Parsing the impact of early detection on duration of untreated psychosis (DUP): Applying quantile regression to data from the Scandinavian TIPS study

Ferrara, Maria; Gülöksüz, Sinan; Li, Fangyong; Burke, Shadie; Tek, Cenk; Friis, Svein; Hegelstad, Wenche ten Velden; Joa, Inge; Johannessen, Jan Olav; Melle, Ingrid; Simonsen, Erik; Srihari, Vinod H.

doi:10.1016/j.schres.2019.05.035

Cited by 22 publications

(19 citation statements)

References 32 publications

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“…Findings of this study are largely consistent with previous estimates of FEP incidence from European (Jongsma et al, 2018) and nearby catchment areas (Ferrara et al, 2019; Tarricone et al, 2012). Moreover, our estimate for clinical recovery is quite similar to that suggested by a recent meta‐analysis (58%) (Lally et al, 2017), suggesting similarities in the effectiveness of the program to international standards.…”

Section: Discussionsupporting

confidence: 92%

“…The early stage of psychosis, in fact, seems a critical period for the attainment of better psychosocial outcomes. In particular, shortening the Duration of Untreated Psychosis (DUP), the time elapsing between psychosis onset and initiation of treatment (Register‐Brown & Hong, 2014), leads to greater individual achievements (Dell'Osso et al, 2013; Ferrara et al, 2019; Murru & Carpiniello, 2018) and better outcomes both in the short and long term (Challis, Nielssen, Harris, & Large, 2013; Hegelstad et al, 2012; Large & Nielssen, 2011; Marshall et al, 2014; Melle et al, 2006, 2004). This might hold true also for affective disorders associated with a lower prevalence of psychotic symptoms, such as depression (Ghio et al, 2015) and bipolar disorder (Dell'Osso, Glick, Baldwin, & Altamura, 2013).…”

Section: Introductionmentioning

confidence: 99%

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First‐episode psychosis in the Ferrara Mental Health Department: Incidence and clinical course within the first 2 years

Murri

Bertelli²,

Carozza³

et al. 2020

Early Intervention Psych

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Aim To examine the incidence of with first‐episode psychosis (FEP) in the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, and to examine the association between the Duration of Untreated Psychosis (DUP) and the clinical course. Methods Participants recruited in 2013–2019 were assessed with the Health of the Nation Outcome Scale (HoNOS) every 6 months for 24 months. Hierarchical growth models analysed changes of global severity (HoNOS total scores) and symptom dimensions. Regression modelled factors associated with remission (HoNOS < 8) and clinical improvement (<12). Results The incidence of FEP was 21.5 (95%CI: 21.2–21.9) cases per 100 000 person year. Among participants (n = 86, mean age 23, 76% males), baseline HoNOS scores were higher for those with a longer DUP. More than half subjects reached clinical remission (61.6%) or improvement (82.6%), while very few (2.3%) were re‐hospitalized. HoNOS total scores decayed with a mixed linear/quadratic trend, with a slower decay among migrants. A longer DUP was associated with reduced improvements of positive symptoms and lower likelihood of clinical improvement (OR: 0.84; 95%CI: 0.73–0.96). Conclusions Patients from the FEP program of Ferrara reached good clinical outcomes. Nonetheless, individuals with a longer DUP may need additional clinical attention. Systematic monitoring of clinical outcomes may be an optimal strategy to improve the outcomes of FEP in the real world.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

First‐episode psychosis in the Ferrara Mental Health Department: Incidence and clinical course within the first 2 years

Murri

Bertelli²,

Carozza³

et al. 2020

Early Intervention Psych

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“…TIPS did not exclude for DUP >3 years and was thus able to demonstrate a larger magnitude of reduction in the third quartile (41 weeks), but a comparable reduction in the second quartile (11 weeks). 32 The largest US FES sample (with usual detection) reported a median DUP of 74 weeks 33 which is longer but comparable to our control site median DUP-Total of 61 weeks.…”

Section: Discussionsupporting

confidence: 71%

“…We simulated 31 and validated this in an independent sample from TIPS. 32 Significance levels were set at P < .05 (two-sided). SAS 9.4 (Cary, NC) was used to conduct all analyses.…”

Section: Methodsmentioning

confidence: 99%

Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial

Srihari

Ferrara

Li³

et al. 2022

Schizophrenia Bulletin Open

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Objective Duration of Untreated Psychosis (DUP) remains unacceptably long and limits effectiveness of care. To determine whether an early detection campaign (‘Mindmap’) can reduce DUP in a US community setting. Methods In this non-randomized controlled trial, Mindmap targeted the catchment of one specialty first-episode service or FES (STEP, Greater New Haven) from 2015-19, while usual detection efforts continued at a control FES (PREP, Greater Boston). Mindmap targeted diverse sources of delay through mass & social media messaging, professional outreach & detailing, and rapid enrollment of referrals. Both FES recruited 16-35 years old with psychosis onset ≤3 years. Outcome measures included DUP-Total (onset of psychosis to FES enrollment), DUP-Demand (onset of psychosis to first antipsychotic medication) and DUP-Supply (first antipsychotic medication to FES enrollment). Results 171 subjects were recruited at STEP and 75 at PREP. Mindmap was associated with an increase in the number of referrals and in efficiency of engagement at STEP. Pre-campaign DUP (2014-15) was equivalent, while Mindmap was associated with DUP reductions at STEP but not PREP. DUP-Total fell significantly in both the first and the second quartile (11.5 and 58.5 days reduction per campaign year, respectively). DUP-Demand and DUP-Supply fell in the third quartiles only (46.3 and 70.3 days reduction per campaign year, respectively). No reductions were detectable across all quartiles at PREP, but between site comparisons were not significant. Conclusions This is the first controlled demonstration of community DUP reduction in the U.S., and can inform future early detection efforts across diverse settings.

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“…Our study also found that the TIPS study recruited men, and singles (across genders) with significantly longer DUP in the upper tail of the distribution. However, gender did not seem to be a moderator of ED(M. Ferrara, Guloksuz, et al, 2019). This result provides a further element of discussion to what delineated in Chapter 6: women need targeted early identification efforts, and tailored programs to promote access to specialized care for psychosis.…”

Section: Discussionmentioning

confidence: 72%

Early intervention in psychosis

Ferrara¹

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Parsing the impact of early detection on duration of untreated psychosis (DUP): Applying quantile regression to data from the Scandinavian TIPS study

Cited by 22 publications

References 32 publications

First‐episode psychosis in the Ferrara Mental Health Department: Incidence and clinical course within the first 2 years

First‐episode psychosis in the Ferrara Mental Health Department: Incidence and clinical course within the first 2 years

Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial

Early intervention in psychosis

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