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Early Predictors of Ten-Year Course in First-Episode Psychosis.

https://arctichealth.org/en/permalink/ahliterature279449
Source
Psychiatr Serv. 2016 Apr 01;67(4):438-43
Publication Type
Article
Date
Apr-01-2016
Author
Svein Friis
Ingrid Melle
Jan Olav Johannessen
Jan Ivar Røssberg
Helene Eidsmo Barder
Julie Horgen Evensen
Ulrik Haahr
Wenche Ten Velden Hegelstad
Inge Joa
Johannes Langeveld
Tor Ketil Larsen
Stein Opjordsmoen
Bjørn Rishovd Rund
Erik Simonsen
Per Wiggen Vaglum
Thomas H McGlashan
Source
Psychiatr Serv. 2016 Apr 01;67(4):438-43
Date
Apr-01-2016
Language
English
Publication Type
Article
Keywords
Adult
Denmark - epidemiology
Disease Progression
Female
Humans
Longitudinal Studies
Male
Middle Aged
Norway - epidemiology
Outcome Assessment (Health Care) - statistics & numerical data
Prognosis
Psychotic Disorders - diagnosis - drug therapy - epidemiology
Remission Induction
Schizophrenia - diagnosis - drug therapy - epidemiology
Social Skills
Time Factors
Abstract
Identifying patients at risk of poor outcome at an early stage of illness can aid in treatment planning. This study sought to create a best-fit statistical model of known baseline and early-course risk factors to predict time in psychosis during a ten-year follow-up period after a first psychotic episode.
Between 1997 and 2000, 301 patients with DSM-IV nonorganic, nonaffective first-episode psychosis were recruited consecutively from catchment area-based sectors in Norway and Denmark. Specialized mental health personnel evaluated patients at baseline, three months, and one, two, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores =4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses.
Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow-up: deterioration in premorbid social functioning, duration of untreated psychosis (DUP) of =26 weeks, core schizophrenia spectrum disorder, and no remission within three months.
First-episode psychosis patients should be followed carefully after the start of treatment. If symptoms do not remit within three months with adequate treatment, there is a considerable risk of a poor long-term outcome, particularly for patients with a deterioration in premorbid social functioning, a DUP of at least half a year, and a diagnosis within the core schizophrenia spectrum.
PubMed ID
26567932 View in PubMed
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From treating to preventing psychosis: personal perspectives.

https://arctichealth.org/en/permalink/ahliterature264218
Source
J Nerv Ment Dis. 2015 May;203(5):352-5
Publication Type
Article
Date
May-2015
Author
Thomas H McGlashan
Source
J Nerv Ment Dis. 2015 May;203(5):352-5
Date
May-2015
Language
English
Publication Type
Article
Keywords
Chronic Disease
Cross-Cultural Comparison
Disease Progression
Early Diagnosis
Follow-Up Studies
Health education
Humans
Norway
Psychoanalytic Theory
Psychoanalytic Therapy
Psychotic Disorders - diagnosis - prevention & control - psychology
Schizophrenia - diagnosis - prevention & control
Schizophrenic Psychology
Social Adjustment
United States
Abstract
The psychoanalytic treatment model of neurotic disorders was applied "experimentally," usually without concomitant pharmacotherapy, to psychotic disorders in the mid to late 20th century at a private institution (Chestnut Lodge) in Maryland. A long-term follow-up (by this author) essentially documented such an approach to be ineffective but suggested that initial treatment earlier in the development of disorder might prevent or ameliorate the "dementia" of dementia praecox. The opportunity to actually measure the effect of earlier detection and treatment became apparent to this author on sabbatical leave in Stavanger, Norway. The sectorized Norwegian health care system made it possible to engineer early detection of first psychosis in an "experimental" health care sector and compare their outcome to that of first onset patients from two control "usual detection" health care sectors. Early detection was engineered in the experimental sector with educational campaigns about the signs and symptoms of first psychosis targeting the sector's doctors, educators, and the general public through massive educational campaigns. The result was clear. Early detection and treatment resulted in a significantly better symptomatic, social, and instrumental outcome in the experimental sectors compared with "usual detection" sectors, a difference that lasted up to a 10-year follow-up (and perhaps permanently). These events and findings will be reviewed to assert that intervention timing may be far more important than intervention type in the overall strategy of antipsychotic interventions.
PubMed ID
25900549 View in PubMed
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Pathways to care for first-episode psychosis in an early detection healthcare sector: part of the Scandinavian TIPS study.

https://arctichealth.org/en/permalink/ahliterature70615
Source
Br J Psychiatry Suppl. 2005 Aug;48:s24-8
Publication Type
Article
Date
Aug-2005
Author
Jan Olav Johannessen
Tor K Larsen
Inge Joa
Ingrid Melle
Svein Friis
Stein Opjordsmoen
Bjørn Rishovd Rund
Erik Simonsen
Per Vaglum
Thomas H McGlashan
Author Affiliation
Division of Psychiatry, General Hospital of Rogaland, Armauer Hanssens vei 20, 4000 Stavanger, Norway. jojo@sir.no
Source
Br J Psychiatry Suppl. 2005 Aug;48:s24-8
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Critical Pathways - organization & administration
Delivery of Health Care - organization & administration - standards
Early Diagnosis
Female
Health Services Accessibility
Humans
Male
Middle Aged
Norway
Patient Acceptance of Health Care
Patient Care Team - organization & administration
Psychotic Disorders - diagnosis - therapy
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Abstract
BACKGROUND: Early detection programmes aim to reduce the duration of untreated psychosis (DUP) by public education and by prompt access to treatment via active outreach detection teams. AIMS: To determine whether those with first-episode psychosis in an early detection healthcare area with existing referral channels differ from those who access care via detection teams. METHOD: Those with first-episode psychosis recruited via detection teams were compared with those accessing treatment via conventional channels, at baseline and after 3 months of acute treatment. RESULTS: Patients recruited via detection teams are younger males with a longer DUP, a less dramatic symptom picture and better functioning; however they recover more slowly, and have more symptoms at 3-month follow-up. CONCLUSIONS: After establishing low threshold active case-seeking detection teams, we found clear differences between those patients entering treatment via detection teams v. those obtaining treatment via the usual channels. Such profiling may be informative for early detection service development.
PubMed ID
16055803 View in PubMed
Less detail