JAN OLAV JOHANNESSEN
University of Stavanger / Stavanger University Hospital, Department of Psychiatry, Stavanger, Norway
The early Treatment and Intervention in Psychosis (TIPS-I) project was a prospective clinical trial designed to examine whether it was possible within a sectorized catchment area to reduce the duration of untreated psychosis (DUP), and whether earlier treatment in first-episode psychosis would improve the course of the disorder.
The study involved three sites: Rogaland county, Norway (370,000 inhabitants), Ullevål sector, Oslo, Norway (190,000) and Roskilde county, Denmark (100,000). The patients are treated with the same psycho-social and medical protocol across all three sites. The inclusion period was 1997–2000, with a 10-year follow-up period.
An extensive education and information system has been carried out in Rogaland, while Ullevål and Roskilde are control sectors that rely on existing detection and referral systems for first-episode cases. Details are provided in Johannessen et al. (2001b) and Larsen et al. (2001).
The average DUP in Rogaland was reduced from 114 in 1993-94 to 26 weeks in 1997-2000. The earlier detected patients were younger and had better premorbid adjustment, less severe psychosis, with more frequent drug abuse. (This latter characteristic probably reflects developments regarding drug abuse in the area). The TIPS study has concluded that it is possible in a quasi- experimentally study to reduce DUP and compared its effect on outcome (Larsen et al 2001, Melle et al 2004, Larsen et al 2006, Melle et al 2006). At two-year follow-up , early detection had a positive effect on course of symptoms and functioning, especially negative symptoms (Melle et al. 2006). At 5 year follow up three-quarters of patients were in remission (Larsen et al. 2008; Melle et al. 2009). The early-detection group had better outcomes for negative, cognitive and depressive components on the PANSS-scale. Patients from the early-detection sector had more regular contact with friends; i.e. 57% vs 36% saw friends at least monthly. The TIPS study showed that the combined use of Detection Teams and Information Campaigns was successful in bringing FEP patients early into treatment (Joa, Johannessen et al. 2008).
At the 10- year follow- up, the groups no longer differed on most of the symptom dimensions, but significantly more patients from the early-detection sectors (4,5 weeks median DUP vs 16 weeks in the comparison sectors) were fully recovered.