Individuals with first-episode psychosis who experience a shorter period between first use of an antipsychotic and enrollment in a coordinated specialty care (CSC) program show improved functioning and quality of life at six months, according to a report in Schizophrenia Bulletin.
Hadar Hazan, M.D., of Yale University School of Medicine, and colleagues wrote that shorter duration of untreated psychosis (DUP) has been repeatedly shown to improve patient outcomes. Their study examined both parts of the treatment pathway: the time between the onset of symptoms and first use of antipsychotic medication (termed DUP-Demand) and the time between antipsychotic initiation and CSC enrollment (DUP-Supply). “Much can occur between the first effort to treat psychosis in an emergency room or psychiatric hospital and eventual entry into a local CSC, including multiple help-seeking events that can involve many community stakeholders,” they wrote.
The researchers examined outcomes for 147 first-episode psychosis patients enrolled from 2014 to 2019 in Specialized Treatment in Early Psychosis (STEP), a CSC in New Haven, Connecticut, that ran a dedicated four-year early detection campaign focused on raising public awareness of psychosis, training health professionals to identify symptoms, and streamlining the CSC referral process. STEP patients were compared with 75 patients enrolled in a CSC in Boston with standard early detection protocols.
Average total DUP for patients enrolled in STEP was 5.9 months shorter than those in the CSC with standard detection protocols. This included a 1.3-month reduction in DUP-Demand and a 4.6-month reduction in DUP-Supply.
This time reduction translated into improvements in functional outcomes: At six months, STEP participants showed significantly greater improvements on their Global Assessment of Function and Quality of Life scales than individuals at the comparison CSC. Further analysis showed that shorter DUP-Supply was the primary driver of these improvements, particularly for quality of life; shorter DUP-Demand time was not significantly associated with either improved functioning or improved quality of life.
The authors said these results demonstrate the value of early detection in CSC. “While reducing DUP may not be easy or cheap, the costs of early detection can be offset by reduced hospitalization and may interact with other health-economic benefits of CSC, including reduced criminal justice involvement,” they wrote.
For related information, see the Psychiatric News article, “New Network Collects Real-Time Data to Improve Treatment of Early Psychosis.”
(Image: Getty Images/iStock/Joel Carillet)
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