Treatment Delay in the Early Course of Schizophrenia and the Duration of Untreated Psychosis

Abstract

<p>Treatment Delay in the Early Course of Schizophrenia and the Duration of Untreated Psychosis </p><p>Michael T. Compton, MD, MPH; Sandra M. Goulding, MPH; Beth Broussard, MPH, CHES; and Hanan Trotman, MA</p> <p>In recent decades, treatment delay in the early course of schizophrenia has evolved as an issue of great interest to schizophrenia researchers, especially early psychosis researchers. This interest is partly derived from accumulating research evidence that delaying treatment of new-onset psychosis, like delaying treatment of any emerging medical condition, is associated with poorer symptomatic and functional outcomes. Additionally, the interest also stems from the clinical observation of countless mental health practitioners — that the period of untreated psychosis is detrimental, confusing, emotionally painful, and even disabling for patients and their families. Thus, in addition to a potential accumulation of biological morbidity (ie, an “active morbid process” or neurotoxicity effect) that may lead to poorer future outcomes, the immediate “psychosocial toxicity” of untreated psychosis is a critical outcome in itself. Because age and level of social development at onset influence the later social course of the disorder, an extended duration of untreated psychosis (DUP) is likely to adversely affect the course of illness through significant social losses that occur during DUP. Early intervention for psychotic disorders, like secondary prevention efforts for any health condition, has the potential to decrease prevalence, enhance outcomes, reduce morbidity, and ameliorate present distress. </p> <h4>ABOUT THE AUTHORS</h4> <p>Michael T. Compton, MD, MPH; Sandra M. Goulding, MPH; and Beth Broussard, MPH, CHES, are with the Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences. Hanan Trotman, MA, is with the Emory University Graduate School of Arts and Sciences, Department of Psychology. </p> <p>Direct correspondence to: Michael T. Compton, MD, MPH, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 49 Jesse Hill Jr. Drive, SE, Room #333, Atlanta, GA 30303; fax 404-616-3241 or e-mail <a href="mailto:Michael.Compton@emory.edu">Michael.Compton@emory.edu</a>. </p> <p>Dr. Compton, Ms. Goulding, Ms. Broussard and Ms. Trotman have disclosed no relevant financial relationships.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol><li>Explain the importance of early intervention efforts aimed at reducing the duration of untreated psychosis.</li> <li>Describe the relationship between duration of untreated psychosis and early-course outcomes. </li> <li>Discuss potential predictive variables of treatment delay in first-episode psychosis. </li></ol>