Retrospective study of a first-episode psychosis service embedded within a home-based treatment team

2019 ◽  
Vol 36 (4) ◽  
pp. 265-269 ◽  
Author(s):  
Nuala Murray ◽  
Karen O’Connor
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Hospital Admissions ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Treatment Team ◽  
Home Based ◽  
Episode Psychosis

ObjectivesTo evaluate if having an early intervention service (EIS), which is embedded within a home-based treatment team (HBTT), is associated with (1) shorter duration of untreated psychosis (DUP), (2) lower rates of hospital admissions at first presentation, (3) a lesser number of hospital admissions within 6 months of presentation and (4) a reduced mean bed usage for the first 6 months.MethodsThe files of those who presented with a first-episode psychosis (FEP) to the South Lee Mental Health Service from January 2016 to February 2017 were identified and a retrospective case review was carried out. The demographics, clinical characteristics and hospital admissions were compared for those admitted to either the EIS or community mental health teams.ResultsForty patients were assessed. DUP was found to be longer for those who presented to the EIS (U = 121, p = 0.03). There were fewer admissions at first presentation (χ2 (1) = 6.51 p = 0.01), fewer admissions within the first 6 months of presentation (χ2 (1) = 5.56 p = 0.02) and less bed usage overall (U = 131, p = 0.047) for those who presented to the EIS.ConclusionThe study provides a baseline clinical and demographic profile of patients with FEP in an Irish mental health service and demonstrates current pathways to care. EIS embedded within an HBTT was associated with fewer hospital admissions and less bed usage. It is unclear whether these findings may have occurred due to the EIS or due to the benefits provided by an HBTT.

scholarly journals Recorded poor insight as a predictor of service use outcomes: cohort study of patients with first-episode psychosis in a large mental healthcare database

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028929 ◽  
Author(s):  
Neha Ramu ◽  
Anna Kolliakou ◽  
Jyoti Sanyal ◽  
Rashmi Patel ◽  
Robert Stewart
Keyword(s):  
Mental Health ◽  
Health Service ◽  
Service Use ◽  
Hospital Admissions ◽  
First Episode Psychosis ◽  
Mental Health Service Use ◽  
Secondary Outcome ◽  
First Episode ◽  
Episode Psychosis

ObjectivesTo investigate recorded poor insight in relation to mental health and service use outcomes in a cohort with first-episode psychosis.DesignWe developed a natural language processing algorithm to ascertain statements of poor or diminished insight and tested this in a cohort of patients with first-episode psychosis.SettingThe clinical record text at the South London and Maudsley National Health Service Trust in the UK was used.ParticipantsWe applied the algorithm to characterise a cohort of 2026 patients with first-episode psychosis attending an early intervention service.Primary and secondary outcome measuresRecorded poor insight within 1 month of registration was investigated in relation to (1) incidence of psychiatric hospitalisation, (2) odds of legally enforced hospitalisation, (3) number of days spent as a mental health inpatient and (4) number of different antipsychotic agents prescribed; outcomes were measured over varying follow-up periods from 12 months to 60 months, adjusting for a range of sociodemographic and clinical covariates.ResultsRecorded poor insight, present in 46% of the sample, was positively associated with ages 16-35, bipolar disorder and history of cannabis use and negatively associated with White ethnicity and depression. It was significantly associated with higher levels of all four outcomes over all five follow-up periods.ConclusionsRecorded poor insight in people with recent onset psychosis predicted subsequent legally enforced hospitalisations and higher number of hospital admissions, number of unique antipsychotics prescribed and days spent hospitalised. Improving insight might benefit patients’ course of illness as well as reduce mental health service use.

First episode psychosis in an adult area mental health service—a closer look at early and late-onset first episode psychosis

2014 ◽  
Vol 22 (3) ◽  
pp. 235-241 ◽  
Author(s):  
Ajit Selvendra ◽  
Dominiek Baetens ◽  
Tom Trauer ◽  
Melissa Petrakis ◽  
David Castle
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Late Onset ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis

Improving outcomes: Factors influencing help-seeking behaviors in immigrants and ethnic minorities with first-episode psychosis

2016 ◽  
Vol 13 (03) ◽  
pp. 152-157
Author(s):  
A. O. Berg ◽  
K. Leopold ◽  
S. Zarafonitis-Müller ◽  
M. Nerhus ◽  
L. H. Stouten ◽  
...  
Keyword(s):  
Mental Health ◽  
Help Seeking ◽  
Service Use ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Factors Influencing ◽  
Increased Risk ◽  
Episode Psychosis ◽  
The Hague

Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.

Retrospective study of first episode psychosis in the Dublin Southwest Mental Health Service: demographics, clinical profile and service evaluation of treatment

2017 ◽  
Vol 36 (4) ◽  
pp. 249-258 ◽  
Author(s):  
A.-M. Clarke ◽  
P. McLaughlin ◽  
J. Staunton ◽  
K. Kerins ◽  
B. Power ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Service ◽  
Family Intervention ◽  
First Episode Psychosis ◽  
First Episode ◽  
Psychological Interventions ◽  
Duration Of Untreated Psychosis ◽  
Episode Psychosis ◽  
Baseline Information ◽  
Healthcare Monitoring

ObjectiveIn Ireland, National Clinical Programmes are being established to improve and standardise patient care throughout the Health Service Executive. In line with internationally recognised guidelines on the treatment of first episode psychosis the Early Intervention in Psychosis (EIP) programme is being drafted with a view to implementation by mental health services across the country. We undertook a review of patients presenting with a first episode of psychosis to the Dublin Southwest Mental Health Service before the implementation of the EIP. This baseline information will be used to measure the efficacy of our EIP programme.MethodsPatients who presented with a first episode psychosis were retrospectively identified through case note reviews and consultation with treating teams. We gathered demographic and clinical information from patients as well as data on treatment provision over a 2-year period from the time of first presentation. Data included age at first presentation, duration of untreated psychosis, diagnosis, referral source, antipsychotic prescribing rates and dosing, rates of provision of psychological interventions and standards of physical healthcare monitoring. Outcome measures with regards to rates of admission over a 2-year period following initial presentation were also recorded.ResultsIn total, 66 cases were identified. The majority were male, single, unemployed and living with their family or spouse. The mean age at first presentation was 31 years with a mean duration of untreated psychosis of 17 months. Just under one-third were diagnosed with schizophrenia. Approximately half of the patients had no contact with a health service before presentation. The majority of patients presented through the emergency department. Two-thirds of all patients had a hospital admission within 2 years of presentation and almost one quarter of patients had an involuntary admission. The majority of patients were prescribed antipsychotic doses within recommended British National Formulary guidelines. Most patients received individual support through their keyworker and family intervention was provided in the majority of cases. Only a small number received formal Cognitive-Behavioural Therapy. Physical healthcare monitoring was insufficiently recorded in the majority of patients.ConclusionsThere is a shortage of information on the profile and treatment of patients presenting with a first episode of psychosis in Ireland. This baseline information is important in evaluating the efficacy of any new programme for this patient group. Many aspects of good practice were identified within the service in particular with regards to the appropriate prescribing of antipsychotic medication and the rates of family intervention. Deficiencies remain however in the monitoring of physical health and the provision of formal psychological interventions to patients. With the implementation of an EIP programme it is hoped that service provision would improve nationwide and to internationally recognised standards.

Pathways to Care, Duration of Untreated Psychosis and Treatments Received by Patients with First-Episode Psychosis

2011 ◽  
Vol 26 (S2) ◽  
pp. 1394-1394
Author(s):  
D. Giacco ◽  
A. Fiorillo ◽  
V. Del Vecchio ◽  
M. Luciano ◽  
G. Sampogna ◽  
...  
Keyword(s):  
Health Professionals ◽  
Suicide Attempts ◽  
Hospital Admissions ◽  
Psychiatric Treatment ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
Long Term Outcome ◽  
Episode Psychosis

IntroductionPathways to care and duration of untreated psychosis (DUP) strongly influence the long-term outcome of schizophrenia.AimsTo investigate pathways to care, duration of untreated psychosis (DUP) and treatments received by a sample of individuals aged between 18 and 35 years meeting diagnostic criteria for psychosis.MethodsPathways to care and DUP were explored by an “ad-hoc” schedule administered to patients and caregivers.ResultsThe sample consists of 30 patients. The first episode of psychosis, which occurred at 19.7 (± 4.7) years, was characterized by negative symptoms and disorganized behaviours in more than half of the sample, suicide attempts (28%) and hospital admissions (26%). DUP was 41.6 ± 60.4 weeks, being longer than that reported in international literature. In 76% of cases patients’ relatives asked for a first contact with health professionals, referring the patients to psychiatrists (34% of cases), general practitioners (31%), neurologists (21%) or psychologists (13%). When professionals other than psychiatrists were contacted, the interval between the contact and receipt of appropriate psychiatric treatment (according to the current guidelines) was particularly long (15.2 ± 32.1 weeks). 34% of patients were treated with a monotherapy of psychotropic drugs: 24% with antipsychotics, 7% with anxiolytics and 3% with antidepressants; 48% received a poly-pharmacotherapy. 35% were treated with psychotherapy (in most of the cases cognitive-behavioural therapy), which was the only treatment for 18% of patients.ConclusionsThese results emphasize the need to train health professionals on diagnosis and treatment of first episode psychosis. DUP may be reduced by anti-stigma campaigns among general population.

The pathways to mental health care of first-episode psychosis patients: a systematic review

2010 ◽  
Vol 40 (10) ◽  
pp. 1585-1597 ◽  
Author(s):  
K. K. Anderson ◽  
R. Fuhrer ◽  
A. K. Malla
Keyword(s):  
Mental Health ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Psychotic Episode ◽  
First Psychotic Episode ◽  
Episode Psychosis ◽  
First Contact ◽  
Pathway To Care ◽  
Delay In Treatment

BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

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