Inge Joa
Section of Nursing Sciences, University of Bergen
Abstract
The purpose of this study is to study the early stages of psychosis development. Earlier studies in the catchment aerea have shown that patients suffer from untreated psychotic symptoms on avergage 2 years before psychiatrc treatment is offered. Such a long period without actual treamtent is correlated with much worry and suffering among both relatives and patients. A period with long delay before actual treament is provided increases the risk of poor outcome and prognosis of the psychosis.The study will draw attention towards prevantive strategies, with an aim of reducing the duration of illness and if possible the prevention of psychotic symptoms. Important research topic to be adressed are the terms premorbid and prodromal phase, and the aim is to increase knowlegde of these phases. The study design is a quantitative survey of a sample of 101 patients with first episode non-affective DSM-IV psychosis. The period of inclusion is 01.01.97 - 31.05.99.
First of all, we study the Premorbid phase, wich are described according to the PAS instrument, both on different levels of functioning and different subtypes. The Prodromal phase is the next target of attention. The symptom formation and the duration of the phase are described. Duration of untreated psychosis and diagnostic distribution are to connected with the earlier developmental phases. We also study the relationship between the Duration of Untreated Psychosis ( DUP ) and the diagnostic distribution at intake, with the premorbid and the prodromal phase. The survey identifies 3 different subtypes of premorbid functioning. Prior to development of psychosis we find that there have decreasing premorbid functioning with poor school performance and tendency til social withdrawal in many of the patients. In short we find that patients with psychosis have nearly 2 years of unspesific symptoms during prepsychotic phase. By increasing the knowlegde about the early phases of illness development, new interventions can be developed with the aim of primary and secondary prevention. Knowlegde from this survey will be of relevance to psychiatric nurses and other proffesionals in mental health services. Employes in the local community health services and teachers are important target for this kind of information due to their important role as first point of contact for persons who are in the early stages of developing a mental problem.
Key words: Psychiatric Nursing, Premorbid functioning, Prodromal phase, DUP, Psychosis, Schizophrenia.
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