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

Background and Hypothesis: 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. Study Design: 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). Study 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.