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Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis.

Abstract

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSION

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

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  • Authors+Show Affiliations

    ,

    Section for Psychosis Research, Division of Psychiatry, Ulleval University Hospital, 0407 Oslo, Norway. ingrid.melle@medisin.uio.no

    , , , , , , , ,

    Source

    Archives of general psychiatry 65:6 2008 Jun pg 634-40

    MeSH

    Adult
    Antipsychotic Agents
    Combined Modality Therapy
    Delusions
    Denmark
    Depression
    Early Diagnosis
    Female
    Follow-Up Studies
    Hallucinations
    Humans
    Male
    Norway
    Patient Care Team
    Patient Readmission
    Prognosis
    Psychiatric Status Rating Scales
    Schizophrenia
    Schizophrenic Psychology
    Suicide, Attempted

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    18519821

    Citation

    Melle, Ingrid, et al. "Prevention of Negative Symptom Psychopathologies in First-episode Schizophrenia: Two-year Effects of Reducing the Duration of Untreated Psychosis." Archives of General Psychiatry, vol. 65, no. 6, 2008, pp. 634-40.
    Melle I, Larsen TK, Haahr U, et al. Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. Arch Gen Psychiatry. 2008;65(6):634-40.
    Melle, I., Larsen, T. K., Haahr, U., Friis, S., Johannesen, J. O., Opjordsmoen, S., ... McGlashan, T. (2008). Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. Archives of General Psychiatry, 65(6), pp. 634-40. doi:10.1001/archpsyc.65.6.634.
    Melle I, et al. Prevention of Negative Symptom Psychopathologies in First-episode Schizophrenia: Two-year Effects of Reducing the Duration of Untreated Psychosis. Arch Gen Psychiatry. 2008;65(6):634-40. PubMed PMID: 18519821.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. AU - Melle,Ingrid, AU - Larsen,Tor K, AU - Haahr,Ulrik, AU - Friis,Svein, AU - Johannesen,Jan O, AU - Opjordsmoen,Stein, AU - Rund,Bjørn R, AU - Simonsen,Erik, AU - Vaglum,Per, AU - McGlashan,Thomas, PY - 2008/6/4/pubmed PY - 2008/6/18/medline PY - 2008/6/4/entrez SP - 634 EP - 40 JF - Archives of general psychiatry JO - Arch. Gen. Psychiatry VL - 65 IS - 6 N2 - BACKGROUND: The duration of untreated psychosis (DUP)-the time from onset of psychotic symptoms to the start of adequate treatment--is consistently correlated with better course and outcome, but the mechanisms are poorly understood. OBJECTIVE: To report the effects of reducing DUP on 2-year course and outcome. DESIGN: A total of 281 patients with a DSM-IV diagnosis of nonorganic, nonaffective psychosis coming to their first treatment during 4 consecutive years were recruited, of which 231 participated in the 2-year follow-up. A comprehensive early detection (ED) system, based on public information campaigns and low-threshold-psychosis-detecting teams, was introduced in 1 health care area (ED area), but not in a comparable area (no-ED area). Both areas ran equivalent 2-year treatment programs. RESULTS: First-episode patients from the ED area had a significantly lower DUP, better clinical status, and milder negative symptoms at the start of treatment. There were no differences in treatment received for the first 2 years between the groups. The difference in negative symptoms was maintained at the 1-year follow-up. There was a statistically significant difference in the Positive and Negative Syndrome Scale negative component, cognitive component, and depressive component in favor of the ED group at the 2-year follow-up. Multiple linear regression analyses gave no indication that these differences were due to confounders. CONCLUSION: Reducing the DUP has effects on the course of symptoms and functioning, including negative symptoms, suggesting secondary prevention of the negative psychopathologies in first-episode schizophrenia. SN - 1538-3636 UR - https://www.unboundmedicine.com/medline/citation/18519821/Prevention_of_negative_symptom_psychopathologies_in_first_episode_schizophrenia:_two_year_effects_of_reducing_the_duration_of_untreated_psychosis_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=18519821.ui DB - PRIME DP - Unbound Medicine ER -