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One-year effect of changing duration of untreated psychosis in a single catchment area

Stavanger University Hospital, Division for Psychiatry, and Department of Psychiatry, University of Bergen, Norway

INGRID MELLE, MD and SVEIN FRIIS, MD

Ullevaal University Hospital, Norway

INGE JOA, RN and JAN OLAV JOHANNESSEN, MD

Stavanger University Hospital, Division for Psychiatry, Norway

STEIN OPJORDSMOEN, MD and ERIK SIMONSEN, MD

Roskilde County Psychiatric Hospital Fjorden, Roskilde, Denmark

PER VAGLUM, MD

Departments of Behavioural Sciences in Medicine, University of Oslo, Norway

THOMAS H. McGLASHAN, MD

Department of Psychiatry, Yale University, New Haven, Connecticut, USA

Correspondence: Tor K. Larsen, Stavanger University Hospital, Psychiatric Clinic, Armauer Hansensv. 20, pb 8100, N-4068 Stavanger, Norway. Email: tklarsen{at}online.no

Declaration of interest None.

Background There is highly replicated positive correlation between longer duration of untreated psychosis and poorer outcome.

Aims To study the effect of early intervention in first psychosis on one-year outcome using an historical quasi-experimental design.

Method We compare the outcome of two samples of first-episode psychosis from the same healthcare district at different time periods. The historical control sample was assessed during 1993–1994, before the establishment of a system for early detection of psychosis. The experimental sample is the early detection sample in the Early Treatment and Intervention in Psychosis study assessed during 1997–2000.

Results At 1-year follow-up, the early detection group was younger, had a smaller fraction of individuals with schizophrenia, had less severe negative and general symptoms and had more friends in the past year than the historical control group. No differences were found in clinical course (remission, relapse, continuously psychotic) or positive symptoms, but more patients in the early detection sample were treated as outpatients without hospitalisation.

Conclusions Early detection of schizophrenia in one healthcare sector is associated with less severe deterioration at 1 year.