Early detection strategies for untreated first-episode psychosis

Some studies in first-episode schizophrenia correlate shorter duration of u ntreated psychosis (DUP) with better prognosis, suggesting that timing of t reatment may be important. A three-site prospective clinical trial in Norwa y and Denmark is underway to investigate the effect of the timing of treatm ent in first-episode psychosis. One health care sector (Rogaland, Norway) i s experimental and has developed an early detection (ED) system to reduce D UP. Two other sectors (Ulleval, Norway, and Roskilde, Denmark) are comparis on sectors and rely on existing detection and referral systems for first-ep isode cases. The study ultimately will compare early detected with usual de tected patients. This paper describes the study's major independent interve ntion variable, i.e. a comprehensive education and detection system to chan ge DUP in first onset psychosis. System variables and first results from the four-year inclusion period (199 7-2000) are described. It includes targeted information towards the general public, health professionals and schools, and ED teams to recruit appropri ate patients into treatment as soon as possible. This plus easy access to p sychiatric services via ED teams systematically changed referral patterns o f first-episode schizophrenia. DUP was reduced by 1.5 years (mean) from bef ore the time the ED system was instituted (to 0.5 years). The ED strategies appear to be effective and to influence directly the community's help-seek ing behaviour. (C) 2001 Elsevier Science B.V. All rights reserved.