scholarly journals Early intervention in psychosis: obstacles and opportunities

2005 ◽  
Vol 11 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Swaran P. Singh ◽  
Helen L. Fisher
Keyword(s):  
Early Intervention ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Early Intervention Services ◽  
Department Of Health ◽  
Short And Long Term ◽  
Intervention Services ◽  
The Uk ◽  
Early Intervention In Psychosis

By focusing therapeutic effort on the early stages of psychotic disorders, effective early intervention should improve short- and long-term outcomes. Strategies include pre-psychotic and prodromal interventions to prevent emergence of psychosis, detecting untreated cases in the community and facilitating recovery in established cases of psychosis. The evidence base for each of these strategies is currently limited, although several international trials are under way. The Department of Health in the UK has announced the intention of setting up 50 early intervention services nationally, several of which are already operational. In this article, we briefly discuss the differing ways in which early intervention is conceptualised, summarise the evidence supporting it in established cases of psychosis, suggest appropriate service models and describe two early intervention services in south-west London.

Early Intervention in Psychosis: An Overdue Reform

2003 ◽  
Vol 37 (4) ◽  
pp. 393-398 ◽  
Author(s):  
Patrick D. McGorry ◽  
Alison R. Yung
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Young People ◽  
Psychotic Disorders ◽  
Public Mental Health ◽  
Psychotic Episode ◽  
Public Health Burden ◽  
Early Intervention Services ◽  
Intervention Services ◽  
Early Intervention In Psychosis

Objective: To discuss the rationale for early intervention in psychotic disorders and to explore why the widespread implementation of early intervention services has stalled. Method: Four central questions are explored regarding early intervention in psychosis: (i) what is the rationale for early intervention services in psychosis and is it justified? (ii) what are the obstacles to the implementation of early intervention services throughout Australia? (iii) how could some of these obstacles be overcome? and (iv) what else needs to occur? Results: Early intervention in psychosis aims to improve recognition and access, promote recovery from the initial psychotic episode, minimize secondary morbidity and reduce collateral damage. It may also prevent some brain dysfunction and damage, which may otherwise occur later in the illness. Despite the now growing body of evidence supporting the idea of early intervention, obstacles remain to its widespread adoption in policy and implementation, principally related to chronic under-funding of the public mental health system. Among the solutions proposed is the need to develop services with a youth focus, able to cater for young people with both psychotic and non-psychotic psychiatric disorders. These services should be well integrated with primary care and other youth orientated agencies. Conclusions: We are hopeful that strong investment in early intervention and better services for young people will be among the highest priorities of the Third National Mental Health Plan. This is not only where the greatest public health burden lies, but also where costeffectiveness of intervention is likely to be maximal.

scholarly journals Early intervention services for psychosis in Ireland: are we there yet?

2019 ◽  
Vol 36 (4) ◽  
pp. 243-248 ◽  
Author(s):  
P. Power
Keyword(s):  
Early Intervention ◽  
Urban Areas ◽  
Psychotic Disorders ◽  
Cost Savings ◽  
Model Of Care ◽  
Service Model ◽  
Health Service Executive ◽  
Early Intervention Services ◽  
Early Intervention In Psychosis ◽  
Roll Out

Early intervention in psychosis (EIP) services are now a priority for Ireland’s Health Service Executive (HSE). A Model of Care for EIP services has been completed after wide consultation. It has just been launched by the Minister for Mental Health and the aim now is to roll out EIP services throughout the country. The Model of Care outlines the rational, configuration, resources, governance, and quality assurance required to operate EIP services. Two models are recommended. The first is a Hub & Spoke service model for rural and smaller urban areas. The second is a Stand-Alone service model for large urban and metropolitan areas. Introducing EIP services is going to be a challenge but there are plenty of good examples overseas. They have been shown to greatly enhance local services’ ability to meet the needs of people developing psychotic disorders. They bring with them better outcomes, service satisfaction and cost savings.

scholarly journals Parental Perceptions Influencing the Utilization of Early Intervention Services in Children with Developmental Delay

2017 ◽  
Vol 37 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Sandhya Chauhan ◽  
Prem Lochan Prasad ◽  
Preeti Lata Rai ◽  
Bhawana Khurana
Keyword(s):  
Early Intervention ◽  
Developmental Delay ◽  
Developmental Delays ◽  
Parental Perceptions ◽  
Care Needs ◽  
Early Intervention Services ◽  
Intervention Services ◽  
First Time ◽  
Structured Questionnaire

Introduction: Early intervention services play a pivotal role in the management of children with developmental delays but the utilization of these is quite low. This study aims to explore the influence of parental perceptions on the utilization of these services.Material and Methods: This is a hospital based qualitative study of 31 parents having children with developmental delay in 2 or more domains who presented for the first time for diagnostic evaluation. A semi-structured questionnaire was used in the interviews, exploring various aspects of parental perceptions regarding the child’s disability and the services required for them.Results: Apart from factors like educational and socioeconomic status of parents, accessibility of the services there are other factors involved at the level of parents which influence their readiness and motivation to utilize a service, viz understanding of the total spectrum of a child’s disability by parents and how well their child care needs are fulfilled.Conclusion: The parents’ long term motivation for utilizing the services depends upon how well their idea of a futuristic goal for their child is being addressed.

scholarly journals Economic evaluation of early intervention services

2007 ◽  
Vol 191 (S51) ◽  
pp. s19-s22 ◽  
Author(s):  
Paul McCrone ◽  
Martin Knapp
Keyword(s):  
Early Intervention ◽  
Cost Effectiveness ◽  
Evidence Base ◽  
Cost Utility ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Utility Analysis ◽  
Early Intervention Services ◽  
Scarce Resources ◽  
Intervention Services

SummaryEarly intervention services have been introduced in a number of countries, but the evidence base to support them is limited. In particular there are very few economic evaluations, which are crucial if decision-makers are to have a better understanding of how scarce resources can be used appropriately. This paper discusses the different approaches used in economic evaluations and shows how these differ in the way in which outcomes are measured. The most useful forms of evaluation are cost-effectiveness and cost-utility analysis. We describe how the results of evaluations can be interpreted using incremental cost-effectiveness ratios and acceptability curves. Finally, the paper summarises some key evidence to date on early intervention services and economic evaluations currently being undertaken

scholarly journals Ethnic variations in pathways into early intervention services for psychosis

2013 ◽  
Vol 202 (4) ◽  
pp. 277-283 ◽  
Author(s):  
Sharif Ghali ◽  
Helen L. Fisher ◽  
John Joyce ◽  
Barnaby Major ◽  
Lorna Hobbs ◽  
...  
Keyword(s):  
Early Intervention ◽  
Ethnic Groups ◽  
Psychotic Disorders ◽  
Black Patient ◽  
Study Data ◽  
Duration Of Untreated Psychosis ◽  
Early Intervention Services ◽  
Patient Groups ◽  
Intervention Services ◽  
Ethnic Variations

BackgroundEthnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories.AimsTo explore ethnic differences in the nature and duration of pathways into early intervention services.MethodIn a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services.ResultsDuration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies.ConclusionsVariations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP.

A systematic review of long-term outcomes of patients with psychosis who received early intervention services

2019 ◽  
Vol 31 (5-6) ◽  
pp. 425-440 ◽  
Author(s):  
Sherry K. W. Chan ◽  
Hei Y. V. Chan ◽  
Jillian Devlin ◽  
Tarun Bastiampillai ◽  
Titus Mohan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Early Intervention ◽  
Long Term Outcomes ◽  
Early Intervention Services ◽  
Intervention Services

Early intervention in psychosis: service models worldwide and the Irish experience

2010 ◽  
Vol 27 (4) ◽  
pp. 210-214 ◽  
Author(s):  
Sami Omer ◽  
Caragh Behan ◽  
John L Waddington ◽  
Eadbhard O'Callaghan
Keyword(s):  
Early Intervention ◽  
Secondary Prevention ◽  
Current Evidence ◽  
Early Intervention Service ◽  
Primary And Secondary Prevention ◽  
Early Intervention Services ◽  
Intervention Service ◽  
Service Models ◽  
Intervention Services ◽  
Early Intervention In Psychosis

AbstractThis paper examines the concept of early intervention in psychosis at primary and secondary prevention levels. Examples of early intervention service models from different countries are presented and we discuss current evidence for efficacy. We highlight the Irish experience of early intervention to date, and discuss future implementation of early intervention services in Ireland.

Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services

2019 ◽  
Vol 217 (3) ◽  
pp. 491-497 ◽  
Author(s):  
Sherry Kit Wa Chan ◽  
Herbert H. Pang ◽  
Kang K. Yan ◽  
Christy Lai Ming Hui ◽  
Yi Nam Suen ◽  
...  
Keyword(s):  
Early Intervention ◽  
Standard Care ◽  
First Episode ◽  
Early Intervention Services ◽  
Employment Trajectories ◽  
Schizophrenia Spectrum ◽  
Intervention Service ◽  
Intervention Services ◽  
First Episode Schizophrenia

BackgroundLittle is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.AimsWe compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored.MethodPatients with FES (N= 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups.ResultsThere were significantly more patients who received the early intervention service in the good employment cluster (early intervention:N= 98 [67.6%]; standard care:N= 76 [52.4%];P= 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1–5 (P< 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group.ConclusionsResults suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.

scholarly journals Prevalence of treatment resistance and clozapine use in early intervention services

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Imogen Stokes ◽  
Siân Lowri Griffiths ◽  
Rowena Jones ◽  
Linda Everard ◽  
Peter B. Jones ◽  
...  
Keyword(s):  
Early Intervention ◽  
Treatment Resistance ◽  
Prescribing Patterns ◽  
Positive Symptoms ◽  
Treatment Resistant ◽  
Medication History ◽  
Early Intervention Services ◽  
Intervention Services ◽  
Definition Of ◽  
Early Intervention In Psychosis

Background Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics. Aims This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services. Method Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points. Results A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine. Conclusions Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.

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