First-episode psychosis intervention – description of our early intervention model

2017 ◽  
Vol 41 (S1) ◽  
pp. s823-s823
Author(s):  
B. Melo ◽  
C. Alves Pereira ◽  
R. Cajão ◽  
J. Ribeiro Silva ◽  
S. Pereira ◽  
...  
Keyword(s):  
Early Intervention ◽  
Relapse Rate ◽  
First Episode Psychosis ◽  
First Episode ◽  
Child Psychiatrist ◽  
Duration Of Untreated Psychosis ◽  
Intervention Model ◽  
Episode Psychosis ◽  
Clinical Records ◽  
Early Intervention In Psychosis

IntroductionThe research about the benefits of early diagnosis and treatment of first-episode psychosis had significantly increased in last decades. There have been several early intervention programs in psychotic disease, implemented worldwide, in order to improve the prognosis of these psychotic patients.ObjectivesTo present a brief description of the first-episode psychosis intervention team of Tondela-Viseu Hospital Centre–Portugal and its model. We aim to further characterize our population and describe its evolution since 2008.AimsWe aim to clarify the benefits of an early intervention in psychosis.MethodsWe conducted a retrospective cohort study of patients being followed by our team from November 2008 to September 2016. Demographic and medical data were collected (such as diagnosis, duration of untreated psychosis, treatments and its clinical effectiveness, relapse rate and hospital admissions) in patient's clinical records. The intervention model protocol of this team was also described and analyzed.ResultsThis multidisciplinary team consists of three psychiatrists, one child Psychiatrist, one psychologist and five reference therapists (areas of nursing, social service and occupational therapy). It includes patients diagnosed with first-episode psychosis, aged 16 to 42 years old, followed for five years. The team followed, since its foundation, 123 patients, mostly male. The most prevalent diagnosis are schizophrenia and schizophreniform psychosis. The team is currently following 51 patients.ConclusionsThis team's intervention have progressively assumed a more relevant importance in the prognosis of patients with first-episode psychosis, by reducing the duration of untreated psychosis, the relapse rate and by promoting social reintegration.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals First-episode psychosis: primary care experience and implications for service development

2009 ◽  
Vol 33 (5) ◽  
pp. 165-168 ◽  
Author(s):  
Mamdouh El-Adl ◽  
John Burke ◽  
Karen Little
Keyword(s):  
Primary Care ◽  
Early Intervention ◽  
General Practitioners ◽  
Psychiatric Service ◽  
First Episode Psychosis ◽  
Health Clinic ◽  
First Episode ◽  
Care Experience ◽  
Episode Psychosis ◽  
Early Intervention In Psychosis

Aim and MethodsTo capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service. A survey of Northamptonshire general practitioners (GPs) using a confidential questionnaire was carried out.ResultsOut of 284 GPs, 123 (43%) responded. General practitioners are unlikely to start treatment before referring to a specialist service: 63 GPs (51% of responders) start treatment in 10% or less of individuals with first-episode psychosis and 19 (15.5%) GPs start treatment in 75% or more before referring them to psychiatric service; 42 GPs (34%) refer those who request/accept a referral and 66 GPs (53%) refer all even if they refuse. Overall, 92 GPs (74%) agreed that an early intervention in psychosis service is needed and 77 (63%) GPs welcome having a mental health clinic in their surgery.Clinical ImplicationsIndividuals are more likely to accept referral to a psychiatric service if offered than to ask for it. People disengaging, stigma, the service being difficult to access/inappropriate and carers' lack of knowledge about mental illness are the likely causes for delayed referral.

scholarly journals T154. WHITE MATTER INTEGRITY, DURATION OF UNTREATED PSYCHOSIS, AND ANTIPSYCHOTIC TREATMENT RESPONSE IN MEDICATION-NAïVE FIRST EPISODE PSYCHOSIS PATIENTS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S289-S289
Author(s):  
Nina Kraguljac ◽  
Anthony Thomas ◽  
Charity Morgan ◽  
Ripu Jindal ◽  
Adrienne Lahti
Keyword(s):  
Early Intervention ◽  
White Matter ◽  
Treatment Response ◽  
First Episode Psychosis ◽  
White Matter Integrity ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Duration Of Untreated Psychosis ◽  
Phase Encoding ◽  
Episode Psychosis

Abstract Background It is becoming increasingly clear that longer duration of untreated psychosis (DUP) is associated with adverse clinical outcomes in patients with psychosis spectrum disorders. Especially because this association is often cited when justifying early intervention efforts, it is imperative to better understand underlying biological mechanisms. Methods We recruited 74 antipsychotic-naïve first episode psychosis (FEP) patients and 45 matched healthy controls in this trial. At baseline, we used a human connectome style diffusion weighted imaging (DWI) sequence to quantify white matter integrity in both groups. Patients then received 16 weeks of treatment with risperidone. DWI scans were acquired with opposite phase encoding directions [TR/TE: 3230ms/ 89.20ms; multiband acceleration factor 4, Flip angle: 84°; slice thickness 1.5mm, 92 slices, voxel size 1.5mm3, 92 diffusion weighted images distributed equally over 2 shells with b-values of ̴ 1500s/mm2 and ̴ 3000s/mm2, as well as 7 interspersed b= ̴ 0s/mm2 images]). Preprocessing of DWI images was performed in TORTOISE (version 3.1.2). This included correction for thermal noise, Gibbs-ringing, high b-value based bulk motion and eddy-current distortions using a MAP-MRI model, resampling of images to 1mm3, and rotation of gradient tables independently for each DWI phase encoding direction. Then, DR-BUDDI was used to correct EPI distortions with input from the anatomical image and to combine the two datasets using geometric averaging to generate the final corrected dataset. Tensors were computed with DIFF_CALC using a linear fitting algorithm. To spatially normalize images to the Illinois Institute of Technology atlas (IIT4) space, we implemented an optimized non-linear image registration procedure using a modified version of 3dQwarp in AFNI. We compared whole brain fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD) and radial diffusivity between groups. To test if structural white matter integrity mediates the relationship between longer DUP and poorer treatment response, we fit a mediator model and estimated indirect effects. Results Groups did not differ in age (FEP: 23.83+/-6.21 years; HC: 24.78+/-6.24 years), sex (FEP: 65.2% male; HC: 64.4% male), or parental socioeconomic status (FEP: 5.95+/-4.83; HC: 4.22+/-4.06). We found decreased whole brain FA and AD in medication-naive FEP compared to controls. In patients, lower FA was correlated with longer DUP (r= -0.32; p= 0.03) and poorer subsequent response to antipsychotic treatment (r= 0.40; p= 0.01). Importantly, we found a significant mediation effect for FA (indirect effect: -2.70; p= 0.03), indicating that DUP exerts its effects on treatment response through affecting white matter integrity. Discussion To our knowledge, this is the first study to examine a putative role of white matter integrity in the observed association between DUP and clinical outcomes in first episode psychosis. Our data provide empirical support to the idea the DUP may have fundamental pathogenic effects on the natural history of psychosis, suggest a biological mechanism underlying this phenomenon, and underscore the importance of early intervention efforts in this disabling neuropsychiatric syndrome.

scholarly journals The challenge of cost-effectiveness research on first-episode psychosis

2019 ◽  
Vol 215 (01) ◽  
pp. 386-387 ◽  
Author(s):  
Robert Rosenheck
Keyword(s):  
Early Intervention ◽  
Cost Effectiveness ◽  
First Episode Psychosis ◽  
First Episode ◽  
Effectiveness Research ◽  
Episode Psychosis ◽  
Effectiveness Studies ◽  
Early Intervention In Psychosis ◽  
Conclusive Data

SummaryEarly intervention in psychosis has generated hope. Cost-effectiveness studies, to determine whether benefits exceed costs, thus far conclude only that early intervention ‘might be’ worth its costs. It is a testament to the importance of the question: even in the absence of conclusive data, a synthesis should be attempted.Declaration of interestNone.

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