Adolescents with psychosis face long treatment delays

Sep 20 2013

By Lucy Piper, Senior medwireNews Reporter

Adolescents have a duration of untreated psychosis (DUP) that is approximately twice that seen in adults, UK study findings show.

Factors associated with this long DUP include White ethnicity, younger age of onset, and lifetime cannabis use.

Indeed, the median DUP for White adolescents far exceeded the UK Department of Health’s target of less than 3 months.

White adolescents also had the highest rate of cannabis use, at 76.2%, and the lowest average age of onset (8–14 years), but the researchers note that ethnicity, cannabis use, and age of onset each independently predicted delayed treatment.

The findings suggest a need for physicians to be vigilant when identifying and managing psychosis in adolescents, says the team of researchers, led by Maria-de-Gracia Dominguez (Imperial College London).

Among the 940 participants, aged 14–35 years, 136 had adolescent-onset psychosis (before 18 years of age). These individuals had a median DUP of 179 days versus 81 days for the 804 participants with adult-onset psychosis.

DUP differed substantially according to ethnicity, with White adolescents found to have the longest, at a median of 454 days, compared with 103 days for Black adolescents, and 29 days for those of Asian and mixed ethnicity.

The researchers acknowledge in Schizophrenia Research that identifying psychosis at early presentation is difficult, and insidious or atypical clinical presentations may lead to adolescents being referred to teachers or welfare services rather than healthcare professionals, thereby delaying proper treatment.

They add that “treatment delay in adolescents using cannabis might be tentatively explained by cannabis use masking psychopathology, and thus potentially reducing individual, family and professionals’ perceptions about need for treatment.”

Dominguez and team conclude that, “given the multifactorial contribution to treatment delay in adolescent psychosis,” different approaches need to be investigated.

They believe the main areas of focus are personal and cultural attitudes to mental illness, service use, and treatment; professionals’ management of adolescents presenting with psychotic symptoms; and differential pathways to care for ethnic groups among adolescents.

Investigation of these issues “may help elucidate the determinants leading to treatment delay and develop new strategies for appropriately managing adolescent psychosis,” they say.

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