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PAPERS: CRAIG MORGAN, RUDWAN ABDUL-AL, JULIA M. LAPPIN, PETER JONES, PAUL FEARON, MORVEN LEESE, TIM CROUDACE, KEVIN MORGAN, PAOLA DAZZAN, TOM CRAIG, JULIAN LEFF, and ROBIN MURRAY Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study The British Journal of Psychiatry 2006; 189: 446-452 [Abstract] [Full text] [PDF]

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Clinical and Social determinants of duration of untreated psychosis (DUP)

SHIBU P THOMAS   (15 February 2007)

Clinical and Social determinants of duration of untreated psychosis (DUP) 15 February 2007
SHIBU P THOMAS, STAFF GRADE PSYCHIATRIST DR HARPAL NANDHRA Send letter to journal: Re: Clinical and Social determinants of duration of untreated psychosis (DUP) neilthomas99{at}aol.com SHIBU P THOMAS	Clinical and Social determinants of duration of untreated psychosis (DUP): A Retrospective study of case records Letter for submission to the British Journal of Psychiatry Harpal Nandhra & Shibu Thomas Early Intervention in Psychosis, Ashton House, 15 George Street, Leamington Spa, CV31 1ET Tel: 01926 313126 Fax: 01926 450469 E-Mail: harpal.nandhra@covwarkpt.nhs.uk Corresponding author: Dr Harpal Nandhra at the above address. Conflict of interest: None Funding: None Clinical and Social determinants of duration of untreated psychosis (DUP) In an important (AESOP first-episode) study published recently, the authors (C Morgan et al 2006) found that longer DUP was associated with insidious onset and less family involvement in help seeking. They concluded that, the DUP is influenced by its early clinical course and social variables. We did a small retrospective study of pathways to care of 74 first- episode psychosis patients under care of Early Intervention Team in Psychosis in South Warwickshire. We investigated the clinical and social determinants of DUP (onset to first contact) in two groups of patients with first-episode psychosis with a cut point of 12 weeks for DUP. We compared two groups of patients, one with a shorter DUP (n=46) and the other with longer DUP (n=28), selected from a total of 74 first- episode patients. Clinical and social variables relating to first-episode were collected from patient’s case notes retrospectively. Of the 74 patients (DUP mean=20.5weeks; median=4weeks), a longer DUP (mean=49.2weeks; median=40weeks) was associated with a significant excess of male patients (c2=5.93; p=0.025), who were unemployed, having unstable pre-morbid functioning, an insidious mode of onset (c2=38.3; p=<0.001), with significant co-morbid substance misuse c2= 8.96; p= <0.01) and less family involvement in help-seeking ( c2=7.07; p=0.01). Conversely, shorter DUP was associated with acute presentation (n=34), a higher probability of the family being involved (n=31), and increased risk of hospital admission (n=20). No statistically significant differences were noted in diagnosis, age of onset, ethnicity and living circumstances. Our findings largely corresponded with the AESOP study that shorter DUP was associated with an acute mode of onset and family involvement. However, they did not find any significant association between longer DUP and male gender. They were not able to investigate any possible association with co-morbid substance misuse. C Morgan et al (2006) Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study. British Journal of Psychiatry, 189, 446 – 452 S Thomas St. Michael’s Hospital, Warwick, UK. H Nandhra Early Intervention in Psychosis, Ashton House, 15 George Street, Leamington Spa, CV31 1ET, UK. E-Mail: harpal.nandhra@covwarkpt.nhs.uk