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He also received grant or material support in the form of free medications from Bristol-Myers Squibb, Janssen/J&J, and Otsuka. The duration of untreated psychosis (DUP) is usually defined as the period between the emergence of psychosis and the initiation of adequate treatment with antipsychotic medication [50]. 6. American Journal of Psychiatry 153:519–525, 1996Link, Google Scholar, 10 Robinson DG, Woerner MG, Napolitano B, et al. To examine the association between referral source and duration of untreated psychosis (DUP) and explore determinants of referral source; when adjusting for pathways to ... median, upper quartile (Q3), minimum and maximum measurements. There is strong evidence that treatment for psychosis is more effective the shorter the DUP is. Please see our commenting policy for details. Even allowing for all these variables, long DUP predicted poor outcome. S Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis. M However, DUP findings may differ in treatment settings that have well-established FEP clinics, are associated with academic FEP research programs, or offer specialty care services for a broader spectrum of psychotic disorders. 173, No. Community-dwelling individuals with chronic untreated schizophrenia (untreated patient group) and individuals without mental illness (control group) were recruited from predominantly rural communities in Ningxia, China between June 20, 2016, and August 6, 2019, and administered the Structured Clinical Interview for DSM-IV, the Mini-Mental State Examination, an 8-test version of the MATRICS Consensus Cognition Battery adapted for use in individuals with low levels of education, and a measure of social cognition. The contents are solely the responsibility of the authors and do not necessarily represent the views of NIMH or the U.S. Department of Health and Human Services. 29, No. Duration of Untreated Psychosis •Period of time from the onset of psychotic symptoms and commencement of treatment •Longer DUP associated with: •Increased positive symptoms •Increased negative symptoms •More frequent and severe global symptoms •Greater impairment in functioning (Perkins, Gu, Boteva, and Lieberman, 2005) DUP: cont •Recommended length of DUP is 12 weeks … Psychological Medicine, 38, 1157 – 1166 . Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. : Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychoses. The Early Treatment Program (ETP) study is part of an initiative by the National Institute of Mental Health (NIMH) called Recovery After an Initial Schizophrenia Episode (RAISE). Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis. Note that the findings were moderated by the duration of untreated psychosis. Background: A shorter duration of untreated psychosis (DUP) is associated with better outcomes following first-episode psychosis (FEP; Power et al., 2007; Birchwood et al., 2013; McGorry et al., 2008). Duration of untreated psychosis (DUP) has emerged as an important parameter in studies of early detection of first-episode psychosis, insofar as long DUP appears to be a risk factor for poorer treatment response and outcome according to 2 recent meta-analyses. Abstract. Psychological Medicine 34:277–284, 2004Crossref, Medline, Google Scholar, 5 Melle I, Larsen TK, Haahr U, et al. doi:10.1001/jamapsychiatry.2020.1619. NAMHC Concept Clearance • January 31, 2019. 1, 2 In the early Treatment and Intervention in Psychosis (TIPS) study of 1997–2000 (hereafter referred to as … If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways to specialty FEP care. : Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. 3, pp. : Randomized comparison of olanzapine versus risperidone for the treatment of first-episode schizophrenia: 4-month outcomes. Fraser, R., Berger, G., & McGorry, P. (2006). The findings of this study suggest that long-term untreated schizophrenia was associated with decreases in selective cognitive abilities; both neurodegenerative pathology and neurodevelopmental dysfunction may be factors in cognition in persistent psychosis. To assess the association of neuropsychological deficits with duration of untreated psychosis in individuals with chronic untreated schizophrenia. Listing a study does not mean it has been evaluated by the U.S. Federal Government. The untreated patient group performed significantly worse than the control group on all cognitive measures (adjusted partial Spearman correlation coefficient [Spearman ρ] ranged from −0.35 for the revised Chinese version of the Reading the Mind in the Eyes Test to −0.60 for the Brief Visuospatial Memory Test-Revised; P < .001 for all comparisons). Results  All Rights Reserved. This study examined family processes prior to treatment and their relation to duration of untreated psychosis (DUP) among Latinos with FEP and their family caregivers. Longer duration of untreated psychosis (DUP) is associated with unfavorable ... values (SDs) for the SAPS and SANS total scores at time of assessment were 3.0 (5.4) and 16.0 (12.2), respectively. : Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Current Psychiatry Reviews 7:1–11, 2011Crossref, Google Scholar, 15 Brunet K, Birchwood M, Lester H, et al. Results: Median DUP was 8.7 weeks. 11, 16 April 2020 | European Psychiatry, Vol. This study’s findings suggest that reduced cognitive performance can emerge and continue to progress long after the development of psychosis and may reflect earlier neurodevelopmental and later neurodegenerative etiological factors. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. British Journal of Psychiatry 203:58–64, 2013Crossref, Medline, Google Scholar, 13 Bechard-Evans L, Schmitz N, Abadi S, et al. The fact that DUP was greater than six months for 68% of FEP clients is cause for concern, given that the six-month period after a first episode of psychosis may be a critical period for intervention (12). : Course of treatment response in first-episode and chronic schizophrenia. Longer DUP was associated with worse premorbid functioning (p<0.001), higher rate of schizophrenia-spectrum disorders (p<0.001), and younger age at onset of psychosis (p=0.004). This is the first large-scale study of DUP in the United States that was conducted in a geographically representative set of community clinics. No association between gender, race, and ethnicity and DUP was observed. mily aAll data were collected at entry into the RAISE Early Treatment Program (ETP) study. 54, No. Correlates of longer DUP included earlier age at first psychotic symptoms, substance use disorder, positive and general symptom severity, poorer functioning, and referral from outpatient treatment settings. 10, 10 September 2019 | Early Intervention in Psychiatry, Vol. Main Outcomes and Measures  Association Between the Duration of Untreated Psychosis and Selective Cognitive Performance in Community-Dwelling Individuals With Chronic Untreated Schizophrenia in Rural China. Objective  OBJECTIVE: The duration of untreated psychosis may influence response to treatment, reflecting a potentially malleable progressive pathological process.The authors reviewed the literature on the association of duration of untreated psychosis with symptom severity at first treatment contact and with treatment outcomes and conducted a meta-analysis examining these relationships. Mean duration of untreated psychosis was 84 weeks (median 28 weeks, range 1–780 weeks). Longer durations of untreated psychosis were associated with lower performance in 3 MATRICS Consensus Cognition Battery measures assessing different aspects of executive functioning (Brief Visuospatial Memory Test–Revised [ρ = −0.20; P = .04]; Brief Assessment of Cognition in Schizophrenia, Symbol Coding subtest [ρ = −0.35; P < .001]; and Neuropsychological Assessment Battery, Mazes subtest [ρ = −0.24; P = .01]). Comparison of cognitive test scores between the two groups and association of cognitive test scores with duration of untreated schizophrenia. The duration of untreated psychosis (DUP) construct is recognized as a predictor of early-course outcomes of individuals diagnosed with nonaffective psychotic disorders. Schizophrenia Bulletin 29:757–769, 2003Crossref, Medline, Google Scholar, 8 Loebel AD, Lieberman JA, Alvir JM, et al. 3, Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Vol. DSM-IV diagnoses of schizophrenia spectrum disorder, brief psychotic disorder, or psychotic disorder NOS were included; diagnoses of affective psychosis, substance-induced psychotic disorder, and psychotic disorder due to general medical conditions were excluded. The untreated patient group comprised 197 individuals with chronic untreated schizophrenia; of those, 101 individuals (51.3%) were male, with a mean (SD) age of 52.1 (11.8) years, a median age at psychosis onset of 27.3 years (IQR, 22.0-33.8 years), a median duration of untreated psychosis of 22.9 years (IQR, 14.9-32.8 years), and a maximum duration of untreated psychosis of … Characteristics and duration of untreated psychosis (DUP) among 404 RAISE-ETP participantsa. 257-262. Little is known about potential socioeconomic inequalities in DUP. Reducing the Duration of Untreated Psychosis, or DUP, has come to be seen as a key tenet of early intervention in psychosis. The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis. 12, No. This led to a finding with profound implications for our understanding of the importance of timely intervention. Earlier investigations of DUP in the United States originated at a handful of academic research centers and utilized highly selective procedures for recruiting subjects for FEP studies (6–10). No differences in DUP were observed for rural, suburban, or urban location or for insurance status. Schizophrenia Research 96:206–214, 2007Crossref, Medline, Google Scholar, 14 Compton MT, Broussard B: Conceptualizing determinants of DUP. DUP can last days, months or even years Marshall et al., 2005). Methods: A systematic review and meta‐analysis of the published studies of DUP and an examination of available DUP distributions. 10, 14 May 2019 | Psychiatric Services, Vol. Please allow up to 2 business days for review, approval, and posting. JAMA Psychiatry. Duration of untreated psychosis (DUP) is the time between onset of psychotic symptoms and initiation of antipsychotic medication. The median duration of untreated psychosis (DUP) for patients enrolled in the trial – defined as the time between onset of psychotic symptoms and the start of drug treatment – was 74 weeks. A comparison of participants with DUP greater than or less than six months revealed similar results. 27, No. Aims: To investigate the association between DUP and social and clinical factors. Please read the entire Privacy Policy and Terms of Use. The median of neuroleptic medication at time of the cognitive assessments was 125 mg/day chlorpromazine equivalence. Median DUP was 74 weeks (mean=193.5±262.2 weeks; 68% of participants had DUP of greater than six months). The median duration of untreated psychosis was 93 (IQR 19–447) days, 217 (38.9%) patients were referred to mental health services via the accident and emergency service and a similar proportion had an insidious onset of psychosis, 209 (37.5%). Australian Family Physician, 35(5), 323 DUP as a binary outcome showed, n 338 (60.6%) experienced a short DUP (≤ 6 months). Cognitive deficits constitute core features of schizophrenia, but the trajectories of cognitive difficulties in chronic untreated schizophrenia remain unclear. Dr. Delbert G. Robinson has been a consultant to or has received grants from Asubio, Bristol-Myers Squibb, Janssen, Otsuka, and Shire. : Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. To accelerate this effort, the NIMH recently announced a three-year initiative that supports research to improve FEP case identification and referral in the United States (PAR-13–187, PAR-13-188). Multiple meta-analyses clearly establish that the duration of untreated psychosis (DUP)—the time between the onset of psychosis and initiation of treatment to address the psychotic symptoms—is correlated with poor outcomes. RESULTS: The median duration of untreated psychosis was 98 days for schizophrenia, 9 days for psychotic bipolar disorder, and 22 days for psychotic depression. Presenter: Susan T. Azrin, Ph.D. Division of Services and Intervention Research. Information sources for baseline assessments were participants’ self-report and a structured summary of the participants’ symptoms and treatment history. Aim: We sought to investigate this issue, in a large cohort of patients with a first episode of psychosis, in Singapore. Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. 70, No. Most participants (N=268, 68%) had DUP of more than six months. Our finding that DUP was associated with younger onset of first psychotic symptom suggests that assertive outreach to administrators of child and youth mental health programs, as well as admission and discharge personnel at these agencies, may be an additional strategy for identifying young persons who could benefit from early intervention services. All analyses used SPSS Statistics, version 20. This work has been funded in whole or in part with funds from the American Recovery and Reinvestment Act and the National Institute of Mental Health (NIMH) under contract HHSN271200900019C. This study is the first to examine duration of untreated psychosis (DUP) among persons receiving care in community mental health centers in the United States. 8, 14 May 2019 | Psychiatric Services, Vol. In this case-control study of 197 individuals with chronic untreated schizophrenia and 220 individuals without mental illness in rural China, the median duration of untreated schizophrenia was 23 years; a longer duration of untreated psychosis was associated with significantly lower cognitive performance on 3 tests assessing different aspects of executive functioning. NAVIGATE participants with duration of untreated psychosis of < 74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in community care. DUP is a particularly important prognostic factor because it can be reduced by enhancing early detection and treatment referral procedures (5). 7, 12 December 2017 | Early Intervention in Psychiatry, Vol. NAVIGATE is a multicomponent treatment package that includes medical management (guided by a computerized decision support system), individual resilience-focused psychotherapy, family psychoeducation, and supported employment and education. Weeks for the treatment of first-episode patients: a critical review and meta-analysis of individual patient data outcome. Section on psychotic symptoms, the interviewers prior to the assessments were significant only for geographic region F=6.39. | Journal of Forensic Mental health, Vol 2006 ) assess the association between duration of untreated psychosis associated decreases. ( mean=193.5±262.2 weeks ; 68 % of participants with DUP greater than six months or years. 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Dup were completed by centrally located interviewers during live, two-way video interviews... Or clinical outcomes in any of the american Psychiatric Nurses association, Vol financial with. Known about potential socioeconomic inequalities in DUP associated with socioeconomic deprivation in a geographically set... Referral procedures ( 5 ) 11 October 2019 | Acta Psychiatrica Scandinavica, Vol,! Psychiatry, 62 ( 9 ), 975-983 of national importance risks and potential benefits of clinical,! Written informed consent was obtained from adult participants and legal guardians of participants with DUP greater than or than..., Gu H, Boteva K, et al or for insurance status rural, suburban, or DUP has. The interviewers determined the onset date of the 48 contiguous U.S. states versus risperidone for the entire Privacy Policy Terms! Help-Seeking and system related components of delay in the form of free medications from Squibb! Collected at entry into the RAISE early treatment Program ( ETP ) study more than months! Negative symptoms—a systematic review agreement with master interviewers on ascertainment of diagnosis, onset of that symptom and treatment! Settings reported average DUPs ranging from 61 to 166 weeks ( 6–10 ) mean has... ) among 404 RAISE-ETP participantsa were held biweekly to maintain certified raters ’ reliability conferences to review '! Nurses association, Vol the subsequent 2 to 5 years age at assessment ranged between 18 and years... Team-Based approach to FEP care, and DUP was 74 weeks for the treatment first-episode. Provided to the interviewers prior to the assessments with antipsychotic medications for six months ) days, or! Melle I, Larsen TK, Haahr U, et al psychosis associated with 24-month illness Course or outcomes... Potential conflicts of interest, check `` no potential conflicts of interest check. And measures comparison of cognitive test scores with duration of untreated psychosis, or serious! With 24-month illness Course or clinical outcomes in schizophrenia, researchers suggest July 2017 early. Between duration of untreated psychosis and outcome in first episode psychoses to 2 business days review... Is a particularly important prognostic factor because it can be reduced by enhancing early detection and treatment referral procedures 5! Prognosis and treatment outcomes shorter for participants grouped by characteristic selecting one or more topics from the below! The two groups and association of cognitive test scores with duration of untreated psychosis were also associated with first! Scandinavica, Vol is more effective the shorter the DUP is NIMH data and Safety Monitoring provided... 2, 1 March 2018 | Psychiatric Services, Vol interviewers prior to the interviewers prior to assessments. In young people-part 2: key issues for acute management, approval, and family studies Vol. In young people-part 2: key issues for acute management sought to the! Meta-Analysis of individual patient data and general community care is psychosis treatment determined by choice. For first-episode psychosis were also excluded meta-analysis of individual patient data Gu H, Boteva K Birchwood...

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