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The role of treatment delay in predicting 5-year outcomes in an early intervention program

Published online by Cambridge University Press:  18 July 2011

R. M. G. Norman ,
R. Manchanda ,
D. Windell ,
R. Harricharan ,
S. Northcott  and
L. Hassall
R. M. G. Norman*
Affiliation:
Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
R. Manchanda
Affiliation:
Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
D. Windell
Affiliation:
Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
R. Harricharan
Affiliation:
Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
S. Northcott
Affiliation:
Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
L. Hassall
Affiliation:
Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
*
*Address for correspondence: R. M. G. Norman, Ph.D., C.Psych., A2-643, LHSC-VH, 800 Commissioners Road E, London, ON, CanadaN6A 5W9. (Email: rnorman@uwo.ca)
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Abstract

Background

Past research on the relationship between treatment delay and outcomes for first-episode psychosis has primarily focused on the role of duration of untreated psychosis (DUP) in predicting symptomatic outcomes up to 2 years. In the current study we examine the influence of both DUP and duration of untreated illness (DUI) on symptoms and functioning at 5 years follow-up while controlling for other early characteristics.

Method

A total of 132 patients with first-episode psychosis and treated in an early intervention program were prospectively followed up for 5 years. Outcomes assessed included positive and negative symptoms, overall functioning, weeks on disability pension and weeks of full-time competitive employment.

Results

While DUP showed a significant correlation with level of positive symptoms at follow-up, this was not independent of pre-morbid social adjustment. DUI emerged as a more robust independent predictor of negative symptoms, social and occupational functioning and use of a disability pension.

Conclusions

Delay between onset of non-specific symptoms and treatment may be a more important influence on long-term functioning for first-episode patients than DUP. This suggests the possible value of treating such signs and symptoms as early as possible regardless of the effectiveness of such interventions in reducing likelihood or severity of psychotic symptoms.

Keywords

Early interventionpsychosistreatment delaytreatment outcomes
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 2 , February 2012 , pp. 223 - 233
Copyright
Copyright © Cambridge University Press 2011

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References

Addington, J, Addington, D (2009). Three-year outcome of treatment in an early psychosis program. Canadian Journal of Psychiatry 54, 626–630.Google Scholar
Addington, J, Van Mastrigt, S, Addington, D (2004). Duration of untreated psychosis: impact on 2-year outcome. Psychological Medicine 34, 277–284.Google Scholar
Andreasen, NC (1983). Scale for the Assessment of Negative Symptoms. University of Iowa Press: Iowa City, IA.Google Scholar
Andreasen, NC (1984). Scale for the Assessment of Positive Symptoms. University of Iowa: Iowa City, IA.Google Scholar
Andreasen, NC, Carpenter, WT Jr., Kane, JM, Lasser, RA, Marder, SR, Weinberger, DR (2005). Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.Google Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlaeger, J, Le Quach, P, Christensen, TØ, Krarup, G, Jørgensen, P, Nordentoft, M (2008). Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65, 762–771.Google Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlaeger, J, Le Quach, P, Østergaard Christensen, T, Krarup, G, Jørgensen, P, Nordentoft, M (2009). Course of illness in a sample of 265 patients with first-episode psychosis – five-year follow-up of the Danish OPUS trial. Schizophrenia Research 107, 173–178.Google Scholar
Birchwood, M, Todd, P, Jackson, C (1998). Early intervention in psychosis. The critical period hypothesis. British Journal of Psychiatry 172, 53–59.Google Scholar
Blanchard, JJ, Cohen, AS (2006). The structure of negative symptoms within schizophrenia: implications for assessment. Schizophrenia Bulletin 32, 238–245.Google Scholar
Boden, R, Sundstrom, J, Lindstrom, E, Lindstrom, L (2009). Association between symptomatic remission and functional outcome in first-episode schizophrenia. Schizophrenia Research 107, 232–237.Google Scholar
Bottlender, R, Sato, T, Jager, M, Wegener, U, Wittmann, J, Strauss, A, Moller, HJ (2003). The impact of the duration of untreated psychosis prior to first psychiatric admission on the 15-year outcome in schizophrenia. Schizophrenia Research 62, 37–44.Google Scholar
Brabban, A, Dodgson, G (2010). What makes early intervention in psychosis services effective? A case study. Early Interventions in Psychiatry 4, 319–322.Google Scholar
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.Google Scholar
Clarke, M, Whitty, P, Browne, S, McTigue, O, Kamali, M, Gervin, M, Kinsella, A, Waddington, JL, Larkin, C, O'Callaghan, E (2006). Untreated illness and outcome of psychosis. British Journal of Psychiatry 189, 235–240.Google Scholar
Compton, MT, Chien, VH, Leiner, AS, Goulding, SM, Weiss, PS (2008). Mode of onset of psychosis and family involvement in help-seeking as determinants of duration of untreated psychosis. Social Psychiatry and Psychiatric Epidemiology 43, 975–982.Google Scholar
Crumlish, N, Whitty, P, Clarke, M, Browne, S, Kamali, M, Gervin, M, McTigue, O, Kinsella, A, Waddington, JL, Larkin, C, O'Callaghan, E (2009). Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis. British Journal of Psychiatry 194, 18–24.Google Scholar
Drake, RJ, Haley, CJ, Akhtar, S, Lewis, SW (2000). Causes and consequences of duration of untreated psychosis in schizophrenia. British Journal of Psychiatry 177, 511–518.Google Scholar
Erhart, SM, Marder, SR, Carpenter, WT (2006). Treatment of schizophrenia negative symptoms: future prospects. Schizophrenia Bulletin 32, 234–237.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1995). Structured Clinical Interview of DSM-IV Axis 1 (SCID-1) Disorders: Clinical Version. Biometrics Research Department; New York State Psychiatric Institute: New York.Google Scholar
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google Scholar
Goyder, J, Frank, K (2007). A scale of occupational prestige in Canada based on NOC major groups. Canadian Journal of Sociology 32, 63–83.Google Scholar
Häfner, H (2000). Onset and early course as determinants of the further course of schizophrenia. Acta Psychiatrica Scandinavica 102 (Suppl. 407), 44–48.Google Scholar
Häfner, H, an der Heiden, W (1999). The course of schizophrenia in the light of modern follow-up studies: the ABC and WHO studies. European Archives of Psychiatry and Clinical Neurosciences 249 (Suppl. 4), 14–26.Google Scholar
Häfner, H, Riecher-Rössler, A, Hambrecht, M, Maurer, K, Meissner, S, Schmidtke, A, Fatkenheuer, B, Loffler, W, van der Heiden, W (1992). IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209–223.Google Scholar
Harris, MG, Henry, LP, Harrigan, SM, Purcell, R, Schwartz, OS, Farrelly, SE, Prosser, AL, Jackson, HJ, McGorry, PD (2005). The relationship between duration of untreated psychosis and outcome: an eight-year prospective study. Schizophrenia Research 79, 85–93.Google Scholar
Harrison, G, Croudace, T, Mason, P, Glazebrook, C, Medley, I (1996). Predicting the long-term outcome of schizophrenia. Psychological Medicine 26, 697–705.Google Scholar
Hay, P, Katsikitis, M, Begg, J, Da Costa, J, Blumenfeld, N (2003). A two-year follow-up study and prospective evaluation of the DSM-IV axis V. Psychiatric Services 54, 1028–1030.Google Scholar
Henry, LP, Amminger, GP, Harris, MG, Yuen, HP, Harrigan, SM, Prosser, AL, Schwartz, OS, Farrelly, SE, Herrman, H, Jackson, HJ, McGorry, PD (2010). The EPPIC follow-up study of first-episode psychosis: longer-term clinical and functional outcome 7 years after index admission. Journal of Clinical Psychiatry 71, 716–728.Google Scholar
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A (1992). Chapter 2. Sociodemograhic, clinical and diagnostic description of the study population. Psychological Medicine 20 (Suppl.), 18–42.Google Scholar
Jeppesen, P, Petersen, L, Thorup, A, Abel, MB, Ohlenschlaeger, J, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2008). The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis. Psychological Medicine 38, 1157–1166.Google Scholar
Keshavan, MS, Haas, G, Miewald, J, Montrose, DM, Reddy, R, Schooler, NR, Sweeney, JA (2003). Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychoses. Schizophrenia Bulletin 29, 757–769.Google Scholar
Keshavan, MS, Roberts, M, Wittmann, D (2006). Guidelines for clinical treatment of early course schizophrenia. Current Psychiatry Reports 8, 329–334.Google Scholar
Kirkpatrick, B, Fenton, WS, Carpenter, WT Jr., Marder, SR (2006). The NIMH-MATRICS consensus statement on negative symptoms. Schizophrenia Bulletin 32, 214–219.Google Scholar
Larsen, TK, Moe, LC, Vibe-Hansen, L, Johannessen, JO (2000). Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophrenia Research 45, 1–9.Google Scholar
Linszen, D, Birchwood, M (2000). The early phase of psychosis and schizophrenia: a critical period for patients, families and the profession. In Early Intervention in Psychosis: A Guide to Concepts, Evidence and Interventions (ed. Birchwood, M., Fowler, D. and Jackson, C.), pp. 261–277. John Wiley & Sons Ltd: Chichester, West Sussex.Google Scholar
Lloyd-Evans, B, Crosby, M, Stockton, S, Pilling, S, Hobbs, L, Hinton, M, Johnson, S (2011). Initiatives to shorten duration of untreated psychoses: systematic review. British Journal of Psychiatry 198, 256–268.Google Scholar
Malla, A, Norman, R, McLean, T, Scholten, D, Townsend, L (2003). A Canadian programme for early intervention in non-affective psychotic disorders. Australia and New Zealand Journal of Psychiatry 37, 407–413.Google Scholar
Malla, A, Norman, R, Scholten, D, Manchanda, R, McLean, T (2005). A community intervention for early identification of first episode psychosis: impact on duration of untreated psychosis (DUP) and patient characteristics. Social Psychiatry and Psychiatric Epidemiology 40, 337–344.Google Scholar
Malla, AM, Norman, RM (2001). Treating psychosis: is there more to early intervention than intervening early? Canadian Journal of Psychiatry 46, 645–648.Google Scholar
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975–983.Google Scholar
Marwaha, S, Johnson, S (2004). Schizophrenia and employment – a review. Social Psychiatry and Psychiatric Epidemiology 39, 337–349.Google Scholar
Meng, X-L, Rosenthal, R, Rubin, DB (1992). Comparing correlated correlation coefficients. Psychological Bulletin 111, 172–175.Google Scholar
Monte, RC, Goulding, SM, Compton, MT (2008). Premorbid functioning of patients with first-episode nonaffective psychosis: a comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores. Schizophrenia Research 104, 206–213.Google Scholar
Morgan, C, Abdul-Al, R, Lappin, JM, Jones, P, Fearon, P, Leese, M, Croudace, T, Morgan, K, Dazzan, P, Craig, T, Leff, J, Murray, R (2006). Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study. British Journal of Psychiatry 189, 446–452.Google Scholar
Norman, RM, Malla, AK (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381–400.Google Scholar
Norman, RM, Malla, AK, Manchanda, R, Townsend, L (2005 a). Premorbid adjustment in first episode schizophrenia and schizoaffective disorders: a comparison of social and academic domains. Acta Psychiatrica Scandinavica 112, 30–39.Google Scholar
Norman, RM, Scholten, DJ, Malla, AK, Ballageer, T (2005 b). Early signs in schizophrenia spectrum disorders. Journal of Nervous and Mental Disease 193, 17–23.Google Scholar
Norman, RM, Townsend, L, Malla, AK (2001). Duration of untreated psychosis and cognitive functioning in first-episode patients. British Journal of Psychiatry 179, 340–345.Google Scholar
Norman, RMG, Malla, AK (2002). Course of Onset and Relapse Schedule: Interview and Coding Instruction Guide. Prevention and Early Intervention Program for Psychoses: London, ON.Google Scholar
Owens, DC, Johnstone, EC, Miller, P, Macmillan, JF, Crow, TJ (2010). Duration of untreated illness and outcome in schizophrenia: test of predictions in relation to relapse risk. British Journal of Psychiatry 196, 296–301.Google Scholar
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 1785–1804.Google Scholar
Ropcke, B, Eggers, C (2005). Early-onset schizophrenia: a 15-year follow-up. European Child and Adolescent Psychiatry 14, 341–350.Google Scholar
Sartorius, N, Gulbinat, W, Harrison, G, Laska, E, Siegel, C (1996). Long-term follow-up of schizophrenia in 16 countries. A description of the International Study of Schizophrenia conducted by the World Health Organization. Social Psychiatry and Psychiatric Epidemiology 31, 249–258.Google Scholar
Silverstein, ML, Mavrolefteros, G, Close, D (2002). Premorbid adjustment and neuropsychological performance in schizophrenia. Schizophrenia Bulletin 28, 157–165.Google Scholar
Singh, SP (2010). Early intervention in psychosis. British Journal of Psychiatry 196, 343–345.Google Scholar
Verdoux, H, Liraud, F, Bergey, C, Assens, F, Abalan, F, van Os, J (2001). Is the association between duration of untreated psychosis and outcome confounded? A two year follow-up study of first-admitted patients. Schizophrenia Research 49, 231–241.Google Scholar
White, C, Stirling, J, Hopkins, R, Morris, J, Montague, L, Tantam, D, Lewis, S (2009). Predictors of 10-year outcome of first-episode psychosis. Psychological Medicine 39, 1447–1456.Google Scholar
WHO (1992). Life Chart Rating Form: Introduction to the Life Chart Schedule [pamphlet]. World Health Organization: Geneva.Google Scholar