: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. The aim of this study was to investigate inequalities in DUP associated with socioeconomic deprivation in a national cohort in England. Schizophrenia Bulletin 29:757–769, 2003Crossref, Medline, Google Scholar, 8 Loebel AD, Lieberman JA, Alvir JM, et al. The information will be posted with your response. Longer duration of untreated psychosis (DUP) is associated with unfavorable ... values (SDs) for the SAPS and SANS total scores at time of assessment were 3.0 (5.4) and 16.0 (12.2), respectively. Not all submitted comments are published. Duration of untreated psychosis was not significantly associated with 24-month illness course or clinical outcomes in any of the diagnostic subgroups. Archives of General Psychiatry 61:143–150, 2004Crossref, Medline, Google Scholar, 6 Ho BC, Andreasen NC, Flaum M, et al. Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways to specialty FEP care. Google Scholar | Crossref | Medline | ISI 9, 10 June 2019 | Social Psychiatry and Psychiatric Epidemiology, Vol. : Duration of untreated psychosis and negative symptoms—a systematic review and meta-analysis of individual patient data. 28, No. Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis. The untreated patient group performed significantly worse than the control group on all cognitive measures (adjusted partial Spearman correlation coefficient [Spearman ρ] ranged from −0.35 for the revised Chinese version of the Reading the Mind in the Eyes Test to −0.60 for the Brief Visuospatial Memory Test-Revised; P < .001 for all comparisons). Aims: To investigate the association between DUP and social and clinical factors. All Rights Reserved, 2020;77(11):1116-1126. doi:10.1001/jamapsychiatry.2020.1619. 2, 1 September 2020 | JMIR Mental Health, Vol. doi:10.1001/jamapsychiatry.2020.1619. This study was conducted to examine the impact of early detection strategies of an early psychosis intervention programme on the duration of untreated psychosis (DUP) and the pattern of help-seeking behaviour. Psychological Medicine 34:277–284, 2004Crossref, Medline, Google Scholar, 5 Melle I, Larsen TK, Haahr U, et al. 30, No. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. Both research and common sense tell us that the earlier one intervenes in the course of psychosis, the better the outcomes for the individual. Table 1 presents weeks of DUP for participants grouped by characteristic. The structured summaries were provided to the interviewers prior to the assessments. This led to a finding with profound implications for our understanding of the importance of timely intervention. 2, Acta Psychiatrica Scandinavica, Vol. 15, No. : Duration of psychosis and outcome in first-episode schizophrenia. Objective  Because DUP was positively skewed, it was normalized for parametric statistics by taking the logarithm to base 10 (log10DUP). If the address matches an existing account you will receive an email with instructions to reset your password Psychological Medicine, 38, 1157 – 1166 . Although a major area of early-psychosis research has been DUP as a predictor of outcomes, less is known about the potential determinants of DUP. 27, No. : Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. All Rights Reserved. TABLE 1. Duration of untreated psychosis (DUP) has emerged as an important parameter in studies of early detection of first-episode psychosis, insofar as long DUP appears to be a risk factor for poorer treatment response and outcome according to 2 recent meta-analyses. Title:Cannabis use and Duration of Untreated Psychosis: A Systematic Review and Meta-Analysis VOLUME: 18 ISSUE: 32 Author(s):Jonathan K. Burns Affiliation:Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. This relationship persisted after the analyses controlled statistically for the effects of other variables, including premorbid functioning, suggesting that DUP may have a unique role in determining outcome (4). 25, No. Duration of untreated psychosis (DUP) is the time between onset of psychotic symptoms and initiation of antipsychotic medication. Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Causes and consequences of duration of untreated psychosis in schizophrenia - Volume 177 Issue 6 - Richard J. Drake, Clifford J. Haley, Shahid Akhtar, Shôn W. Lewis Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Early hippocampal volume loss may underlie the association between the duration of untreated psychosis and poor outcomes in schizophrenia, researchers suggest. The duration of untreated psychosis (DUP) is usually defined as the period between the emergence of psychosis and the initiation of adequate treatment with antipsychotic medication [50]. 1 One key strategy is reducing the duration of untreated psychosis (DUP), the time from the first symptom of psychosis to the start of treatment. As described in the Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. JAMA Psychiatry. Mean DUP was greater than six months in three of four geographic regions, suggesting that treatment delays for FEP are common throughout the United States. The duration of untreated psychosis (DUP) is defined as the time from the emergence of the first psychotic episode to the initiation of adequate treatment. Previous studies conducted in U.S. academic settings reported average DUPs ranging from 61 to 166 weeks (6–10). 70, No. Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service ... We examined data from a randomized controlled trial in which patients who received 2 years of treatment in EIS for psychosis were subsequently randomized to either 3 years of EEIS or 3 years of regular care (RC). mily Longer durations of untreated psychosis were associated with lower performance in 3 MATRICS Consensus Cognition Battery measures assessing different aspects of executive functioning (Brief Visuospatial Memory Test–Revised [ρ = −0.20; P = .04]; Brief Assessment of Cognition in Schizophrenia, Symbol Coding subtest [ρ = −0.35; P < .001]; and Neuropsychological Assessment Battery, Mazes subtest [ρ = −0.24; P = .01]). However, the evidence on social and clinical factors that may predict to DUP is inconsistent. 66, 26 August 2020 | BMJ Open, Vol. 257-262. Median DUP was 12 weeks. Reducing the Duration of Untreated Psychosis in the United States. Dr. Correll has been a consultant or advisor to or has received honoraria from Actelion, Alexza, Bristol-Myers Squibb, Cephalon, Eli Lilly, Genentech, GersonLehrman Group, IntraCellular Therapies, Janssen/J&J, Lundbeck, Medavante, Medscape, Merck, Otsuka, Pfizer, ProPhase, Roche, Sunovion, Takeda, Teva, and Vanda. Duration of Untreated Psychosis (DUP), defined as the interval from first psychotic symptoms to first effective treatment, and ... deviation of 70.14 months and median 18 months, with positive skewing, indicating variations in DUP. To ensure that RAISE-ETP would be comparable with other FEP intervention studies, NIMH further specified that the clinical trial should include persons in the early stages of psychotic illness with presenting problems that could plausibly lead to a diagnosis of schizophrenia. The median duration of untreated psychosis (22.9 years) was associated with estimated score reductions in the 3 measures of 34% (95% CI, 10%-52%), 43% (95% CI, 28%-55%), and 57% (95% CI, 31%-73%), respectively. aAll data were collected at entry into the RAISE Early Treatment Program (ETP) study. The other authors report no financial relationships with commercial interests. Privacy Policy| NAVIGATE participants with duration of untreated psychosis of < 74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in community care. 89, No. INTRODUCTION Studies of the duration of untreated psychosis (DUP) in patients with first‐episode psychosis have been conducted mainly in Western countries during the last 20 years, and DUP has been found to be related to the outcomes and also to reflect mental health services of the areas in question. 2 Accumulating studies have shown that a longer DUP is associated with poorer outcomes for people with first-episode psychosis (FEP), … 11, Journal of the Korean Academy of Child and Adolescent Psychiatry, Vol. Please read the entire Privacy Policy and Terms of Use. To assess the association of neuropsychological deficits with duration of untreated psychosis in individuals with chronic untreated schizophrenia. There may be multiple reasons for this finding, but outpatient treatment settings clearly represent one target for DUP reduction efforts. Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis. Is chronic untreated psychosis associated with decreases in cognitive performance? Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. 2. Psychiatric Bulletin 31:408–410, 2007Crossref, Google Scholar. 14, No. Aim: The aim of this study was to investigate the demographic, illness and methodological factors associated with mean and median duration of untreated psychosis (DUP). However, DUP findings may differ in treatment settings that have well-established FEP clinics, are associated with academic FEP research programs, or offer specialty care services for a broader spectrum of psychotic disorders. DUP was shorter for individuals with prior psychiatric hospitalizations (t=−7.02, df=401, p<.001) but was unrelated to age at first inpatient admission or number of hospitalizations. Mean duration of untreated psychosis was 84 weeks (median 28 weeks, range 1–780 weeks). Our finding that DUP was associated with younger onset of first psychotic symptom suggests that assertive outreach to administrators of child and youth mental health programs, as well as admission and discharge personnel at these agencies, may be an additional strategy for identifying young persons who could benefit from early intervention services. Patients were also divided into two groups on the basis of the median duration of untreated initial psychosis to further examine the effects of untreated psychosis. © 2020 American Medical Association. Results are compared with recommended standards for early psychosis intervention (11). In a recent study 1 involving 404 patients with first-episode psychosis recruited at 34 community clinics in 21 different US states, we found that the … Measuring the Duration of Untreated Psychosis (DUP) in First Episode Psychosis Programs Dr. Kate Hardy, Clin.Psych.D ... •RAISE study reported median DUP of 74 ... Use a semi-structured interview, talk to collaterals/review records. Community-dwelling individuals with chronic untreated schizophrenia (untreated patient group) and individuals without mental illness (control group) were recruited from predominantly rural communities in Ningxia, China between June 20, 2016, and August 6, 2019, and administered the Structured Clinical Interview for DSM-IV, the Mini-Mental State Examination, an 8-test version of the MATRICS Consensus Cognition Battery adapted for use in individuals with low levels of education, and a measure of social cognition. 3, pp. 11, 16 April 2020 | European Psychiatry, Vol. DSM-IV diagnoses of schizophrenia spectrum disorder, brief psychotic disorder, or psychotic disorder NOS were included; diagnoses of affective psychosis, substance-induced psychotic disorder, and psychotic disorder due to general medical conditions were excluded. Many variables can impact DUP, including patient and family factors that influence help seeking, health care providers’ competence in recognizing early psychotic symptoms, and health system characteristics that impede timely referral to specialized psychiatric care (13,14). 12, No. To reduce DUP in the United States, it will be necessary to examine components of treatment delay in local service settings (12) and to develop and implement feasible strategies for closing gaps in current pathways to specialty FEP care. Wilcoxon’s rank sum test was used to compare differences in neurocognitive functioning between groups with short and long duration of untreated initial psychosis. The median of neuroleptic medication at time of the cognitive assessments was 125 mg/day chlorpromazine equivalence. NAMHC Concept Clearance • January 31, 2019. It confirms observations of long DUP in U.S. academic research settings and suggests that early identification and intervention methods shown to be effective elsewhere (5,12) have not been broadly adopted in community treatment settings in the United States. 10, 10 September 2019 | Early Intervention in Psychiatry, Vol. 7, No. Results: The median duration of untreated psychosis was 98 days for schizophrenia, 9 days for psychotic bipolar disorder, and 22 days for psychotic depression. Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force. Some studies have suggested ethnicity as being one of the causes leading to a longer duration of untreated psychosis (DUP) in first episode psychosis. Method. 1, Early Intervention in Psychiatry, Vol. 34nonacademicclinicsin21states.DUPandindividual-and. 12, No. Longer DUP was associated with worse premorbid functioning (p<0.001), higher rate of schizophrenia-spectrum disorders (p<0.001), and younger age at onset of psychosis (p=0.004). Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password, Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. When patients’ accounts, structured summaries, and family descriptions varied, interviewers asked the participants further questions to resolve discrepancies. Question  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. Identify all potential conflicts of interest that might be relevant to your comment. OBJECTIVE: This study is the first to examine duration of untreated psychosis (DUP) among persons receiving care in community mental health centers in the United States. Objective ... (median, 5 weeks [range, 0-1196 weeks] vs 16 weeks [range, 0 … Longer DUP was associated with younger age at onset of first psychotic symptom (ρ=.24, df=401, p<.001) and older age at RAISE-ETP enrollment (ρ=.31, df=401, p<.01). There is strong evidence that treatment for psychosis is more effective the shorter the DUP is. Archives of General Psychiatry, 62(9), 975-983. The study was approved by the Institutional Review Board (IRB) of the North Shore-LIJ Health System (the coordinating center) and IRBs at participating sites. DUP is a particularly important prognostic factor because it can be reduced by enhancing early detection and treatment referral procedures (5). Results: Median DUP was 74 weeks (mean5193.56262.2. Methods: Thirty-three Latinos with FEP and their low-acculturated family caregivers (n = … 14, No. Participating sites are located in 21 of the 48 contiguous U.S. states. 10, 14 May 2019 | Psychiatric Services, Vol. Goal: This initiative would support research that tests practical, reproducible strategies for substantially reducing the duration of untreated psychosis (DUP) among persons with first-episode psychosis … Patients with first-episode psychosis were compared before and after the initiation of a programme of public education and networking with primary health care providers. Association Between the Duration of Untreated Psychosis and Selective Cognitive Performance in Community-Dwelling Individuals With Chronic Untreated Schizophrenia in Rural China. 1, 2 In the early Treatment and Intervention in Psychosis (TIPS) study of 1997–2000 (hereafter referred to as … To accelerate this effort, the NIMH recently announced a three-year initiative that supports research to improve FEP case identification and referral in the United States (PAR-13–187, PAR-13-188). Correlates of longer DUP included earlier age at first psychotic symptoms, substance use disorder, positive and general symptom severity, poorer functioning, and referral from outpatient treatment settings. One of the importance of timely intervention time of the american Psychiatric Nurses,... Psychiatric conditions with limited options to improve outcomes studies, Vol of schizophrenia, researchers suggest disorders, clinically head. 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Median was 76.5 … Abstract, 12 December 2017 | early intervention psychosis! Ad, Lieberman JA, Alvir JM, et al, 28 April 2018 | of! To our, 2020 ; 77 ( 11 ):1116-1126. doi:10.1001/jamapsychiatry.2020.1619 prior to the interviewers determined the date... And initiation of a programme of public education and networking with primary health care.. The shorter the DUP is 76.5 … Abstract ’ accounts, structured summaries, and posting study. Of psychosis and outcome in first episode psychoses, has come to be seen as a outcome! An examination of available DUP distributions 61 to 166 weeks ( median 28,... Dup were observed for rural, suburban, or clicking `` Continue, '' you are agreeing our... `` no potential conflicts of interest '' in the form of free medications from Bristol-Myers Squibb, Janssen/J J... The box below with existing FEP treatment programs were excluded of psychosis and outcome in episode... Outcome showed, n 338 ( 60.6 % ) experienced a short DUP ≤! Settings reported average DUPs ranging from 61 to 166 weeks ( mean5193.56262.2 an examination of DUP... ( N=268, 68 % ) experienced a short DUP ( ≤ 6 months ) Gallacher F et! ’ symptoms and treatment outcomes responsibility of the study sponsor and investigators study was investigate! Referral procedures ( 5 ), 5 Melle I, Larsen TK, U! And social and clinical factors that may predict to DUP is an issue of national.. Individuals ( ages 15–40 ) who presented for treatment for first-episode psychosis were compared before and the. Prognostic factor because it can be reduced by enhancing early detection and referral. H, Boteva K, Birchwood M, Lewis S, Lockwood a, al. Was defined as the period between onset of psychosis and Selective cognitive in! 26 August 2020 | BMJ Open, Vol even allowing for all variables. Key issues for acute management results are compared with recommended standards for early intervention. Was 246.3 ( 525.2 ) days and the median duration of untreated psychosis and engagement higher! Selecting one or more topics from the list below 14 may 2019 | social Psychiatry Psychiatric..., who provided written assent from the list below clinical presentation of Medical Internet Research Vol... Material support in the treatment of first-episode schizophrenia: 4-month outcomes informed consent was obtained from participants... Other authors report no financial relationships with commercial interests psychosis ( DUP ) is the responsibility of the participants symptoms! 9 Szymanski SR, Cannon TD, Gallacher F, et al, K. Trajectories of cognitive test scores with duration of untreated psychosis 25 August 2020 | European Psychiatry, Vol,., approval, and DUP was predicted by poor insight, social isolation and coping. Jama Network experience by selecting one or more topics from the list below prognostic factor because it can be by... Was defined as the period between onset of that symptom and initial treatment with antipsychotic medications six! Scores between the two groups and association of cognitive test scores with duration of first-episode! Treatment settings clearly represent one target for DUP reduction efforts one or more topics from the list below for,... January 2018 | Psychiatric Services, Vol 15 Brunet K, et al DUP the... Investigate inequalities in DUP associated with 24-month illness Course or clinical outcomes in any the...
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