Disparities in Access to Early Psychosis Intervention Services: Comparison of Service Users and Nonusers in Health Administrative Data

Objective: There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. Methods: Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. Results: Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. Conclusions: We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.

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Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services

Psychological Medicine ◽

10.1017/s0033291718002933 ◽

2018 ◽

Vol 49 (12) ◽

pp. 2091-2099 ◽

Cited By ~ 8

Author(s):

Kelly K. Anderson ◽

Ross Norman ◽

Arlene G. MacDougall ◽

Jordan Edwards ◽

Lena Palaniyappan ◽

...

Keyword(s):

Psychotic Disorder ◽

Administrative Data ◽

Catchment Area ◽

Population Based ◽

First Episode Psychosis ◽

Case Definition ◽

First Episode ◽

Affective Psychosis ◽

Health Administrative Data ◽

Episode Psychosis

AbstractBackgroundDiscrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates.MethodsWe constructed a retrospective cohort (1997–2015) of incident cases of non-affective psychosis aged 16–50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach.ResultsOur case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4–35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4–20.3).ConclusionsCase ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.

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Understanding the role of the family physician in early psychosis intervention

BJPsych Open ◽

10.1192/bjo.2018.67 ◽

2018 ◽

Vol 4 (6) ◽

pp. 447-453 ◽

Cited By ~ 1

Author(s):

Kelly K. Anderson ◽

Suzanne Archie ◽

Richard G. Booth ◽

Chiachen Cheng ◽

Daniel Lizotte ◽

...

Keyword(s):

Primary Care ◽

Administrative Data ◽

Family Physician ◽

Psychiatric Treatment ◽

First Episode Psychosis ◽

First Episode ◽

Health Administrative Data ◽

Episode Psychosis ◽

The Family

BackgroundThe family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.AimsOur objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.MethodWe will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.DiscussionThese findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.Declaration of interestNone.

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Risk factors associated with treatment-resistant schizophrenia in first-episode psychosis

Revista Debates em Psiquiatria ◽

10.25118/2236-918x-7-4-1 ◽

2017 ◽

Vol Ano 7 ◽

pp. 8-12

Author(s):

Ana Beatriz de Oliveira Assis ◽

Jayse Gimenez Pereira Brandão ◽

Pedro Otávio Piva Espósito ◽

Osmar Tessari Junior ◽

Bruno Berlucci Ortiz

Keyword(s):

Risk Factors ◽

First Episode Psychosis ◽

First Episode ◽

Treatment Resistant ◽

Factors Associated ◽

Syndrome Scale ◽

Episode Psychosis ◽

Negative Syndrome

Objetivo: Ainda não está claro quais são os fatores de risco para a esquizofrenia resistente ao tratamento (ERT) em primeiro episódio psicótico (PEP). O objetivo deste trabalho é investigar indicadores de risco para ERT em PEP. Métodos: Foram selecionados 53 pacientes em primeiro episódio psicótico, com diagnóstico de esquizofrenia, que deram entrada à enfermaria de psiquiatria do Hospital das Clínicas Luzia de Pinho Melo entre 2011 e 2015. Ao ser admitido na enfermaria, o paciente era avaliado com a Escala de Sintomas para as Síndromes Positiva e Negativa (Positive and Negative Syndrome Scale – PANSS) e recebia tratamento inicial por 4 semanas. Caso sua resposta fosse inferior a 40% de redução na PANSS, o antipsicótico era trocado, e as escalas eram aplicadas novamente após mais 4 semanas. Após a falha com dois antipsicóticos, em doses plenas, por 4 semanas cada, a clozapina era introduzida, e o paciente era considerado ERT. Uma regressão logística foi aplicada onde sexo, idade de início, tempo de doença não tratada, uso de substâncias, avaliação global do funcionamento inicial e PANSS inicial total foram inseridos como variáveis independentes, e ERT foi inserida como variável dependente. Resultados: Tempo de doença não tratada apresentou significância de p = 0,038 e Exp (B) = 4,29, enquanto que PANSS total apresentou p = 0,012 e Exp (B) = 1,06. Conclusão: Identificar os fatores associados à resistência precoce ao tratamento poderia permitir aos clínicos evitar o atraso na introdução da clozapina e prevenir um pior prognóstico para esses pacientes.

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Early Psychosis Prevention and Intervention Centre long-term follow-up study of first-episode psychosis: methodology and baseline characteristics

Early Intervention in Psychiatry ◽

10.1111/j.1751-7893.2007.00008.x ◽

2007 ◽

Vol 1 (1) ◽

pp. 49-60 ◽

Cited By ~ 31

Author(s):

Lisa P. Henry ◽

Meredith G. Harris ◽

G. Paul Amminger ◽

Hok Pan Yuen ◽

Susy M. Harrigan ◽

...

Keyword(s):

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Prevention And Intervention ◽

Follow Up Study ◽

Episode Psychosis ◽

Long Term Follow Up ◽

Baseline Characteristics

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Suicide Prevention in First Episode Psychosis: The Development of a Randomised Controlled Trial of Cognitive Therapy for Acutely Suicidal Patients With Early Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2003.01209.x ◽

2003 ◽

Vol 37 (4) ◽

pp. 414-420 ◽

Cited By ~ 94

Author(s):

P.J.R. Power ◽

R.J. Bell ◽

R. Mills ◽

T. Herrman-Doig ◽

M. Davern ◽

...

Keyword(s):

Early Intervention ◽

Treatment Group ◽

Young People ◽

Controlled Trial ◽

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Randomised Controlled ◽

Suicidal Patients

Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.

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S101. CLINICAL FACTORS ASSOCIATED WITH CANNABIS USE IN A CHILEAN SAMPLE OF FIRST EPISODE PSYCHOSIS PATIENTS

Schizophrenia Bulletin ◽

10.1093/schbul/sby018.888 ◽

2018 ◽

Vol 44 (suppl_1) ◽

pp. S364-S364

Author(s):

Barbara Iruretagoyena ◽

Nicolas Crossley ◽

Alfonso Gonzalez-Valderrama ◽

Cristian Mena ◽

Carmen Castañeda ◽

...

Keyword(s):

First Episode Psychosis ◽

Cannabis Use ◽

First Episode ◽

Clinical Factors ◽

Factors Associated ◽

Episode Psychosis

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199. Disrupted Integration in Early Psychosis: A Preliminary Exploration of the Relationship Between Neural Synchronization and Higher Order Cognition in a First-Episode Psychosis Sample.

Schizophrenia Bulletin ◽

10.1093/schbul/sbx021.277 ◽

2017 ◽

Vol 43 (suppl_1) ◽

pp. S103-S103 ◽

Cited By ~ 2

Author(s):

Bethany Leonhardt ◽

Jennifer Vohs ◽

Paul Lysaker ◽

Lisa Bartolomeo ◽

Brian O’Donnell ◽

...

Keyword(s):

First Episode Psychosis ◽

Higher Order ◽

Early Psychosis ◽

First Episode ◽

Neural Synchronization ◽

Episode Psychosis ◽

The Relationship

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The Implementation and Review of Cognitive Remediation Training for First Episode Psychosis in Singapore

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.784935 ◽

2021 ◽

Vol 12 ◽

Author(s):

Nigel Ian Ming Chong ◽

Yogeswary Maniam ◽

Yi Chian Chua ◽

Charmaine Tang

Keyword(s):

Verbal Memory ◽

Cognitive Abilities ◽

Statistical Significance ◽

Real Life ◽

Cognitive Remediation ◽

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Educational Approach ◽

Episode Psychosis

Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed.Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05.Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding.Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.

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Developing services for first-episode psychosis and the critical period

The British Journal of Psychiatry ◽

10.1192/bjp.187.48.s91 ◽

2005 ◽

Vol 187 (S48) ◽

pp. s91-s97 ◽

Cited By ~ 33

Author(s):

Jane Edwards ◽

Meredith G. Harris ◽

Swagata Bapat

Keyword(s):

Evaluation Studies ◽

Complex Interventions ◽

Clinical Work ◽

First Episode Psychosis ◽

Early Psychosis ◽

Current Evidence ◽

First Episode ◽

Episode Psychosis ◽

Assessment And Treatment ◽

Recent Evaluation

BackgroundProviding specialised services to individuals experiencing first-episode psychosis (FEP) is a relatively new endeavour.AimsTo overview developing services for newly diagnosed cases of FEP and the context in which they develop.MethodThis paper describes five model multi-element FEP programmes, outlines recent evaluation studies of FEP services, discusses current evidence gaps relating to the evaluation of complex interventions and specific interventions for FEP and illustrates attempts to examine aspects of clinical work practised at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.ResultsConsiderable progress has been made in terms of influencing practice in the assessment and treatment of early psychosis.ConclusionsThere is need for quality clinical and research efforts to inform and accelerate progress in this burgeoning field.

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