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DURATION OF UNTREATED PSYCHOSIS AND NEGATIVE SYMPTOMS: HOW DO THEY RELATE?
150
Abstracts
relationship between longer DUP and worse outcome is still unclear and the causality of this relationship has not yet been demonstrated. In DUP-outcome studies most attention has been paid to positive symptoms and related outcome measures, such as relapse rates, time to positive symptom response and positive symptom remission. The relationships of DUP with other outcome domains, such as negative symptoms have not been very well documented yet. In this symposium a meta-analysis will be presented showing an association of DUP and negative symptoms at baseline and throughout 5 years of follow-up. These relationships are of interest in view of the potential harm untreated psychosis might cause to the integrity of brain function. Findings from the London Institute of Psychiatry show that gray matter change is associated with poorer outcome and long exposure to antipsychotics, while DUP did not mediate these longitudinal brain changes. Though long DUP was associated with poor outcome, it was not shown to be related to the rate of secondary degeneration and cortical thinning as the disease progressed. Despite the current wide-spread implementation of early detection programs for first episode psychosis only few studies so far did address the effectiveness of these programs. Is it possible to reduce DUP, and if so, what specific ingredients do the job, and what were the achievements in terms of outcome? The TIPS study from Scandinavia still is the only quasi-experimental study in the field, revealing some unexpected results, while the Birmingham, U.K. experiences with early intervention shed a light on practical obstacles encountered when trying to reduce DUP in an urban area.
doi:10.1016/j.schres.2010.02.140
CHAIRPERSON Lex Wunderink Friesland Mental Health Services OVERALL PANEL PROPOSAL: SPEAKER 1 ABSTRACT: SPEAKER 2 ABSTRACT: SPEAKER 3 ABSTRACT: SPEAKER 4 ABSTRACT: REDUCING DUP IN A LARGE URBAN, MULTI-CULTURAL CITY: WHY WE NEED TO USE AND UNDERSTAND DATA ON PATHWAYS TO CARE Max Birchwood1, Paul Patterson2, Swaran Singh3, Charlotte Connor2, Linda McCarthy2, Helen Lester4 1 University of Birmingham, Birmingham, UK; 2Birmingham Early Intervention service & University of Birmingham; 3Birmingham Early Intervention service & University of Warwick, UK; 4Dept. Primary Care, University of Manchester, UK Birmingham is the UK's second largest city (pop 1.2M) and in a few years time will be populated by an ethnic majority. In spite of well developed secondary care early intervention services for first episode psychosis, DUP remains stubbornly high. In this paper we present data on DUP from over the last 2.5 years (N ∼ 350) and how these are systematically linked to different ethnic groups and geographical areas of the city. The Birmingham 'DUP problem' is essentially a problem of outliers (> 1 year DUP) and these are again over-represented in some ethnic groups , particularly the Muslim community, whose pathway to care nearly always involves the Mosques. I will also present data from a qualitative study of the construction of psychotic presentations by the Imams and other Muslim elders and how these may be linked to delays. Our NIHR 'CLAHRC' and 'ENRICH' projects will be described which aim to
reduce DUP through a focused approach to care pathways and engaging directly with Birmingham's cultural diversity. doi:10.1016/j.schres.2010.02.141
DURATION OF UNTREATED PSYCHOSIS AND NEGATIVE SYMPTOMS: HOW DO THEY RELATE? Nynke Boonstra1,2, Lex Wunderink2, Rianne Klaassen1, Sjoerd Sytema1, Durk Wiersma1 1 GGZ Friesland, Leeuwarden, Friesland, Netherlands; 2University Medical Center Groningen, Groningen, Netherlands Negative symptoms are at the core of the schizophrenia syndrome. They have been referred to as primary or deficit symptoms and they are related to poor functional outcome The association between duration of untreated psychosis (DUP) and poor outcome is overwhelming. In recent meta-analyses, DUP emerged as an independent predictor of the degree of recovery from an initial episode of psychosis, independent of potential confounders. However the causality of the association between DUP and poor outcome has not been proven: a later start of treatment might merely be a marker of other factors that contribute to poor outcome. So far both research and clinical programs mainly focus on the relationship between DUP and positive symptoms: early detection and intervention of psychosis, aiming at reducing the DUP, are focused on early positive symptoms and their precursors. Positive psychotic symptoms are easier to recognize and antipsychotic treatment is directed to reduce positive symptoms. Few studies report on the relationship between negative symptoms and DUP. It is unclear how strong this relationship is and whether there is a longitudinal relationship between positive and negative symptoms. If positive symptoms are causally related to negative symptoms then short DUP and better course of positive symptoms will be correlated with better course and outcome of negative symptoms. We conducted a meta-analysis on studies of first episode psychosis published after December1992. We included all studies that quantitatively assessed DUP, and assessed positive as well as negative psychotic symptoms by either PANSS, SAPS & SANS or BPRS at baseline and at least one follow-up assessment at 6 months or later. We included 29 studies from different countries. The main findings of this study are; 1)Long DUP is associated with more severe positive and negative symptoms throughout follow-up 2) There is no DUP x time interaction; the initial drawback of long DUP is still present at 96 months. These findings might indicate that early detection programs should not exclusively focus on the detection of positive psychotic symptoms but also on the presence of negative symptoms. The predictive value of rating these symptoms at an early stage, concurrent with positive symptoms, would have to be established, to determine the possibility of shifting the focus of early intervention teams from positive symptoms only to emerging negative symptoms as well. doi:10.1016/j.schres.2010.02.142
BRAIN CHANGES FOLLOWING THE FIRST PSYCHOTIC EPISODE: THE ROLE OF TREATMENT Paola Dazzan, S. Reinders, K. Morgan, C. Morgan, G. Hutchison, P. Fearon, P.K. McGuire, P.B. Jones, R.M. Murray, J. Lappin Kings College London Institute of Psychiatry, London, UK It remains unclear at what stage brain anatomical changes occur following the first episode of psychosis, and whether they are associated with poorer clinical and functional outcome. Furthermore, the role of
Abstracts
relationship between longer DUP and worse outcome is still unclear and the causality of this relationship has not yet been demonstrated. In DUP-outcome studies most attention has been paid to positive symptoms and related outcome measures, such as relapse rates, time to positive symptom response and positive symptom remission. The relationships of DUP with other outcome domains, such as negative symptoms have not been very well documented yet. In this symposium a meta-analysis will be presented showing an association of DUP and negative symptoms at baseline and throughout 5 years of follow-up. These relationships are of interest in view of the potential harm untreated psychosis might cause to the integrity of brain function. Findings from the London Institute of Psychiatry show that gray matter change is associated with poorer outcome and long exposure to antipsychotics, while DUP did not mediate these longitudinal brain changes. Though long DUP was associated with poor outcome, it was not shown to be related to the rate of secondary degeneration and cortical thinning as the disease progressed. Despite the current wide-spread implementation of early detection programs for first episode psychosis only few studies so far did address the effectiveness of these programs. Is it possible to reduce DUP, and if so, what specific ingredients do the job, and what were the achievements in terms of outcome? The TIPS study from Scandinavia still is the only quasi-experimental study in the field, revealing some unexpected results, while the Birmingham, U.K. experiences with early intervention shed a light on practical obstacles encountered when trying to reduce DUP in an urban area.
doi:10.1016/j.schres.2010.02.140
CHAIRPERSON Lex Wunderink Friesland Mental Health Services OVERALL PANEL PROPOSAL: SPEAKER 1 ABSTRACT: SPEAKER 2 ABSTRACT: SPEAKER 3 ABSTRACT: SPEAKER 4 ABSTRACT: REDUCING DUP IN A LARGE URBAN, MULTI-CULTURAL CITY: WHY WE NEED TO USE AND UNDERSTAND DATA ON PATHWAYS TO CARE Max Birchwood1, Paul Patterson2, Swaran Singh3, Charlotte Connor2, Linda McCarthy2, Helen Lester4 1 University of Birmingham, Birmingham, UK; 2Birmingham Early Intervention service & University of Birmingham; 3Birmingham Early Intervention service & University of Warwick, UK; 4Dept. Primary Care, University of Manchester, UK Birmingham is the UK's second largest city (pop 1.2M) and in a few years time will be populated by an ethnic majority. In spite of well developed secondary care early intervention services for first episode psychosis, DUP remains stubbornly high. In this paper we present data on DUP from over the last 2.5 years (N ∼ 350) and how these are systematically linked to different ethnic groups and geographical areas of the city. The Birmingham 'DUP problem' is essentially a problem of outliers (> 1 year DUP) and these are again over-represented in some ethnic groups , particularly the Muslim community, whose pathway to care nearly always involves the Mosques. I will also present data from a qualitative study of the construction of psychotic presentations by the Imams and other Muslim elders and how these may be linked to delays. Our NIHR 'CLAHRC' and 'ENRICH' projects will be described which aim to
reduce DUP through a focused approach to care pathways and engaging directly with Birmingham's cultural diversity. doi:10.1016/j.schres.2010.02.141
DURATION OF UNTREATED PSYCHOSIS AND NEGATIVE SYMPTOMS: HOW DO THEY RELATE? Nynke Boonstra1,2, Lex Wunderink2, Rianne Klaassen1, Sjoerd Sytema1, Durk Wiersma1 1 GGZ Friesland, Leeuwarden, Friesland, Netherlands; 2University Medical Center Groningen, Groningen, Netherlands Negative symptoms are at the core of the schizophrenia syndrome. They have been referred to as primary or deficit symptoms and they are related to poor functional outcome The association between duration of untreated psychosis (DUP) and poor outcome is overwhelming. In recent meta-analyses, DUP emerged as an independent predictor of the degree of recovery from an initial episode of psychosis, independent of potential confounders. However the causality of the association between DUP and poor outcome has not been proven: a later start of treatment might merely be a marker of other factors that contribute to poor outcome. So far both research and clinical programs mainly focus on the relationship between DUP and positive symptoms: early detection and intervention of psychosis, aiming at reducing the DUP, are focused on early positive symptoms and their precursors. Positive psychotic symptoms are easier to recognize and antipsychotic treatment is directed to reduce positive symptoms. Few studies report on the relationship between negative symptoms and DUP. It is unclear how strong this relationship is and whether there is a longitudinal relationship between positive and negative symptoms. If positive symptoms are causally related to negative symptoms then short DUP and better course of positive symptoms will be correlated with better course and outcome of negative symptoms. We conducted a meta-analysis on studies of first episode psychosis published after December1992. We included all studies that quantitatively assessed DUP, and assessed positive as well as negative psychotic symptoms by either PANSS, SAPS & SANS or BPRS at baseline and at least one follow-up assessment at 6 months or later. We included 29 studies from different countries. The main findings of this study are; 1)Long DUP is associated with more severe positive and negative symptoms throughout follow-up 2) There is no DUP x time interaction; the initial drawback of long DUP is still present at 96 months. These findings might indicate that early detection programs should not exclusively focus on the detection of positive psychotic symptoms but also on the presence of negative symptoms. The predictive value of rating these symptoms at an early stage, concurrent with positive symptoms, would have to be established, to determine the possibility of shifting the focus of early intervention teams from positive symptoms only to emerging negative symptoms as well. doi:10.1016/j.schres.2010.02.142
BRAIN CHANGES FOLLOWING THE FIRST PSYCHOTIC EPISODE: THE ROLE OF TREATMENT Paola Dazzan, S. Reinders, K. Morgan, C. Morgan, G. Hutchison, P. Fearon, P.K. McGuire, P.B. Jones, R.M. Murray, J. Lappin Kings College London Institute of Psychiatry, London, UK It remains unclear at what stage brain anatomical changes occur following the first episode of psychosis, and whether they are associated with poorer clinical and functional outcome. Furthermore, the role of