The Tips Project

A Systematized Program to Reduce Duration of Untreated Psychosis in First Episode Schizophrenia
  • Jan Olav Johannessen
  • Tor Ketil Larsen
  • Marthe Horneland
  • Inge Joa
  • Sigurd Mardal
  • Rune Kvebæk
  • Svein Friis
  • Ingrid Melle
  • Stein Opjordsmoen
  • Erik Simonsen
  • Per Vaglum
  • Thomas H. McGlashan
Part of the NATO Science Series book series (ASID, volume 91)


Schizophrenia is the single most costly disorder between as well the serious psychiatric disorders as for the larger somatic diseases as cancer, vascular diseases (1, 2, 3). In all NATO countries combined, the costs connected with this disorder are estimated at over 1% of the gross national budget (4). While the worldwide rate of new cases (incidence) is low (1 per 10000 per year) (5), the disorder’s lifetime prevalence is high because the disorder often results in chronic deficits in mental functioning. The suffering connected to the schizophrenia spectrum disorders for the affected individuals and their families is enormous and beyond measurement. Although contemporary treatments as neuroleptic medication, family psychoeducation and assertive continuity of care has demonstrated efficacy in clinical trials (6), these treatments are essentially palliative and must apparently be provided indefinitely because discontinuation leads to clinical deterioration in almost every case. Schizophrenia and related psychotic disorders can be seen as disorders developing through different stages or phases. Sullivan (7) wrote that the psychiatrist sees too many end states and deals professionally with too few of the prepsychotic. Kraepelin stated that if no essential improvement intervenes, in at most two or three years after the appearance of the more striking morbid phenomena, a state of weakmindedness will be developed which usually changes only slowly and insignificantly (8). One model for illustrating these different phases is outlined in figure 1.


Information Campaign Prodromal Symptom Untreated Psychosis Episode Schizophrenia Schizophrenia Bulletin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rishovd Rund, B. (1994) Schizophrenia, how much do we use on treatment and research? Journal for the Norwegian Medical Association 21, 2682–2683.Google Scholar
  2. 2.
    Fog, R. Schizophrenia research. (1996) Journal of the Danish Medical Association 158/30, 4269.Google Scholar
  3. 3.
    Andreasen, N.C. (1991) Assessment issues and the cost of schizophrenia. Schizophrenia Bulletin 17, 475–481.PubMedCrossRefGoogle Scholar
  4. 4.
    Mednick, S., McGlashan, T. (1996) Early detection and intervention with psychosis: Opportunities forpreventing chronicity. NATO International Scientific Exchange Programmes, Advanced study institute, 1–10.Google Scholar
  5. 5.
    McGlashan T.H. (1998) Early detection and intervention schizophrenia: rationale and research British Journal of Psychiatry 172 (suppl. 33) 3–6.Google Scholar
  6. 6.
    Lehman, A.F., Carpenter, W.T., Jr, Goldman, H.H., and Steinwachs, D.M. (1995) Treatment outcomes in schizophrenia: Implications for practice, policy, and research. Schizophrenia Bulletin, 21 (4), 669–675.PubMedCrossRefGoogle Scholar
  7. 7.
    Sullivan, H.S. (1994) The onset of schizophrenia [1927] American Journal of Psychiatry, 151 (Suppl. 6), 135–139.Google Scholar
  8. 8.
    Kraepelin, E. (1971) Dementia Praecox and Paraphrenia [1919], Robert E. Krieger Publishing Company New York, NY.Google Scholar
  9. 9.
    Keshavan, S., Schooler, N.R. (1992) First-Episode Studies in Schizophrenia: Criteria and Characterization. Schizophrenia Bulletin 18, 491–513.CrossRefGoogle Scholar
  10. 10.
    McGlashan, T.H., Johannessen, J.O. (1996) Early Detection and Intervention With Schizophrenia: Rationale. Schizophrenia Bulletin 22 (2), 201–222.PubMedCrossRefGoogle Scholar
  11. 11.
    Wyatt, R.J. (1991) Neuroleptics and the natural course of schizophrenia. Schizophrenia Bulletin 17, 325–351.PubMedCrossRefGoogle Scholar
  12. 12.
    Wyatt, R.J., Green, M.F. (1995) Early treatment improves the outcome of schizophrenia. Abstract, Symposium no. 98D, American Psychiatric Association.Google Scholar
  13. 13.
    Huber, G., Gross, G., and Schuttler, R. (1979) Schizophrenie. Monographien aus dem Gesamtgebiete der Psychiatrie. Springer Verlag, Berlin, Germany.Google Scholar
  14. 14.
    Opjordsmoen, S. (1991) Long-term clinical outcome of schizophrenia with special reference to gender differences. Acta Psychiatr Scand 83, 307–313.PubMedCrossRefGoogle Scholar
  15. 15.
    Lo, W.H., and Lo, T. (1977) A ten-year follow-up study of Chinese schizophrenics in Hong Kong. British Journal of Psychiatry, 131, 63–66.PubMedCrossRefGoogle Scholar
  16. 16.
    Helgason, L. (1990) Twenty years’ follow-up of first psychiatric presentation for schizophrenia: what could have been prevented? Acta Psychiatr Scand 81: 231–235.PubMedCrossRefGoogle Scholar
  17. 17.
    Inoue, K., Nakajima, T., and Kato, N. (1986) A longitudinal study of schizophrenia in adolescence: I. the one to three year outcome. Japanese Journal of Psychiatry and Neurology, 40, 143–151.PubMedGoogle Scholar
  18. 18.
    Birchwood, M., Cocharne, et al. (1992) The influence of ethnicity and family structure on relapse in first-episode schizophrenia: A comparison of Asian, Afro-Caribbean, and White patients. British Journal of Psychiatry, 161, 783–790.PubMedCrossRefGoogle Scholar
  19. 19.
    Haas, G.L., Sweeney, J.A. (1992) Premorbid and onset features of first episode schizophrenia. Schizophrenia Bulletin 18, 373–386.PubMedCrossRefGoogle Scholar
  20. 20.
    Moscarelli, M. (1994) Health and economic evaluation in schizophrenia: implications for health policies. Acta Psychiatr Scand 84 (suppl. 382), 84–88.CrossRefGoogle Scholar
  21. 21.
    Johnstone, E.C., Crow, T.J., Johnson, A.L., and MacMillan, J.F. (1986) The Northwick Park Study of first-episode schizophrenia: I. Presentation of the illness and problems relating to admission. British Journal of Psychiatry, 148, 115–120.PubMedCrossRefGoogle Scholar
  22. 22.
    Crow, T.J., MacMillan, J.F., Johnson, A.L., and Johnstone, E.C. (1986) A randomised controlled trial of prophylactic neuroleptic treatment. British Journal of Psychiatry 148, 120–127.PubMedCrossRefGoogle Scholar
  23. 23.
    Rabiner, C.J., Wegner, J.T., and Kane, J.M. (1986) Outcome study of first episode psychosis: I. Relapse rates after 1 year. American Journal of Psychiatry, 143 (9), 1155–1158.PubMedGoogle Scholar
  24. 24.
    Spitzer, R.L., Endicott, J., and Robins, E. (1978a) Research Diagnostic Criteria; Rationale and reliability. Archives of General Psychiatry, 35, 773–782.CrossRefGoogle Scholar
  25. 25.
    Loebel, A.D.; Lieberman, J.A.; Alvir, J.M.J., et al. (1992) Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry 149, 1183–1188.PubMedGoogle Scholar
  26. 26.
    Ha efner, H.; Maurer, K.; Loeffler, W., et al. (1996) The influence of age and sex on the onset of the early course of schizophrenia. British Journal of Psychiatry 80–86.Google Scholar
  27. 27.
    Beiser, M.; Erickson, D.; Fleming, A.E.J., et al. (1993) Establishing the onset of Psychotic illness. Am J Psychiatry 150, 1349–1354.PubMedGoogle Scholar
  28. 28.
    American Psychiatric Association DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders. 3rd ed., revised. Washington DC: The Association, 1987 166Google Scholar
  29. 29.
    Larsen, T.K.; McGlashan, T.H.; Johannessen, J.O., et al. (1996) First-episode Schizophrenia: II Premorbid patterns by Gender. Schizophrenia Bulletin 22, 241–256.PubMedCrossRefGoogle Scholar
  30. 30.
    Lieberman, J.; Koreen, A.R.; Geisler, S.H., et al. (1996) The psychobiology of first-episode psychosis. Abstract book, First international Conference on Strategies for Prevention in Early Psychosis, p. 15.Google Scholar
  31. 31.
    McGorry, P. (1998) Preventive strategies in early prognosis: Verging on reality. British Journal of Psychiatry 172 (suppl. 33) 1–2.Google Scholar
  32. 32.
    Falloon, J.R.H., Coverdale, J.H. et al. (1998) Early intervention for schizophrenic disorders: Implementing optimal strategies in routine clinical services. British Journal of Psychiatry 172 (suppl. 33), 33–38.Google Scholar
  33. 33.
    Falloon, I.R.H. (1992) Early intervention for first episode of schizophrenia: A preliminary exploration. Psychiatry 55, 4–14.PubMedGoogle Scholar
  34. 34.
    Larsen T.K., Opjordsmoen, S. (1996) Early Identification and Treatment of Schizophrenia: Conceptual and Ethical Considerations. Psychiatry 59, 371–379.PubMedGoogle Scholar
  35. 35.
    McGorry, P.D.; Edwards J; Mihalopoulos C; Harrigan, S.M and Jackson, H.J. (1996) Eppic. An evolving system of Early Detection and Optimal Management. Schizophrenia Bulletin 22, 305–326PubMedCrossRefGoogle Scholar
  36. 36.
    Lincoln C., Harrigan S., McGorry P.D. (1998) Understanding the topography of the early psychosis pathway: An opportunity to reduce delays in treatment. British Journal of Psychiatry 172 (suppl. 33), 21–25Google Scholar
  37. 37.
    Olin, S.S., Mednick, S. (1996) Identifying Vulnerable Populations Premorbidly. Schizophrenia Bulletin 22, 223–240PubMedCrossRefGoogle Scholar
  38. 38.
    Larsen, T.K., Johannessen, J.O., Opjordsmoen, S. (1998) First-episode schizophrenia with long duration of untreated psychosis: Pathways to care. British Journal of Psychiatry 172 (suppl. 33), 45–52Google Scholar
  39. 39.
    Edwards, J.; Shona, M.F.; McGorry, P., et al. (1994) Early psychosis prevention and intervention: Evolution of a comprehensive community-based specialised service. Behaviour change 11, 223–233.Google Scholar
  40. 40.
    Johannessen, J.O., Larsen, T.K., McGlashan, T.H. (1999) Duration of Untreated Psychosis (DUP): An Important target for Intervention in Schizophrenia? Nord Psych Journal 53, 275–283CrossRefGoogle Scholar
  41. 41.
    Johannessen, J.O. (1985) The epidemiology of Schizophrenia in a Norwegian county. Nordic Journal of Psychiatry, 217–223Google Scholar
  42. 42.
    McGlashan, T.H. (1996) Early Detection and Intervention in Schizophrenia: Research. Schizophrenia Bulletin 22, 327–346PubMedCrossRefGoogle Scholar
  43. 43.
    Lehman A.F., Steinwacks D.M. (1998) Translating Research Into Practice: The Schizophrenia Patient Outcome Research Team (PORT) Treatment Recommendations. Schizophrenia Bulletin 24 (1), 1–10.PubMedCrossRefGoogle Scholar
  44. 44.
    McFarlane W., Deakins M.D. et aI. (1994) Multiple-Family Psychoeducational Group Treatment Manual. New York State Psychiatric Institute.Google Scholar
  45. 45.
    Kay, S.R.; Fiszbein, A.; Opler, L.A. (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13(2), 261–269.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Jan Olav Johannessen
  • Tor Ketil Larsen
  • Marthe Horneland
  • Inge Joa
  • Sigurd Mardal
  • Rune Kvebæk
  • Svein Friis
  • Ingrid Melle
  • Stein Opjordsmoen
  • Erik Simonsen
  • Per Vaglum
  • Thomas H. McGlashan

There are no affiliations available

Personalised recommendations