Health Services Determinants of the Duration of Untreated Psychosis Among African-American First-Episode Patients

Abstract

Objective-The duration of untreated psychosis is associated with poor outcomes in multiple domains in the early course of nonaffective psychotic disorders, although relatively little is known about determinants of this critical period, particularly health services-level determinants. This study examined three hypothesized predictors of duration of untreated psychosis (lack of insurance, financial problems, and broader barriers) among urban, socioeconomically disadvantaged African Americans, while controlling for the effects of three patient-level predictors (mode of onset of psychosis, living with family versus alone or with others before hospitalization, and living above versus below the federally defined poverty level). Methods-Analyses included data from 42 patient-family member dyads from a larger sample of 109 patients with a first episode of nonaffective psychosis. The duration of untreated psychosis and all other variables were measured in a rigorous, standardized fashion in a study designed specifically to examine determinants of treatment delay. Survival analyses and Cox regression

Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a US sample

“…This report is a secondary analysis based on common variables collected during two sequential cross-sectional studies of first-episode nonaffective psychosis that were conducted by the same research team [8][9][10][11][12]. One crosssectional study (2004)(2005)(2006)(2007)(2008) was about treatment delay and the other (2008-present) is about the effects of premorbid cannabis use on early-course features.…”

Duration of untreated psychosis is associated with more negative schizophrenia symptoms after acute treatment for first-episode psychosis

“…Recent research on early psychosis has focused on questions of duration of untreated psychosis (DUP) and its effects on later psychiatric condition and wellbeing (Compton et al, 2009;Ho & Andreasen, 2001;Kirkbride et al, 2010;Marshall et al, 2005;Melle et al, 2008;Perkins, Gu, Boteva, & Lieberman, 2005;Schmitz, Malla, Norman, Archie, & Zipursky, 2007). DUP has been defined as the time from the manifestation of the first psychotic symptom to the initiation of antipsychotic drug treatment in first-episode psychosis (FEP) patients (Marshall et al, 2005).…”

Subtyping first‐episode non‐affective psychosis using four early‐course features: potentially useful prognostic information at initial presentation

“…This analysis was performed using a combined dataset (n = 200) that included data collected during 6 years as part of two research studies -one focused on predictors of treatment delay and DUP, [27][28][29][46][47][48] and the other being an ongoing study of the impact of premorbid cannabis use on the early course of psychotic disorders. 49,50 The two studies had identical eligibility criteria, recruitment processes and data collection procedures.…”

“…21,24,25 In terms of the prodromal period, there are some indications that the duration of untreated illness (which represents the time from prodrome onset to initiation of adequate treatment) is more strongly associated with functional outcomes than duration of untreated psychosis (DUP) in first-episode patients; 26 thus, the duration of the prodromal phase may be critical to parsing heterogeneity. The duration of the prodrome was chosen as a key early-course variable in this study because it may be considered an inherent aspect of the illness, whereas DUP is largely a function of factors external to the illness such as financial/insurance status, family functioning, and the characteristics of the local health-care system, [27][28][29] making DUP less attractive as a primary aspect of the early illness for subtyping, although clearly a target for early-intervention strategies. Finally, regarding the onset of psychosis, age at onset is known to be a key prognostic factor in schizophrenia.…”