10-year outcome study of an early intervention program for psychosis compared with standard care service

2014 ◽  
Vol 45 (6) ◽  
pp. 1181-1193 ◽  
Author(s):  
S. K. W. Chan ◽  
H. C. So ◽  
C. L. M. Hui ◽  
W. C. Chang ◽  
E. H. M. Lee ◽  
...  
Keyword(s):  
Early Intervention ◽  
Standard Care ◽  
Intervention Program ◽  
Suicide Attempts ◽  
Care Service ◽  
Structured Interview ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Short Term ◽  
Long Term Outcome

Background.Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design.Method.Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed.Results.Results suggested that EI patients had reduced suicide rate (χ2(1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR −0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery.Conclusions.The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.

scholarly journals Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan–Monaghan early intervention service

2021 ◽  
pp. 1-14
Author(s):  
S. Fayyaz ◽  
N. Nkire ◽  
B. Nwosu ◽  
N. Amjad ◽  
A. Kinsella ◽  
...  
Keyword(s):  
Early Intervention ◽  
Negative Symptoms ◽  
Education Programme ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Research Findings ◽  
Prospective Research ◽  
Operational Activities

Objectives: As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan–Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. Methods: COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. Results: During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. Conclusions: COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

Effects of early intervention in children at risk: Short-term and long-term findings from an attachment-based intervention program

2015 ◽  
Vol 3 (3) ◽  
pp. 98-102 ◽  
Author(s):  
Annabel Zwönitzer ◽  
Ute Ziegenhain ◽  
Ina Bovenschen ◽  
Kristina Bressem ◽  
Melanie Pillhofer ◽  
...  
Keyword(s):  
At Risk ◽  
Early Intervention ◽  
Intervention Program ◽  
Children At Risk ◽  
Short Term

Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

2011 ◽  
Vol 27 (8) ◽  
pp. 557-562 ◽  
Author(s):  
J.-M. Azorin ◽  
A. Kaladjian ◽  
M. Adida ◽  
E. Fakra ◽  
E. Hantouche ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Correct Diagnosis ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Prodromal Phase ◽  
Multiple Episode ◽  
Patients At Risk ◽  
Bipolar Patients

AbstractObjective:To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.Methods:One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.Results:Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.Conclusion:In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

scholarly journals Psychosis in youth in Singapore: a case series

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S117-S117
Author(s):  
Pei Ling Lim ◽  
Roselyne Shirley ◽  
Pat Fong
Keyword(s):  
Adult Population ◽  
Psychiatric Service ◽  
Case Series ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Paediatric Hospital ◽  
Seeking Help

ObjectiveIn this report, we present a case series of children with psychotic symptoms referred to a child consultation liaison psychiatric service within a tertiary paediatric hospital in Singapore. The purpose of this case series is to identify common symptoms at presentation, review the current practices in our hospital for investigation and treatment of first episode psychosis and short-term outcomes.Case reportWe identified 9 cases over a 1 year period, for which 7 were seen whilst admitted to hospital and 2 in the outpatient clinic. There were 6 females and 5 males ranging in age from 11 to 16 years old. The commonest symptoms on presentation were perceptual disturbance (88%) most commonly auditory hallucinations and altered behaviour (55%). Of the 7 children admitted to hospital, all were seen by the neurology team prior to the request for a psychiatric opinion. All admitted patients had blood and radiological investigations carried out. Most of the children were started on a short course of antipsychotic medication with the majority continuing to attend follow-up outpatient.DiscussionOnly 9 cases were identified in this case series over a 1 year period highlighting that psychosis is not a common presentation in the paediatric population. From the history alone, it can be challenging to distinguish between primary and secondary causes of psychosis. Acute onset of symptoms and the presence of other neurological signs should raise the suspicion of an underlying organic cause. Out of 9 cases, only 1 case was treated for a presumed organic aetiology, which is consistent with findings from other authors who only found underlying organic factors in 12.5% of cases.In this case series, we also noted that 45% of cases reported having symptoms for over 1 year before seeking help. This is also seen in the adult population in Singapore. Stigma, denial and lack of information about psychosis may all contribute to delay in seeking help. Although prolonged duration of untreated psychosis has been shown to be associated with poor long-term outcome, we found in our case series that even patients who reported a long duration of symptoms still responded well to medication.ConclusionThere is room for collaboration with our neurology colleagues in the approach towards children with first presentation of psychosis, both in terms of investigations and management. Identifying reasons for disengagement from psychiatric care is an area for further investigations to improve outcomes in our patients.

Social Work Training Intervention to Increase Referral Rates for Preventive Psychosis Services: A Randomized Trial

2021 ◽  
pp. 104973152110597
Author(s):  
Jordan E. DeVylder ◽  
Nicole D. Andorko ◽  
Melissa E. Smith ◽  
John Fitzgerald ◽  
Emily Petti ◽  
...  
Keyword(s):  
Early Intervention ◽  
Social Workers ◽  
Intervention Program ◽  
Controlled Trial ◽  
Psychotic Symptoms ◽  
Training Intervention ◽  
Early Intervention Services ◽  
Social Work Training ◽  
Work Training ◽  
Active Training

Purpose Social workers are employed in a broad range of community settings, in which they may be able to identify youth with emerging psychotic symptoms and facilitate connection to specialized services. Methods: This randomized controlled trial tested the efficacy of a training intervention for social workers ( N = 959) intended to increase the volume of referrals and rate of successful referrals to specialized early psychosis services. Results: During the 2-year study period, referrals to the early intervention program nearly doubled, t (df = 11) = 5.46, p < 0.001. Additionally, the rate of successful referrals was greater among social workers who received the active training (41.7%) compared to the other referral sources (19.2%), X2 (df = 1, n = 311) = 3.69, p = 0.055. Conclusions: The active training was associated with a marginally greater rate of successful referrals. Overall referrals increased greatly during the training period although this could not be linked to specific participants, suggesting contamination effects may have increased community awareness of early intervention services.

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 Impact of Cannabis in the Early Stages of Schizophrenia: A 3-Year Longitudinal Study on Cannabis Influence on Relapse Rates

2017 ◽  
Vol 41 (S1) ◽  
pp. S196-S197
Author(s):  
M. Gomez Revuelta ◽  
M. Juncal Ruiz ◽  
O. Porta Olivares ◽  
V. Gajardo Galan ◽  
G. Pardo de Santayana Jenaro ◽  
...  
Keyword(s):  
Intervention Program ◽  
Response To Treatment ◽  
Rank Test ◽  
First Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Early Stages ◽  
Increased Risk ◽  
The Impact

IntroductionThe first five years after the onset of a first episode of psychosis (FEP) are crucial for long term outcome. In this period, the risk of relapse is particularly high. Consequences of relapse include an increased risk of neurotoxicity, chronicity, hospitalization, decreased response to treatment, increased economic burden and functional impairment.ObjectivesTo discern the influence of cannabis on relapse as it may contribute to adopt specific measures in patients during early stages of the illness.Material and methodsPAFIP is an early intervention program for patients with a FEP. Between January 2005 and January 2011, 163 patients were recruited for this study. They were followed-up during 3 years at intervals of three months. The sample was divided into three groups: (1) those non-cannabis users neither before the FEP nor during follow-up (nn), (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn).ResultsNo statistically significant differences between the three groups were observed but a trend (P = 0.057) towards a more enduring survival in Group 3 (sn). (Kaplan–Meier curve and detailed Log Rank Test results will be included in the final poster).ConclusionsCannabis has a detrimental effect on schizophrenia. The interruption of its use could contribute to improve the outcome of the disease, as the results of our study suggest.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Anticipating Outcome: Predictors of First and Subsequent Relapses in Schizoprenia. A 3-year Follow-up

2017 ◽  
Vol 41 (S1) ◽  
pp. S97-S97
Author(s):  
M. Gomez Revuelta ◽  
V. Gajardo Galan ◽  
M. Juncal Ruiz ◽  
O. Porta Olivares ◽  
R. Landera Rodriguez ◽  
...  
Keyword(s):  
Intervention Program ◽  
Age Of Onset ◽  
Univariate Analysis ◽  
First Episode ◽  
Long Term Outcome ◽  
Factors Associated ◽  
Adherence To Medication ◽  
Modifiable Factors ◽  
Wide Range ◽  
First Relapse

IntroductionRelapse prevention during early stages after psychosis onset is a key factor for long term outcome. While factors associated with first relapse have been widely studied, factors associated with subsequent relapses are poorly described.ObjectivesTo determine predictive factors of first and subsequent relapses among patients recruited from a cohort of PAFIP Early Intervention Program.Material and methodsWe analyzed socio-demographic and clinical data of a cohort of 393 first episode psychosis (FEP) patients that were recruited since February 2001 to May 2011. Of these, 341 achieved clinical remission and were, therefore, considered to be at risk of relapse. They were followed-up for 3 years. A wide range of potential factors were included as possible predictors of relapse. Test univariate, analysis logistics of regression, regression of Cox and analysis of survival of Kaplan-Meier were carried out.ResultsPoor adherence to medication was the main predictor associated to first relapse (ExpB: 2.979; P < 0.001). After the first relapse, only 56 patients (33.9%) underwent a second relapse, being the diagnosis (ExpB: 1.975; P = 0.074), the age of onset, (ExpB: 1.078; P = 0.003) and a low level of positive symptomatology (ExpB: 0.863; P = 0.03) the predictors of associated with a second relapse.ConclusionsAfter a FEP, non-adherence to medication is the main predictor of first relapse. Second and subsequent relapses relate with non-modifiable factors such as age of onset or schizophrenia diagnosis. This subgroup of patients could have greater predisposition to relapse related with the severity of the disease itself.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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