Reduction of DUP in early intervention programmes: No pain… almost no gain.

Abstract

Considering the negative impact of long duration of untreated psychosis (DUP) on outcome, its reduction has become one of the aims of early intervention programmes. The TIPP programme (Treatment and early Intervention in Psychosis Program) was implemented in 2004 in Lausanne and hoped to reduce DUP, without any specific campaign in this regard, through the provision of accessible and specialized treatment. The aim of this study was to evaluate the evolution of patients' DUP over time and the characteristics of patients with extreme DUP. Clinical follow-up data of 380 patients aged 18-35 years with a first psychotic episode who entered the TIPP programme between 2004 and 2017 were analysed. The evolution of DUP over time as well as referring entities and destination after the programme were assessed. The characteristics of patients with extreme DUPs (>percentile 90) were compared with that of other patients. The mean value of the DUP was 452.11 days with a median of 88 days. DUP decreased only moderately over time. We also observe a decrease in discharges to specialized outpatient care at our university hospital. The main characteristics of patients with extreme DUP were early age of onset of psychosis, diagnosis of schizophrenia and presence of history of psychiatric treatment for other conditions before onset of psychosis. These figures suggest that the DUP has reduced over time but that without specific interventions at this level, this reduction is only moderate.