In this thesis we contrasted several aspects of the impact of delays in the treatment of psychosis with its early detection. We found that a delay in treatment is associated with a worse outcome.
The study reported above concerns new referrals to mental health care in two geographical areas in the Netherlands (Twente and Friesland). We found that in 3.7% of the cases primary psychotic symptoms, like delusions, hallucinations, disorganized speech and grossly disorganized behaviour were documented in the medical files.
But of these only 37% of patients were diagnosed as suffering from a psychotic disorder and subsequently treated. The incidence of these psychotic disorders is about 22 per 100.000 inhabitants which is consistent with the 75th percentile of the cumulative incidence of a large recent meta-analysis.
Psychotic disorders are generally associated with poor outcome. An important factor in this association is the period of untreated psychosis. Early detection teams are aimed to shorten the untreated psychosis in order to achieve better functional outcome. We showed the usefulness of broadening the focus of early detection to negative symptoms. The relationship between duration of untreated psychosis (DUP) and negative symptoms is strong and persistent, even after 8 years of followup, and so far has been underestimated. Negative symptoms are diffi cult to treat and therefore prevention seems the best option of ameliorating the course of psychotic disorders. These negative symptoms are characterized by a decrease or complete loss of the ability to emotionally respond (blunted affect, affective fl attening), a poverty of speech (alogia) and a lack of initiative (avolition, social withdrawal).