scholarly journals Early intervention in psychosis team (EIT): pathways to care

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S109-S109
Author(s):  
Chloe Uffendell ◽  
John Stevens
Keyword(s):  
Waiting Time ◽  
Early Recognition ◽  
Single Point ◽  
Urgent Care ◽  
Pathways To Care ◽  
First Episode ◽  
Liaison Psychiatry ◽  
Care Package ◽  
Time Standard ◽  
Early Intervention In Psychosis

AimsThe main aim of this study was to investigate whether the EIT access and waiting time standard (>60% of people experiencing first episode psychosis (FEP) are treated with a NICE-approved care package within two weeks of referral) was being met within Liverpool EIT.We also wanted to understand the pathway to treatment within EIT services, identify delays in the process of triage/assessment/MDT/medical review and implement changes to reduce delays.MethodThis study was a retrospective cross-sectional audit of all patients accepted on to the FEP pathway following MDT discussion in the Liverpool EIT Teams across May and June 2020.Case notes were analysed for delays in referral, engagement with assessment and care-coordinators, as well as prescriber review offering medication. The data were collated and analysed before implementing changes.Result40 patients presented as FEP in May and June 2020, 6 were excluded due to an extended inpatient stay.Within the remaining patient cohort (n = 34), 64.7% of patients were engaged with a care package within 14 days. Only 14.7% of patients received an offer of medication within 14 days, the mean time to be offered medication was 39 days.26% of patients first contact within MerseyCare Trust was with EIT, 74% presented elsewhere. 24% instead presented to liaison psychiatry from A&E departments, 18% to the single point of access team, 9% to criminal justice liaison team (CJLT) and 9% to North West Ambulance Service triage car.29% of referrals came from the community (GP and counselling services), 15% from CRHT (crisis resolution and home treatment team), 14% from CJLT, 12% from urgent care team, 9% from liaison psychiatry.ConclusionThe Access and Waiting time standard was met. However, this study showed that patients were not being referred to EIT at first point of contact. This study shows 26% of service users first presented to liaison psychiatry, yet only 1/3 of those were immediately referred to EIT, the remainder being later referred by other services e.g. CRHT.In addition to referral delays, lack of medical practitioner availability caused significant delays in arranging medical reviews, delaying patients access to medication.The changes implemented to address these issues included educating MerseyCare services in the early recognition of psychosis to increase early referral. Non-medical prescribers’ roles were developed to perform initial medical reviews in addition to doctors, allowing patients earlier medication access. This allowed ‘urgent slots’ to be developed, time set aside for emergencies enabling prompt review of urgent cases.

scholarly journals Access and Waiting Time Standard for Early Intervention in Psychosis: At Risk Mental State Identification and Interventions Accepted within a Routine Service

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Vidyah Adamson
Keyword(s):  
At Risk ◽  
Early Intervention ◽  
Waiting Time ◽  
Mental State ◽  
Psychotic Symptoms ◽  
Service Users ◽  
Routine Service ◽  
Time Standard ◽  
Early Intervention In Psychosis ◽  
At Risk Mental State

Aim: Following the introduction of an access and waiting time standard for Early Intervention in Psychosis (EIP) services, the identification and treatment of people experiencing an At-Risk Mental State (ARMS) for psychosis has become a national priority. However, there is a dearth of literature concerning what is offered to and accepted by ARMS service users within routine services. Methods: This descriptive evaluation reports upon the assessment and treatment of people with an at-risk mental state identified during the first year of a routine service operating in line with the EIP standard. The paper details referral sources, referral to treatment times, socio-demographic characteristics, ARMS subgroups and the interventions accepted by these service users. Results: A total of 138 ARMS cases were identified over the evaluation period, with 73% (n=101) aged between 18-34 years and 86% (n=118) meeting attenuated psychotic symptoms criteria. The majority (64%) of service users engaged in multiple interventions; 54% (n=75) accepted psychoeducation and coping skills enhancement work, 42% (n=58) participated in a sleep programme, 33% (n=45) undertook coping with voices and visions work and 28% (n=39) engaged in individual psychological therapy. Conclusion: The findings indicate that the majority of ARMS service users presenting to the EIP service were aged 18-34 and experienced attenuated psychotic symptoms. A range of NICE and CBT informed interventions as well as individual psychological therapies appear to be acceptable to ARMS service users and many engaged in multiple interventions offered.

scholarly journals First-episode psychosis: factors associated with delayed access to care in a rural Egyptian setting

2008 ◽  
Vol 5 (4) ◽  
pp. 95-97 ◽  
Author(s):  
Mamdouh El-Adl ◽  
Mohammed El-Mahdy ◽  
Musheera Anis
Keyword(s):  
Help Seeking ◽  
Psychotic Disorders ◽  
Clinical Care ◽  
Cost Effective ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Early Results ◽  
Episode Psychosis ◽  
Early Intervention In Psychosis

Over the past few decades there has been a growing interest in first-episode psychosis (FEP), help-seeking behaviour and pathways to care. Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care (Yung & McGorry, 2007). FEP studies show that the average time between onset of symptoms and first effective treatment is often 1 year or more (McGlashan, 1987). This long duration of untreated psychosis (DUP) is undesirable. Early treatment helps minimise the risk of the serious consequences of untreated psychosis, in terms of changes in mental state and behaviour (Larsen et al, 1998; Wyatt et al, 1998) and can reduce suffering (Ho et al, 2003). Some early results suggested that an ‘early intervention in psychosis’ (EIP) service is more cost-effective than generic services (Mihalopoulos et al, 1999).

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.

scholarly journals Machine learning-based ability to classify psychosis and early stages of disease through parenting and attachment-related variables is associated with social cognition

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Linda A. Antonucci ◽  
Alessandra Raio ◽  
Giulio Pergola ◽  
Barbara Gelao ◽  
Marco Papalino ◽  
...  
Keyword(s):  
Machine Learning ◽  
Social Cognition ◽  
Attachment Style ◽  
Learning Algorithm ◽  
Early Recognition ◽  
Emotion Perception ◽  
First Episode ◽  
Support Vector ◽  
Significant Group ◽  
Early Stages

Abstract Background Recent views posited that negative parenting and attachment insecurity can be considered as general environmental factors of vulnerability for psychosis, specifically for individuals diagnosed with psychosis (PSY). Furthermore, evidence highlighted a tight relationship between attachment style and social cognition abilities, a key PSY behavioral phenotype. The aim of this study is to generate a machine learning algorithm based on the perceived quality of parenting and attachment style-related features to discriminate between PSY and healthy controls (HC) and to investigate its ability to track PSY early stages and risk conditions, as well as its association with social cognition performance. Methods Perceived maternal and paternal parenting, as well as attachment anxiety and avoidance scores, were trained to separate 71 HC from 34 PSY (20 individuals diagnosed with schizophrenia + 14 diagnosed with bipolar disorder with psychotic manifestations) using support vector classification and repeated nested cross-validation. We then validated this model on independent datasets including individuals at the early stages of disease (ESD, i.e. first episode of psychosis or depression, or at-risk mental state for psychosis) and with familial high risk for PSY (FHR, i.e. having a first-degree relative suffering from psychosis). Then, we performed factorial analyses to test the group x classification rate interaction on emotion perception, social inference and managing of emotions abilities. Results The perceived parenting and attachment-based machine learning model discriminated PSY from HC with a Balanced Accuracy (BAC) of 72.2%. Slightly lower classification performance was measured in the ESD sample (HC-ESD BAC = 63.5%), while the model could not discriminate between FHR and HC (BAC = 44.2%). We observed a significant group x classification interaction in PSY and HC from the discovery sample on emotion perception and on the ability to manage emotions (both p = 0.02). The interaction on managing of emotion abilities was replicated in the ESD and HC validation sample (p = 0.03). Conclusion Our results suggest that parenting and attachment-related variables bear significant classification power when applied to both PSY and its early stages and are associated with variability in emotion processing. These variables could therefore be useful in psychosis early recognition programs aimed at softening the psychosis-associated disability.

Programma 2000: Celebrating 10 Years of Activity of an Italian Pilot Programme on Early Intervention in Psychosis

2008 ◽  
Vol 42 (12) ◽  
pp. 1003-1012 ◽  
Author(s):  
Angelo Cocchi ◽  
Anna Meneghelli ◽  
Antonio Preti
Keyword(s):  
Early Intervention ◽  
High Risk ◽  
Rating Scale ◽  
Young Patients ◽  
Skills Training ◽  
First Episode ◽  
Global Functioning ◽  
Adult Intelligence Scale ◽  
Cognitive Behavioural ◽  
Early Intervention In Psychosis

Objective: This paper describes the structure and the organization of the single Italian programme specifically targeted at the early detection of and interventions for subjects at onset of or at high risk of psychosis, Programma 2000. Methods: Programma 2000 is a comprehensive multi-modal protocol of early intervention in psychosis, set up in Milan in 1999. The service has been very active since its opening, and at the time of writing (spring (April) 2008), more than 300 young patients have been evaluated through a detailed protocol that embraces Health of the Nation Outcome Scale (HoNOS), Brief Psychiatric Rating Scale (BPRS), Cognitive Behavioural Assessment 2.0, Disability Assessment Schedule, Camberwell Family Interview, Wechsler Adult Intelligence Scale and the Early Recognition Inventory Retrospective Assessment of Symptoms. The treatment includes psychoeducation, cognitive behavioural therapy (CBT), both structured and unstructured psychosocial interventions and pharmacotherapy, when necessary. Results: The programme focuses on young people aged 17–30 years: to date, a total of 132 subjects with definite psychosis or within the high-risk category have been enrolled in treatment after assessment. Patients with first-episode psychosis were, on average and expectedly, more severe than those in the at-risk group, and were more likely to be prescribed antipsychotic drugs. A large majority of patients in both groups received tailored CBT; individual sessions of skills training were provided to two-thirds of patients. In both groups, improvement was found in both the BPRS and HoNOS, and in the level of global functioning as assessed on Global Assessment of Functioning at 6 month and 1 year follow up. Global functioning was more sensitive to change than symptom severity, reflecting the intensive and personalized efforts to improve social and role functioning in patients. Conclusions: Programma 2000 is still in development but it has already gained the support of therapists and other relevant people involved in the life of subjects at onset, or at high risk of psychosis.

scholarly journals Pathways to care for first-episode psychosis in an early detection healthcare sector

2005 ◽  
Vol 187 (S48) ◽  
pp. s24-s28 ◽  
Author(s):  
Jan Olav Johannessen ◽  
Tor K. Larsen ◽  
Inge Joa ◽  
Ingrid Melle ◽  
Svein Friis ◽  
...  
Keyword(s):  
Early Detection ◽  
First Episode Psychosis ◽  
Healthcare Sector ◽  
Service Development ◽  
Pathways To Care ◽  
First Episode ◽  
Access To Treatment ◽  
Episode Psychosis ◽  
Low Threshold

BackgroundEarly detection programmes aim to reduce the duration of untreated psychosis (DUP) by public education and by prompt access to treatment via active outreach detection teams.AimsTo determine whether those with first-episode psychosis in an early detection healthcare area with existing referral channels differ from those who access care via detection teams.MethodThose with first-episode psychosis recruited via detection teams were compared with those accessing treatment via conventional channels, at baseline and after 3 months of acute treatment.ResultsPatients recruited via detection teams are younger males with a longer DUP a less dramatic symptom picture and better functioning; however they recover more slowly, and have more symptoms at 3-month follow-up.ConclusionsAfter establishing low threshold active case-seeking detection teams, we found clear differences between those patients entering treatment via detection teams v. those obtaining treatment via the usual channels. Such profiling may be informative for early detection service development.

scholarly journals Pathways to care and ethnicity. 2: Source of referral and help-seeking

2005 ◽  
Vol 186 (4) ◽  
pp. 290-296 ◽  
Author(s):  
Craig Morgan ◽  
Rosemarie Mallett ◽  
Gerard Hutchinson ◽  
Hemant Bagalkote ◽  
Kevin Morgan ◽  
...  
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Help Seeking ◽  
Pathways To Care ◽  
First Episode ◽  
Criminal Justice Agency ◽  
Black African ◽  
African Caribbean ◽  
African Patients ◽  
Pathway To Care

BackgroundPrevious research has found that African–Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres.MethodWe included all White British, other White, African–Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.ResultsCompared with White British patients, general practitioner referral was less frequent for both African–Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders.ConclusionsThese findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.

Major lupus organ involvement: severe lupus nephritis

Lupus ◽  
2010 ◽  
Vol 19 (12) ◽  
pp. 1391-1398 ◽  
Author(s):  
Y. Avihingsanon ◽  
N. Hirankarn
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Opportunistic Infections ◽  
Early Recognition ◽  
Asian Population ◽  
Immunosuppressive Drugs ◽  
First Episode ◽  
Asian Patients ◽  
Renal Flare ◽  
Number Of Patients

Lupus nephritis is a common and severe complication of systemic lupus erythematosus. A number of patients have nephritis as a presenting feature that, in its severe form, can shortly lead to end-stage renal disease and/or death. Renal flare usually occurs a few years after the first episode and is remarkably predominant in the Asian population. Frequent monitoring for renal flare enhances early recognition and timely treatment. The mainstay therapy continues to be the prolonged use of cytotoxic/immunosuppressive drugs that have a number of undesirable effects, particularly ovarian failure and development of opportunistic infections. This review will focus on the pathogenesis and the unique genetic factors found in Asian patients with lupus nephritis. Here, we propose an appropriate management scheme for the treatment of lupus nephritis in Asian patients.

Sign in / Sign up

Export Citation Format

Share Document