title: A controlled evaluation of a targeted early case detection intervention for reducing delay in treatment of first episode psychosis.
abstract: OBJECTIVE
  Interventions aimed at influencing specific pathways to care may reduce the duration of untreated psychosis (DUP). The purpose of this study was to reduce delay in referral to an early intervention service following first contact for help seeking for psychosis in a defined urban catchment area.
  
  
  METHODS
  Using a historical control design, we conducted a targeted intervention comprised of intensive training and education regarding first onset of psychosis and benefits of early intervention with all potential points of contact in pathways to care in a defined catchment area of a specialized early intervention (EI) service. Data collected on different components of DUP [help seeking (H-DUP) and referral (R-DUP)] and demographic and clinical characteristics on patients seeking treatment of first episode of a psychotic (FEP) disorder accepted in the EI service for 3 years before and 3 years after the intervention were contrasted. No other systemic changes occurred in this catchment area during this period.
  
  
  RESULTS
  There was a significant increase in the number of cases of FEP referred to the EI service post-intervention from hospitals other than the parent institute, in the proportion with a diagnosis of affective psychosis and proportion of patients from a lower socioeconomic status (SES). Although largest proportion of patients continued to make their first contact with community services, the latter failed to refer cases of psychosis to the EI service despite making a large number of mostly non-cases (for psychosis). The intervention had no direct effect on total DUP, R-DUP or H-DUP. After controlling for diagnosis and SES, post-intervention, R-DUP remained significantly lower for patients making first contact with the emergency service of the parent institute.
  
  
  CONCLUSIONS
  The intervention failed to reduce R-DUP for patients making contact with or referred from community services and most patients still used hospital resources to enter treatment at the EI service.
authors.affiliation: McGill University, Douglas Mental Health University Institute, Prevention and Early Intervention Program for Psychoses (Montreal), 6875 Boul Lasalle, Verdun, QC, H4H 1R2, Canada, ashok.malla@mcgill.ca.
authors.forename: Ashok
authors.initials: A
authors.lastname: Malla
authors.forename: Gerald
authors.initials: G
authors.lastname: Jordan
authors.forename: Ridha
authors.initials: R
authors.lastname: Joober
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Ross
authors.initials: R
authors.lastname: Norman
authors.forename: Thomas
authors.initials: T
authors.lastname: Brown
authors.forename: Karen
authors.initials: K
authors.lastname: Goldberg
authors.forename: Heleen
authors.initials: H
authors.lastname: Loohuis
authors.forename: Nadia
authors.initials: N
authors.lastname: Vracotas
authors.forename: Joseph
authors.initials: J
authors.lastname: Rochford
mesh_terms: D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D012017:Referral and Consultation; D013997:Time Factors; D061665:Time-to-Treatment; D055815:Young Adult