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Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 12, pp 1831–1841 | Cite as

Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients

  • Frauke Schultze-LutterEmail author
  • Jonas Rahman
  • Stephan Ruhrmann
  • Chantal Michel
  • Benno G. Schimmelmann
  • Wolfgang Maier
  • Joachim Klosterkötter
Original Paper

Abstract

Purpose

Prevention of psychosis requires both presence of clinical high risk (CHR) criteria and early help-seeking. Previous retrospective studies of the duration of untreated illness (i.e. prodrome plus psychosis) did not distinguish between prodromal states with and without CHR symptoms. Therefore, we examined the occurrence of CHR symptoms and first help-seeking, thereby considering effects of age at illness-onset.

Methods

Adult patients first admitted for psychosis (n = 126) were retrospectively assessed for early course of illness and characteristics of first help-seeking.

Results

One-hundred and nine patients reported a prodrome, 58 with CHR symptoms. In patients with an early illness-onset before age 18 (n = 45), duration of both illness and psychosis were elongated, and CHR symptoms more frequent (68.9 vs. 33.3 %) compared to those with adult illness-onset. Only 29 patients reported help-seeking in the prodrome; this was mainly self-initiated, especially in patients with an early illness-onset. After the onset of first psychotic symptoms, help-seeking was mainly initiated by others. State- and age-independently, mental health professionals were the main first point-of-call (54.0 %).

Conclusions

Adult first-admission psychosis patients with an early, insidious onset of symptoms before age 18 were more likely to recall CHR symptoms as part of their prodrome. According to current psychosis-risk criteria, these CHR symptoms, in principle, would have allowed the early detection of psychosis. Furthermore, compared to patients with an adult illness-onset, patients with an early illness-onset were also more likely to seek help on their own account. Thus, future awareness strategies to improve CHR detection might be primarily related to young persons and self-perceived subtle symptoms.

Keywords

Psychoses First episode Early intervention Health behaviour Child and adolescent psychiatry 

Notes

Acknowledgments

The study was funded by the German Federal Ministry of Education and Research (Grant 01 GI 0235 to Prof. J. Klosterkötter, Cologne, and Prof. W. Maier, Bonn). Data assessments were supported by Daniel Köhn, Heinz Picker, Sarah von der Laage, Annett Nüchter, all formerly Cologne; Verena Pützfeld, Cologne; Julia Berning, Julia Bludau, both formerly Bonn, and Antje Niedersteberg, formerly Duisburg.

Conflict of interest

All authors declare no conflict of interest in relation to the present study.

References

  1. 1.
    Wittchen HU, Jacobi F, Rehm J et al (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21:655–679CrossRefPubMedGoogle Scholar
  2. 2.
    Penttilä M, Jääskeläinen E, Hirvonen N, Isohanni M, Miettunen J (2014) Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 205:88–94CrossRefPubMedGoogle Scholar
  3. 3.
    Norman RM, Manchanda R, Windell D, Harricharan R, Northcott S, Hassall L (2012) The role of treatment delay in predicting 5-year outcomes in an early intervention program. Psychol Med 42:223–333CrossRefPubMedGoogle Scholar
  4. 4.
    Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 62:975–983CrossRefPubMedGoogle Scholar
  5. 5.
    Keshavan MS, Haas G, Miewald J et al (2003) Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychoses. Schizophr Bull 29:757–769CrossRefPubMedGoogle Scholar
  6. 6.
    Schimmelmann BG, Huber CG, Lambert M, Cotton S, McGorry PD, Conus P (2008) Impact of duration of untreated psychosis on pre-treatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort. J Psychiatr Res 42:982–990CrossRefPubMedGoogle Scholar
  7. 7.
    Schimmelmann BG, Conus P, Cotton S, McGorry PD (2007) Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophr Res 95:1–8CrossRefPubMedGoogle Scholar
  8. 8.
    Marshall M, Husain N, Bork N et al (2014) Impact of early intervention services on duration of untreated psychosis: data from the National EDEN prospective cohort study. Schizophr Res 159:1–6CrossRefPubMedGoogle Scholar
  9. 9.
    Schultze-Lutter F, Michel C, Schmidt SJ et al (2015) EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry 30:405–416CrossRefPubMedGoogle Scholar
  10. 10.
    Schaffner N, Schimmelmann BG, Niedersteberg A, Schultze-Lutter F (2012) Pathways-to-Care for First-Episode psychotic patients–an overview of international studies. Fortschr Neurol Psychiatr 80:72–78CrossRefPubMedGoogle Scholar
  11. 11.
    Archie S, Akhtar-Danesh N, Norman R, Malla A, Roy P, Zipursky RB (2010) Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophr Bull 36:688–701PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Cheung D, Roper L, Purdon SE (2014) Pathways to (specialized) care: patient costs and contacts en route to a first-episode psychosis clinic. Early Interv Psychiatry 8:375–381CrossRefPubMedGoogle Scholar
  13. 13.
    O’Callaghan E, Turner N, Renwick L et al (2010) First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol 45:381–391CrossRefPubMedGoogle Scholar
  14. 14.
    Chung YC, Jung HY, Kim SW et al (2010) What factors are related to delayed treatment in individuals at high risk for psychosis? Early Interv Psychiatry 4:124–131CrossRefPubMedGoogle Scholar
  15. 15.
    Cocchi A, Meneghelli A, Erlicher A, Pisano A, Cascio MT, Preti A (2013) Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy. Soc Psychiatry Psychiatr Epidemiol 48:1905–1916CrossRefPubMedGoogle Scholar
  16. 16.
    Fridgen GJ, Aston J, Gschwandtner U et al (2013) Help-seeking and pathways to care in the early stages of psychosis. Soc Psychiatry Psychiatr Epidemiol 48:1033–1043CrossRefPubMedGoogle Scholar
  17. 17.
    Platz C, Umbricht DS, Cattapan-Ludewig K et al (2006) Help-seeking pathways in early psychosis. Soc Psychiatry Psychiatr Epidemiol 41:967–974PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Shin YM, Jung HY, Kim SW et al (2010) A descriptive study of pathways to care of high risk for psychosis adolescents in Korea. Early Interv Psychiatry 4:119–123CrossRefPubMedGoogle Scholar
  19. 19.
    Stowkowy J, Colijn MA, Addington J (2013) Pathways to care for those at clinical high risk of developing psychosis. Early Interv Psychiatry 7:80–83CrossRefPubMedGoogle Scholar
  20. 20.
    Von Reventlow HG, Krüger-Özgürdal S, Ruhrmann S et al (2014) Pathways to care in subjects at high risk for psychotic disorders—a European perspective. Schizophr Res 152:400–407CrossRefGoogle Scholar
  21. 21.
    Wiltink S, Velthorst E, Nelson B, McGorry PM, Yung AR (2015) Declining transition rates to psychosis: the contribution of potential changes in referral pathways to an ultra-high-risk service. Early Interv Psychiatry 9:200–206CrossRefPubMedGoogle Scholar
  22. 22.
    Häfner H, Maurer K, Ruhrmann S et al (2004) Early detection and secondary prevention of psychosis: facts and visions. Eur Arch Psychiatry Clin Neurosc 254:117–128CrossRefGoogle Scholar
  23. 23.
    Schultze-Lutter F, Ruhrmann S, Berning J, Maier W, Klosterkötter J (2010) Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state. Schizophr Bull 36:182–191PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Maurer K, Horrmann F, Trendler G, Schmidt M, Häfner H (2006) Früherkennung des Psychoserisikos mit dem Early Recognition Inventory (ERIraos). Beschreibung des Verfahrens und erste Ergebnisse zur Reliabilitat und Validitat der Checkliste. Nervenheilkunde 1–2:11–16Google Scholar
  25. 25.
    Maurer K, Häfner H (1995) Methodological aspects of the onset assessment in schizophrenia. Schizophr Res 15:265–276CrossRefPubMedGoogle Scholar
  26. 26.
    Klosterkötter J, Hellmich M, Steinmeyer EM, Schultze-Lutter F (2001) Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry 58:158–164CrossRefPubMedGoogle Scholar
  27. 27.
    Yung AR, Phillips LJ, McGorry PD et al (1998) Prediction of psychosis. A step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl 172:14–20PubMedGoogle Scholar
  28. 28.
    Gater R, Almeida Sousa de B, Barrientos G et al (1991) The pathways to psychiatric care: a cross-cultural study. Psychol Med 21:761–774CrossRefPubMedGoogle Scholar
  29. 29.
    Schultze-Lutter F, Ruhrmann S, Schimmelmann BG, Michel C (2013) “A rose is a rose is a rose”, but at-risk criteria differ. Psychopathology 46:75–87CrossRefPubMedGoogle Scholar
  30. 30.
    Schimmelmann BG, Michel C, Schaffner N, Schultze-Lutter F (2011) What percentage of people in the general population satisfy the current clinical at-risk criteria of psychosis? Schizophr Res 125:99–100CrossRefPubMedGoogle Scholar
  31. 31.
    Schultze-Lutter F, Klosterkötter J, Ruhrmann S (2014) Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms. Schizophr Res 154:100–106CrossRefPubMedGoogle Scholar
  32. 32.
    Schultze-Lutter F, Resch F, Koch E, Schimmelmann BG (2011) Early detection of psychosis in children and adolescents—have developmental particularities been sufficiently considered? Z Kinder Jugendpsychiatr Psychother 39:301–311CrossRefPubMedGoogle Scholar
  33. 33.
    Yung AR, Stanford C, Cosgrave E, Killackey E, Phillips L, Nelson B, McGorry PD (2006) Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophr Res 84:57–66CrossRefPubMedGoogle Scholar
  34. 34.
    Mack S, Jacobi F, Gerschler A et al (2014) Self-reported utilization of mental health services in the adult German population—evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH). Int J Methods Psychiatr Res 23:289–303CrossRefPubMedGoogle Scholar
  35. 35.
    Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG (2014) Prevalence of DSM-5 Attenuated Psychosis Syndrome in adolescents and young adults of the general population: the Bern Epidemiological At-Risk (BEAR) study. Schizophr Bull 40:1499–1508PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Friis S, Melle I, Larsen TK et al (2004) Does duration of untreated psychosis bias study samples of first-episode psychosis? Acta Psychiatr Scand 110:286–291CrossRefPubMedGoogle Scholar
  37. 37.
    Schimmelmann BG, Michel C, Martz-Irngartinger A, Linder C, Schultze-Lutter F (2015) Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: findings from the BEAR and BEARS-Kid studies. World Psychiatry 14:189–197PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Harris MG, Henry LP, Harrigan SM et al (2005) The relationship between duration of untreated psychosis and outcome: an eight-year prospective study. Schizophr Res 79:85–93CrossRefPubMedGoogle Scholar
  39. 39.
    Harrigan SM, McGorry PD, Krstev H (2003) Does treatment delay in first-episode psychosis really matter? Psychol Med 33:97–110CrossRefPubMedGoogle Scholar
  40. 40.
    Joa I, Johannessen JO, Langeveld J et al (2009) Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection program. Acta Psychiatr Scand 119:494–500CrossRefPubMedGoogle Scholar
  41. 41.
    Anderson KK, Fuhrer R, Malla AK (2013) “There are too many steps before you get to where you need to be”: help-seeking by patients with first-episode psychosis. J Ment Health 22:384–395CrossRefPubMedGoogle Scholar
  42. 42.
    Boydell KM, Volpe T, Gladstone BM, Stasiulis E, Addington J (2013) Youth at ultra high risk for psychosis: using the Revised Network Episode Model to examine pathways to mental health care. Early Interv Psychiatry 7:170–186CrossRefPubMedGoogle Scholar
  43. 43.
    Johannessen JO, McGlashan TH, Larsen TK et al (2001) Early detection strategies for untreated first-episode psychosis. Schizophr Res 51:39–46CrossRefPubMedGoogle Scholar
  44. 44.
    Johannessen JO, Friis S, Joa I et al (2007) First-episode psychosis patients recruited into treatment via early detection teams versus ordinary pathways: course, outcome and health service use during first 2 years. Early Interv Psychiatry 1:40–48CrossRefPubMedGoogle Scholar
  45. 45.
    Fuchs J, Steinert T (2002) Inanspruchnahme professioneller Hilfe, Einweisungswege und Dauer der unbehandelten Psychose bei erstmals stationär aufgenommenen Patienten. Fortschr Neurol Psychiatr 70:40–45CrossRefPubMedGoogle Scholar
  46. 46.
    Fuchs J, Steinert T (2004) Patients with first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Soc Psychiatry Psychiatr Epidemiol 39:375–380CrossRefPubMedGoogle Scholar
  47. 47.
    Köhn D, Pukrop R, Niedersteberg A et al (2004) Wege in die Behandlung: Hilfesuchverhalten schizophrener Ersterkrankter. Fortschr Neurol Psychiatr 72:1–8CrossRefGoogle Scholar
  48. 48.
    Köhn D, Niedersteberg A, Wieneke A et al (2004) Frühverlauf schizophrener Ersterkrankungen mit langer Dauer der unbehandelten Erkrankung. Fortschr Neurol Psychiatr 72:88–92CrossRefPubMedGoogle Scholar
  49. 49.
    Delnoij DM (2013) Bismarck or Beveridge: primary care matters. Eur J Public Health 23:349CrossRefPubMedGoogle Scholar
  50. 50.
    Lameire N, Joffe P, Wiedemann M (1999) Healthcare systems–an international review: an overview. Nephrol Dial Transplant 14:3–9CrossRefPubMedGoogle Scholar
  51. 51.
    Reynolds N, Wuyts P, Badger S, Fusar-Poli P, McGuire P, Valmaggia L (2014) The impact of delivering GP training on the clinical high risk and first-episode psychosis on referrals and pathways to care. Early Interv Psychiatry. doi: 10.1111/eip.12126 PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Frauke Schultze-Lutter
    • 1
    Email author
  • Jonas Rahman
    • 1
  • Stephan Ruhrmann
    • 2
  • Chantal Michel
    • 1
  • Benno G. Schimmelmann
    • 1
  • Wolfgang Maier
    • 3
  • Joachim Klosterkötter
    • 2
  1. 1.University Hospital of Child and Adolescent PsychiatryUniversity of BernBern 60Switzerland
  2. 2.Department of Psychiatry and PsychotherapyUniversity of CologneCologneGermany
  3. 3.Department of Psychiatry and PsychotherapyUniversity of BonnBonnGermany

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