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Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study

  • Craig Morgan (a1), Rudwan Abdul-Al (a2), Julia M. Lappin (a1), Peter Jones (a2), Paul Fearon (a1), Morven Leese (a3), Tim Croudace (a2), Kevin Morgan (a4), Paola Dazzan (a4), Tom Craig (a4), Julian Leff (a4), Robin Murray (a4) and ÆSOP Study Group (a4)...

Abstract

Background

Despite considerable research investigating the relationship between a long duration of untreated psychosis (DUP) and outcomes, there has been much less considering predictors of a long DUP.

Aims

To investigate the clinical and social determinants of DUP in a large sample of patients with a first episode of psychosis.

Method

All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined catchment areas in London and Nottingham, UK were included in the ÆSOP study Data relating to clinical and social variables and to DUP were collected from patients, relatives and case notes.

Results

An insidious mode of onset was associated with a substantially longer DUP compared with an acute onset, independent of other factors. Unemployment had a similar, if less strong, effect. Conversely family involvement in help-seeking was independently associated with a shorter duration. There was weak evidence that durations were longer in London than in Nottingham.

Conclusions

These findings suggest that DUP is influenced both by aspects of the early clinical course and by the social context.

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Copyright

Corresponding author

Dr Craig Morgan, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: +44(0)20 7848 0351; email: spjucrm@iop.kcl.ac.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study

  • Craig Morgan (a1), Rudwan Abdul-Al (a2), Julia M. Lappin (a1), Peter Jones (a2), Paul Fearon (a1), Morven Leese (a3), Tim Croudace (a2), Kevin Morgan (a4), Paola Dazzan (a4), Tom Craig (a4), Julian Leff (a4), Robin Murray (a4) and ÆSOP Study Group (a4)...
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Clinical and Social determinants of duration of untreated psychosis (DUP)

SHIBU P THOMAS, STAFF GRADE PSYCHIATRIST
15 February 2007

Clinical and Social determinants of duration of untreated psychosis (DUP):A Retrospective study of case records

Letter for submission to the British Journal of Psychiatry

Harpal Nandhra & Shibu ThomasEarly Intervention in Psychosis,Ashton House,15 George Street,Leamington Spa,CV31 1ET

Tel: 01926 313126Fax: 01926 450469E-Mail: href="mailto:harpal.nandhra@covwarkpt.nhs.uk" target="_blank">harpal.nandhra@covwarkpt.nhs.uk Corresponding author: Dr Harpal Nandhra at the above address.Conflict of interest: NoneFunding: None

Clinical and Social determinants of duration of untreated psychosis (DUP)

In an important (AESOP first-episode) study published recently, the authors (C Morgan et al 2006) found that longer DUP was associated with insidious onset and less family involvement in help seeking. They concluded that, the DUP is influenced by its early clinical course and social variables.

We did a small retrospective study of pathways to care of 74 first-episode psychosis patients under care of Early Intervention Team in Psychosis in South Warwickshire.

We investigated the clinical and social determinants of DUP (onset tofirst contact) in two groups of patients with first-episode psychosis witha cut point of 12 weeks for DUP.

We compared two groups of patients, one with a shorter DUP (n=46) andthe other with longer DUP (n=28), selected from a total of 74 first-episode patients. Clinical and social variables relating to first-episode were collected from patient’s case notes retrospectively.

Of the 74 patients (DUP mean=20.5weeks; median=4weeks), a longer DUP (mean=49.2weeks; median=40weeks) was associated with a significant excess of male patients (c2=5.93; p=0.025), who were unemployed, having unstable pre-morbid functioning, an insidious mode of onset (c2=38.3; p=<0.001),with significant co-morbid substance misuse c2= 8.96; p= <0.01) and less family involvement in help-seeking ( c2=7.07; p=0.01).

Conversely, shorter DUP was associated with acute presentation (n=34), a higher probability of the family being involved (n=31), and increased risk of hospital admission (n=20). No statistically significant differences were noted in diagnosis, age of onset, ethnicity and living circumstances.

Our findings largely corresponded with the AESOP study that shorter DUP was associated with an acute mode of onset and family involvement. However, they did not find any significant association between longer DUP and male gender. They were not able to investigate any possible association with co-morbid substance misuse.

C Morgan et al (2006)Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study. British Journal of Psychiatry,189,446 – 452

S Thomas St. Michael’s Hospital, Warwick, UK.

H Nandhra Early Intervention in Psychosis,Ashton House, 15 George Street, Leamington Spa,

CV31 1ET, UK.E-Mail: harpal.nandhra@covwarkpt.nhs.uk ... More

Conflict of interest: None Declared

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