Factors contributing to the duration of untreated psychosis.

BACKGROUND: Shortening the duration of untreated psychosis (DUP) - with the aim of improving the prognosis of psychotic disorders - requires an understanding of the causes of treatment delay. Current findings concerning several candidate risk factors of a longer DUP are inconsistent. Our aim was to identify factors contributing to DUP in a large sample that represents the treated prevalence of non-affective psychotic disorders. METHOD: Patients with a non-affective psychotic disorder were recruited from mental health care institutes from 2004 to 2008. Of the 1120 patients enrolled, 852 could be included in the present analysis. Examined candidate factors were gender, educational level, migration status, premorbid adjustment and age at onset of the psychotic disorder. DUP was divided into five ordinal categories: less than one month, one month to three months, three months to six months, six months to twelve months and twelve months and over. An ordinal logistic regression analysis was used to identify the risk factors of a longer DUP. RESULTS: Median DUP was less than one month (IQR 2). The factors migration status (p=0.028), age at onset of the psychotic disorder (p=0.003) and gender (p=0.034) were significantly associated with DUP in our analysis. CONCLUSION: First generation immigrant patients, patients with an early onset of their psychotic disorder and male patients seem at risk of a longer DUP. These findings can assist in designing specific interventions to shorten treatment delay.

Priorities, satisfaction and treatment goals in psychosis patients: an online consumer's survey.

BACKGROUND: An insight into preferences, satisfaction and treatment goals of patients is important for reaching treatment alliance and may increase the success of initiated treatment. METHODS: Participants from the Netherlands,with at least one psychotic episode, were asked to fill in an online questionnaire. Participants ranked their priorities in treatment content, stated whether they were satisfied on these items and ranked a list of treatment goals. RESULTS: 462 respondents ranked their treatment preferences regarding treatment content(mean age: 40.3 years; mean duration of illness: 13.5 years). Items ranked most important: "prompt assistance, preferably in own environment", "attention for medication", "appropriate attitude of the professional caregiver". More than 50 % rated "unsatisfied" or "very unsatisfied" for: "practical help in resocialization", "aid to acquire autonomy" and "help with physical health". 345 participants ranked treatment goals (mean age: 40.4 years; mean duration of illness: 13.7 years). Items ranked most important: "reducing apathy and lack of initiative", "reducing disturbing or unusual experiences", "reducing confusion and concentration problems". CONCLUSION: Psychiatric services should pay great attention to early outpatient intervention with supportive counseling and an appropriate attitude of the caregiver with attention for medication use. Improvement is warranted for practical assistance, help in regaining autonomy and help with physical health.

Association of treatment delay, migration and urbanicity in psychosis.

BACKGROUND: Several factors may contribute to duration of untreated psychosis (DUP): patient-delay, referral-delay and treatment-delay caused by mental health care services (MHS-delay). In order to find the most effective interventions to reduce DUP, it is important to know what factors in these pathways to care contribute to DUP. AIM: To examine the relationship of the constituents of treatment delay, migration status and urbanicity. METHOD: In first episode psychotic patients (n=182) from rural, urban and highly urbanized areas, DUP, migration status and pathways to care were determined. RESULTS: Mean DUP was 53.6 weeks (median 8.9, SD=116.8). Patient-delay was significantly longer for patients from highly urbanized areas and for first generation immigrants. MHS-delay was longer for patients who were treated already by MHS for other diagnoses. CONCLUSIONS: Specific interventions are needed focusing on patients living in highly urbanized areas and first generation immigrants in order to shorten patient delay. MHS should improve early detection of psychosis in patients already in treatment for other diagnosis.

ICD-implantation guidelines versus clinical practice: a prospective study of out-of-hospital cardiac arrest survivors.

AIMS: The aim of this study was prospectively to compare clinical practice of implantable cardioverter defibrillator (ICD) use with current guidelines in out-of-hospital cardiac arrest (OHCA) survivors. METHODS AND RESULTS: From January 2000 till March 2002, 70 consecutive patients (pts) discharged from 15 hospitals after OHCA, with ventricular fibrillation (VF) as initial rhythm were included. Documentation of diagnosis, left ventricular function, ischaemia, electrophysiological studies (EPS), and decisions regarding ICD implantation were obtained from medical records. An expert committee compared these data with current guidelines. According to these guidelines 18 pts (26%) had an ICD indication and received an ICD while 37 pts (53%) had no indication and did not receive an ICD. In 13 pts without acute myocardial infarction insufficient diagnostic procedures were performed to permit a decision on ICD indication, hence no ICD was implanted. Two pts had an ICD indication but did not receive an ICD. During the follow-up with duration of 25 months (range 12-38 months), two sudden deaths occurred in the group of pts without an ICD. Of the pts with an ICD, 4 pts (22%) were reported to have received one or more shocks for VT/VF. CONCLUSION: In at least 21% of OHCA survivors, insufficient diagnostic procedures concerning the indication for ICD implantation were performed or no ICD was implanted when indicated, despite clear guidelines. In particular, there was no proof of ischaemia prior to revascularization and no confirmation of the absence of ischaemia and EPS thereafter. Clinicians should be guided better in evaluating pts after OHCA concerning the indication for ICD implantation, especially when a transient of reversible condition was present or when treatment was sufficiently established safely to refrain from ICD implantation.