07 August 2001

Early detection systems for schizophrenia appear to be effective in improving help-seeking behavior, thus reducing duration of untreated psychosis (DUP), claim researchers. They stress that this could have important public health implications, particularly as a shorter DUP has been correlated with a better prognosis.

Jan Olav Johannessen (Rogaland Psychiatric Hospital, Stavanger, Norway) and colleagues compared three health care sectors. The first, in Rogaland, Norway is experimental and has developed an early detection system to reduce DUP. The other two, Ullevå in Norway and Roskilde in Denmark, are comparison sectors and they rely on existing detection and referral systems.

The Treatment and Intervention Psychosis (TIPS) project introduced in Rogaland addresses treatment delivery systems, community awareness, and help-seeking behaviors of patients and their families. The project has established a comprehensive, multi-level, multi-target information, education and service delivery system, consisting of early detection teams and an education program about early psychosis and TIPS. The targets aimed at were the general public, health professionals, and schools.

Johannessen's team found that the introduction of detection teams, making psychiatric services more accessible, coupled with targeted information, resulted in the referral of cases that were largely appropriate.

'The referrals came from various sources but mostly the families, schools, and patients themselves, as opposed to prior to the TIPS project, when all the referrals had to come via the GPs,' the researchers write.

The introduction of early intervention strategies appeared to change help-seeking behavior, successfully expanding pathways to care. However, despite widening access, the early detection system was not over-whelmed by referrals, which was an initial fear of clinical systems.

Moreover, introduction of the TIPS project successfully reduced DUP from 114 weeks to a mean of 26 weeks, a difference of about one and a half years.

Johannessen et al conclude that education can address the cultural responses of the family and community to the pathophysiology of schizophrenia, such as literacy, stigma, and defensive denial that drive DUP to alarming magnitudes. 'Overall, the TIPS study thus far demonstrates that DUP can be reduced significantly with early detection strategies and systems,' they add.

The study is published in Schizophrenia Research.

Schiz Res 2001; 51: 39–46 [not yet available online]