Mølstrøm Ida-Marie, Handest Rasmus, Henriksen Mads Gram, Parnas Annick Urfer, Nordgaard Julie
Mental Health Center Amager, Capital Region Psychiatry, Copenhagen, Denmark.
Psychiatry East, Region Zealand, Roskilde, Denmark.
BJPsych Open. 2025 Mar 25;11(2):e65. doi: 10.1192/bjo.2025.19.
Early detection of psychosis is paramount for reducing the duration of untreated psychosis (DUP). One key factor contributing to extended DUP is service delay - the time from initial contact with psychiatric services to diagnosis. Reducing service delay depends on prompt identification of psychosis. Patients with schizophrenia and severe social impairment have been found to have prolonged DUP. Whether service delay significantly contributes to prolonged DUP in this group is unclear.
To examine and compare the course of illness for patients with schizophrenia who are homeless or domiciled, with a focus on service delay in detecting psychosis.
In this case-control study, we included out-patients with a schizophrenia spectrum diagnosis and who were homeless or domiciled but in need of an outreach team to secure continuous treatment. Interviews included psychosocial history and psychopathological and social functioning scales.
We included 85 patients with schizophrenia spectrum disorder. Mean service delay was significantly longer in the homeless group (5.5 years) compared with the domiciled group (2.5 years, = 0.001), with a total sample mean of 3.9 years. Similarly, DUP was significantly longer in the homeless group, mean 15.5 years, versus 5.0 years in the domiciled group ( < 0.001). Furthermore, the homeless group had an earlier onset of illness than the domiciled group but were almost the same age at diagnosis.
Our findings point to the concerning circumstance that individuals with considerable risk of developing severe schizophrenia experience a substantial delay in diagnosis and do not receive timely treatment.
早期发现精神病对于缩短未治疗精神病持续时间（DUP）至关重要。导致DUP延长的一个关键因素是服务延迟——从首次接触精神科服务到确诊的时间。减少服务延迟取决于精神病的及时识别。已发现患有精神分裂症且社会功能严重受损的患者DUP延长。尚不清楚服务延迟是否对该群体中DUP延长有显著影响。
研究并比较无家可归或有家可归的精神分裂症患者的病程，重点关注精神病检测中的服务延迟。
在这项病例对照研究中，我们纳入了诊断为精神分裂症谱系障碍的门诊患者，他们无家可归或有家可归，但需要外展团队来确保持续治疗。访谈包括社会心理病史以及心理病理学和社会功能量表。
我们纳入了85例精神分裂症谱系障碍患者。无家可归组的平均服务延迟（5.5年）显著长于有家可归组（2.5年，P = 0.001），总样本平均为3.9年。同样，无家可归组的DUP显著更长，平均为15.5年，而有家可归组为5.0年（P < 0.001）。此外，无家可归组的发病年龄比有家可归组早，但诊断时年龄几乎相同。
我们的研究结果指出了一个令人担忧的情况，即有发展为严重精神分裂症高风险的个体在诊断上存在显著延迟，且未得到及时治疗。
