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October 3, 2004
Delay in Intensive Psychosocial Treatment
Anti-Stigma
We have heard and read a great deal about DUP (duration of untreated psychosis) as a delay in treatment with atypical antipsychotic agents. DUP was observed to be associated with an unfavorable course of schizophrenia. However, DIPT (delay in intensive psychosocial treatment) may also have a significant bearing on course and outcome of schizophrenia. Lieuwe de Haan et al (2003) compared delay in intensive psychosocial treatment with delay in treatment with antipsychotic agents (“Duration of untreated psychosis and outcome of schizophrenia: delay in intensive psychosocial treatment versus delay in treatment with antipsychotic medication” in Schizophrenia Bulletin 29 (2) 2003; 341-348). They studied 88 consecutively admitted patients with early-onset schizophrenia across several outcome domains 6 years after onset. Both DUP and DIPT were found to be associated with negative symptoms at outcome. DUP was associated with mild psychotic relapse, while DIPT was associated with months of rehospitalization. When the researchers controlled for age at onset, gender, and duration of treated first psychotic episode, only DIPT was associated with negative symptoms at outcome. De Haan et al concluded that DIPT (delay in intensive psychosocial treatment) may be a more important predictor of negative symptoms at outcome than delay in starting antipsychotic medication alone.
A separate brief message:
As part of their anti-stigma campaign, “Changing Minds,” the Royal College of Psychiatrists, have recently published a volume Every Family in the Land: Understanding Prejudice and Discrimination Against People with Mental Illness (Revised edition) edited by Arthur Crisp in 2004 for the Royal Society of Medicine Press. It includes chapters on people’s perceptions of the mentally ill (Kay Redfield Jamison has a piece on her experience with bipolar disorder in this section), the relation between stigma and models of psychopathology, the origins and history of stigma of the mentally ill, creativity and spirituality b in mental disorder, strategies to counteract stigma, the law and mental illness, etc. I use this volume with my graduate students-it is quite a valuable resource for researchers and clinicians working with persons diagnosed with a severe mental illness. It helps one examine one’s own deeper thoughts/feelings on this topic. I highly recommend it.
Brian Koehler
New York University
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