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Early detection of psychosis: positive effects on 5-year outcome

  • T. K. Larsen (a1) (a2), I. Melle (a3) (a4), B. Auestad (a5), U. Haahr (a6), I. Joa (a1), J. O. Johannessen (a1), S. Opjordsmoen (a3) (a4), B. R. Rund (a7), J. I. Rossberg (a3) (a4), E. Simonsen (a6), P. Vaglum (a8), S. Friis (a3) (a4) and T. McGlashan (a9)...



During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome. This study reports the effects of reducing DUP on 5-year course and outcome.


During 1997–2000 a total of 281 consecutive patients aged >17 years with first episode non-affective psychosis were recruited, of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) programme with public information campaigns and low-threshold psychosis detection teams was established in one healthcare area (ED-area), but not in a comparable area (no-ED area). Both areas ran equivalent treatment programmes during the first 2 years and need-adapted treatment thereafter.


At the start of treatment, ED-patients had shorter DUP and less symptoms than no-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modelling showed better scores for the ED group on the Positive and Negative Syndrome Scale negative, depressive and cognitive factors and for global assessment of functioning for social functioning at 5-year follow-up. The ED group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders.


Early treatment had positive effects on clinical and functional status at 5-year follow-up in first episode psychosis.


Corresponding author

*Address for correspondence: T. K. Larsen, M.D., Stavanger University Hospital, Division of Psychiatry, Armauer Hansensv 20, p.b. 8100, N-4068 Stavanger, Norway. (Email:


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Bentsen, H, Munkvold, OG, Notland, TH (1996). The interrater reliability of the Positive and Negative Syndrome Scale. International Journal of Methods in Psychiatric Research 6, 19.
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2008). Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65, 762771.
Bosanac, P, Patton, GC, Castle, DJ (2010). Early intervention in psychotic disorders: faith before facts? Psychological Medicine 40, 353358.
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.
Drake, RE, Osher, FC, Noordsy, DL, Hurlbut, SC, Teague, GB, Beaudett, MS (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin 16, 5767.
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1995). The Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID I/P, version 2.0). New York State Psychiatric Institute Biometrics Research Department: New York.
Friis, S, Larsen, TK, Melle, I, Opjordsmoen, S, Johannessen, JO, Haahr, U, Simonsen, E, Rund, BR, Vaglum, P, McGlashan, T (2003). Methodological pitfalls in early detection studies – the NAPE Lecture 2002. Nordic Association for Psychiatric Epidemiology. Acta Psychiatrica Scandinavica 107, 39.
Gueorguieva, R, Krystal, JH (2004). Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Archives of General Psychiatry 61, 310317.
Haahr, U, Friis, S, Larsen, TK, Melle, I, Johannesen, JO, Opjordsmoen, S, Simonsen, E, Rund, BR, Vaglum, P, McGlashan, T (2008). First episode psychosis: diagnostic stability over one and two years. Psychopathology 41, 322329.
Joa, I, Johannessen, JO, Auestad, B, Friis, S, McGlashan, T, Melle, I, Opjordsmoen, S, Simonsen, E, Vaglum, P, Larsen, TK (2008). The key to reducing duration of untreated first psychosis: information campaigns. Schizophrenia Bulletin 34, 466472.
Johannessen, JO, McGlashan, TH, Larsen, TK, Horneland, M, Joa, I, Mardal, S, Kvebaek, R, Friis, S, Melle, I, Opjordsmoen, S, Simonsen, E, Ulrik, H, Vaglum, P (2001). Early detection strategies for untreated first-episode psychosis. Schizophrenia Research 51, 3946.
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Larsen, TK, Friis, S, Haahr, U, Johannessen, JO, Melle, I, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, PV, McGlashan, TH (2004). Premorbid adjustment in first-episode non-affective psychosis: distinct patterns of pre-onset course. British Journal of Psychiatry 185, 108115.
Larsen, TK, Melle, I, Auestad, B, Friis, S, Haahr, U, Johannessen, JO, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2006). Early detection of first-episode psychosis: the effect on 1-year outcome. Schizophrenia Bulletin 32, 758764.
Larsen, TK, Melle, I, Friis, S, Joa, I, Johannessen, JO, Opjordsmoen, S, Simonsen, E, Vaglum, P, McGlashan, TH (2007). One-year effect of changing duration of untreated psychosis in a single catchment area. British Journal of Psychiatry (Suppl.) 51, s128s132.
Lehman, AF (1988). A quality of life interview for the chronically mental ill. Evaluation and Program Planning 11, 5162.
McGlashan, TH (1999). Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biological Psychiatry 46, 899907.
McGlashan, TH, Hoffman, RE (2000). Schizophrenia as a disorder of developmentally reduced synaptic connectivity. Archives of General Psychiatry 57, 637648.
McGlashan, TH, Johannessen, JO (1996). Early detection and intervention with schizophrenia: rationale. Schizophrenia Bulletin 22, 201222.
McGorry, P, Johanessen, JO, Lewis, S, Birchwood, M, Malla, A, Nordentoft, M, Addington, J, Yung, A (2010). Early intervention in psychosis: keeping faith with evidence-based health care. Psychological Medicine 40, 399404.
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975983.
Melle, I, Haahr, U, Friis, S, Hustoft, K, Johannessen, JO, Larsen, TK, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2005). Reducing the duration of untreated first-episode psychosis – effects on baseline social functioning and quality of life. Acta Psychiatrica Scandinavica 112, 469473.
Melle, I, Johannesen, JO, Friis, S, Haahr, U, Joa, I, Larsen, TK, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2006). Early detection of the first episode of schizophrenia and suicidal behavior. American Journal of Psychiatry 163, 800804.
Melle, I, Larsen, TK, Haahr, U, Friis, S, Johannesen, JO, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2008). Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. Archives of General Psychiatry 65, 634640.
Pedersen, G, Hagtvedt, HA, Karterud, S (2007). Generalizability studies of the Global Assessment of Functioning – split version. Comprehensive Psychiatry 48, 8894.
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 17851804.
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Ohlenschlaeger, J, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 602.
Pinheiro, JC, Bates, DM (2000). Mixed Effect Models in S- and S-PLUS. Springer: New York.
R Development Core Team (2005). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria (



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