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Schizophrenia Bulletin Advance Access originally published online on June 29, 2006
Schizophrenia Bulletin 2006 32(4):758-764; doi:10.1093/schbul/sbl005
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© The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Early Detection of First-Episode Psychosis: The Effect on 1-Year Outcome

Tor K. Larsen1,2, Ingrid Melle3, Bjørn Auestad4, Svein Friis3, Ulrik Haahr5, Jan Olav Johannessen2, Stein Opjordsmoen3, Bjørn Rishovd Rund6, Erik Simonsen5, Per Vaglum7 and Thomas McGlashan8
2 Psychiatric Clinic, University of Stavanger, Armauer Hansensv. 20, PB 8100, N-4068 Stavanger, Norway
3 Ullevaal University Hospital, Oslo, Norway
4 Faculty of Science and Technology, University of Stavanger, Norway
5 Roskilde Psychiatric University Hospital Fjorden, Roskilde, Denmark
6 Institute of Psychology, University of Oslo, Oslo, Norway
7 Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
8 Yale University School of Medicine, New Haven, CT

1To whom correspondence should be addressed; tel: +47 908 32 795, fax: +47 51515675. e-mail: tklarsen{at}online.no.

Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven. Objective: To study whether 1-year outcome will be better in a health care sector with early detection (ED) of psychosis compared with sectors with no early detection (no-ED). Design: a quasi-experimental study with ED in 2 experimental sectors and no-ED in 2 control sectors. ED was achieved through low-threshold ED teams and information campaigns about psychosis for the public, schools, and primary health care providers. The ED and no-ED health care areas offered an equivalent assessment and treatment program during the first year. Two hundred and eighty-one patients were included; 88% were reassessed after 1 year. Results: The ED-area patients (N = 141) had a median duration of untreated psychosis of 5 weeks at baseline compared with 16 weeks for patients in the no-ED area (N = 140). Positive and general symptoms, global assessment of functioning, quality of life, time to remission, and course of psychosis at 1 year after the start of treatment were not different between ED and no-ED groups. Outcome was significantly better for the ED area for negative symptoms. Conclusions: The ED, no-ED differences at baseline become attenuated by 1 year but not the difference in negative symptoms, suggesting secondary prevention in this domain of psychopathology. However, this possibility requires further testing by follow-up and replication.

Keywords: psychosis / schizophrenia / early detection / outcome


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