For a number of reasons treatment delay is one of the most serious deficiencies in the clinical management of schizophrenia and related psychotic disorders. Untreated psychosis is distressing, derails normal development and is associated with behavioral disturbances that may be embarrassing, aggressive or have legal consequences. In addition, duration of untreated psychosis (DUP) has emerged as an independent predictor of likelihood and extent of recovery from an initial first episode and thus may be a potentially modifiable prognostic factor. In 2005, we established the University of North Carolina Outreach and Support Intervention Services (OASIS), one of the first US clinical programs specializing in treatment of a first episode of psychosis. Findings from our local pathways to care study in first episode patients are consistent with the literature, with average delays of 18 months from onset of psychosis to initiation of antipsychotic treatment. Treatment delays in study participants mainly stemmed from a lack of awareness by the patient, persons close to the patient, community clinicians and the legal system that the subjective and behavioral difficulties were due to emerging psychosis. While both the demand- and the supply-sides of the DUP problem need to be addressed, we propose that enhancing community clinicians' awareness and skills in the evaluation of the first psychotic episode is a key step. We propose that a well-designed online continuing education course has the potential to address supply-side deficiencies effectively, with a potential for broad dissemination. We will benchmark DUP and pathways to care in patients referred to the OASIS program to inform online course development, especially to clarify the target audience, and to assess the impact of course participation on DUP for new OASIS referrals. We will develop and determine the effectiveness of the course, Recognizing Psychosis in the Early Stages: A Window of Opportunity, to the development of clinicians' knowledge of the importance of early recognition of psychosis, competence in recognizing warning signs for psychosis and performance of early recognition strategies in clinical practice. Finally, we will determine if course promotion efforts impact the numbers of local community clinicians who take the online course.
Delays in diagnosis and treatment initiation are the rule, not the exception, with psychotic disorders including schizophrenia. Untreated psychosis is associated with violence, suicidal behaviors, derailment of normal development, school and work problems, and serious negative social consequences. In our first episode treatment program, OASIS, we propose to benchmark pathways to care to better determine reasons for treatment delay. We propose to develop an online continuing education course to address common clinical misassumptions about emerging psychosis.
