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1
Project 4.2.1 Awareness program
Funded by
Köhn D.1, Maier W.2, Klosterkötter J.1
1Department of Psychiatry at the University of
Cologne 2Department of Psychiatry at the
University of Bonn

• Background
• A prerequisite for any early detection and
  intervention program is to increase the number of
  at-risk persons who get in contact with
  specialized services, in future.Therefore, broad
  public relations and information campaigns are
  needed, which inform about risk indicators, early
  signs, possible treatment and pathways to care.
  In the Norwegian-American TIPS-project
  (Stavanger), public information campaigns
  resulted in a reduction of the duration of
  untreated psychosis (DUP) from 114 to 17 weeks in
  3 years (Larsen et al. 1998).
• Therefore, the Awareness-program within the
  Research Network Schizophrenia includes the
  development, implementation and evaluation of a
  public campaign on early recognition and early
  intervention.
• Original aims of the project
• The main targets of the project are
• enhancing knowledge about prodromal symptoms and
  further indicators of a higher risk of psychosis,
  
• teaching knowledge about help-seeking behavior
  and practical ways to help in that area,
• introduction into the early recognition of
  prodromal signs and further risk factors for
  psychosis and
• teaching the possibility of a differential early
  intervention.
• Objective and hypotheses
• Do information and training campaigns
  significantly support an earlier identification
  of persons at risk to schizophrenia and,
  consequently, their earlier referral to an
  adequate counselling and treatment ?

DUI DUP
Figure 1 illustrates the DUI/ DUP and the
prodromal phase in the total sample.
DUP (Duration of Untreated Psychosis) mean 78
weeks (median 19 weeks)
For the evaluation of the aware-ness-program it
is necessary to compare the awareness-areas to
the control area. Baseline mea-surements did not
show any significant differences between these
areas DUI mean Cologne/Bonn 292.4 weeks
mean Duisburg 312.0 weeks DUP mean
Cologne/Bonn 80.0 weeks mean Duisburg 71.0
weeks
prodromal phase 4.2 years
DUI (Duration of Untreated Illness) mean 296
weeks (median 212 weeks)
age
22.8
28.5
27.0
positive symptoms
n.s.
negative/ unspecific symptoms
n.s.
first (negative or unspecific) sign of mental
disorder
first positive symptom
first admission
Figure 1 DUI/ DUP
Pathways to Care
Evaluation-Design
Following figure illustrates the
evaluation-design
Unspecific, negative and/ or positiv symptoms
Figure 2 Pathways to care
The pathways to care diagram is shown in Figure
2. On average, persons with a first-episode
schizophrenia had 3.1 contacts with professionals
or semi-professionals before the diagnosis of a
psychosis was made and adequate treatment
started. In total 14 of the patients saw only
one carer, nearly a third (31) had two carers,
17 had three carers while more than a third
(38) had four or more carers. The mean interval
between onset of the illness (first unspecific or
negative symptom, measured by the ERIraos) and
first seeking care for all patients is 193.6
weeks (SD 290.1).
Results
Baseline assessment is concluded. In between a
6-months period, 152 patients with the diagnosis
of first-episode schizophrenia or suspicion of
beginning psychosis (initial prodrom) were
examined. 9 patients refused to participate, so
adequate data of 143 patients were available.
Table 1 shows the sample characteristics.
Public campaign
So far the Cologne-Bonn early recognition network
includes more than 600 cooperating partners
(psychotherapists, psychiatrist, general
practitioners, schools, school psychologists,
advisory centers, psychiatric clinics).
workplan
Public activities will continue in Cologne and
Bonn. The Cologne-Bonn early recognition network
will be enriched and extended. The post
measurement will start in March 2004, to evaluate
the Awareness-program. Final analysis and
publication will follow.
There are no significant differences in the main
demographic data (age, gender, marital status,
level of education, vocational education) between
the awareness and the control areas.