Advertisement

How Do Early Psychosis Services Define and Operationalize the Duration of Untreated Psychosis?

  • Mark Savill
  • Melissa Gosdin
  • Pooja Patel
  • Joy Melnikow
  • Rachel Loewy
  • Tara Niendam
Article
  • 53 Downloads

Abstract

Reducing the duration of untreated psychosis (DUP) is a key aim of early psychosis (EP) care. However, substantial variability in how the start and end points of DUP are defined impact its utility in clinical decision-making, and as an outcome measure. In this study, qualitative interviews were conducted with providers to assess how EP services and providers define, operationalize, and measure DUP. Twenty-five providers across 14 clinics were interviewed. Participants emphasized symptom frequency, conviction, distress caused, and impact when determining psychosis onset. DUP endpoint was typically identified as the first assessment in an episode of care that included an accurate diagnosis, leading to specialty EP treatment. Participants proposed a more structured operationalization of DUP, relative to those historically adopted in the literature. Integrating front-line provider perspectives could improve the accuracy of DUP measurement and address the heterogeneity in how the construct is operationalized across research and practice.

Keywords

DUP Schizophrenia Assessment Psychosis onset Treatment initiation 

Notes

Acknowledgements

The authors would like to thank all participants who agreed to be interviewed.

Funding information

This work was supported by the National Institute of Mental Health (grant number MH018261-31, PI: Pfiffner) and the Mental Health Services Oversight and Accountability Committee (grant number 14MHSOAC010; PI: Niendam).

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest.

Supplementary material

11414_2018_9630_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19.9 kb)

References

  1. 1.
    Marshall M, Lewis S, Lockwood A, et al. Association Between Duration of Untreated psychosis and Outcome in Cohorts of First-Episode Patients: A Systematic Review. Archives of General Psychiatry. 2005; 62: 975–983.CrossRefGoogle Scholar
  2. 2.
    Kane JM, Robinson DG, Schooler NR et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes from the NIMH RAISE Early Treatment Program. American Journal of Psychiatry. 2015; 173: 362–372.CrossRefGoogle Scholar
  3. 3.
    Perkins DO, Gu H, Boteva K, et al. Relationship Between Duration of Untreated Psychosis and Outcome in First-Episode Schizophrenia: A Critical Review and Meta-Analysis. American Journal of Psychiatry. 2005; 162: 1785–1804.CrossRefGoogle Scholar
  4. 4.
    Johannessen JO, McGlashan TH, Larsen TK, et al. Early detection Strategies for Untreated First-Episode Psychosis. Schizophrenia Research. 2001; 51: 39–46.CrossRefGoogle Scholar
  5. 5.
    Scholten DJ, Malla AK, Norman RM, et al. Removing Barriers to Treatment of First-Episode Psychotic Disorders. Canadian Journal of Psychiatry. 2003; 48: 561–565.CrossRefGoogle Scholar
  6. 6.
    Melle I, Larsen TK, Haahr U, et al. Reducing the Duration of Untreated First-Episode Psychosis: Effects on Clinical Presentation. Archives of General Psychiatry. 2004; 61: 143–150.CrossRefGoogle Scholar
  7. 7.
    Bertolote J, McGorry P. Early Intervention and Recovery for Young People with Early Psychosis: Consensus Statement. British Journal of Psychiatry 2005; 187: s119.CrossRefGoogle Scholar
  8. 8.
    Register-Brown K, Hong LE. Reliability and Validity of Methods for Measuring the Duration of Untreated Psychosis: A Quantitative Review and Meta-Analysis. Schizophrenia Research. 2014; 160: 20–26.CrossRefGoogle Scholar
  9. 9.
    Compton MT, Carter T, Bergner E, et al. Defining, Operationalizing and Measuring the Duration of Untreated Psychosis: Advances, Limitations and Future Directions. Early Intervention in Psychiatry. 2007; 1: 236–250.CrossRefGoogle Scholar
  10. 10.
    Norman RM, Malla AK. Duration of Untreated Psychosis: A Critical Examination of the Concept and its Importance. Psychological Medicine. 2001; 31: 381–400.CrossRefGoogle Scholar
  11. 11.
    Singh SP. Outcome Measures in Early Psychosis. British Journal of Psychiatry. 2007 ;191: s63.CrossRefGoogle Scholar
  12. 12.
    [Blinded for Review]Google Scholar
  13. 13.
    Amminger GP, Edwards J, Brewer WJ, et al. Duration of Untreated Psychosis and Cognitive Deterioration in First-Episode Schizophrenia. Schizophrenia Research. 2002; 54: 223–230.CrossRefGoogle Scholar
  14. 14.
    Bottlender R, Strau A, Mller H. Impact of Duration of Symptoms Prior to First Hospitalization on Acute Outcome in 998 Schizophrenic Patients. Schizophrenia Research. 2000; 44: 145–150.CrossRefGoogle Scholar
  15. 15.
    Keshavan MS, Haas G, Miewald J, et al. Prolonged Untreated Illness Duration from Prodromal Onset Predicts Outcome in First Episode Psychoses. Schizophrenia Bulletin. 2003; 29: 757–769.CrossRefGoogle Scholar
  16. 16.
    Ho B, Andreasen NC, Flaum M, et al. Untreated Initial Psychosis: Its Relation to Quality of Life and Symptom Remission in First-Episode Schizophrenia. American Journal of Psychiatry. 2000; 157: 808–815.CrossRefGoogle Scholar
  17. 17.
    Addington J, Van Mastrigt S, Addington D. Duration of Untreated Psychosis: Impact on 2-Year Outcome. Psychological Medicine. 2004; 34: 277–284.CrossRefGoogle Scholar
  18. 18.
    Black K, Peters L, Rui Q, et al. Duration of Untreated Psychosis Predicts Treatment Outcome in an Early Psychosis Program. Schizophrenia Research. 2001;47:215–222.CrossRefGoogle Scholar
  19. 19.
    Harrigan SM, McGorry PD, Krstev H. Does Treatment Delay in First-Episode Psychosis Really Matter? Psychological Medicine. 2003; 33: 97–110.CrossRefGoogle Scholar
  20. 20.
    Larsen TK, Moe LC, Vibe-Hansen L, et al. Premorbid Functioning Versus Duration of Untreated Psychosis in 1-Year Outcome in First-Episode Psychosis. Schizophrenia Research. 2000; 45:1–9.CrossRefGoogle Scholar
  21. 21.
    Wiersma D, Wanderling J, Dragomirecka E, et al. Social Disability in Schizophrenia: Its Development and Prediction over 15 years in Incidence Cohorts in Six European Centres. Psychological Medicine. 2000; 30: 1155–1167.CrossRefGoogle Scholar
  22. 22.
    Barnes TR, Hutton SB, Chapman MJ, et al. West London First-Episode Study of Schizophrenia. British Journal of Psychiatry 2000; 177: 207–211.CrossRefGoogle Scholar
  23. 23.
    Crow TJ, MacMillan JF, Johnson AL, et al. A Randomised Controlled Trial of Prophylactic Neuroleptic Treatment. British Journal of Psychiatry. 1986; 148: 120–127.CrossRefGoogle Scholar
  24. 24.
    Craig TJ, Bromet EJ, Fennig S, et al. Is There an Association Between Duration of Untreated Psychosis and 24-Month Clinical Outcome in a First-Admission Series? American Journal of Psychiatry. 2000; 157: 60–66.CrossRefGoogle Scholar
  25. 25.
    Loebel AD, Lieberman JA, Alvir JM, et al. Duration of Psychosis and Outcome in First-Episode Schizophrenia. American Journal of Psychiatry. 1992; 149: 1183.CrossRefGoogle Scholar
  26. 26.
    de Haan L, Linszen DH, Lenior ME, et al. Duration of Untreated Psychosis and Outcome of Schizophrenia: Delay in Intensive Psychosocial Treatment Versus Delay in Treatment with Antipsychotic Medication. Schizophrenia Bulletin. 2003; 29: 341–348.CrossRefGoogle Scholar
  27. 27.
    Larsen TK, McGlashan TH, Moe LC. First-Episode Schizophrenia: I. Early Course Parameters. Schizophrenia Bulletin. 1996; 22: 241–256.CrossRefGoogle Scholar
  28. 28.
    Malla AK, Norman RM, Manchanda R, et al. One-Year Outcome in First Episode Psychosis: Influence of DUP and Other Predictors. Schizophr Research. 2002; 54: 231–242.CrossRefGoogle Scholar
  29. 29.
    Townsend LA, Norman RM, Malla AK, et al. Changes in Cognitive Functioning Following Comprehensive Treatment for First Episode Patients with Schizophrenia Spectrum Disorders. Psychiatry Research. 2002; 113: 69–81.CrossRefGoogle Scholar
  30. 30.
    Rund BR, Melle I, Friis S, et al. Neurocognitive Dysfunction in First-Episode Psychosis: Correlates with Symptoms, Premorbid Adjustment, and Duration of Untreated Psychosis. American Journal of Psychiatry. 2004; 161: 466–472.CrossRefGoogle Scholar
  31. 31.
    Large M, Nielssen O, Slade T, et al. Measurement and Reporting of the Duration of Untreated psychosis. Early Intervention in Psychiatry. 2008; 2: 201–211.CrossRefGoogle Scholar
  32. 32.
    Heinssen R. Early Psychosis Intervention Network (EPINET): A Learning Healthcare System for Early Serious Mental Illness. National Institute of Mental Health. Available online https://www.nimh.nih.gov/funding/grant-writing-and-application-process/concept-clearances/2015/early-psychosis-intervention-network-epinet-a-learning-healthcare-system-for-early-serious-mental-illness.shtml. Accessed on December 7, 2017.
  33. 33.
    Birchwood M, Todd P, Jackson C. Early Intervention in Psychosis: The Critical-Period Hypothesis. International Clinical Psychopharmacology. 1998; 13: S31-S40.CrossRefGoogle Scholar
  34. 34.
    Hsieh HF, Shannon SE. Three Approaches to Qualitative Content Analysis. Qualitative Health Research. 2005; 15: 1277–1288.CrossRefGoogle Scholar
  35. 35.
    Ryan GW, Bernard HR. Techniques to Identify Themes. Field Methods.2003; 15 85–109. CrossRefGoogle Scholar
  36. 36.
    First MB, Williams J, Karg RS. Structured clinical interview for DSM-5—Research version. Arlington, VA: American Psychiatric Association; 2015.Google Scholar
  37. 37.
    Miller TJ, McGlashan TH, Rosen JL, et al. Prodromal Assessment with the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms: Predictive Validity, Interrater Reliability, and Training to Reliability. Schizophrenia Bulletin. 2003; 29: 703.CrossRefGoogle Scholar
  38. 38.
    UCLA Research Group. Diagnostic Timeline. University of California, Los Angeles, Los Angeles. 2017.Google Scholar
  39. 39.
    Macneil C, Foster F, Nicoll A, et al. Evaluation of a Professional Development Training Programme for Mental Health Clinicians Specializing in Early Psychosis. Early Intervention in Psychiatry. 2017; DOI:  https://doi.org/10.1111/eip.1242.

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  1. 1.Department of Psychiatry, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Center for Healthcare Policy and ResearchUniversity of CaliforniaDavisUSA
  3. 3.Department of Psychiatry, Davis School of MedicineUniversity of CaliforniaSacramentoUSA

Personalised recommendations