title: Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients.
abstract: OBJECTIVE
  Prevention of psychosis requires both presence of clinical high risk (CHR) criteria and early help-seeking. Previous retrospective studies of the duration of untreated illness (i.e. prodrome plus psychosis) did not distinguish between prodromal states with and without CHR symptoms. Therefore, we examined the occurrence of CHR symptoms and first help-seeking, thereby considering effects of age at illness-onset.
  
  
  METHODS
  Adult patients first admitted for psychosis (n = 126) were retrospectively assessed for early course of illness and characteristics of first help-seeking.
  
  
  RESULTS
  One-hundred and nine patients reported a prodrome, 58 with CHR symptoms. In patients with an early illness-onset before age 18 (n = 45), duration of both illness and psychosis were elongated, and CHR symptoms more frequent (68.9 vs. 33.3 %) compared to those with adult illness-onset. Only 29 patients reported help-seeking in the prodrome; this was mainly self-initiated, especially in patients with an early illness-onset. After the onset of first psychotic symptoms, help-seeking was mainly initiated by others. State- and age-independently, mental health professionals were the main first point-of-call (54.0 %).
  
  
  CONCLUSIONS
  Adult first-admission psychosis patients with an early, insidious onset of symptoms before age 18 were more likely to recall CHR symptoms as part of their prodrome. According to current psychosis-risk criteria, these CHR symptoms, in principle, would have allowed the early detection of psychosis. Furthermore, compared to patients with an adult illness-onset, patients with an early illness-onset were also more likely to seek help on their own account. Thus, future awareness strategies to improve CHR detection might be primarily related to young persons and self-perceived subtle symptoms.
authors.affiliation: University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland. frauke.schultze-lutter@kjp.unibe.ch.
authors.forename: Frauke
authors.initials: F
authors.lastname: Schultze-Lutter
authors.affiliation: University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Rahman
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ruhrmann
authors.affiliation: University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland.
authors.forename: Chantal
authors.initials: C
authors.lastname: Michel
authors.affiliation: University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland.
authors.forename: Benno G
authors.initials: BG
authors.lastname: Schimmelmann
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
mesh_terms: D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D055815:Young Adult
keywords: Child and adolescent psychiatry; Early intervention; First episode; Health behaviour; Psychoses