F256. Can We Reduce the Duration of Untreated Psychosis?

Abstract

BackgroundReduction of duration of untreated psychosis (DUP) is the key strategy of early interventions for improving the outcomes of first episode psychosis. Although several controlled interventional studies have been conducted with the aim of reducing DUP, the results are highly inconsistent and conflicting.MethodsThe current study systematically searched Web of Science and Ovid for English original articles investigating interventions adopted to reduce DUP, compared to a control intervention, up to 6th April 2017. 16 controlled interventional studies were retrieved, including 1964 patients in the intervention arm and 1358 in the control arm. The controlled interventions studies were characterised by: standalone first episode psychosis services, standalone clinical high risk services, community interventions, healthcare professional training and multifocus interventions. Random effects meta-analyses were conducted.ResultsThere was no summary evidence that available interventions are successful in reducing DUP during the first episode of psychosis (Hedges’ g = -0.12, 95%CIs -0.25 to 0.01). Subgroup analyses showed no differences within each subgroup, with the exception of clinical high risk services (Hedges’ g = -0.386, 95%CI -0.726 to -0.045). . There was substantial heterogeneity (I2 = 66.4%), most of which was accounted by different definitions of DUP onset (R2=0.88).DiscussionThese negative findings may reflect a parcelled research base in the area, lack of prospective randomized controlled trials (only two randomised cluster designed studies were present) and small sample sizes. Psychometric standardisation of DUP definition, improvement of study design and implementation of preventative strategies seem the most promising avenues for reducing DUP and improving outcomes of first-episode psychosis.

Psychosis-Spectrum Screening and Assessment within a College Counseling Center: A Pilot Study Exploring Feasibility and Clinical Need

“…Evidence shows that comprehensive psychosocial treatment initiated at the first episode of psychosis can alleviate symptoms; improve functioning; and reduce treatment disengagement, suicide rates, hospitalization time, and readmission rates (Chen et al, 2011;Penn et al, 2005). Even earlier intervention, during the CHR phase prior to the onset of full-threshold psychotic symptoms, may be influential and possibly reduce or prevent DUP (Malla et al, 2018;Oliver et al, 2018).…”