Understanding delay in treatment for first-episode psychosis

Norman, Ross; Malla, Ashok; Verdi, Mary; Hassall, L. D.; Fazekas, Christian

doi:10.1017/s0033291703001119

Cited by 180 publications

(225 citation statements)

References 29 publications

Supporting

Mentioning

201

Contrasting

Unclassified

Order By: Relevance

“…Some papers sought to answer more than one question. Six studies explored reasons for treatment delays and barriers in pathways to care in first-episode psychosis (Larsen et al, 1998, Lincoln et al, 1998, Addington et al, 2002, Etheridge et al, 2004, Fuchs and Steinert, 2004, Norman et al, 2004, five explored the influence of ethnicity on pathways (Cole et al, 1995, Burnett et al, 1999, Morgan et al, 2005b, Morgan et al, 2005, Bhugra et al, 2000 Two studies explored social determinants of pathways (Bhugra et al, 2000, Cougnard et al, 2004, one investigated clinical influences on pathways (Cougnard et al, 2004) and two articles examined the relationship between DUP and pathways to care (Larsen et al, 1998, Chong et al, 2005. One paper looked at the usefulness of a pathway to care model and tool (Perkins et al, 1999), one sought to understand help-seeking contacts (Fuchs and Steinert, 2004), one investigated the time point in early psychosis when antipsychotics were initiated (Cougnard et al, 2004) and one paper made cross-national comparison on the epidemiology and presentation of first-episode psychosis (Sartorious et al, 1986)].…”

Section: Study Aimsmentioning

confidence: 99%

“…Most studies came from the UK (Cole et al, 1995, Burnett et al, 1999, Morgan et al, 2005b, Morgan et al, 2005, Bhugra et al, 2000, Etheridge et al, 2004, three were from other European countries (Larsen et al, 1998, Cougnard et al, 2004, Fuchs and Steinert, 2004, three were from North America/Canada (Perkins et al, 1999, Addington et al, 2002, Norman et al, 2004 and one each from Australia (Lincoln et al, 1998) and Singapore (Chong et al, 2005) and one study was multinational (Sartorious et al, 1986). The smallest study had 9 subjects (Perkins et al, 1999) while the largest had 1379 subjects (Sartorious et al, 1986) the mean number of subjects being 210 (SD= 352; mode 86).…”

Section: Study Settings and Populationsmentioning

confidence: 99%

“…We obtained copies of measures used in eleven studies (Sartorious et al, 1986, Perkins et al, 1999, Lincoln et al, 1998, Bhugra et al, 2000, Addington et al, 2002, Cougnard et al, 2004, Etheridge et al, 2004, Norman et al, 2004, Morgan et al, 2005b, Morgan et al, 2005, Burnett et al, 1999. In one study, the pathways measure was available in French with no English translation (Cougnard et al, 2004).…”

Section: Pathways Measure Usedmentioning

confidence: 99%

“…Two studies reported using semi-structured questionnaires (Cole et al, 1995, Cougnard et al, 2004) and one reported simply asking patients for information on their contacts with professionals before admission and their pathways to care (Fuchs and Steinert, 2004). One study used the Encounter Form (Gater et al, 1991) and two others based their measures on other assessment tools (Etheridge et al, 2004, Norman et al, 2004; one on the IRIS audit tool kit (Partnerships, 2001) and the other, the Circumstances of Onset and Relapse Schedule (CORS) which is based on the Interview for the Retrospective Assessment of Schizophrenia (IRAOS) (Hafner et al, 1992). One study gathered data on pathways to care using qualitative techniques i.e.…”

Section: Pathways Measure Usedmentioning

confidence: 99%

See 3 more Smart Citations

Measuring pathways to care in first-episode psychosis: A systematic review

Singh

Grange

2006

Schizophrenia Research

119

120

View full text Add to dashboard Cite

Background: Adequately measuring pathways to care is a prerequisite for early detection and effective treatment of first-episode psychosis. Method:We conducted a systematic review of studies on pathways to care in firstepisode psychosis to establish what measures currently exist to assess pathways in first-episode psychosis and to compare these measures. Results:We identified 15 studies which had used six different measures of pathways to care. Differences in aims, methodology and lack of psychometric data did not allow a direct comparison of pathways measures but certain common themes emerged.Discussion: Pathways to care in first-episode psychosis are diverse and varied. There is no measure with established psychometric properties that has been devised on a well-developed theoretical or conceptual framework and had its psychometric properties established. The conflict between exploring the patient"s narrative and journey through the healthcare system and developing an empirical measure of pathways with optimal outcomes has hindered the development of such a measure.

show abstract

Section: Study Aimsmentioning

confidence: 99%

Section: Study Settings and Populationsmentioning

confidence: 99%

Section: Pathways Measure Usedmentioning

confidence: 99%

Section: Pathways Measure Usedmentioning

confidence: 99%

See 2 more Smart Citations

Measuring pathways to care in first-episode psychosis: A systematic review

Singh

Grange

2006

Schizophrenia Research

119

120

View full text Add to dashboard Cite

show abstract

“…Scores on Global Assessment of Functioning (GAF) were obtained based on ratings conducted at the time of the first assessment. Patients were administered a semi-structured interview schedule, the Circumstances of Onset and Relapse Schedule (Norman et al, 2004;Malla et al, 2006), to provide estimates of the time of onset of psychosis, of the duration of untreated psychosis (DUP) and of the duration of untreated illness (DUI). DUP was defined as the period between the time of onset of psychotic symptoms and the commencement of adequate treatment (taking anti-psychotic medication for a period of one month or until significant response, which ever came first).…”

Section: Participantsmentioning

confidence: 99%

P300 asymmetry and positive symptom severity: A study in the early stage of a first episode of psychosis

Renoult

Prévost

Brodeur

et al. 2007

Schizophrenia Research

View full text Add to dashboard Cite

The amplitude of the P300 event-related potential (ERP) has been reported to be reduced over left compared to right temporal sites in schizophrenia patients. This left temporal P300 reduction has been associated with positive symptom severity and gray matter reduction in the left superior temporal gyrus. We investigated a group of patients with a first episode of schizophrenia spectrum psychosis and a group of normal controls to verify if P300 amplitude asymmetry already exists around the time of presentation for treatment. Relative to normal control subjects, no P300 asymmetry was found in patients. Nevertheless, P300 asymmetry was correlated with the severity of positive symptoms and worse global functioning (GAF), a good predictor of poor outcome.

show abstract

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis

et al. 2023

View full text Add to dashboard Cite

ImportanceReducing the duration of untreated psychosis (DUP) is essential to improving outcomes for people with first-episode psychosis (FEP). Current US approaches are insufficient to reduce DUP to international standards of less than 90 days.ObjectiveTo determine whether population-based electronic screening in addition to standard targeted clinician education increases early detection of psychosis and decreases DUP, compared with clinician education alone.Design, Setting, and ParticipantsThis cluster randomized clinical trial included individuals aged 12 to 30 years presenting for services between March 2015 and September 2017 at participating sites that included community mental health clinics and school support and special education services. Eligible participants were referred to the Early Diagnosis and Preventative Treatment (EDAPT) Clinic. Data analyses were performed in September and October 2019 for the primary and secondary analyses, with the exploratory subgroup analyses completed in May 2021.InterventionsAll sites in both groups received targeted education about early psychosis for health care professionals. In the active screening group, clients also completed the Prodromal Questionnaire–Brief using tablets at intake; referrals were based on those scores and clinical judgment. In the group receiving treatment as usual (TAU), referrals were based on clinical judgment alone.Main Outcomes and MeasuresPrimary outcomes included DUP, defined as the period from full psychosis onset to the date of the EDAPT diagnostic telephone interview, and the number of individuals identified with FEP or a psychosis spectrum disorder. Exploratory analyses examined differences by site type, completion rates between conditions, and days from service entry to telephone interview.ResultsTwenty-four sites agreed to participate, and 12 sites were randomized to either the active screening or TAU group. However, only 10 community clinics and 4 school sites were able to fully implement population screening and were included in the final analysis. The total potentially eligible population size within each study group was similar, with 2432 individuals entering at active screening group sites and 2455 at TAU group sites. A total of 303 diagnostic telephone interviews were completed (178 [58.7%] female individuals; mean [SD] age, 17.09 years [4.57]). Active screening sites reported a significantly higher detection rate of psychosis spectrum disorders (136 cases [5.6%], relative to 65 [2.6%]; P &lt; .001) and referred a higher proportion of individuals with FEP and DUP less than 90 days (13 cases, relative to 4; odds ratio, 0.30; 95% CI, 0.10-0.93; P = .03). There was no difference in mean (SD) DUP between groups (active screening group, 239.0 days [207.4]; TAU group 262.3 days [170.2]).Conclusions and RelevanceIn this cluster trial, population-based technology-enhanced screening across community settings detected more than twice as many individuals with psychosis spectrum disorders compared with clinical judgment alone but did not reduce DUP. Screening could identify people undetected in US mental health services. Significant DUP reduction may require interventions to reduce time to the first mental health contact.Trial RegistrationClinicalTrials.gov Identifier: NCT02841956

show abstract

Understanding delay in treatment for first-episode psychosis

Abstract: Interventions to reduce treatment delay should increase the public's awareness of the symptoms of psychotic illness and the need to seek treatment, but of equal importance is the education of service providers to recognize such illness and the potential benefits of earlier intervention.

Cited by 180 publications

References 29 publications

Measuring pathways to care in first-episode psychosis: A systematic review

Measuring pathways to care in first-episode psychosis: A systematic review

P300 asymmetry and positive symptom severity: A study in the early stage of a first episode of psychosis

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis

Contact Info

Product

Resources

About