The role of treatment delay in predicting 5-year outcomes in an early intervention program

Norman, Ross; Manchanda, Rahul; Windell, Deborah; Harricharan, Raj; Northcott, Sandra; Hassall, L. D.

doi:10.1017/s0033291711001140

Cited by 24 publications

(38 citation statements)

References 57 publications

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“…First, we recognize that age at first presentation, contact or hospitalization are not necessarily indicative of age at first onset, and that a small number of people will experience several months or even years of untreated psychosis [196]. Second, disorder when measured by other endophenotypic markers, such as cognitive decline or social withdrawal, may have given rise to alternative incidence patterns than those typically reported; here duration of untreated illness becomes relevant [197], although we note a dearth of incidence studies which have incorporated this concept. Further, we recognize that studies included in this report adopted different definitions of age (first presentation/contact/hospitalization) across which we assumed some commonality.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

et al. 2012

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BackgroundWe conducted a systematic review of incidence rates in England over a sixty-year period to determine the extent to which rates varied along accepted (age, sex) and less-accepted epidemiological gradients (ethnicity, migration and place of birth and upbringing, time).ObjectivesTo determine variation in incidence of several psychotic disorders as above.Data SourcesPublished and grey literature searches (MEDLINE, PSycINFO, EMBASE, CINAHL, ASSIA, HMIC), and identification of unpublished data through bibliographic searches and author communication.Study Eligibility CriteriaPublished 1950–2009; conducted wholly or partially in England; original data on incidence of non-organic adult-onset psychosis or one or more factor(s) pertaining to incidence.ParticipantsPeople, 16–64 years, with first -onset psychosis, including non-affective psychoses, schizophrenia, bipolar disorder, psychotic depression and substance-induced psychosis.Study Appraisal and Synthesis MethodsTitle, abstract and full-text review by two independent raters to identify suitable citations. Data were extracted to a standardized extraction form. Descriptive appraisals of variation in rates, including tables and forest plots, and where suitable, random-effects meta-analyses and meta-regressions to test specific hypotheses; rate heterogeneity was assessed by the I2-statistic.Results83 citations met inclusion. Pooled incidence of all psychoses (N = 9) was 31.7 per 100,000 person-years (95%CI: 24.6–40.9), 23.2 (95%CI: 18.3–29.5) for non-affective psychoses (N = 8), 15.2 (95%CI: 11.9–19.5) for schizophrenia (N = 15) and 12.4 (95%CI: 9.0–17.1) for affective psychoses (N = 7). This masked rate heterogeneity (I2: 0.54–0.97), possibly explained by socio-environmental factors; our review confirmed (via meta-regression) the typical age-sex interaction in psychosis risk, including secondary peak onset in women after 45 years. Rates of most disorders were elevated in several ethnic minority groups compared with the white (British) population. For example, for schizophrenia: black Caribbean (pooled RR: 5.6; 95%CI: 3.4–9.2; N = 5), black African (pooled RR: 4.7; 95%CI: 3.3–6.8; N = 5) and South Asian groups in England (pooled RR: 2.4; 95%CI: 1.3–4.5; N = 3). We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported.LimitationsIncidence studies were predominantly cross-sectional, limiting causal inference. Heterogeneity, while evidencing important variation, suggested pooled estimates require interpretation alongside our descriptive systematic results.Conclusions and Implications of Key FindingsIncidence of psychotic disorders varied markedly by age, sex, place and migration status/ethnicity. Stable incidence over time, together with a robust socio-environmental epidemiology, provides a platform for developing prediction models for health service planning.

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Section: Discussionmentioning

confidence: 99%

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

et al. 2012

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“…Study protocol was fully explained, and written informed consent was obtained according Duration of untreated illness was estimated as the period of time between the onset of any noticeable changes in behaviour leading up to psychosis and initiation of treatment (in weeks). Treatment in this case was defined as initiation of antipsychotic medication of a dose and for sufficient time (4 weeks) that would lead to significant response in most patients (Norman et al, 2012).…”

Section: Participantsmentioning

confidence: 99%

Glutamatergic metabolite correlations with neuropsychological tests in first episode schizophrenia

Dempster

Norman

Théberge

et al. 2015

Psychiatry Research: Neuroimaging

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“…Duration of untreated psychosis (DUP) was identified by the length of active psychosis (in weeks) before the initiation of treatment, and duration of untreated illness (DUI) was the length of time between the onset of any noticeable changes in behavior leading up to psychosis (Norman et al, 2012).…”

Section: Diagnosis and Pretreatment Characteristicsmentioning

confidence: 99%

The course of negative symptoms over the first five years of treatment: Data from an early intervention program for psychosis

Norman

Manchanda

Harricharan

et al. 2015

Schizophrenia Research

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The role of treatment delay in predicting 5-year outcomes in an early intervention program

Cited by 24 publications

References 57 publications

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

Glutamatergic metabolite correlations with neuropsychological tests in first episode schizophrenia

The course of negative symptoms over the first five years of treatment: Data from an early intervention program for psychosis

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