title: Treatment delay and pathways to care in early psychosis.
abstract: OBJECTIVE
  To examine the treatment delay associated with community and inpatient pathways into care for persons experiencing a first episode of psychosis.
  
  
  METHODS
  A total of 104 clients entering a specialized early psychosis intervention (EPI) program and their family members were assessed for help-seeking behaviours, psychiatric symptoms, level of functioning and duration of untreated psychosis (DUP).
  
  
  RESULTS
  DUP (median = 30.5 weeks) was associated with younger age of onset, poorer engagement with the EPI program and more severe symptoms. Almost one-third of clients had four or more contacts before receiving antipsychotic medication or entering the EPI program and one in five received interventions not specifically indicated for psychosis. Referrals directly involving family members accounted for about 81% of hospital-initiated treatment (39% of all referrals) and 46% of community-initiated treatment (61% of all referrals). Community entry was associated with longer DUP, more time-seeking treatment, younger age of onset, younger age at referral, greater likelihood of receiving other medication or counselling before receiving antipsychotic medication, schizophrenia, less severe symptoms and less substance use in the previous year. Those with schizophrenia showed no differences across pathway type for time-seeking treatment, being provided interventions not specifically indicated for psychosis after onset or rates of substance use.
  
  
  CONCLUSIONS
  Treatment delay and the provision of interventions not specifically indicated for psychosis may be increased in first-episode populations who are younger and have less severe symptoms. Improving literacy about early psychosis in both professionals and families merits greater attention.
authors.affiliation: Early Psychosis Intervention Program, c/o Peace Arch Hospital, White Rock, British Columbia, Canada.
authors.forename: Tom S
authors.initials: TS
authors.lastname: Ehmann
authors.forename: Karen A
authors.initials: KA
authors.lastname: Tee
authors.forename: G W
authors.initials: GW
authors.lastname: MacEwan
authors.forename: Kacey L
authors.initials: KL
authors.lastname: Dalzell
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hanson
authors.forename: Geoff N
authors.initials: GN
authors.lastname: Smith
authors.forename: Lili C
authors.initials: LC
authors.lastname: Kopala
authors.forename: William G
authors.initials: WG
authors.lastname: Honer
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001955:British Columbia / Q000453:epidemiology; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000628:therapy*; D012017:Referral and Consultation; D012559:Schizophrenia / Q000453:epidemiology* / Q000628:therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D061665:Time-to-Treatment; D055815:Young Adult
keywords: duration of untreated psychosis; pathways to psychiatric care; psychosis; schizophrenia; service delivery