Early intervention a key to early recovery

By Elin Fugelsnes and Else Lie

(Medical Xpress) -- Patients who receive early treatment for their psychoses recover more quickly and become healthier in the long run. Ten years on, twice as many of these patients are leading healthy lives compared with the control group.

Psychoses are considered to be serious “states of confusion” and are characterized by hallucinations, delusions and impaired thinking.

“It is a heavy burden to go untreated for psychosis over a long period. The symptoms severely impact an individual’s quality of life and ability to function day to day,” states Wenche ten Velden Hegelstad, doctoral fellow at Stavanger University Hospital/University of Bergen.

Preliminary examination within 24 hours

Previous research indicates the importance of early intervention in halting the development of symptoms, improving the prognosis for recovery and reducing the risk of suicidal behavior. The reality is, however, that many people continue to suffer from psychotic symptoms for months or even several years before getting help – often because they do not even realize that they are ill.

This was the point of departure for the establishment of the Early intervention in psychosis 1997-2000 study (TIPS), funded under the Research Council of Norway’s Program on Public Health (FOLKEHELSE). The primary objective of the TIPS study was to shorten the period between the appearance of symptoms potentially linked to psychosis and intervention by health personnel.

In 1997, a low-threshold, early detection team oriented toward children and adolescents was established at Stavanger University Hospital. Since that time, extensive information campaigns have been carried out to spread the news about the service.

Anyone who thinks that they or someone they know may be experiencing psychosis can call the team and speak with a psychiatric nurse. If psychosis is suspected, the individual will be given a preliminary examination within 24 hours and further treatment if necessary.

Three out of ten recover in full

“We have demonstrated that it is possible to intervene with patients early and that they also benefit greatly from receiving prompt treatment,” states Dr. Hegelstad.

Before the TIPS study began, half of the individuals suffering from psychosis in the Stavanger region had to wait over 26 weeks before receiving help. After the early detection work began, the wait came down to four weeks.

Three out of ten patients are fully recovered after ten years. That is, they have remained symptom-free for at least six months and function well in their everyday lives. In addition, nearly three out of ten have full-time employment.

Waiting four times longer in Oslo

Control groups comprised patients at Oslo University Hospital and Roskilde Hospital in Denmark. For the control groups, no special initiatives towards achieving earlier intervention were in place.

According to the TIPS study, patients in the control groups had to wait an average of four times longer for intervention than the patients in Stavanger. In addition, only half as many of these patients could be considered recovered after ten years and even fewer had full-time employment.

While the level of symptoms experienced after one, three and five years was more positive for patients in Stavanger than for those in Oslo or Roskilde, this difference disappeared after ten years; the level of symptoms experienced among the control groups was at that point the same as the TIPS patients. Still, the TIPS patients were healthier and functioned more normally.

“It may be that our patients regained stability more quickly and thus had more time to return to a normal life,” says Dr. Hegelstad.

Following in the footsteps of the TIPS study

is becoming more and more common in Norway. In addition, all hospitals are required to register the duration of untreated psychosis and to report it to the Norwegian Directorate of Health.

The effectiveness of the TIPS study remains unique, according to Dr. Hegelstad. She believes that much of the study’s success is due to the information campaigns.

“We were the first to initiate such a massive, widespread campaign and to make the public aware of our service. Our research has proven that this was vital to our success,” Dr. Hegelstad states.

Psychoses

may vary greatly from person to person. An individual suffering more than one psychotic episode may also experience different symptoms.

For many people, the symptoms accompanying psychosis appear and disappear quickly.

Psychosis is often triggered by a dramatic experience or in connection with the consumption of narcotic substances.

The inherent properties of an individual’s brain or certain physical illnesses may also lead to .

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