Duration of Untreated Psychosis in Community Treatment Settings in the United States.

Jean Addington Robert K Heinssen Delbert G Robinson Nina R Schooler Patricia Marcy Mary F Brunette Christoph U Correll Sue Estroff Kim T Mueser David Penn James A Robinson Robert A Rosenheck Susan T Azrin Amy B Goldstein Joanne Severe John M Kane

Psychiatr Serv

Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (e-mail: ). Dr. Heinssen, Dr. Azrin, Dr. Goldstein, and Ms. Severe are with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Delbert G. Robinson, Dr. Correll, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York, where Ms. Marcy is also affiliated, and with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is with the Department of Psychiatry, Georgetown University School of Medicine, Washington, D.C. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Dr. Estroff is with the Department of Social Medicine and Dr. Penn is with the Department of Psychology, University of North Carolina at Chapel Hill. Dr. Penn is also with the Australian Catholic University, Melbourne, Victoria. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Mr. James A. Robinson is with the Information Sciences Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, and the U.S. Department of Veterans Affairs Mental Illness Research, Education and Clinical Center, both in West Haven, Connecticut. This report is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.

Published: July 2015

Objective: This study is the first to examine duration of untreated psychosis (DUP) among persons receiving care in community mental health centers in the United States.

Methods: Participants were 404 individuals (ages 15-40) who presented for treatment for first-episode psychosis at 34 nonacademic clinics in 21 states. DUP and individual- and site-level variables were measured.

Results: Median DUP was 74 weeks (mean=193.5±262.2 weeks; 68% of participants had DUP of greater than six months). Correlates of longer DUP included earlier age at first psychotic symptoms, substance use disorder, positive and general symptom severity, poorer functioning, and referral from outpatient treatment settings.

Conclusions: This study reported longer DUP than studies conducted in academic settings but found similar correlates of DUP. Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways to specialty FEP care.

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http://dx.doi.org/10.1176/appi.ps.201400124	DOI Listing

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