Enhancing Coordinated Specialty Care Through Early Detection: Impact of Reduced Duration of Untreated Psychosis.

Objective: Early intervention can improve outcomes for individuals with first-episode psychosis (FEP). We hypothesized that an early detection campaign (ED) targeting the duration of untreated psychosis (DUP) can significantly improve functional outcomes in coordinated specialty care (CSC) patients.

Methods: Functional outcomes were compared for FEP patients enrolled from 2014 to 2019 in 2 CSCs: Specialized treatment early in psychosis (STEP), which implemented a 4-year ED campaign, and the prevention and recovery in early psychosis (PREP) clinic, which maintained usual detection practices. The relationship between DUP-Total (time from psychosis onset to CSC enrollment) with global assessment of functioning (GAF) and quality of life (QoL) scores at 6 and 12 months was assessed. Mediation analyses explored the contributions of DUP-Demand (time from psychosis onset to the first use of antipsychotic medication) and DUP-Supply (time from the first use of antipsychotic medication to CSC enrollment).

Results: Shorter DUP-total was associated with higher GAF and QoL scores, particularly at 6 months. STEP patients showed significantly greater improvements in GAF (12.2 points higher at 6 months, P < .0001) and QoL (6.8 points higher at 6 months, P = .03) compared to PREP. Mediation analyses revealed that DUP-Supply, rather than DUP-Demand, was the primary driver of these improvements at 6 months, explaining 36% of the QoL difference between clinics.

Conclusions: Shorter DUP accelerates functional recovery, particularly in the first 6 months of CSC. Reducing DUP-Supply is critical for maximizing the benefits of early intervention. Streamlined referral and intake processes should be prioritized to enhance recovery outcomes.