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Schizophrenia Bulletin Advance Access published online on June 29, 2006
Schizophrenia Bulletin, 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.

Article

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

Tor K. Larsen 1 *, Ingrid Melle 2, Bjørn Auestad 3, Svein Friis 2, Ulrik Haahr 4, Jan Olav Johannessen 1, Stein Opjordsmoen 2, Bjørn Rishovd Rund 5, Erik Simonsen 4, Per Vaglum 6, and Thomas McGlashan 7
1 Psychiatric Clinic, University of Stavanger, Armauer Hansensv. 20, PB 8100, N-4068 Stavanger, Norway
2 Ullevaal University Hospital, Oslo, Norway
3 Faculty of Science and Technology, University of Stavanger, Norway
4 Roskilde Psychiatric University Hospital Fjorden, Roskilde, Denmark
5 Institute of Psychology, University of Oslo, Oslo, Norway
6 Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
7 Yale University School of Medicine, New Haven, CT

* To whom correspondence should be addressed.
Tor K. Larsen, E-mail: tklarsen{at}online.no


  Abstract

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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