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A community intervention for early identification of First Episode Psychosis

Impact on duration of untreated psychosis (DUP) and patient characteristics

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Abstract

Objective

The aim of this study was to assess the impact of a community case identification program on duration of untreated psychosis (DUP) (a measure of delay in treatment) and characteristics of patients entering treatment for a first episode of psychosis.

Method

Using a quasi-experimental historical control design, patients within a defined geographic catchment area who met DSM-IV criteria for a first episode of a psychotic disorder (FEP) were assessed on a number of demographic and clinical variables including DUP, length of prodromal period and symptoms at initial presentation, for 2 years prior to and 2 years after the introduction of a community-wide Early Case Identification Program (ECIP). The ECIP was designed to promote early recognition and referral of individuals with a FEP from any possible source of referral including self-referrals. Treatment interventions offered were the same throughout the two phases.

Results

In all, 88 and 100 patients met criteria respectively in phases I and II. There were no significant differences in rates of treated incidence or DUP between the two phases. Patients recruited in phase II had significantly longer prodromal periods and higher level of psychotic and disorganization symptoms. There were no differences in level of negative symptoms or pre-morbid adjustment.

Conclusion

A community-wide approach to early case identification may not be the most effective way to reduce delay in treatment of psychosis, but may bring into treatment patients who have been ill for long periods of time and have a higher level of psychopathology. A more targeted approach directed at primary care and emergency services may achieve different results in reducing delay in treatment.

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Authors and Affiliations

  1. McGill University, Montréal (QC), Canada

    Ashok Malla M. B., FRCPC

  2. Douglas Hospital Research Centre, 2, 6875 LaSalle Boul., Montréal (QC), Canada 4H4 1R3

    Ashok Malla M. B., FRCPC & Terry McLean R. N., B.A., M.Ed.

  3. University of Western Ontario and London Health Sciences Centre, London (OT), Canada

    Ross Norman Ph.D., C. Psych & Rahul Manchanda M.D., FRCPC

  4. Health Canada, Ottawa, Canada

    Derek Scholten M. Sc.

Authors
  1. Ashok Malla M. B., FRCPC
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  2. Ross Norman Ph.D., C. Psych
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  3. Derek Scholten M. Sc.
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  4. Rahul Manchanda M.D., FRCPC
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  5. Terry McLean R. N., B.A., M.Ed.
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Correspondence to Ashok Malla M. B., FRCPC.

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Malla, A., Norman, R., Scholten, D. et al. A community intervention for early identification of First Episode Psychosis. Soc Psychiat Epidemiol 40, 337–344 (2005). https://doi.org/10.1007/s00127-005-0901-6

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  • DOI: https://doi.org/10.1007/s00127-005-0901-6

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