Abstract
The duration of untreated psychosis (DUP) has been shown to have an effect on outcome after first-episode psychosis. The premise of specialized early intervention (SEI) services is that intervention in the early years of illness can affect long-term outcomes. In this study, we investigate whether DUP affects treatment response after 5 years of SEI treatment compared to 2 years of SEI treatment. As part of a randomized controlled trial testing the effect of prolonged SEI treatment 400 participants diagnosed within the schizophrenia spectrum were recruited. For this specific study participants were dichotomized based on DUP, treatment delay, and time from first symptom until start of SEI treatment. The groups were analyzed with regard to treatment response on psychopathology, level of functioning, and cognitive functioning. The participants with a short DUP had a tendency to respond better to the prolonged treatment with regards to disorganized and negative dimension. For participants with short duration from first symptom until start of SEI treatment there was a significant difference on the negative dimension favoring the prolonged OPUS treatment. The finding of an effect of prolonged treatment for participants with a short total treatment delay could mean that prolonged SEI treatment is more beneficial than treatment as usual (TAU) so long as it is provided in the early years of illness and not just in the early years after diagnosis.
Highlights
The critical phase theory from which early intervention in the psychosis field grew was proposed in the early to midnineties.[1, 2] Based on studies of patients with first-episode schizophrenia it appeared that the first 5 years after onset of illness were more fluctuating compared to the later years, when symptom level and functional deficits seemed to stabilize.[3, 4] Based on this background, it was suggested that interventions in the early years could have a disproportionally large impact on the long-term outcome of the illness than interventions in the more static later years
There was a tendency for the functional level to be higher in participants with a short duration of untreated psychosis (DUP) and short total treatment delay
Even though mode of onset was significantly associated with DUP, there was no evidence that it could explain the enhanced treatment response seen in the short DUP group
Summary
The critical phase theory from which early intervention in the psychosis field grew was proposed in the early to midnineties.[1, 2] Based on studies of patients with first-episode schizophrenia it appeared that the first 5 years after onset of illness were more fluctuating compared to the later years, when symptom level and functional deficits seemed to stabilize.[3, 4] Based on this background, it was suggested that interventions in the early years could have a disproportionally large impact on the long-term outcome of the illness than interventions in the more static later years. The effects seen on long-term outcomes have been more contradictory.[6,7,8] The specialized early intervention (SEI) programs that were established in many developed countries typically treat patients from 1 to 3 years after their initial diagnosis, not for the entire first 5 years as originally suggested
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call