Maria Ferrara1,2, Sinan Guloksuz3,4, Walter S Mathis3,5, Fangyong Li6, I-Hsin Lin6, Sumaiyah Syed3,5, Keith Gallagher3,5, Jai Shah7,8, Emily Kline9, Cenk Tek3, Matcheri Keshavan9, Vinod H Srihari3,5. 1. Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA. maria.ferrara@yale.edu. 2. Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. maria.ferrara@yale.edu. 3. Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA. 4. Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, Maastricht, The Netherlands. 5. Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA. 6. Center for Science and Social Science Information, YCAS Yale University, PO Box 208111, New Haven, CT, 06520, USA. 7. PEPP-Montreal, Douglas Mental Health University Institute, Montreal, Canada. 8. Department of Psychiatry, McGill University, Montreal, Canada. 9. Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Abstract
PURPOSE: Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care. METHODS: Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview. RESULTS: Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups. CONCLUSION: Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.
PURPOSE: Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care. METHODS: Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview. RESULTS: Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups. CONCLUSION: Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.
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