Median Duration Of Untreated Psychosis Research Articles

Associations between rural/urban status, duration of untreated psychosis and mode of onset of psychosis: a mental health electronic clinical records analysis in the East of England, UK.

The influence of rurality on the duration of untreated psychosis (DUP) in first-episode psychosis (FEP) is poorly understood. We investigated factors associated with FEP in rural/urban settings and whether there are rural/urban differences in DUP and the mode (speed) of onset of psychosis. We used the Cambridgeshire and Peterborough NHS Foundation Trust Research Database (CPFTRD) to identify all persons presenting to an early intervention for psychosis service with FEP between 2013 and 2015. We performed descriptive statistics and multivariable linear and multinomial regression to assess the relationships between the study outcomes and the independent variables. One hundred and fifty-five FEP patients were identified, with a mean age of 23.4 (SD, 5.3) years. The median DUP was 129.0 (IQR: 27.5-524.0) days. In rural areas, FEP patients were more likely to be employed and live with family than those in urban areas. A longer DUP was observed among patients with an insidious onset of psychosis compared with an acute onset (619.5 (IQR: 333.5-945.0)) vs. (17.0 (IQR: 8.0-30.5)) days respectively, p < 0.0001. We found evidence that the mode of onset of psychosis differed by employment status and living circumstances. There was insufficient evidence of rural/urban differences in DUP and mode of onset of psychosis. Our results suggest that the mode of onset of psychosis is an important indicator of treatment delay and could provide vital information for service planning and delivery. Sociodemographic variations in FEP exist in rural populations, and our findings are similar to those observed in urban settings.

Factors associated with improved outcomes in the first psychotic episode at a specialized outpatient clinic in northeastern Brazil.

The present study aimed to evaluate data from patients admitted to the first-episode psychotic (FEP) outpatient clinic at the Hospital of Clinics of the Federal University of Pernambuco from July 2018 to July 2021, seeking to identify factors related to better clinical outcomes. This study was conducted using a convenience sample, including all patients between 15 and 65 years of age who were admitted to the FEP outpatient clinic from July 2018 to July 2021. Descriptive statistical analysis was performed using mean and standard deviation or median and interquartile range for continuous quantitative variables, and absolute number/percentage for qualitative variables. Paired T-test, a parametric test, was used to compare PANSS scores upon admission and after 6 months. Spearman's correlation test was employed to assess the correlation between duration of untreated psychosis (DUP) and treatment response with other variables. The sample consisted of 85.3% male individuals, with 50% of patients aged between 19 and 30 years, and 82% residing in the metropolitan area of Recife. Seventy percent of patients responded to the treatment implemented by the outpatient clinic, and only 30% required psychiatric hospitalization within 6 months of follow-up. The majority of patients had a history of psychoactive substance use (82.4%); however, the use of these substances did not impact the prognosis within the analysed sample. The median DUP was 4 weeks, and a shorter DUP was associated with a lower probability of psychiatric hospitalization and a greater treatment response (reduction >50% in PANSS). A shorter DUP was associated with a lower likelihood of psychiatric hospitalization and a greater treatment response. Furthermore, the specialized early psychosis outpatient clinic itself appears to yield positive outcomes, as 70% of the treated patients exhibited a positive treatment response.

Duration of untreated psychosis and 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' sociodemographic and clinical factors. A cross-sectional, descriptive study was conducted in the department of psychiatry at Tertiary Hospital in the Eastern part of Nepal. Eighty-six patients were enrolled. ICD-10 was used to make the diagnosis. The 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 regions, those who were 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 living in 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.

Identifying Individuals With Early Psychosis in Jail: Lessons Learned for Coordinated Specialty Care Services.

This study sought to establish the feasibility of a two-component intervention embedded within a jail setting that would detect detainees with early psychosis and connect them to coordinated specialty care (CSC) in the community upon release. The two components of the intervention were a targeted educational campaign for correction officers and a specialized early engagement support service to facilitate jail discharge planning. Jail detainees with early psychosis were referred to the project and assessed for positive and negative symptoms, substance use, and duration of untreated psychosis (DUP). During a 24-month period, 25 individuals were referred, of whom eight were eligible and interviewed. The sociodemographic and clinical characteristics of the jail detainees were similar to those of individuals in hospital settings. The median DUP was 36 weeks. One of the eight detainees with early psychosis was successfully referred to CSC; for the other detainees, social or criminal legal factors precluded referral. A targeted educational campaign for correction officers and a specialized early engagement support service can be implemented in a jail setting, and referrals can be facilitated. Success of the campaign may depend on having dedicated liaisons within the jail setting (e.g., among correctional health staff) as well as liaisons in local CSC programs and leadership. Changes in the law and policy environments (e.g., criminal legal system reform) and changes in organizational practices and processes for corrections, correctional health, and local CSC programs (such as those made during the COVID-19 pandemic) require ongoing collaborations.

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.

Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) protocol.

Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.

The duration of untreated psychosis among U.S. Latinxs and social and clinical correlates.

This study (a) documents the duration of untreated psychosis (DUP) and (b) examines both social and clinical correlates of DUP in a sample of U.S. Latinxs with first-episode psychosis (FEP). Data were collected for a longitudinal study evaluating a community education campaign to help primarily Spanish-speaking Latinxs recognize psychotic symptoms and reduce the DUP, or the delay to first prescribed antipsychotic medication after the onset of psychotic symptoms. Social and clinical variables were assessed at first treatment presentation. A sequential hierarchical regression was conducted using √DUP to identify independent predictors of the DUP. A structural equation model was used to explore the association between DUP predictors, DUP, and clinical and social correlates. In a sample of 122 Latinxs with FEP, the median DUP was 39 weeks (M = 137.78, SD = 220.31; IQR = 160.39-5.57). For the full sample, being an immigrant and having self-reported relatively poor English-speaking proficiency and self-reported strong Spanish-speaking proficiency were related to a longer delay to first prescribed medication after psychosis onset. For the immigrant subgroup, being older at the time of migration was related to a longer delay. Self-reported English-speaking proficiency emerged as an independent predictor of the DUP. Although the DUP was not related to symptomatology, it was associated with poorer social functioning. Low self-reported English-speaking ability is associated with poorer social functioning via the DUP. Latinxs with limited English language skills are especially at high risk for experiencing prolonged delays to care and poor social functioning. Intervention efforts to reduce the delay in Latinx communities should pay particular attention to this subgroup.

Prodromal symptoms and the duration of untreated psychosis in first episode of psychosis patients: what differences are there between early vs. adult onset and between schizophrenia vs. bipolar disorder?

To assess the role of age (early onset psychosis-EOP < 18 years vs. adult onset psychosis-AOP) and diagnosis (schizophrenia spectrum disorders-SSD vs. bipolar disorders-BD) on the duration of untreated psychosis (DUP) and prodromal symptoms in a sample of patients with a first episode of psychosis. 331 patients with a first episode of psychosis (7–35 years old) were recruited and 174 (52.6%) diagnosed with SSD or BD at one-year follow-up through a multicenter longitudinal study. The Symptom Onset in Schizophrenia (SOS) inventory, the Positive and Negative Syndrome Scale and the structured clinical interviews for DSM-IV diagnoses were administered. Generalized linear models compared the main effects and group interaction. 273 AOP (25.2 ± 5.1 years; 66.5% male) and 58 EOP patients (15.5 ± 1.8 years; 70.7% male) were included. EOP patients had significantly more prodromal symptoms with a higher frequency of trouble with thinking, avolition and hallucinations than AOP patients, and significantly different median DUP (91 [33–177] vs. 58 [21–140] days; Z = − 2.006, p = 0.045). This was also significantly longer in SSD vs. BD patients (90 [31–155] vs. 30 [7–66] days; Z = − 2.916, p = 0.004) who, moreover had different profiles of prodromal symptoms. When assessing the interaction between age at onset (EOP/AOP) and type of diagnosis (SSD/BD), avolition was significantly higher (Wald statistic = 3.945; p = 0.047), in AOP patients with SSD compared to AOP BD patients (p = 0.004). Awareness of differences in length of DUP and prodromal symptoms in EOP vs. AOP and SSD vs. BD patients could help improve the early detection of psychosis among minors.

A study on the pathway to care among patients with first episode psychosis attending a tertiary health care center in North Karnataka

ABSTRACT Context: Early treatment of schizophrenia and other psychotic disorders has a significant impact on the prognosis and outcome of these disorders. To reduce the time of untreated psychosis, it is necessary to know the help-seeking behavior and the path taken by the patients and their caregivers. Efforts at reducing the time to initiate treatment for first-episode psychosis (FEP) are very much needed. The pathway to care helps in determining various factors associated with the delay and also creates awareness regarding the negative pathway determinants. Aim: This study aims to find out the pathway to care in FEP. Settings and Design: This is a hospital-based, time-bound, cross-sectional study, conducted from January to June 2022 in the department of psychiatry of a tertiary health care center in North Karnataka. Subjects and Methods: Basic sociodemographic, clinical, and details related to pathway to care were collected using semi-structured pro forma. MINI plus 5.0.0 and International Classification of Diseases-10 DCR were used to assess and confirm the diagnosis. Brief Psychiatric Rating Scale was used to measure the severity of symptoms. Statistical Analysis: Data were compiled and appropriate statistical tests were used to analyze the data with the help of SPSS version 17.0. Results: Sixty-one cases of FEP were assessed. The majority (44.2%) of the cases were diagnosed with acute and transient psychotic disorders and 16.4% were schizophrenia. The median duration of untreated psychosis was 30 days (15–150 days). For the majority (54.1%) of the patients, first contact was faith healers and for 31.1%, it was mental health facilities. Conclusion: The most common pathway taken by the patients was faith healers as they were easily available in rural areas and free from stigma associated with mental illness. These findings can be utilized in making policies to increase awareness about mental health and also about the availability of mental health services.

Duration of untreated psychosis and pathways to care in Suriname: a qualitative study among patients, relatives and general practitioners

PurposePsychosis is a severe mental health problem and is responsible for poor health outcomes, premature mortality and morbidity, especially in low- and middle-income countries. The duration of untreated psychosis (DUP),...

An exploratory evaluation of predictors of duration of untreated psychosis in first-episode psychosis in lower income patients

A longer duration of untreated psychosis (DUP) may adversely affect the course and impact of the illness. Little is known about predictors of duration of untreated psychosis in lower socioeconomic strata (SES) in urban India. We examined variables associated with DUP in 60 urban lower SES patients diagnosed with first-episode, untreated psychosis. Instruments used included the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the UCLA Social Attainment Scale (SAS), and the Stigma Subscale from the Family Interview Schedule. The mean age of the sample was 30.5 years. The sample was 50% male. Most patients (90%) were living in a nuclear family. The median DUP was 120 days. DUP was <6 months in 31.7% of the sample and >2 years in 23.3%. A third of the sample had been taken to faith healers before being brought into medical care. DUP was not significantly associated with age, sex, religion, education, family history of mental illness, marital status, employment status, income, substance use, PANSS subscale and total scale scores, and GAF scores. Presence of an antecedent stressor, acute onset of psychosis, presence of medical co-morbidities, lower stigma scores, and higher SAS scores were significantly associated with shorter DUP.

Association between duration of untreated psychosis and executive function in early-onset psychosis

• Psychosis can present at an early onset (≤18 years old) which may cause impaired executive function. • Behavior Rating Inventory of Executive Function (BRIEF) can assess executive function and its subdomains-the behavioral regulation (inhibition, shifting, emotional control) and the metacognition (initiate, plan/organize, organization of material, monitor, and working memory) during a period of time (not a one-time testing). • Duration of untreated psychosis showed a significant relationship with executive function, and with both of its two subdomains i.e. the behavioral regulation and metacognition . Psychosis is a severe mental illness that causes impaired executive function (EF). The prolonged duration of untreated psychosis (DUP) is one of the negative factors in the course of psychosis. However, the results of previous studies remain inconsistent. The aim of this study is to find out the association between DUP and all the components of EF, i.e. behavioral regulation and metacognition with all their subdomains. This was a cross-sectional study involving patients with early onset-psychosis aged 5–18 years old. DUP were collected from medical records, whereas sociodemographic data were collected by interview and EF was measured using the Behavior Rating Inventory of Executive Function-Parent Indonesian Version questionnaire. Total 50 subjects were included in the study. The median age of subjects was 15.9 ± 1.9 years old with schizophrenia as majority of diagnosis (58%). Median DUP was 2 (0; 84) months. Subjects were divided into short DUP ( ≤ 2 months) and long DUP (>2 months) group. A significant association was found between long DUP (>2 months) and higher Global Executive Composite (GEC) score indicating poorer function, which consisted of Behavioral Regulation Index (BRI) and Metacognition Index (MI) ( p = 0.001, p = 0.007, p = 0.001, respectively). All subdomains of BRI and MI, except material organization, showed significant associations with DUP. There was a significant association between long DUP (>2 months) and poorer EF in early-onset psychosis.

The effects of patient personality traits and family cohesion on the treatment delay for patients with first-episode schizophrenia spectrum disorder.

The duration of untreated psychosis (DUP) is an important prognostic indicator of schizophrenia. We explored the effects of patient personality and family relationships on delayed schizophrenia treatment. We prospectively included data from 169 patients diagnosed with first-episode schizophrenia. Personality traits were investigated using the Big Five Inventory (BFI-10) and family relationship was assessed employing the Family Adaptability and Cohesion Evaluation Scale-III (FACES-III). We explored patient clinical characteristics using the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). The DUP was defined as the time between the first appearance of psychotic symptoms and commencement of adequate antipsychotic treatment. Subjects were divided into two groups by the 3-month median DUP cutoff. The average and median DUPs were 12 and 3months, respectively. A longer DUP was associated with older age, a higher PANSS score, and a lower SOFAS score. The frequency of suicide attempts tended to be higher in the delayed treatment group (P=.055). The delayed treatment group scored significantly higher in conscientiousness factor of the BFI-10 and scored significantly lower family cohesion and adaptability factors of the FACES-III. Logistic regression showed that a longer DUP was significantly associated with higher-level conscientiousness on the BFI-10 and poorer family cohesion on the FACES-III. Treatment delay was associated with reduced family cohesion and higher patient conscientiousness, suggesting that the family plays a crucial role in terms of patient access to mental health services when early psychotic symptoms appear.

Association Between the Duration of Untreated Psychosis and Selective Cognitive Performance in Community-Dwelling Individuals With Chronic Untreated Schizophrenia in Rural China

Cognitive deficits constitute core features of schizophrenia, but the trajectories of cognitive difficulties in chronic untreated schizophrenia remain unclear. To assess the association of neuropsychological deficits with duration of untreated psychosis in individuals with chronic untreated schizophrenia. Community-dwelling individuals with chronic untreated schizophrenia (untreated patient group) and individuals without mental illness (control group) were recruited from predominantly rural communities in Ningxia, China between June 20, 2016, and August 6, 2019, and administered the Structured Clinical Interview for DSM-IV, the Mini-Mental State Examination, an 8-test version of the MATRICS Consensus Cognition Battery adapted for use in individuals with low levels of education, and a measure of social cognition. Comparison of cognitive test scores between the two groups and association of cognitive test scores with duration of untreated schizophrenia. The patient group included 197 individuals with chronic untreated schizophrenia (101 men [51.3%]; mean [SD] age, 52.1 [11.8] years; median [interquartile range] years of schooling, 3 [0-6] years; median [interquartile range] years of untreated psychosis, 22.9 [14.9-32.8] years). The control group included 220 individuals (118 men [53.6%]; mean [SD] age, 52.1 [11.2] years; median [interquartile range] years of schooling, 4 [0-6] years). The untreated patient group performed significantly worse than the control group on all cognitive measures (adjusted partial Spearman correlation coefficient [Spearman ρ] ranged from -0.35 for the revised Chinese version of the Reading the Mind in the Eyes Test to -0.60 for the Brief Visuospatial Memory Test-Revised; P < .001 for all comparisons). Longer durations of untreated psychosis were associated with lower performance in 3 MATRICS Consensus Cognition Battery measures assessing different aspects of executive functioning (Brief Visuospatial Memory Test-Revised [ρ = -0.20; P = .04]; Brief Assessment of Cognition in Schizophrenia, Symbol Coding subtest [ρ = -0.35; P < .001]; and Neuropsychological Assessment Battery, Mazes subtest [ρ = -0.24; P = .01]). The median duration of untreated psychosis (22.9 years) was associated with estimated score reductions in the 3 measures of 34% (95% CI, 10%-52%), 43% (95% CI, 28%-55%), and 57% (95% CI, 31%-73%), respectively. The findings of this study suggest that long-term untreated schizophrenia was associated with decreases in selective cognitive abilities; both neurodegenerative pathology and neurodevelopmental dysfunction may be factors in cognition in persistent psychosis. Expanding research to include cohorts of patients from underserved rural communities in low- and middle-income countries may provide new insights about the etiological factors, disease course, and management of schizophrenia.

T241. INCIDENCE AND SOCIO-DEMOGRAPHIC/CLINICAL CHARACTERISTICS OF PSYCHOTIC DISORDERS IN INDIA, NIGERIA AND TRINIDAD: PRELIMINARY BASELINE FINDINGS FROM INTREPID II

BackgroundThe incidence, presentation, and course of psychotic disorders are highly variable across populations. A recent review noted a lack of evidence from low- and middle-income countries in the global South, where around 85% of the world’s population lives. Robust population-based data from these contexts are needed to better understand the sources of variation in psychotic disorders. INTREPID II is a multi-country programme comprising incidence, case-control, and follow-up studies of psychotic disorders in three diverse catchment areas with populations at risk of ~ 500,000 in Tamil Nadu (India), Oyo state (Nigeria), and northern Trinidad. Here, using baseline data from the initial 15 months, we present findings on variations in incidence and clinical presentation.MethodsBaseline recruitment and assessment is ongoing. In each site individuals with an untreated psychotic disorder are identified through a comprehensive case detection system that includes professional, folk, and popular sectors. Inclusion criteria are age of 18–64, resident in catchment area, presence of a ICD-10 psychotic disorder, and no more than one continuous month of treatment with antipsychotic medication prior to the start of case identification. At baseline, detailed data on demographic and clinical characteristics and putative risk factors are collected using established tools.ResultsIn the first 15 months, we identified 614 cases (199 in India, 92 in Nigeria, and 264 in Trinidad).There was wide variation in where cases were identified: In India, 9% via professional services and 91% via the popular sector (i.e., in the community); In Nigeria, 33% via professional services and 63% via the folk sector (traditional and religious service providers); In Trinidad, 98% via professional services.Further, there were notable variations in incidence and sociodemographic and clinical characteristics. Age-adjusted rates were highest in Trinidad (men: 47.1, 95% CI 39.8–55.4; women: 38.7, 95% CI 32.0–46.3) compared with India (men: 23.0, 95% CI 18.4–28.4; women: 30.2, 95% CI 24.9–36.4) and Nigeria (men: 13.0, 95% CI 9.5–17.2; women: 12.4, 95% CI 9.0–16.6). The proportion with age of onset before 29 years was higher in Trinidad (74%) compared to Nigeria (45%) and India (36%).Among those on whom full data are currently available (n, 327), more in Nigeria were assigned a diagnosis of schizophrenia (63%) than in India (46%) and Trinidad (42%). Median duration of untreated psychosis was was longer in India (5.1 years, IQR 1.9–13.6) than in Nigeria (1.5 years, IQR 0.1–4.1) and Trinidad (2.6 years, IQR 0.3–15.2). However, an insidious onset (i.e., gradual emergence of symptoms over several months) was more common in Trinidad (50% of cases) than in India (28%) and Nigeria (14%).Education levels were lower in India (31% completed secondary education or higher) than in Nigeria (74%) or Trinidad (68%). However, the proportion of cases who were married or in a steady relationship was similar in all sites (India: 42%, Nigeria: 38%, Trinidad: 38%), as was the proportion who were unemployed (India: 48%, Nigeria: 55%, Trinidad: 51%).DiscussionIn initial analyses, we found evidence that the incidence and presentation of psychoses varied by site, findings that both further highlight the heterogeneity of psychoses across contexts and challenge assumptions about the basic epidemiology based on findings from the global North. For example, the data from our India site suggest higher rates among women and a later age of onset than commonly supposed. Our findings also show that many people with psychotic disorders in these settings are untreated for long periods, indicating an urgent need to develop more accessible services.

Association between referral source and duration of untreated psychosis in pathways to care among first episode psychosis patients in Northern Malawi.

AimsTo examine the association between referral source and duration of untreated psychosis (DUP) and explore determinants of referral source; when adjusting for pathways to care, positive and negative symptoms, diagnosis and socio‐demographic characteristics.MethodsA total of 140 subjects with first episode psychosis (FEP) were enrolled from a pilot early intervention service for psychosis in Northern Malawi between June 2009 and September 2012. Logistic regression analyses were used to quantify the associations between variables of interest.ResultsAge ranged between 18 and 65 at assessment, with median, 33. Median DUP was 12.5 months. First contact did not independently determine DUP. Long DUP (>6 months) was associated with referral from community based volunteer (CBV) or traditional healer (TH), a unit increase in severity of negative symptoms and having schizophrenia, which was also associated with referral from CBV or TH. Additionally, being unemployed was associated with referral from CBV or TH. However, a unit increase in the number of times religious advice (RA) was sought, GP was contacted and severity of positive symptoms was associated with referral by GP.ConclusionsMental health awareness is justified for this population and collaboration with THs in identifying and treating patients with psychosis may help reduce treatment delays. Access to mental health services ought to improve, particularly for the unemployed group. Future studies should consider adjusting for referral source when ascertaining first contact source as a predictor of DUP.

Clinical and Sociodemographic Characteristics in First-Episode Psychosis Patients in a Rural Region of Latvia

Abstract The first psychosis is a crucial point for further development of mental disorders. Previous evidence has demonstrated that psychotic disorders, including schizophrenia, are associated with a large number of years living with the disability. It is a global aim to improve prognosis of psychotic disorders, especially in rural regions, where mental health care possibly is not so easily accessible for patients. The aim of this study was to investigate clinical and sociodemographic determinants in association with patient and illness related factors to improve knowledge and understanding of first time psychosis patients in a rural region. This is a descriptive, cohort-based study of all consecutive first episode psychosis (F20, F23, ICD 10) patients admitted in the Daugavpils Psychoneurological Hospital (DPNH) between January 2016 and December 2017. Of the 94 first-time patients hospitalised in DPNH with symptoms of psychosis, 69 met the inclusion criteria. Our results showed that median age of patients was 33 years (IQR 27.5–42.0), median duration of untreated illness (DUI) was 30 months (IQR 11.0–60.0), and median duration of untreated psychosis (DUP) was 8 weeks (IQR 4.0–48.0). The results showed that 55.1% of first psychosis patients had not seen any health care specialist before being admitted to the psychiatric hospital. We found statistically significant differences between some sociodemographic aspects in DUI/DUP. Patients who lived with relatives had the longest DUI — 36 months, compared with 12 months for those who had established their own family. Unemployed patients had longer DUI — 36 months, compared with 12 months for employed patients. Similar findings were shown for associations with DUP. To our knowledge this study adds several important findings that help to better understand first psychosis patients.

Effects of socio-demographic characteristics, premorbid functioning, and insight on duration of untreated psychosis in first-episode schizophrenia or schizophreniform disorder in Northern Malawi.

AimLong duration of untreated psychosis (DUP) is prevalent and has been shown to be associated with poorer prognosis. Thus, knowledge of its determinants may help to target early interventions to reduce DUP on the needed population. Previous studies seeking to understand determinants of DUP have been inconclusive. Therefore, this study aimed to investigate the effects of socio‐demographic characteristics, premorbid functioning, and insight on DUP in patients with first‐episode schizophrenia or schizophreniform disorder.MethodsThis cross‐sectional study recruited 110 subjects (aged 18‐65) during a pilot early intervention service for psychosis in Northern Malawi, between June 2009 and September 2012. Short DUP was defined as ≤6 months, whereas long DUP was defined as >6 months. Unadjusted and adjusted analyses were performed to identify determinants of DUP.ResultsOf the 110 subjects, 99 (90%) had schizophrenia. Median DUP was 27.5 months, while mean (SD) DUP was 71.24 (92.32) months. In addition, at least 75% had long DUP, which was associated with lower level of education, poor insight, younger age at onset, and at least one parent deceased.ConclusionsLong DUP is prevalent in Northern Malawi. Thus, early interventions to reduce DUP are warranted in this population. Although having at least one parent deceased predicted long DUP in this study, this remains speculative because factors, such as timing of parents' death and grief reactions of the patients were not assessed. Therefore, further investigations incorporating these factors are needed to ascertain this result.

Treatment outcomes and associations in an adolescent-specific early intervention for psychosis service.

Compared with adult onset psychosis, adolescent psychosis has been associated with poorer outcomes in terms of social and cognitive functioning and negative symptoms. Young people experiencing first episode psychosis have developmental needs that frequently pre-date and are compounded by psychosis onset (a previous study). There is a lack of published studies of adolescent onset psychosis and further information is needed so that developmentally appropriate interventions can be developed. We report an observational naturalistic cohort study of an adolescent specific service, the Early Psychosis Support service (EPSS). We examined baseline demographic and clinical variables, treatments outcomes and predictors of outcome for this population. The mean age of our sample was 16.3 years. Median duration of untreated illness (DUI) was 88 weeks, and median duration of untreated psychosis (DUP) was 16 weeks. We found significant improvements in positive symptoms, negative symptoms, disorganization, excitement, emotional distress and depression from 0 to 12 months. We found that baseline positive symptoms and DUI significantly predicted positive symptoms at 12 months and only negative symptoms at baseline predicted 12-month negative symptoms. Our finding that specialist early intervention for adolescents experiencing psychosis is effective suggests that such treatment should be routinely offered in line with existing clinical guidelines. Our finding that DUI is predictive of poorer outcome at 12 months suggests that even earlier intervention from a specialist team may further improve treatment outcomes.

S254. IMPLEMENTATION OF A PROGRAM FOR EARLY INTERVENTION IN PSYCHOSIS ONSET: THE EXPERIENCE OF REGIONE EMILIA ROMAGNA, NORTHERN ITALY

BackgroundEarly interventions services (EIS) for psychosis are not uniformly available in the Italian public mental health care system. In 2012, Region Emilia Romagna funded the implementation of a comprehensive population based program to deliver EIS. These services provide a package of care including psychiatric consultation, family psychoeducation, case management, recovery oriented activities (e.g. supported employment, social inclusion), and physical health monitoring, consistent with international models but embedded within community mental health services (CMHS). We report feasibility, descriptors of enrolled samples, and clinical variables associated with remission.MethodsDemographic and clinical data of CMHS users that accepted EIS from January 1st, 2013 to December 31st, 2016 were acquired from paper and electronic health records in each province. Inclusion criteria were: residence in Regione Emilia Romagna, age 18–35, presence of non-organic, affective and non-affective psychotic symptoms within two years of onset. Exclusion criteria included severe intellectual disability and non-fluency in Italian. Remission was defined as a total score of 8 on the Health of Nation Outcome Scale (HoNOS) at 6 months after enrollment.ResultsSix hundred and eighty-nine patients accepted EIS. Median age was 22, 93% had diagnoses of non-affective psychosis, whereas 7% affective psychosis, with a median duration of untreated psychosis (DUP) of 6 months [IQR=10; 0–120], 41% had comorbid substance use disorders, 31.1% had personality disorders, and 39% had a previous hospitalization. The proportion of migrants (23%) was almost twice that of the entire Region (11.9%). Psychiatric visits represented 44% of total utilization, whereas only 14% received at least one case management visit, 79% a family session, 19% a recovery oriented activity, and 1% physical health monitoring.Of the sample, 460 subjects (67%) improved as presented with significant reduction in the 4 subscales scores of the follow up HoNOS, and 164 (35.7%) showed remission. Shorter DUP and lower HoNOS scores at baseline were associated with an increased likelihood of achieving remission (OR=1.03, p=0.0068, and OR=1.04, p=<0.0001, respectively), whereas the presence of personality disorder was associated with a reduced likelihood of remission (OR=0.48, p=0.0057).DiscussionEIS was acceptable to most eligible patients in regional CMHS. EIS enrollees evidenced significant clinical improvement in the first 6 months. Only a minority was diagnosed with bipolar disorder, suggesting a possible later onset of affective psychosis and reduced chance of accessing the Program.The correlation of comorbid personality disorder with worse outcomes, suggests the need to develop a targeted treatment. The EIS were also well accepted by the high proportion of migrants. Further work is required to understand possible social determinants of psychosis onset and pathways to care in these fragile communities. The high rate of concomitant substance use at intake must be considered for developing specific pharmacological and psychoeducational treatment.One in five patients needed admission to the inpatient unit in the first six months after onset, showing high levels of symptomatic distress. Moreover, referrals from hospital units show also possible barriers to access outpatient mental health facilities when users present with acute and urgent clinical conditions.This report establishes the feasibility of a regional network of EIS in Northern Italy with shared data elements that will lead to useful comparisons across EIS sites within the region, and also collaborative efforts to address specific gaps in access or outcomes.