Can We Reduce the Duration of Untreated Psychosis? A Systematic Review and Meta-Analysis of Controlled Interventional Studies

Abstract

Reduction of duration of untreated psychosis (DUP) is the key strategy of early interventions for improving the outcomes of first-episode psychosis. Although several controlled interventional studies have been conducted with the aim of reducing DUP, the results are highly inconsistent and conflicting. The current study systematically searches Web of Science and Ovid for English original articles investigating interventions adopted to reduce DUP, compared to a control intervention, up to April 6, 2017. Sixteen controlled interventional studies were retrieved, including 1964 patients in the intervention arm and 1358 in the control arm. The controlled intervention studies were characterized by standalone first episode psychosis services, standalone clinical high risk services, community interventions, healthcare professional training, and multifocus interventions. Random effects meta-analyses were conducted. There was no summary evidence that available interventions are successful in reducing DUP during the first episode of psychosis (Hedges’ g = −0.12, 95% CI = −0.25 to 0.01). Subgroup analyses showed no differences within each subgroup, with the exception of clinical high risk services (Hedges’ g = −0.386, 95% CI = −0.726 to −0.045). These negative findings may reflect a parceled research base in the area, lack of prospective randomized controlled trials (only 2 randomized cluster designed studies were present) and small sample sizes. There was substantial heterogeneity (I2 = 66.4%), most of which was accounted by different definitions of DUP onset (R2 = .88). Psychometric standardization of DUP definition, improvement of study design, and implementation of preventative strategies seem the most promising avenues for reducing DUP and improving outcomes of first-episode psychosis.

Stigmas toward psychosis‐related clinical features among the general public in Taiwan

“…It is well known that the general public's stigma toward schizophrenia is significantly higher than other mental illnesses (Baba et al, 2017;Lee et al, 2016;Pescosolido et al, 2010;Schomerus et al, 2012), consequently, the stigma might result in delayed detection, prolonged duration of untreated psychosis (DUP), and further lead to poorer long-term symptomatic and functioning prognosis (Marshall et al, 2005;Penttilä, Jääskeläinen, Hirvonen, Isohanni, & Miettunen, 2014). Efforts focused on reduction of DUP alone might not be effective as a recent review concluded negative evidence on pooling results of available interventions for reducing DUP (Oliver et al, 2018). Jorm (2000) has proposed that mental health literacy, defined as "knowledge and beliefs about mental disorders which aid their recognition, management, or prevention," is a key notion for community mental health education if we hope to enhance early recognition.…”

The Predicted Long-Term Benefits of Ensuring Timely Treatment and Medication Adherence in Early Schizophrenia

“…Although not all early intervention programs have been able to shorten DUP (Oliver et al 2018), the goal of reducing DUP is attainable as demonstrated by successful programs (e.g., Melle et al 2012). Over time, these programs coupled with efforts to improve antipsychotic adherence will generate sufficient numbers of treated individuals to enable empirical research of their long-term effects on clinical, functional, and economic outcomes.…”

The “Parma—Early Psychosis” program: General description and process analysis after 5 years of clinical activity

“…Recent evidence that "Clinical High Risk for Psychosis" (CHR-P) services may be beneficial in reducing the negative impact of Duration of Untreated Psychosis (DUP) on both direct and indirect costs of care (Oliver et al, 2018) also contributed to spread focused EIP protocols (most often as centralized and autonomous services) within the mental health care network of different countries .…”