=2.2×10-6 ) and more severe global psychopathology (beta=-0.16, p=4.7×10-6 ). Results were unchanged when analysis was restricted to prospective studies. These effect sizes are clinically meaningful, with a DUP of four weeks predicting >20% more severe symptoms at follow-up relative to a DUP of one week. We conclude that DUP is an important prognostic factor at first presentation and predicts clinically relevant outcomes over the course of illness. We discuss conceptual issues in DUP research and methodological limitations of current evidence, and provide recommendations for future research.
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Affiliation(s)
- Oliver D. Howes
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | - Thomas Whitehurst
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Ekaterina Shatalina
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Leigh Townsend
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Ellis Chika Onwordi
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | | | - Atheeshaan Arumuham
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | - Oisín O’Brien
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Maria Lobo
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Luke Vano
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Uzma Zahid
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Emma Butler
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | - Martin Osugo
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
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22
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Fresan A, Apiquian R, Robles-García R, Zarate CAT, Balducci PM, Broussard B, Wan CR, Compton MT. Similarities and Differences in Associations Between Duration of Untreated Psychosis (DUP) and Demographic, Premorbid, and Symptom Severity Measures in Two Samples of First-Episode Psychosis Patients from Mexico and the United States. Psychiatr Q 2020; 91:769-781. [PMID: 32221766 PMCID: PMC7780290 DOI: 10.1007/s11126-020-09736-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Early-psychosis researchers have documented that duration of untreated psychosis (DUP) is an important predictor of outcomes in first-episode psychosis. Very few cross-national studies have been conducted, and none have been carried out involving patients from both Mexico and the U.S. We collaborated to answer three questions: (1) Are DUP estimates similar in two very different settings and samples? (2) Are demographic variables, premorbid adjustment, and symptom severity similarly related to DUP in the two different settings? (3) Does the same set of variables account for a similar proportion of variance in DUP in the two settings? Data on sociodemographic characteristics, premorbid adjustment, symptom severity, and DUP were available for 145 Mexican and 247 U.S. first-episode psychosis patients. DUP was compared, and bivariate analyses and multiple linear regressions were carried out in each sample. DUP estimates were similar (medians of 35 weeks in Mexico and 38 weeks in the U.S.). In the Mexican sample, DUP was associated with gender, employment status, premorbid social adjustment, and positive symptom severity (explaining 18% of variance). In the U.S. sample, DUP was associated with age, employment status, premorbid social adjustment, and positive symptom severity (but in the opposite direction of that observed in the Mexican sample), accounting for 25% of variance. Additional cross-national collaborations examining key facets of early-course psychotic disorders, including DUP, will clarify the extent of generalizability of findings, strengthen partnerships for more internationally relevant studies, and support the global movement to help young people struggling with first-episode psychosis and their families.
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Affiliation(s)
- Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, DF, Mexico
| | - Rogelio Apiquian
- División de Ciencias del Comportamiento y del Desarrollo, Universidad de las Américas A.C, Mexico City, DF, Mexico
| | - Rebeca Robles-García
- Dirección de Investigaciones Epidemiológicas y Sociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, DF, Mexico
| | | | - Pierfrancesco Maria Balducci
- Scuola di Specializzazione in Psichiatria, Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy
| | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Michael T Compton
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians & Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA.
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Melton R, Blajeski S, Glasser D. Understanding Individual and Family Experiences Associated with DUP: Lessons from the Early Assessment and Support Alliance (EASA) Program in Oregon, USA. Community Ment Health J 2020; 56:1121-1127. [PMID: 32157514 DOI: 10.1007/s10597-020-00599-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
Research shows that a longer duration of untreated psychosis (DUP) is associated with worse psychiatric outcomes, with average length of DUP of 73 weeks in the U.S. The aim was to examine the DUP period for first episode psychosis in Oregon, with a focus on the processes between the first positive symptoms and first treatment. To investigate DUP, researchers used methods consistent with grounded theory to collect data from 9 participants and their families about the process between onset of psychotic symptoms and entrance into treatment. Results suggest that recognition of symptoms was the primary driver of help-seeking in this study, and this was influenced by type of symptom as well as the presence or absence of supportive others, which in most cases was regular family contact. Implications indicate a need for in-depth research on individual and family recognition of symptoms, as well as underscoring the need for community education.
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Affiliation(s)
- Ryan Melton
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA.
| | - Shannon Blajeski
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA
| | - Diana Glasser
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA
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24
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Ku BS, Pauselli L, Manseau M, Compton MT. Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders. Schizophr Res 2020; 218:247-254. [PMID: 31948900 PMCID: PMC7299734 DOI: 10.1016/j.schres.2019.12.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/20/2019] [Accepted: 12/27/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Recent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP). METHODS Data were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis. RESULTS 143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status. CONCLUSIONS This study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.
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Affiliation(s)
- Benson S. Ku
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA,Corresponding author: Benson Ku, M.D., , 100 Woodruff Circle Suite 327, Atlanta, GA 30322, (404) 727-8381, Fax: 289-802-1992
| | - Luca Pauselli
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA,Icahn School of Medicine at Mount Sinai, St. Luke’s/West Hospital Center, Department of Psychiatry, New York, NY, USA
| | - Marc Manseau
- New York University School of Medicine, Department of Psychiatry, New York, NY, USA
| | - Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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Zhang PP, Li YF, Deng W, Wei W, Zhang YM, Zhang CC, Li T. [An MRI Study of the Relationship Between Duration of Untreated Psychosis and Morphology of Cerebral Cortex in First-episode Schizophrenia]. Sichuan Da Xue Xue Bao Yi Xue Ban 2020; 51:35-41. [PMID: 31950787 DOI: 10.12182/20200160503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective We analyzed the brain structure of schizophrenia patients from multiple perspectives to explore the relationship between the duration of untreated psychosis (DUP) and clinical outcomes. Methods For 85 patients and 86 controls, clinical symptoms and cognitive function were evaluated, magnetic resonance imaging (MRI) and free surfer analysis were used to extract the cortical indicator, such as brain cortex thickness, surface area, volume, and so on. The patients were divided into four subgroups according to the boundary of March, June and two year due to the distribution and median of DUP. Finally multi-group comparison and correlation analysis for above indicators were analysed. Results DUP was associated with the surface area of the left insula, parsorbitalis, right hippocampus, superior frontal gyrus, frontal pole, and temporal pole; DUP mainly influenced the cortical thickness of left posterior cingulate gyrus, postcentral gyrus, right lateral occipital cortex, parsopercularis, medial orbitofrontal cortex, and the bilateral precentral gyrus. For cortical volume, DUP significantly affected left postcentral gyrus, right precuneus, lateral occipital cortex, parsopercularis, lingual gyrus, superior temporal gyrus, bilateral cuneus, pericalcarine cortex, precentral gyrus,superior parietal lobule, and insula.The first three months after onset is a critical period for the deterioration of cortical morphology and clinical function. Conclusion DUP in first-episode schizophrenia is associated with cortical morphological changes of temporal lobe, precentral, orbitofrontal cortex and the majority of medial regions of occipital lobe, it is very important to conduct early intervention for patients.
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Affiliation(s)
- Ping-Ping Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yin-Fei Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wei Deng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wei Wei
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ya-Min Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Cheng-Cheng Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Zhang T, Xu L, Tang Y, Cui H, Tang X, Wei Y, Wang Y, Hu Q, Qian Z, Liu X, Li C, Wang J. Relationship between duration of untreated prodromal symptoms and symptomatic and functional recovery. Eur Arch Psychiatry Clin Neurosci 2019; 269:871-877. [PMID: 29942980 DOI: 10.1007/s00406-018-0917-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/18/2018] [Indexed: 01/19/2023]
Abstract
Our previous study has found that a long duration of untreated prodromal symptoms (DUPrS) does not increase the conversion risk to psychosis in individuals with attenuated psychosis syndrome (APS). However, whether a long DUPrS will lead to other poor outcomes remains unknown. The purpose of this study was to analyse the association between the DUPrS and outcomes (symptomatic and functional recovery) in APS population. A post hoc analysis was performed in 391 individuals with APS as identified by the structured interview. APS subjects had follow-up interviews every 6 months for 2 years following diagnosis. Poor functional outcome was defined as a Global Assessment of Functioning (GAF) score less than 60 at the time of follow-up. Poor symptomatic outcome was defined as at least one of the positive symptoms rated scores of 3 or higher. A post hoc analysis was performed in 391 individuals with APS as identified by the structured interview. APS subjects had follow-up interviews every 6 months for 2 years following diagnosis. Poor functional outcome was defined as a Global Assessment of Functioning (GAF) score less than 60 at the time of follow-up. Poor symptomatic outcome was defined as at least one of the positive symptoms rated scores of 3 or higher. Of total 391 individuals, 334 were followed up for 2 years to assess clinical outcome, 82 (24.6%) had shown conversion to psychosis, 79 (23.7%) met the criteria of poor functioning outcome, and 145 (43.4%) met the criteria of poor symptomatic outcome. A significant correlation between GAF scores and DUPrS was observed in the non-converter group, but not in the converters. Individuals with APS who had a longer DUPrS were correlated with poorer functional outcome. However, it was not correlated with poorer symptomatic outcome. While a longer DUPrS was not related to poor symptomatic outcome, it was significantly related to poor functional outcome. Our findings highlight the importance of reducing DUPrS to decrease future functional impairment in populations at risk for psychosis.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China.
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - Yan Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - Qiang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - ZhenYing Qian
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - XiaoHua Liu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Beijing, People's Republic of China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, 600 Wanping Nan Road, Shanghai, 200030, People's Republic of China. .,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Beijing, People's Republic of China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, People's Republic of China.
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Maximo JO, Nelson EA, Armstrong WP, Kraguljac NV, Lahti AC. Duration of Untreated Psychosis Correlates With Brain Connectivity and Morphology in Medication-Naïve Patients With First-Episode Psychosis. Biol Psychiatry Cogn Neurosci Neuroimaging 2019; 5:231-238. [PMID: 31902581 DOI: 10.1016/j.bpsc.2019.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In the United States, the average duration of untreated psychosis (DUP) is 21 months, and it remains unknown how longer DUP may affect brain functioning in antipsychotic-naïve patients with first-episode psychosis. The objective was to determine the effects of DUP on functional connectivity and brain morphology measured with resting-state functional and structural magnetic resonance imaging. METHODS Medication-naïve patients with first-episode psychosis were referred from various clinical settings. After accounting for exclusion criteria, attrition, and data quality, final analyses included 55 patients (35 male and 20 female; mean age, 24.18 years). Patients with first-episode psychosis were subjected to a 16-week trial of risperidone, a commonly used antipsychotic drug. Treatment response was calculated as change in the psychosis subscale of the Brief Psychiatric Rating Scale between baseline and 16 weeks. Resting-state functional connectivity magnetic resonance imaging and brain morphology (surface area and cortical thickness) were assessed. RESULTS Longer DUP was associated with worse treatment response and reduced functional connectivity-more specifically in the default, salience, and executive networks. Moreover, longer DUP was associated with reduced surface area in the salience and executive networks and with increased cortical thickness in the default mode and salience networks. When the functional connectivity of the default mode network was added as a mediator, the relationship between DUP and treatment response was no longer significant. CONCLUSIONS These data suggest that several neurobiological alterations in the form of reduced functional connectivity and surface area and increased cortical thickness underpin the effect of prolonged DUP.
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Affiliation(s)
- Jose O Maximo
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric A Nelson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William P Armstrong
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nina V Kraguljac
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adrienne C Lahti
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama.
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Schoer N, Huang CW, Anderson KK. Differences in duration of untreated psychosis for racial and ethnic minority groups with first-episode psychosis: an updated systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1295-1298. [PMID: 31183503 DOI: 10.1007/s00127-019-01737-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Ethnic minority groups with early psychosis may have longer treatment delays, potentially leading to poorer outcomes. We updated a previous systematic review of the literature on racial and ethnic differences in duration of untreated psychosis (DUP) among people with first-episode psychosis. RESULTS Six of 17 studies described significant differences across aggregated racial groups; however, the pooled estimates did not show differences across groups. Additional data from this update allowed for disaggregated analyses, finding that Black-African groups have a shorter DUP, whereas Black-Caribbean groups have longer DUP, relative to White groups. CONCLUSIONS These findings highlight the importance of in-depth research on disaggregated ethnic groups to inform targeted early intervention strategies for minority populations.
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Affiliation(s)
- Nicole Schoer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, Kresge Building, Room K213, London, ON, N6A 5C1, Canada
| | - Chen Wei Huang
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, Kresge Building, Room K213, London, ON, N6A 5C1, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, Kresge Building, Room K213, London, ON, N6A 5C1, Canada. .,Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada.
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Zhang Y, Xu L, Hu Y, Wu J, Li C, Wang J, Yang Z. Functional Connectivity Between Sensory-Motor Subnetworks Reflects the Duration of Untreated Psychosis and Predicts Treatment Outcome of First-Episode Drug-Naïve Schizophrenia. Biol Psychiatry Cogn Neurosci Neuroimaging 2019; 4:697-705. [PMID: 31171498 DOI: 10.1016/j.bpsc.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Somatic symptoms and motor abnormalities have been consistently reported as typical symptoms of schizophrenia, but evidence linking impaired functional connectivity among the primary sensory-motor network and its associations to schizophrenia is largely lacking. The present study aims to examine abnormal functional connectivity in the sensory-motor network in schizophrenia and its associations with the duration of untreated psychosis and medication treatment effects. We hypothesize that patients with schizophrenia suffer from disrupted functional connectivity between the sensory-motor subnetworks. The degree of impairment in the connectivity could reflect the duration of untreated psychosis and predict outcomes of medication treatment. METHODS At baseline, resting-state functional magnetic resonance imaging data were acquired from 60 first-episode patients with drug-naïve schizophrenia (36 were female) and 60 matching normal control subjects (31 were female). After 2 months, 23 patients who received medication treatment and 32 normal control subjects were rescanned. Functional connectivity among subnetworks in the sensory-motor system was compared between the groups and correlated with the duration of untreated psychosis and the treatment outcome. RESULTS Patients with schizophrenia showed significantly disrupted functional connectivity in the sensory-motor network. The degree of impairment reflected the duration of untreated psychosis and motor-related symptoms. It further predicted the improvement of positive scores after medication. CONCLUSIONS These findings suggest that functional connectivity in the sensory-motor network could indicate the severity of neural impairment in schizophrenia, and it deserves more attention in the search for neuroimaging markers for evaluating neural impairment and prognosis.
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Affiliation(s)
- Yiwen Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Hu
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jinfeng Wu
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Science, Shanghai, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Science, Shanghai, China.
| | - Zhi Yang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
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Manivannan A, Foran W, Jalbrzikowski M, Murty VP, Haas GL, Tarcijonas G, Luna B, Sarpal DK. Association Between Duration of Untreated Psychosis and Frontostriatal Connectivity During Maintenance of Visuospatial Working Memory. Biol Psychiatry Cogn Neurosci Neuroimaging 2019; 4:454-461. [PMID: 30852127 DOI: 10.1016/j.bpsc.2019.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND A longer duration of untreated psychosis (DUP) has been linked with poor clinical outcomes and variation in resting-state striatal connectivity with central executive regions. However, the link between DUP and task-based activation of executive neurocognition has not previously been examined. This functional magnetic resonance imaging study examined the association between DUP and both activation and frontostriatal functional connectivity during a visual working memory (WM) paradigm in patients with first-episode psychosis. METHODS Patients with first-episode psychosis (n = 37) underwent functional magnetic resonance imaging scanning while performing a visual WM task. At the single-subject level, task conditions were modeled; at the group level, each condition was examined along with DUP. Activation was examined within the dorsolateral prefrontal cortex, a primary region supporting visual WM activation. Frontostriatal functional connectivity during the WM was examined via psychophysical interaction between the dorsal caudate and the dorsolateral prefrontal cortex. Results were compared with a reference range of connectivity values in a matched group of healthy volunteers (n = 25). Task performance was also examined in relation to neuroimaging findings. RESULTS No significant association was observed between DUP and WM activation. Longer DUP showed less functional frontostriatal connectivity with the maintenance of increasing WM load. Results were not related to task performance measures, consistent with previous work. CONCLUSIONS Our data suggest that DUP may affect frontostriatal circuitry that supports executive functioning. Future work is necessary to examine if these findings contribute to the mechanism underlying the relationship between DUP and worsened clinical outcomes.
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Affiliation(s)
- Ashwinee Manivannan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria Jalbrzikowski
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Goda Tarcijonas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Abstract
INTRODUCTION Patients with psychosis often seek treatment at a later date after the onset of illness. There are a multitude of factors behind the treatment delay in these patients, reduction of this delay will help in better prognosis of these patients. MATERIALS AND METHODS A cross sectional study was conducted to understand the various reasons responsible for treatment delay in patients with psychosis. 25 subjects were selected by purposive sampling and their family members were interviewed. Qualitative analysis was carried out to identify various factors. RESULTS Reasons for treatment delay were at several levels like illness related, patient related, treatment related, family related factors. However the most common themes among these were unawareness of illness, explanatory models of illness, stigma, financial constraints. Other themes like relation of symptoms with premorbid personality, life events, absence of paternal support were also unfolded in the current study. CONCLUSIONS There is significant delay between onset of psychosis and treatment seeking. Several factors are responsible for treatment delay in patients with psychotic illness. However they vary depending upon the socio-cultural background of the patient and their family members. Hence the interventions devised towards reducing the delay should be individualised.
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Affiliation(s)
- Mithun Dutta
- Department of Psychiatry, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Shrimaan Patel
- Department of Psychiatry, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Nitish Agarwala
- Department of Psychiatry, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Lee SW, Lee A, Choi TK, Kim B, Lee KS, Bang M, Lee SH. White matter abnormalities of the tapetum and their associations with duration of untreated psychosis and symptom severity in first-episode psychosis. Schizophr Res 2018; 201:437-8. [PMID: 29895415 DOI: 10.1016/j.schres.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/03/2018] [Accepted: 06/03/2018] [Indexed: 11/21/2022]
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Fond G, Boyer L, Andrianarisoa M, Godin O, Brunel L, Bulzacka E, Coulon N, Llorca PM, Berna F, Aouizerate B, Capdevielle D, D'Amato T, Dubertret C, Dubreucq J, Faget C, Gabayet F, Mallet J, Misdrahi D, Rey R, Richieri R, Roux P, Passerieux C, Schandrin A, Tronche AM, Vidailhet P, Leboyer M, Schürhoff F; FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group. Risk factors for increased duration of untreated psychosis. Results from the FACE-SZ dataset. Schizophr Res 2018; 195:529-33. [PMID: 28888362 DOI: 10.1016/j.schres.2017.08.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Reducing the duration of untreated psychosis (DUP) may improve the prognosis of schizophrenia. This study investigated the prevalence, and associated risk factors, of long DUP in a large, non-selected sample of community-dwelling schizophrenia patients (SZ). METHOD 478 community-dwelling stable SZ participants (122 women and 356 men; mean age 32.37±9.86years) were recruited between 2010 and 2016. The mean retrospective DUP was evaluated from both patient and family reports, as well as hospital/psychiatrists records. Long DUP was defined as >2years. RESULTS The mean DUP was 1.5years. 80 participants (16.7%) had a DUP>2years. In multivariate analyses, after adjustment for sex, education level, history of childhood trauma and history of maternal schizophrenia or bipolar disorder, long DUP was associated with a younger age of illness onset (19.3±6.67years vs. 22.0±6.51years, adjusted odd ratio aOR=0.91, 95%CI [0.86; 0.97], p=0.003) and cannabis use disorder (20.0% vs. 10.3%, aOR=2.41, 95%CI [1.14-5.09], p=0.02). CONCLUSION A high proportion of SZ patients still have a long DUP. The present results suggest that illness onset before age 19years and cannabis use are associated with long DUP in schizophrenia patients. Early psychosis detection programs should prioritize the targeting of these populations.
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Ho RWH, Chang WC, Kwong VWY, Lau ESK, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of self-stigma in early psychosis: 3-Year follow-up of the randomized-controlled trial on extended early intervention. Schizophr Res 2018; 195:463-468. [PMID: 28888358 DOI: 10.1016/j.schres.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Self-stigma represents a major barrier to recovery in people with psychotic disorders but is understudied in early illness stage. Longitudinal investigation of prediction for self-stigma is scarce and none is conducted in early psychosis. We aimed to prospectively examine baseline predictors of self-stigma in early psychosis patients in the context of a 3-year follow-up of a randomized-controlled trial (RCT) comparing 1-year extension of early intervention (EI) with step-down psychiatric care for first-episode psychosis (FEP). METHOD One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they had completed this 2-year EI service, and underwent a 12-month RCT. Participants were followed up and reassessed 3years after inclusion to the trial. Comprehensive evaluation encompassing clinical, functional, subjective quality of life and treatment-related variables were conducted. Data analysis was based on 136 participants who completed self-stigma assessment at 3-year follow-up. RESULTS Fifty patients (36.8%) had moderate to high levels of self-stigma at 3-year follow-up. Multivariate regression analysis revealed that female gender, prior psychiatric hospitalization, longer duration of untreated psychosis and greater positive symptom severity at study intake independently predicted self-stigma at the end of 3-year study period. CONCLUSION Our results of more than one-third of early psychosis patients experienced significant self-stigma underscore the clinical needs for early identification and intervention of self-stigmatization in the initial years of psychotic illness. Further research is warranted to clarify prediction profile and longitudinal course of self-stigma in the early illness phase.
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Affiliation(s)
- Ryan Wui Hang Ho
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
| | - Vivian Wing Yan Kwong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Emily Sin Kei Lau
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Gloria Hoi Kei Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Olivia Tsz Ting Jim
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
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Abstract
BACKGROUND Duration of untreated psychosis (DUP) is an important measure of access to care as it predicts prognosis and treatment outcomes. Little is known about potential socioeconomic inequalities in DUP. The aim of this study was to investigate inequalities in DUP associated with socioeconomic deprivation in a national cohort in England. METHOD We analysed a cohort of 887 patients with a first-episode in psychosis using the administrative Mental Health Services Dataset in England for 2012/13-2014/15. We used a Generalised Linear Model to account for non-linearity in DUP and looked at inequalities across the whole distribution of DUP using quantile regression. RESULTS The median DUP was 22 days (mean = 74 days) with considerable variations between and within the 31 hospital providers. We found evidence of significant inequalities regarding the level of socioeconomic deprivation. Patients living in the second, third and fourth deprived neighbourhood quintiles faced a 36, 24 and 31 day longer DUP than patients from the least deprived neighbourhoods. Inequalities were more prevalent in higher quantiles of the DUP distribution. Unemployment prolonged DUP by 40 days. Having been in contact with mental health care services prior to the psychosis start significantly reduced the DUP by up to 53 days. CONCLUSIONS Socioeconomic deprivation is an important factor in explaining inequalities in DUP. Policies to improve equitable access to care should particularly focus on preventing very long delays in treatment and target unemployed patients as well as people that have not been in contact with any mental health professional in the past.
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Affiliation(s)
- A Reichert
- Centre for Health Economics,University of York,York YO105DD,UK
| | - R Jacobs
- Centre for Health Economics,University of York,York YO105DD,UK
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Mezquida G, Cabrera B, Martínez-Arán A, Vieta E, Bernardo M. Detection of early psychotic symptoms: Validation of the Spanish version of the "Symptom Onset in Schizophrenia (SOS) inventory". Psychiatry Res 2018; 261:68-72. [PMID: 29287238 DOI: 10.1016/j.psychres.2017.12.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 01/16/2023]
Abstract
The period of subclinical signs that precedes the onset of psychosis is referred to as the prodrome or high-risk mental state. The "Symptom Onset in Schizophrenia (SOS) inventory" is an instrument to characterize and date the initial symptoms of a psychotic illness. The present study aims to provide reliability and validity data for clinical and research use of the Spanish version of the SOS. Thirty-six participants with a first-episode of psychosis meeting DSM-IV criteria for schizophrenia/schizoaffective/schizophreniform disorder were administered the translated SOS and other clinical assessments. The internal validity, intrarater and interrater reliability were studied. We found strong interrater reliability. To detect the presence/absence of prodromal symptoms, Kappa coefficients ranged between 0.8 and 0.7. Similarly, the raters obtained an excellent level of agreement regarding the onset of each symptom and the duration of symptoms until first treatment (intraclass correlation coefficients between 0.9 and 1.0). Cronbach's alpha was 0.9-1.0 for all the items. The interrater reliability and concurrent validity were also excellent in both cases. This study provides robust psychometric properties of the Spanish version of the SOS. The translated version is adequate in terms of good internal validity, intrarater and interrater reliability, and is as time-efficient as the original version.
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Abstract
Neurocognitive impairment is a well-established feature of first-episode psychosis (FEP). Neurotoxicity hypothesis of psychosis suggests that untreated psychosis before the initiation of first effective treatment is associated with loss of acquired cognitive abilities. However, the outcome of the studies investigating the relationship between duration of untreated psychosis (DUP) and cognitive impairment in FEP remains inconclusive. No previous meta-analysis investigating the relationship between DUP and cognitive impairment in FEP has been published. Following the systematic review of FEP studies, a random-effects meta-analysis of the relationship between DUP and neurocognition in schizophrenia was conducted. Current meta-analysis included 27 studies including 3127 patients with first-episode psychosis. Overall, DUP and cognitive abilities were not significantly related, with the exception of evidence for a weak relationship with a single cognitive domain. There was a very small but significant association between longer DUP and reduced performance in planning/problem-solving ability (r=-0.09, CI=-0.14 to -0.03). Current findings do not provide support for the neurotoxicity hypothesis of psychosis.
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Affiliation(s)
- Emre Bora
- Dokuz Eylül University, Faculty of Medicine, Department of Psychiatry, Izmir, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, South, Victoria 3053, Australia.
| | - Berna Yalincetin
- Department of Neurosciences, Dokuz Eylül University, Izmir 35340, Turkey
| | - Berna Binnur Akdede
- Dokuz Eylül University, Faculty of Medicine, Department of Psychiatry, Izmir, Turkey; Department of Neurosciences, Dokuz Eylül University, Izmir 35340, Turkey
| | - Koksal Alptekin
- Dokuz Eylül University, Faculty of Medicine, Department of Psychiatry, Izmir, Turkey; Department of Neurosciences, Dokuz Eylül University, Izmir 35340, Turkey
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Hastrup LH, Haahr UH, Jansen JE, Simonsen E. Determinants of duration of untreated psychosis among first-episode psychosis patients in Denmark: A nationwide register-based study. Schizophr Res 2018; 192:154-158. [PMID: 28578812 DOI: 10.1016/j.schres.2017.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Information on determinants of duration of untreated psychosis (DUP) is still needed to inform campaigns targeting people with first episode psychosis (FEP). This nation-wide study analysed the association between demographic factors (age, sex, ethnicity, marital status, and geographic area), premorbid and illness-related factors (global functional level, substance misuse, and contact to police), healthcare factors (referral source and first FEP contact) and DUP. METHOD The study population of 1266 patients aged 15-25years diagnosed with FEP (ICD10 F20.0-F20.99) was drawn from the Danish National Indicator Project during 2009-2011. The study population was combined with data from national administrative registers. A multinomial regression model was estimated to analyse the impact of demographic, premorbid and illness-related, and healthcare factors on DUP. RESULTS One third of the population had a DUP below 6months. DUP longer than 12months was associated with older age at onset, being female, having cannabis misuse, and living in peripheral municipalities. Being charged by the criminal authorities during one year before FEP was associated with a DUP over 6months. CONCLUSION DUP is related to a number of demographic, premorbid and healthcare factors. These findings suggest that future information campaigns should focus on increasing the awareness of early signs of psychosis not only among mental health professionals but also other professionals in contact with adolescents such as the police. It may also be useful to consider how to target information campaigns towards persons living in peripheral areas.
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Affiliation(s)
| | | | | | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Denmark
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Bhullar G, Norman RMG, Klar N, Anderson KK. Untreated illness and recovery in clients of an early psychosis intervention program: a 10-year prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:171-82. [PMID: 29188310 DOI: 10.1007/s00127-017-1464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether duration of untreated psychosis (DUP) and duration of untreated illness (DUI) are associated with measures of both subjective and objective recovery 10 years after a first episode of psychosis. METHODS A cohort of 65 clients from an early psychosis intervention program completed a battery of outcome measures 10 years following initial treatment for first-episode psychosis (FEP). The outcomes of interest were self-perceived recovery scores (Maryland Assessment of Recovery in People with Serious Mental Illness Scale) and occupational activity, defined as engagement in work and/or school on a full/part-time basis. Multiple linear and logistic regression analyses were used to estimate the associations between DUP and DUI with each measure of recovery, adjusting for potential confounding factors. RESULTS We did not find a statistically significant association between DUP and either occupational activity (OR = 1.26, 95% CI 0.81-1.95) or self-perceived recovery score (β = - 0.73, 95% CI - 2.42 to 0.97). However, we found a significant negative association between DUI and self-perceived recovery score (β = - 0.52, 95% CI - 0.87 to - 0.16). CONCLUSIONS Our findings suggest that DUI may have a stronger influence than DUP on recovery from FEP at 10-year follow-up. This suggests the potential value in targeted interventions for people with a long DUI to increase the likelihood of achieving recovery after the first episode of psychosis.
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Renwick L, Owens L, Lyne J, O'Donoghue B, Roche E, Drennan J, Sheridan A, Pilling M, O'Callaghan E, Clarke M. Predictors of change in social networks, support and satisfaction following a first episode psychosis: A cohort study. Int J Nurs Stud 2017; 76:28-35. [PMID: 28910597 DOI: 10.1016/j.ijnurstu.2017.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 07/04/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks and perceived satisfaction, explore the clinical correlates of these outcomes and examine whether phases of untreated psychosis are linked with social network variables to determine potential opportunities for intervention. METHODS During the study period, we assessed 222 people with first-episode psychosis at entry into treatment using valid and reliable measures of diagnosis, positive and negative symptoms, periods of untreated psychosis and prodrome and premorbid adjustment. For follow-up we contacted participants to conduct a second assessment (n=158). There were 97 people who participated which represented 61% of those eligible. Social network and support information obtained at both time points included the number of friends, self-reported satisfaction with support and social network size and clinician's evaluation of the degree of support received through networks. Mixed effects modelling determined the contribution of potential explanatory variables to social support measured. RESULTS A number of clinical variables were linked with social networks, support and perceived support and satisfaction. The size of networks did not change over time but those with no friends and duration of untreated psychosis was significantly longer for those with no friends at entry into treatment (n=129, Median=24.5mths, IQR=7.25-69.25; Mann-Whitney U=11.78, p=0.008). Social support at baseline and at one year was predicted by homelessness (t=-2.98, p=0.001, CI -4.74 to -1.21), duration of untreated psychosis (t=-0.86, p=0.031, CI -1.65 to -0.08) and premorbid adjustment (t=-2.26, p=0.017, CI -4.11 to -0.42). Social support improved over time but the duration of untreated psychosis was not linked with the rate of improvement in this outcome. CONCLUSIONS Improved social support could indicate greater reliance on social support or becoming more adept at mobilising resources to meet social needs. Particularly vulnerable groups with very long duration of untreated psychosis confirm the need for earlier intervention or targeted social network interventions to preserve social connectedness.
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Affiliation(s)
- Laoise Renwick
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
| | - Liz Owens
- DETECT Early Psychosis Service, Dublin, Ireland
| | - John Lyne
- DETECT Early Psychosis Service, Dublin, Ireland; North Dublin Mental Health Services, Dublin, Ireland
| | - Brian O'Donoghue
- DETECT Early Psychosis Service, Dublin, Ireland; Orygen, the National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Eric Roche
- DETECT Early Psychosis Service, Dublin, Ireland
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Ann Sheridan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Mark Pilling
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Eadbhard O'Callaghan
- DETECT Early Psychosis Service, Dublin, Ireland; St. John of God Hospital, Dublin, Ireland; Department of Psychiatry, University College Dublin, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Psychosis Service, Dublin, Ireland; St. John of God Hospital, Dublin, Ireland; Department of Psychiatry, University College Dublin, Dublin, Ireland
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Kim SW, Jang JE, Lee JY, Lee GY, Yu HY, Park C, Kang HJ, Kim JM, Yoon JS. Effects of Group Cognitive-Behavioral Therapy in Young Patients in the Early Stage of Psychosis. Psychiatry Investig 2017; 14:609-617. [PMID: 29042886 PMCID: PMC5639129 DOI: 10.4306/pi.2017.14.5.609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/13/2016] [Accepted: 11/07/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To develop a model of group cognitive-behavioral therapy (CBT) for Korean patients with early psychosis. METHODS The group CBT utilized in the present study consisted of metacognitive training, cognitive restructuring, and lifestyle managements. The Subjective Well-being Under Neuroleptics (SWN-K), Ambiguous Intentions Hostility Questionnaire (AIHQ), Drug Attitude Inventory (DAI), Beck Depression Inventory (BDI), Perceived Stress Scale (PSS), and Clinical Global Impression (CGI) were administered prior to and after CBT sessions. The participants were categorized into two groups according to the median duration of untreated psychosis (DUP; 4 months). RESULTS A total of 34 patients were included in this analysis. From pre- to post-therapy, there were significant increases in the SWN-K and DAI scores and significant decreases in the hostility subscale of the AIHQ, PSS, and CGI scores. Significant time × DUP interaction effects were observed for the SWN-K, DAI, and BDI scores, such that there were significant changes in patients with a short DUP but not in those with a long DUP. CONCLUSION The group CBT program had a positive effect on subjective wellbeing, attitude toward treatment, perceived stress, and suspiciousness of young Korean patients with early psychosis. These effects were particularly significant in patients with a short DUP.
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Affiliation(s)
- Sung-Wan Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ji-Eun Jang
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ga-Young Lee
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Hye-Young Yu
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Cheol Park
- Department of Psychiatry, Gwangju Veterans Hospital, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Coentre R, Talina MC, Góis C, Figueira ML. Depressive symptoms and suicidal behavior after first-episode psychosis: A comprehensive systematic review. Psychiatry Res 2017; 253:240-248. [PMID: 28395229 DOI: 10.1016/j.psychres.2017.04.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 03/09/2017] [Accepted: 04/02/2017] [Indexed: 11/29/2022]
Abstract
Depressive symptoms and suicidal behavior are common among patients that suffered a first-episode psychosis. We searched Web of KnowledgeSM and Pubmed® for English and Portuguese original articles investigating prevalence of depressive symptoms and/or suicidal behavior and associated factors after first-episode psychosis. We included 19 studies from 12 countries, 7 studied depressive symptoms and 12 suicidal behavior. The findings confirm that depressive symptoms and suicidal behavior have high rates in the years after first-episode psychosis. Factors identified as being associated with depressive symptoms after first-episode psychosis were anomalies of psychosocial development, poor premorbid childhood adjustment, greater insight, loss, shame, low level of continuing positive symptoms and longer duration of untreated psychosis. Suicidal behavior was associated with previous suicide attempt, sexual abuse, comorbid polysubstance use, lower baseline functioning, longer time in treatment, recent negative events, older patients, longer duration of untreated psychosis, higher positive and negative psychotic symptoms, family history of severe mental disorder, substance use, depressive symptoms and cannabis use. Data also indicate that treatment and early intervention programs reduce depressive symptoms and suicidal behavior after first-episode psychosis. Future research should overcome some methodological discrepancies that exist between studies and limit generalization of current findings.
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Affiliation(s)
- Ricardo Coentre
- Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; First-Episode Psychosis Program, Department of Psychiatry, Hospital Vila Franca de Xira, Estrada Nacional N1, 2600-009 Vila Franca de Xira, Portugal.
| | - Miguel Cotrim Talina
- Department of Psychiatry, Hospital Vila Franca de Xira, Estrada Nacional N1, 2600-009 Vila Franca de Xira, Portugal; CEDOC, Chronic Diseases Research Centre, Nova Medical School, Faculdade de Ciências Médicas, New University of Lisbon, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal
| | - Carlos Góis
- Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Luísa Figueira
- Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
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Kvig EI, Brinchmann B, Moe C, Nilssen S, Larsen TK, Sørgaard K. "Lanthanic Presentation" in First-Episode Psychosis Predicts Long Service Delay: The Challenge of Detecting Masked Psychosis. Psychopathology 2017; 50:282-289. [PMID: 28797004 DOI: 10.1159/000478989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/26/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS Studies of pathways to care in first-episode psychosis have documented a substantial treatment delay occurring after patients enter mental health services. An initial presentation with neurotic rather than psychotic symptoms is common in first-episode psychosis. The term "lanthanic patient" has been used to refer to patients presenting with a reason for help-seeking that is unrelated to the underlying pathology. The aim of this study is to explore whether a lanthanic presentation is related to prolonged service delay. METHODS The sample comprises 62 patients with recent-onset psychosis. Data on sociodemographic, clinical, help-seeking, and pathway indicators were collected using a comprehensive, semistructured-interview schedule. RESULTS Service delay accounted for more than half of the overall treatment delay. An initially presenting complaint of neurotic symptoms was related to prolonged service delay. The effect remained after controlling for other potential risk factors of service delay. CONCLUSION Anomalous experiences of pleasure, desire, or motivation are common in emerging psychosis. These difficulties are often misinterpreted as complaints of depression and anxiety by health professionals. The presence of such symptoms can introduce a focal vision on the part of health care professionals on the immediate presentation rather than the underlying psychopathology, leading to the underdetection of psychosis.
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Okasha T, Zaki N, Meguid MAE, El-Missiry M, Sabry W, Ismaeil MK, Fouad SM. Duration of untreated psychosis in an Egyptian sample: Sociodemographic and clinical variables. Int J Soc Psychiatry 2016; 62:661-671. [PMID: 27683283 DOI: 10.1177/0020764016670429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Duration of untreated psychosis (DUP) has been considered as a poor prognostic factor for psychotic disorder. Several studies have been investigating different predictors of DUP in Western countries, while in Egypt only a few studies have examined various predictors of DUP. AIMS To study DUP in Egyptian patients with psychotic disorders and to investigate how certain illnesses, patient, socio-cultural risk factors and help-seeking behaviour are correlated with prolonged DUP. METHOD The sample included 100 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) diagnosis of psychotic disorder were selected and interviewed to assess DUP. They were interviewed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scale. RESULTS Mean (±standard deviation ( SD)) of DUP was found to be 36.93(±45.27) months. DUP was correlated with various sociodemographic and clinical variables. Following log transformation of DUP, correlation with PANSS scores was done and revealed highly significant statistical relation of DUP to PANSS negative and PANSS positive scores. In linear regression analysis, it was found that age of patients, the age of onset, residence, being illiterate, the insidious mode of onset, negative family history of psychiatric disorder and the severity of illness as indicated by PANSS are among DUP predictors. CONCLUSION Longer DUP results from multiple patient- and illness-related factors. This has many implications in targeting early intervention with specific consideration to cultural factors.
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Affiliation(s)
- Tarek Okasha
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Nivert Zaki
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Marwa Abd El Meguid
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Marwa El-Missiry
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Walaa Sabry
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Mostafa Kamel Ismaeil
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Samar M Fouad
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
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Clarke M, McDonough CM, Doyle R, Waddington JL. Are We Really Impacting Duration of Untreated Psychosis and Does It Matter?: Longitudinal Perspectives on Early Intervention from the Irish Public Health Services. Psychiatr Clin North Am 2016; 39:175-86. [PMID: 27216898 DOI: 10.1016/j.psc.2016.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although early intervention in psychosis is clinically intuitive and theoretically feasible, the reality is that over recent decades the evidence base to support it has not advanced as much as might have been anticipated. Material benefits of early intervention in established psychosis have not been universally demonstrated and much uncertainty continues to surround the field of treatment in the prodromal phase. Undoubtedly methodological differences between studies are relevant and better understanding of different treatment models and the effectiveness of their constituent parts may yield the most benefit, particularly from a public health perspective.
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Affiliation(s)
- Mary Clarke
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland; DETECT Early Intervention Services, St John of God Community Services Ltd, Avila House, Block 5, Blackrock Business Park, Blackrock, Co. Dublin, Ireland
| | - Catherine M McDonough
- Cavan-Monaghan Mental Health Service, COPE Early Intervention Psychosis Service, St Davnet's Hospital, Monaghan, Co. Monaghan, Ireland; Cavan-Monaghan Community Rehabilitation Service, St. Davnet's Hospital, Monaghan, Co. Monaghan, Ireland
| | - Roisin Doyle
- DETECT Early Intervention Services, St John of God Community Services Ltd, Avila House, Block 5, Blackrock Business Park, Blackrock, Co. Dublin, Ireland
| | - John L Waddington
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland; Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric-Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
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Golay P, Alameda L, Baumann P, Elowe J, Progin P, Polari A, Conus P. Duration of untreated psychosis: Impact of the definition of treatment onset on its predictive value over three years of treatment. J Psychiatr Res 2016; 77:15-21. [PMID: 26950643 DOI: 10.1016/j.jpsychires.2016.02.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/21/2016] [Accepted: 02/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND While reduction of DUP (Duration of Untreated Psychosis) is a key goal in early intervention strategies, the predictive value of DUP on outcome has been questioned. We planned this study in order to explore the impact of three different definition of "treatment initiation" on the predictive value of DUP on outcome in an early psychosis sample. METHODS 221 early psychosis patients aged 18-35 were followed-up prospectively over 36 months. DUP was measured using three definitions for treatment onset: Initiation of antipsychotic medication (DUP1); engagement in a specialized programme (DUP2) and combination of engagement in a specialized programme and adherence to medication (DUP3). RESULTS 10% of patients never reached criteria for DUP3 and therefore were never adequately treated over the 36-month period of care. While DUP1 and DUP2 had a limited predictive value on outcome, DUP3, based on a more restrictive definition for treatment onset, was a better predictor of positive and negative symptoms, as well as functional outcome at 12, 24 and 36 months. Globally, DUP3 explained 2 to 5 times more of the variance than DUP1 and DUP2, with effect sizes falling in the medium range according to Cohen. CONCLUSIONS The limited predictive value of DUP on outcome in previous studies may be linked to problems of definitions that do not take adherence to treatment into account. While they need replication, our results suggest effort to reduce DUP should continue and aim both at early detection and development of engagement strategies.
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Souaiby L, Gaillard R, Krebs MO. [ Duration of untreated psychosis: A state-of-the-art review and critical analysis]. Encephale 2016; 42:361-6. [PMID: 27161262 DOI: 10.1016/j.encep.2015.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/26/2015] [Accepted: 09/07/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Prognosis of schizophrenia has not significantly improved despite extensive research. There is often a relatively long delay between onset of symptoms and treatment initiation. Lately, duration of untreated psychosis (DUP), the time between the onset of psychosis and initiation of treatment, has been one of the most studied variables in patients presenting for a first psychotic episode in order to evaluate the impact of early intervention on the prognosis of schizophrenia. In the literature, a variety of criteria have been used to define both transition to psychosis and initiation of treatment. Furthermore, the dating of both of these variables is usually retrospective, further complicating the measurement of DUP. METHODS We conducted a comprehensive review about DUP using Pubmed and Google Scholar databases up to January 2015 using the following keywords "schizophrenia", "duration of untreated psychosis", "duration of untreated illness" and "early intervention". Papers were included if they were published in French or English. RESULTS The mean DUP was found to be 2 years but it can vary according to multiple factors such as denial of illness by the patient and family, withdrawal and isolation from friends and relatives, diagnostic errors, paranoid views of the mental health treatment systems, or negative symptoms. Long DUP may also be a correlate of poor premorbid functioning or of an insidiously unfolding psychosis. Considerable discrepancies exist in the way that DUP is estimated in different studies. Although the clinical interview remains the most common way of measuring DUP, so far there is no evidence for favoring one method over another. Regardless of measurement method, a longer DUP is found to be associated with poorer outcome in schizophrenia in both the short and long-term across a number of domains: symptoms severity, remission rates, the risk of relapse, global functioning and quality of life. Its role in functional outcome appears to be mediated largely by negative symptoms, for which there is still no effective treatment. A recent meta-analysis has shown that shorter DUP is associated with less severe negative symptoms at short and long-term follow-up, especially when DUP is shorter than 9 months. The mechanism of the relationship between DUP and outcome is still undefined. A hypothesis is that the shorter the DUP, the more likely the intervention is being applied during the period in which neurobiological deficit processes in schizophrenia are most active. DISCUSSION A study of the duration of untreated illness (DUI), which is defined as the DUP and the prodromal phase, seems necessary because results of studies evaluating the effect of early detection and intervention in individuals with clinical high risk for psychosis are promising. A number of interventions such as omega 3 fatty acids and integrated psychosocial interventions seem to delay transition in the at-risk population. However, replication studies are lacking, and a great proportion of at high-risk individuals will spontaneously remit or develop diseases other than chronic psychosis, making us question the advantages and disadvantages of a treatment. Taking into consideration the high prevalence of comorbidities in individuals referred for clinical high-risk state and their effect on the individual's functioning, future interventions in the field need to address not only the preventative efficacy on psychosis transition but also their effectiveness in improving the functioning of this population and their effect on the outcome of schizophrenia when transition to psychosis has occurred. CONCLUSION Despite the huge advances in the field of schizophrenia, many questions remain unanswered and huge efforts are still necessary to understand the pathophysiology of this illness in order to improve its outcome.
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Affiliation(s)
- L Souaiby
- Service hospitalo-universitaire, -S14, centre hospitalier Sainte-Anne, 75014 Paris, France; Faculté de médecine, université Saint-Joseph, Beyrouth, Liban.
| | - R Gaillard
- Service hospitalo-universitaire, -S14, centre hospitalier Sainte-Anne, 75014 Paris, France; Inserm U894, centre psychiatrie et neurosciences, université Paris-Descartes, Paris Sorbonne Cité, Paris, France; Institut de psychiatrie (GDR3557), Paris, France
| | - M-O Krebs
- Service hospitalo-universitaire, -S14, centre hospitalier Sainte-Anne, 75014 Paris, France; Inserm U894, centre psychiatrie et neurosciences, université Paris-Descartes, Paris Sorbonne Cité, Paris, France; Institut de psychiatrie (GDR3557), Paris, France
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48
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O'Donoghue B, Lyne JP, Renwick L, Lane A, Madigan K, Staines A, O'Callaghan E, Clarke M. Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis. Psychol Med 2016; 46:1367-1378. [PMID: 27032697 DOI: 10.1017/s003329171500286x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The incidence of psychotic disorders varies between geographical areas and it has been hypothesized that neighbourhood-level factors may influence this variation. It is also plausible that the duration of untreated psychosis (DUP) is associated with neighbourhood characteristics. The aims of this study were to determine whether the incidence of first-episode psychosis (FEP) and the DUP are associated with the level of social deprivation, fragmentation, social capital and population density. METHOD All individuals with a FEP from a geographical defined catchment area over a 5-year period were included. Age-standardized incidence rates were calculated for each neighbourhood factor. RESULTS A total of 292 cases of FEP were included in the study and 45% had a diagnosis of a schizophrenia-spectrum disorder. The age standardized incidence rate of FEP in the most deprived area was 72.4 [95% confidence interval (CI) 26.4-162.7] per 100 000 person-years compared with 21.5 (95% CI 17.6-26.0) per 100 000 person-years in the most affluent areas. This represents a 3.4-fold increase in FEP incidence in the most deprived areas. The incidence of FEP was also increased in neighbourhoods that were more socially fragmented [incidence rate ratio (IRR) = 2.40, 95% CI 1.05-5.51, p = 0.04] and there was a trend for the incidence to be increased in neighbourhoods with lower social capital (IRR = 1.43, 95% CI 0.99-2.06, p = 0.05). The median DUP was 4 months and was higher in more socially fragmented neighbourhoods. CONCLUSIONS The incidence of psychotic disorders is related to neighbourhood factors and it may be useful to consider neighbourhood factors when allocating resources for early intervention services.
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Affiliation(s)
- B O'Donoghue
- The Centre for Youth Mental Health,University of Melbourne,Melbourne,VIC,Australia
| | - J P Lyne
- Department of Psychiatry,Royal College of Surgeons in Ireland,Dublin,Republic of Ireland
| | - L Renwick
- School of Nursing, Midwifery and Social Work,University of Manchester,Manchester,UK
| | - A Lane
- Department of Psychiatry,School of Medicine,University College Dublin,Belfield,Dublin 4,Republic of Ireland
| | - K Madigan
- DETECT,Early Intervention for Psychosis Service,Blackrock,Dublin,Republic of Ireland
| | - A Staines
- School of Nursing and Human Services,Dublin City University,Dublin,Republic of Ireland
| | - E O'Callaghan
- Department of Psychiatry,School of Medicine,University College Dublin,Belfield,Dublin 4,Republic of Ireland
| | - M Clarke
- Department of Psychiatry,School of Medicine,University College Dublin,Belfield,Dublin 4,Republic of Ireland
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49
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Del Rey-Mejías Á, Fraguas D, Díaz-Caneja CM, Pina-Camacho L, Castro-Fornieles J, Baeza I, Espliego A, Merchán-Naranjo J, González-Pinto A, de la Serna E, Payá B, Graell M, Arango C, Parellada M. Functional deterioration from the premorbid period to 2 years after the first episode of psychosis in early-onset psychosis. Eur Child Adolesc Psychiatry 2015; 24:1447-59. [PMID: 25726022 DOI: 10.1007/s00787-015-0693-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/10/2015] [Indexed: 01/10/2023]
Abstract
The aim of the study was to analyze changes in functional adjustment from childhood to 2 years after the first episode of psychosis (FEP) in patients with early-onset schizophrenia spectrum disorders (SSD) and affective psychoses (AFP) and a good or intermediate level of premorbid adjustment. We followed 106 adolescents (aged 12-17 years) with FEP for 2 years after recruitment. Premorbid adjustment in childhood was assessed in 98 patients with the childhood subscale of the Cannon-Spoor Premorbid Adjustment Scale (c-PAS). Global functioning was assessed 2 years after the FEP with the Children's Global Assessment Scale (c-GAS) or the Global Assessment of Functioning scale (GAF), as appropriate. Functional deterioration was defined as a downward shift in the level of functional adjustment from childhood to 2 years after the FEP. In patients with good or intermediate premorbid adjustment, functional deterioration was observed in 28.2 % (26.5 % of the AFP group, 29.4 % of the SSD group). Longer duration of untreated psychosis (Beta = 0.01; P = 0.01) and higher symptom severity at the FEP, as measured with the Clinical Global Impression Scale (Beta = 1.12; P = 0.02), significantly predicted the presence of functional deterioration, accounting for 21.4 % of the variance. Irrespective of diagnosis (SSD or AFP), almost one-third of adolescents with FEP and good or intermediate premorbid adjustment showed functional deterioration from the premorbid period to 2 years after the FEP.
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Affiliation(s)
- Ángel Del Rey-Mejías
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain.
| | - David Fraguas
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Ana Espliego
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Jessica Merchán-Naranjo
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Ana González-Pinto
- Mood Disorders Research Center, 03-RC-003, Hospital Santiago Apóstol, CIBERSAM, Vitoria, Spain
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Beatriz Payá
- Department of Child Psychiatry, Hospital Universitario Marqués de Valdecilla, CIBERSAM, Santander, Spain
| | - Montserrat Graell
- Section of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesus, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
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50
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Del Vecchio V, Luciano M, Sampogna G, De Rosa C, Giacco D, Tarricone I, Catapano F, Fiorillo A. The role of relatives in pathways to care of patients with a first episode of psychosis. Int J Soc Psychiatry 2015; 61:631-7. [PMID: 25614470 DOI: 10.1177/0020764014568129] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To explore the role of relatives in pathways to care of patients with a recent onset of psychosis. METHODS A total of 34 consecutive patients and their relatives from the Department of Psychiatry of the University of Naples SUN participated in the study. Pathways to care were retrospectively evaluated by administering the Pathways to Care Form and the Nottingham Onset Schedule (NOS) to patients, relatives and treating physicians. Relatives were addressed with the Family Involvement in Pathways to care Schedule (FIPS). RESULTS Duration of untreated illness (DUI) and duration of untreated psychosis (DUP) were 145.4 (±141.9) and 33.3 (±54.0) weeks, respectively. Help-seeking delay was 17.6 (±45.0) weeks. The first request for help was made by relatives in 76% of cases. Among health professionals, general practitioners were those most frequently contacted, followed by psychiatrists, neurologists or psychologists. Stigma and wrong attribution of psychotic symptoms were the main reasons for help-seeking delays. CONCLUSIONS Relatives play a crucial role in pathways to care of patients with psychosis. DUI and DUP could be reduced by interventions aimed at increasing knowledge of early symptoms in the general population, and by the provision of psychiatric consultations in non-stigmatizing settings for young people with psychological distress.
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Affiliation(s)
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Corrado De Rosa
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Domenico Giacco
- Department of Psychiatry, University of Naples SUN, Naples, Italy Unit for Social and Community Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Bologna, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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