Early intervention in first-episode psychosis--the impact of a community development campaign.
OBJECTIVE
Substantial delays in providing access to treatment in first-episode psychosis have been well documented. The present study examines the impact of strategies aimed at improving access and reducing delays.


METHODS
A pilot community education campaign was conducted with the aim of reducing the duration of untreated psychosis (DUP) in a geographically defined intervention sector located in the northwestern region of Melbourne, Australia. Utilising a quasi-experimental design, a comparison sector with similar demographics was selected from another part of the north-western region. A mobile early detection team and the same treatment system served both sectors.


RESULTS
While there was no significant difference between the mean DUP for intervention and comparison sectors, the distributional features of DUP between the two regions were significantly different. In the intervention sector, disproportionately more cases with very long DUP were detected. When a small number of outliers were removed, the mean and median DUP in the intervention sector was reduced.


CONCLUSIONS
These findings highlight the complexity of treatment access and delay and suggest that efforts to reduce DUP may have two effects, not one. Firstly, a different sample of cases is treated through the detection of hidden "long DUP" cases that otherwise may have remained untreated. Secondly, the DUP for the remainder may indeed be reduced. More research with larger samples and more potent campaign strategies is clearly required. It may also be worth considering whether there is a safe and ethical way to undertake a RCT of early versus delayed antipsychotic treatment to perhaps settle the DUP debate once and for all.
Krstev
Helen
H
Early Psychosis Prevention & Intervention Centre, Locked Bag 10, Parkville (Vic) 3052, Australia. hkrstev@unimelb.edu.au
Carbone
Steve
S
Harrigan
Susy M
SM
Curry
Christina
C
Elkins
Kathryn
K
McGorry
Patrick D
PD
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000458:organization & administration*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008952:Mobile Health Units; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000628:therapy*; D014739:Victoria
D014150:Antipsychotic Agents