Mean Duration Of Untreated Psychosis Research Articles

Aberrant salience mediates the interplay between emotional abuse and positive symptoms in schizophrenia

IntroductionChildhood trauma and adversities (CTA) and aberrant salience (AS) have a pivotal role in schizophrenia development, but their interplay with psychotic symptoms remains vague. We explored the mediation performed by AS between CTA and psychotic symptomatology in schizophrenia. MethodsWe approached 241 adults suffering from schizophrenia spectrum disorders (SSDs), who have been in the unit for at least 12 consecutive months, excluding the diagnosis of dementia, and recent substance abuse disorder, and cross-sectional evaluated through the Aberrant Salience Inventory (ASI), Childhood Trauma Questionnaire Short-Form (CTQ-SF), and Positive and Negative Symptom Scale (PANSS). We tested a path-diagram where AS mediated the relationship between CTA and psychosis, after verifying each measure one-dimensionality through confirmatory factor analysis. ResultsThe final sample comprised 222 patients (36.9% female), with a mean age of 42.4 (± 13.3) years and an average antipsychotic dose of 453.6 (± 184.2) mg/day (chlorpromazine equivalents). The mean duration of untreated psychosis was 1.8 (± 2.0) years while the mean onset age was 23.9 (± 8.2) years. Significant paths were found from emotional abuse to ASI total score (β = 0.39; p < .001) and from ASI total score to PANSS positive (β = 0.17; p = .019). Finally, a statistically significant indirect association was found from emotional abuse to PANSS positive mediated by ASI total score (β = 0.06; p = .041; CI 95% [0.01, 0.13]). ConclusionEmotional abuse has an AS-mediated effect on positive psychotic symptomatology. AS evaluation could allow a better characterization of psychosis as well as explain the presence of positive symptoms in adults with SSDs who experienced CTA.

Duration of untreated psychosis and its associated sociodemographic and clinical factors in first-episode psychosis: A study from Eastern Nepal.

Duration of untreated psychosis (DUP) is considered an important factor in outcome. Individual, familial and illness factors may prolong DUP. Little data on this issue is available from the country of Nepal. The purpose of the present study was to assess DUP in patients with first-episode psychosis and identify associations with patients' socio-demographic and clinical factors. A cross-sectional, descriptive study was conducted in the department of psychiatry, of Tertiary Hospital in the Eastern part of Nepal. Eighty-six patients were enrolled. ICD-10 was used to make the diagnosis. Nottingham Onset Schedule-DUP version (NOS-DUP) was used to assess DUP. Positive and Negative Syndrome Scale (PANSS) was used to assess patients' clinical symptoms. The mean (SD) DUP was 21.4 (42.1) months and median DUP was 3.0 months (IQR = 23.5). Participants from mountainous region, the unemployed, having an insidious onset of illness, and patients with a diagnosis of schizophrenia had significantly longer DUP (P < .005). Duration of untreated psychosis was also positively correlated with negative symptoms (r = .42, (P < .001) and total PANSS score (r = .42, P < .001). Duration of untreated psychosis in first-episode psychotic patients was relatively long (compared to studies in other countries), and was found to be positively associated with mountainous regions of Nepal, being unemployed, having an insidious onset of illness, and having a diagnosis of schizophrenia. Programs and educational efforts are needed to ensure early treatment of patients with first-episode psychosis, especially in the mountainous rural areas of Nepal.

Patients with first-episode psychosis in northern Taiwan: neurocognitive performance and niacin response profile in comparison with schizophrenia patients of different familial loadings and relationship with clinical features

BackgroundExamining patients with first-episode psychosis (FEP) provides opportunities to better understand the mechanism underlying these illnesses. By incorporating quantitative measures in FEP patients, we aimed to (1) determine the baseline distribution of clinical features; (2) examine the impairment magnitude of the quantitative measures by comparing with external controls and then the counterparts of schizophrenia patients of different familial loadings; and (3) evaluate whether these quantitative measures were associated with the baseline clinical features.MethodsPatients with FEP were recruited from one medical center, two regional psychiatric centers, and two private clinics in northern Taiwan with clinical features rated using the Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) scale. Quantitative measurements included the Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), niacin response abnormality (NRA), and minor physical anomalies and craniofacial features (MPAs). To evaluate the relative performance of the quantitative measures in our FEP patients, four external comparison groups from previous studies were used, including three independent healthy controls for the CPT, WCST, and NRA, respectively, and one group of treatment-resistant schizophrenia patients for the MPAs. Additionally, patients from simplex families and patients from multiplex families were used to assess the magnitude of FEP patients’ impairment on the CPT, WCST, and NRA.ResultsAmong the 80 patients with FEP recruited in this study (58% female, mean age = 25.6 years, mean duration of untreated psychosis = 132 days), the clinical severity was mild to moderate (mean PANSS score = 67.3; mean PSP score = 61.8). Patients exhibited both neurocognitive and niacin response impairments (mean Z-scores: −1.24 for NRA, − 1.06 for undegraded d', − 0.70 for degraded d', − 0.32 for categories achieved, and 0.44 for perseverative errors) but did not show MPAs indicative of treatment resistance. Among these quantitative measures, three of the four neurocognitive indices were correlated with the baseline clinical features, whereas NRA did not show such correlation.ConclusionsThis FEP study of Taiwanese patients revealed the presence of neurocognitive performance and niacin response and their different relationships with clinical features, rendering this sample useful for future follow-up and incorporation of multiomics investigation.

What is the duration of untreated psychosis worldwide? - A meta-analysis of pooled mean and median time and regional trends and other correlates across 369 studies.

Duration of untreated psychosis (DUP) has been associated with poor mental health outcomes. We aimed to meta-analytically estimate the mean and median DUP worldwide, evaluating also the influence of several moderating factors. This PRISMA/MOOSE-compliant meta-analysis searched for non-overlapping individual studies from inception until 9/12/2022, reporting mean ± s.d. or median DUP in patients with first episode psychosis (FEP), without language restrictions. We conducted random-effect meta-analyses, stratified analyses, heterogeneity analyses, meta-regression analyses, and quality assessment (PROSPERO:CRD42020163640). From 12 461 citations, 369 studies were included. The mean DUP was 42.6 weeks (95% confidence interval (CI) 40.6-44.6, k = 283, n = 41 320), varying significantly across continents (p < 0.001). DUP was (in descending order) 70.0 weeks (95% CI 51.6-88.4, k = 11, n = 1508) in Africa; 48.8 weeks (95% CI 43.8-53.9, k = 73, n = 12 223) in Asia; 48.7 weeks (95% CI 43.0-54.4, k = 36, n = 5838) in North America; 38.6 weeks (95% CI 36.0-41.3, k = 145, n = 19 389) in Europe; 34.9 weeks (95% CI 23.0-46.9, k = 11, n = 1159) in South America and 28.0 weeks (95% CI 20.9-35.0, k = 6, n = 1203) in Australasia. There were differences depending on the income of countries: DUP was 48.4 weeks (95% CI 43.0-48.4, k = 58, n = 5635) in middle-low income countries and 41.2 weeks (95% CI 39.0-43.4, k = 222, n = 35 685) in high income countries. Longer DUP was significantly associated with older age (β = 0.836, p < 0.001), older publication year (β = 0.404, p = 0.038) and higher proportion of non-White FEP patients (β = 0.232, p < 0.001). Median DUP was 14 weeks (Interquartile range = 8.8-28.0, k = 206, n = 37 215). In conclusion, DUP is high throughout the world, with marked variation. Efforts to identify and intervene sooner in patients with FEP, and to promote global mental health and access to early intervention services (EIS) are critical, especially in developing countries.

Factors Associated with Duration of Untreated Psychosis - A Retrospective Study done in a Rural Medical College

Background and Aim: Duration of untreated psychosis (DUP) is the measure of time from the emergence of the psychosis to intervention. There is a lot of controversy about its importance and the factors affecting the length of it. In this study, we investigate factors possibly affecting DUP in a patient’s attending psychiatry OPD in a rural medical college. Materials and Methods: This was a retrospective cross-sectional study. Cases were selected from the register of medical records identifying the occurrence of first-episode psychosis diagnosed with paranoid schizophrenia and delusional disorder according to the International Classification of Diseases -10 between July 2020 and July 2021. A total of 30 cases were included following approval from the ethical committee. These cases were investigated further for the factors of interest, i.e. sociodemographic details, substance abuse, family history, magico-religious beliefs, social support, and awareness of mental illness among caretakers. Results: The mean age of our sample (n = 30) was 32.7 years, and out of them, 53% were male, 53.3% of them were married, and maximum (53.3%) of them belonged to the age group of 18–29 years. The mean DUP among our patients was 13.27 weeks. 53.3% belonged to lower/upper lower socio - economic status, most of them (63.4%) belonging to rural background. 33.3% of the patients had family history of psychosis. Conclusion: Patient’s sociodemographic profile as well as social support, religious beliefs, and awareness of mental illness act as a predictor for the DUP. Therefore, the morbidity and stress of the caregivers can be reduced by identifying these factors and taking appropriate action.

Sociodemographic and clinical characteristics of the population with a first psychotic episode attended in the mental health services of area 5 of Madrid (Spain)

IntroductionRisk of functional impairment and progression to chronic illness in people with a first episode of psychosis (FEP) has motivated early intervention programs, showing promising results. Defining the characteristics of people with FEP at local level enables the clinicians to adjust interventional models to the reality of the population. The area 5 of Madrid (Spain) is referred to La Paz University Hospital and it serves a catchment area of roughly 527,000 people.ObjectivesWe aim to identify sociodemographic and clinical characteristics of patients in the area 5 of Madrid (Spain) who meet the criteria of FEP.MethodsA descriptive retrospective study including 179 people (age range 18-40 years) who were attended in mental health services of La Paz University Hospital (area 5 of Madrid, Spain), between January 2019 and May 2020, having suffered a psychotic episode in the last five years.ResultsThe average age of people with FEP was 29.32 years, with a higher proportion of men (62%). The mean duration of untreated psychosis (DUP) was 3.64 months and 47% of patients consume cannabis. We found disparities in DUP among the different districts in the area and we also observed differences depending on the district for inclusion in rehabilitation programs or psychotherapy. The following averages were obtained for the aggregate sample: 1.01 hospitalization/year, 1.42 emergency room visits/year, 1.81 years of illness and a mean dosage equivalent to olanzapine 6.75 mg/day. The incidence of psychosis in our area has been 7.01 cases per 100000 inhabitants/year.ConclusionsThe incidence of psychosis has been as expected according to data recorded at previous studies in Spain. The results obtained in our sample have included a lower DUP and a higher use of cannabis than those described in the literature. We have also found differences when observing the inclusion of patients in different treatments (psychotherapy, rehabilitation), which may be related to the differences in the DUP by districts. Further exploration in this field is needed to draw causal conclusions.Disclosure of InterestNone Declared

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

Reducing 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. To 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. This 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. All 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. Primary 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. Twenty-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 < .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]). In 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. ClinicalTrials.gov Identifier: NCT02841956.

Association between Sociodemographic Factors and Severity of Psychiatric Symptoms with Duration of Untreated Psychosis in Patients with First Episode Psychosis: A Cross-sectional Study

Introduction: The Duration of Untreated Psychosis (DUP) is the time interval between the manifestation of the first psychotic symptom in a patient and the starting of proper treatment. Though, considered as a modifiable factor in the outcome of mental illness, many confounding variables such as sociodemographic factors and illness related factors can affect the DUP. Aim: To identify the association between sociodemographic factors and the severity of psychiatric symptoms with the DUP in patients with the first episode of psychosis. Materials and Methods: A descriptive cross-sectional study conducted in the Department of Psychiatry, Government Medical College, Kottayam, Kerala, India, from March 2018 to February 2019. The first 50 consecutive patients reporting for treatment for the first time, who were diagnosed with psychotic disorders were recruited into the study. Details of the onset of psychosis were collected from the relative based on a clear, unequivocal description of symptoms by the relative. A specially designed proforma was used to gather the sociodemographic details and Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of psychotic symptoms. Statistical analysis was done using independent Student’s t-test, one-way Analysis of Variance (ANOVA) and Pearson’s correlation and p-value &lt;0.05 is considered significant. Results: The mean age of the participants was 30.46 years and males constituted 31 (62%) of the participants. A total of 32 (64%) of the participants were unmarried or married but living separately. The mean DUP was 24.3 weeks (SD=23.9 weeks) and the mean BPRS score of the participants was 57.4 (SD=10.1). Schizophrenia was the diagnosis in 28 (56%) of participants. There was a significant correlation between the DUP and BPRS with a p-value=0.021 and Pearson’s correlation coefficient of 0.326. A significant association was found between the BPRS scores and the psychiatric diagnosis, with schizophrenia having higher mean BPRS scores. Conclusion: The DUP is considered a modifiable factor in the outcome of psychotic disorders. Many factors affect the time interval between the manifestation of initial symptoms in a patient and starting of the proper treatment. A significant association was found between the DUP and the severity of psychotic symptoms as evidenced by the BPRS score.

Clinical and Social Correlates of Duration of Untreated Psychosis and Impact on Short-Term Outcome in Patients with First-Episode Psychosis

Abstract Background: The duration of untreated psychosis (DUP) impacts symptomatic and functional outcome in patients with psychosis. Objectives: This study assessed DUP, its association with sociodemographic and clinical factors and its impact on short-term clinical and functional outcome in patients with first episode psychosis. Methodology: Sixty-nine first contact patients with first episode psychosis who had not received adequate treatment for psychosis (adequate treatment - antipsychotic medication of ≥3.5 mg haloperidol equivalents for ≥ 4 weeks) previously were assessed with Symptom Onset in Schizophrenia Inventory to determine DUP. They were followed up for 12 weeks. Positive and Negative Syndrome Scale and World Health Organization Disability Assessment Scale – II were used to assess symptoms and functioning at presentation and after 12 weeks. Results: The mean DUP for the sample (n=69) was 56.7 ± 89.1 weeks (13.2 ± 20.8 months). About three fifths (60.9%) of the subjects had DUP ≤ 3 months (short DUP) and two fifths (39.1%) had DUP &gt; 3 months (long DUP). Univariate analysis found age, employment, mode of onset and diagnosis to be significant. At followup, treatment-related improvement in positive, general and total symptom scores was significantly negatively correlated with DUP and improvement in functioning was significantly greater in patients with DUP &lt; 3 months. A step-wise multiple logistic regression model identified mode of onset, age, and history of prior attempts at treatment as independent predictors of membership to the two DUP categories; insidious onset led to a 20-fold and a history of prior treatment attempts indicated a 400% increase in the odds of belonging to the long DUP category. An average of 9% increase in odds of having long DUP was observed with every one-year increase in age. Conclusion: Early detection (short DUP) of psychosis was found to have a salutary impact on clinical and functional outcome.

Toward reducing the duration of untreated psychosis in a Latinx community.

To carry out and evaluate a communications campaign (La CLAve) to reduce the duration of untreated psychosis (DUP) in a U.S. Latinx community. We employed evidence-based messaging in multiple media outlets. We recruited 132 Latinxs with first-episode psychosis (FEP) and caregivers seeking mental health care within a high-density Latinx community. We evaluated the campaign's dissemination, the extent to which the community received the campaign message, and the campaign outcome. We tested whether DUP (number of weeks) changed across three time periods (16-month baseline, 2-year campaign, and 16-month postcampaign) and whether participants' language background (primarily Spanish speaking or English speaking) moderated change in DUP. The campaign was disseminated widely. During the height of the campaign over a 1-year period, our team distributed 22,039 brochures and performed 740 workshops. The campaign message was received by the community as noted for example by increases in the number of unduplicated weekly calls to the campaign's 1-800 number. Applying square root transformations to DUP, we found a significant main effect for language background but not for campaign period nor their interaction. The unadjusted mean DUP for Spanish-speaking persons with FEP was more than twice as high as the mean DUP for English-speaking persons with FEP. Spanish-speaking Latinxs with FEP are especially in need of early psychosis treatment. The campaign reached the community but additional steps are needed to reduce treatment delay. Greater attention is needed to increase access to early intervention services for communities of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Characteristics of Pacific Island People Admitted to a New Zealand Inpatient Forensic Service.

This study describes the characteristics of Pacific Island patients admitted to the Auckland Regional Forensic Psychiatry Service, at Mason Clinic, the largest of five forensic hospitals in New Zealand. Sixty-nine Pacific Island patients admitted over a 9-year period (2009--2017) are described in terms of their sociodemographic and clinical characteristics, access to community mental health care prior to arrest, and their legal history. The majority were men, born in New Zealand, who were single, with poor educational achievement, unemployed, with minimal religious and cultural affiliations, and still living with family prior to the index offense. Almost all had a major psychotic illness, with a mean duration of untreated psychosis of 2.5 years. Most used alcohol and cannabis, and almost half used methamphetamine. The majority of index offenses were violent in nature. These findings identified a disadvantaged and vulnerable group with multiple diagnoses and limited access to mental health services. Culture is fundamental to the causes, course, and care of mental illness. The design and delivery of services that are responsive to the mental health needs of this culturally diverse group may lead to better health outcomes and reduced inequities.

Pathways of Psychiatric Treatment in Rural Patients with Psychosis

Background: Pathways of care support the development of care partnerships and empower patients and their care providers along with necessary modifications in the existing health services. Aim: To examine the various pathways of psychiatric treatment in rural patients with psychosis and to know the source of referral, first contact for treatment, awareness about the signs and symptoms and various symptoms (complains) with which the patients presented themselves to the different modalities of treatment. Methods: It was a cross sectional hospital based study conducted at Out-Patient Department of Ranchi Institute of Neuro-Psychiatry & Allied Sciences (RINPAS) Kanke, Ranchi. Purposive sampling technique was used for the study, total 96 participants were selected in 1 month duration. Subjects were evaluated using socio demographic datasheet, WHO counter form and BPRS-24. Results: The present study found that the mean duration of untreated psychosis was 558.80±707.08 days. First symptoms appeared at onset of illness, in which fearfulness (13.5%) appeared in most patients. Time taken to decide to go for consultation after onset of illness was 417.67±621.11 days. Maximum first consultations were to native & faith healers (69.8%) and only 17.7% consulted psychiatric services at first contact. For the first referral, 64.6% patients shifted to psychiatric services from other modes such as native / faith healer, general hospital and medical practitioner. CONCLUSION: The study provides an insight into the nature of the pathway and referral taken by rural patients with psychosis and their caregivers.Key Words: Pathways, Psychiatric treatment, rural patients.

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BACKGROUND:Duration of untreated psychosis refers to the time elapsing between onset of psychosis and treatment initiation. The fact that schizophrenia generally begins in the late adolescence/adulthood, that it often remains untreated for a long time before being recognized and treated, and that it frequently shows a chronic, recurrent and disabling course, dramatically impact on the relational and functional life of patients and care givers. For this reason, the first episode of psychosis, considered as the early stage of schizophrenia, is classically viewed as a critical period.AIMS AND OBJECTIVES:1) To estimate the duration of untreated psychosis and its variation over the years.2) To determine possible correlation between duration of untreated psychosis and other independent variables.MATERIALS AND METHODS:This is a retrospective case record study. Data is collected from medical records department of a tertiary care psychiatric hospital, every five years starting from 1995 to 2020 with a sample size of 50 each year. The data is entered in a data collection sheet. The duration of untreated psychosis and its variation over the years has been estimated. Multivariate analysis to look for possible correlation between duration of untreated psychosis and other independent variables like sociodemographic details, predominant presenting symptoms, presence of aggression and mode of onset of symptoms has been done.RESULTS:The mean duration of untreated psychosis shows a decreasing trend over the years from 1995 to 2020. Most common variables correlating with shorter DUPs include positive symptoms, presence of aggression and male gender.CONCLUSION:Various factors could be attributable to this reduction in duration of untreated psychosis including increasing in awareness about mental health in general population, inception of district mental health programs and reduction in stigma towards mental health. Yet, the present DUP is higher when compared with developed countries.REFERENCES: 1) Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India Jagadisha Thirthalli 1, Naveen Kumar Channaveerachari, Doddaballapura K Subbakrishna, Linda B Cottler, Mathew Varghese, Bangalore N Gangadhar2) An exploratory evaluation of predictors of duration of untreated psychosis in first-episode psychosis in lower income patients Ankita Mishra 1, Abha Bang Soni 2, Maithili S Umate 3, Chittaranjan Andrade 4

Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan-Monaghan early intervention service.

As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan-Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

Clinical Predictors of Duration of Untreated Psychosis: Exploring Psychosocial and Clinical Predictors of Duration of Untreated Psychosis in First-Episode Psychotic Patients in Mzuzu, Malawi

The duration of untreated Psychosis (DUP) is a modifiable factor in the management and outcome of patients with psychosis. However, its predictive factors have not been studied much in Malawi. Our study was aimed at determining the psychosocial and clinical predictors of DUP in first episode psychosis in Malawi. A quantitative cross-sectional study, using secondary data from an early intervention study project was done in Mzuzu, Malawi. We analysed 140 adult participants enrolled in early intervention project in 2010. Data was collected using abstraction sheet to target predictive factors. We conducted univariate and multivariate logistic regression at confidence interval of 95%. We described the mean DUP, and looked at relationship of clinical and psychosocial factors with DUP. Most participants were male (60%, n=84) and single (51.4%, n=72). The median age of male participants was 31 years (Range=18 to 60), lower than females 35 years (Range=18 to 65). (what were the numbers of females). The majority of the participants' highest education level was secondary school (63.6%, n=89), and most had DUP of ≥ 6 months (74%, n=103). We found mean DUP of 42 months (SD= ±71). Employment status, diagnosis of schizophrenia (OR=10.93, 95% C.I 3.08-38.89), and negative symptoms of psychosis were associated with DUP of ≥ 6 months. Public self-consciousness and social quality of life were associated with long DUP. Our study shows psychosocial and clinical factors that predict long DUP in Malawi. This highlights the need to target these factors when working on first episode psychosis for a better outcome.

The relationship of sociodemographic and clinical profiles to the duration of untreated psychosis among adolescents with first-episode psychosis in an Oman tertiary hospital

ABSTRACT Background: The duration of untreated psychosis (DUP) among adolescents with first-episode psychosis has received scant attention in non-western societies. Aim: This study aims to explore both sociodemographic and clinical profiles and examine their relationship to the DUP among adolescents with first-episode psychosis admitted to a tertiary care hospital in Oman Method: This is a retrospective, cross-sectional, analytical study conducted at a tertiary care hospital in Oman from January 2010 to December 2018. The subjects of the study included 121 drug-naive adolescents between the ages of 10 and 19 years old with first-episode psychosis. Sociodemographic data and risk factors were also solicited. Result: A total of 121 adolescents fulfilled the study criteria. The mean DUP was 4 months (SD 4.5). Place of residence, family history of psychosis, presence of both positive and negative symptoms, use of traditional healing systems, length of stay, and leaving against medical advice were the significant factors associated with the duration of untreated psychosis. Discussion: Some of the factors presently found to contribute to the DUP could lay the groundwork for the reduction in the duration of untreated psychosis and redesigning services for such population.

Duration of untreated psychosis and response to treatment: an analysis of response in the OPTiMiSE cohort

Some, but not all, studies have found longer duration of untreated psychosis (DUP) to be associated with poor response to treatment and more severe negative symptoms in schizophrenia. The aim of the current analysis was to investigate these parameters in a large cohort of patients in their first psychotic episode. The OPTiMiSE cohort included 446 patients with DUP up to two years, who were administered amisulpride for 4 weeks (Phase I). Patients who did not meet Andreasen remission criteria were randomized to double-blind continuation of amisulpride or olanzapine for 6 additional weeks in a blinded study (Phase II). Analyses showed that shorter DUP was associated with lower baseline CGI scores (p<0.001, r = 0.184), PANSS total (p = 0.025, r = 0.106) and PANSS negative subscale scores (p = 0.023, r = 0.107). Remitters had a significantly shorter mean DUP compared to non-remitters both in Phase I (24.5 weeks ±24.3 vs. 35 weeks ± 32.2, p = 0.01, t=−2.521) and in Phase II (24.3 weeks ± 26.4 vs. 38.3 weeks ± 31.3, p = 0.031, t=−2.194). Logistic regression analyses showed a significant effect of DUP on treatment response both in phase I (p = 0.008) and phase II (p = 0.041). Linear regression analyses found that DUP significantly affects PANSS Total change at the end of phase I (p = 0.028) but not at the end of phase II (p = 0.236). Based on these findings, it is possible to conclude that shorter DUP is associated with better response to treatment, particularly during the first weeks after treatment initiation. These findings highlight the need for early identification of the first psychotic episode.

Pathways to care, DUP, and types of interventions over 5years following psychosis onset: findings from a naturalistic study conducted in routine generalist mental health services.

To describe pathways to care, duration of untreated psychosis (DUP), and types of interventions provided to first-episode psychosis (FEP) patients by routine Italian mental health services over 5years since the first service contact. Naturalistic study conducted in Veneto, within the context of the Psychosis Incident Cohort Outcome Study (PICOS). A comprehensive set of measures was used, including schedules designed to collect information on referrals to psychiatric services and on psychological and pharmacological treatments at 1, 2, and 5years since first service contact. Overall, 397 patients were assessed. Most engaged with services with the help of family members (47.4%) and through emergency routes (60.3%). Those referred by clinicians were more likely to access care in a non-emergency way. Mean DUP was 5.62months (SD 11.8) and longer DUP was associated with poorer functioning at 2 and 5years. Interventions provided over 5years were mainly constituted by antipsychotic medications (95.4% at 1year; 85.8% at 2years; 80.6% at 5years), whereas a lower percentage (69.1% at 1year; 61.5% at 2years; 44.9% at 5years) also received some forms of psychological interventions, mainly consisting of unspecific support sessions. Other structured interventions, such as CBT or family interventions, were seldom provided at each time-point. Mental health services in Veneto seem effective in engaging FEP patients within a short time since illness onset. However, type of care provided does not meet quality standards recommended by treatment guidelines, especially regarding psychological interventions.

Determinants of pathways to care among young adults with early psychosis entering a coordinated specialty care program.

To describe the characteristics of the pathway to coordinated specialty care for young adults with early psychosis in the United States, to examine how various factors correlate with the duration of untreated psychosis (DUP), and to explore factors associated with time from onset of symptoms to first mental health service contact (help-seeking DUP). The sample included 779 individuals ages 16 to 30 with recent-onset non-affective psychosis enrolled in OnTrackNY. Domains assessed included demographics, clinical characteristics, mental health service utilization and characteristics of the pathway to care. Primary outcomes included the time from onset of psychotic symptoms to admission to OnTrackNY (DUP) and time from onset of psychotic symptoms to first mental health service contact (help-seeking DUP). The mean DUP was 231.2 days (SD = 87.7, median = 169) and mean help-seeking DUP was 73.7 days (SD = 110.8, median = 27). Being in school, better social functioning, and greater number of ER visits or hospitalizations were associated with shorter DUP. Violent ideation or behaviour and having an outpatient mental health visit as the first service contact or hallucinations as the reason for first service contact were significantly associated with longer DUP. Only the type of first service contact (outpatient mental health treatment or other non-mental health service provider) and having hallucinations as the clinical reason for the first service contact were associated with help-seeking DUP. Referral delays were longer than help-seeking delays. Strategies to reduce treatment referral delays through systems-level interventions may be most likely to reduce the overall DUP in this population.

Early intervention in psychosis in the North Lee Mental Health Services programme: a 5-year review.

An Early Intervention in Psychosis (EIP) programme aims to engage patients in early assessment and phase-specific interventions which are the key elements of the Irish National Clinical Programme for psychosis. This study aims to describe and review the EIP programme offered by Cork's North Lee Mental Health Services over a 5-year period. A retrospective descriptive study design was adopted to describe and review the EIP programme, patient demographics and treatments offered in the service over a 5-year period. A total of 139 patients were accepted into the programme over the 5-year period. The mean age of onset was 30 years (median = 28, SD = 9.9), and the mean duration of untreated psychosis was 8 months (median = 2.5, SD = 15.3). Two-thirds of patients were single on initial assessment, had a history of substance misuse and were unemployed. The majority of the cohort engaged with the keyworkers and occupational therapy but did not complete the full psychological or family programmes offered. Hospital admission was required for 12% of the cohort. Patients experiencing their first episode of psychosis can successfully be treated in the community with appropriate professional and family support. However, deficiencies were noted in physical health monitoring, as well as in the availability and engagement with family and psychological therapies. Properly resourced early interventions in psychosis teams are necessary to deliver services at internationally recognised standards.