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 O4.5. LONG TERM EFFECTS OF EARLY INTERVENTION SERVICES FOR FIRST EPISODE PSYCHOSIS: OUTCOMES OVER FIVE YEARS FROM THE RECOVERY AFTER A 1ST EPISODE OF SCHIZOPHRENIA-EARLY TREATMENT PROGRAM (RAISE-ETP)

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S10-S11
Author(s):  
Delbert Robinson ◽  
Nina Schooler ◽  
John Kane
Keyword(s):  
Clinical Trial ◽  
Early Intervention ◽  
Usual Care ◽  
Standard Care ◽  
Clinical Care ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Services ◽  
Episode Psychosis

Abstract Background Early intervention services (EIS) for first episode psychosis (FEP) are now implemented worldwide and these integrated and team-based treatment programs improve FEP outcomes while patients are participating. EIS service and treatment models provide care for limited periods followed by return to standard services. Cross sectional follow-up studies conducted after EIS participation ends have not been able to find advantages compared with standard care. The RAISE-ETP study was the first US-based, multi-center randomized clinical trial to compare an EIS, labeled NAVIGATE, to usual clinical care. Those who received NAVIGATE experienced significant improvement in symptoms and functioning compared to those who received usual care during the initial two-year treatment period. We now report clinical outcomes covering five years, a time frame that includes care after EIS participation ended. Methods RAISE-ETP was a cluster randomized clinical trial conducted at 34 US sites; 17 sites provided NAVIGATE to 223 participants and 17 sites provided usual clinical care to 181 participants. NAVIGATE was available until the last randomized subject had the opportunity for two years of services. Participants were assessed every six months for up to 60 months by masked, centralized assessors utilizing live two-way video and with the Heinrichs-Carpenter Quality of Life Scale (QLS) and the Positive and Negative Syndrome Scale (PANSS). Results Participants had a mean age of 23 years and the majority were male; (78% in NAVIGATE and 66% in usual care). The mean opportunity for NAVIGATE treatment was 33.8 (SD=5.1) months; the longest 44.4 months. Compared with usual care, NAVIGATE over 5 years was associated with a 13.14 unit QLS (p&lt;0.001) and 7.73 unit PANSS (p&lt;0.002) better improvement and 2.5 fewer inpatient days (p=0.02). NAVIGATE opportunity length did not affect QLS outcome; duration of untreated psychosis did not moderate differential QLS outcome. Discussion RAISE-ETP provides compelling evidence of a substantial long-term benefit for FEP treatment with the NAVIGATE EIS compared with standard care.

Views of Young People in Early Intervention Services for First-Episode Psychosis in England

2011 ◽  
Vol 62 (8) ◽  
pp. 882-887 ◽  
Author(s):  
Helen Lester ◽  
Max Marshall ◽  
Peter Jones ◽  
David Fowler ◽  
Tim Amos ◽  
...  
Keyword(s):  
Early Intervention ◽  
Young People ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Intervention Services

scholarly journals Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada

2020 ◽  
pp. 1-10
Author(s):  
Srividya N. Iyer ◽  
Ashok Malla ◽  
Aarati Taksal ◽  
Anika Maraj ◽  
Greeshma Mohan ◽  
...  
Keyword(s):  
Early Intervention ◽  
Family Involvement ◽  
Proportional Hazards ◽  
Family Engagement ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Early Intervention Services ◽  
Service Engagement ◽  
Intervention Services ◽  
Family Contact

Abstract Background It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. Methods Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). Results The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = −1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81–0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). Conclusions This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.

scholarly journals Loneliness in early psychosis: A qualitative study exploring the views of mental health practitioners in early intervention services

2020 ◽  
Author(s):  
Theodora Stefanidou ◽  
Jingyi Wang ◽  
Nicola Morant ◽  
Brynmor Lloyd-Evans ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Public Health Problem ◽  
Early Psychosis ◽  
Mental Health Practitioners ◽  
First Episode ◽  
Physical And Mental Health ◽  
Early Intervention Services ◽  
Health Practitioners ◽  
Intervention Services

Abstract Background: Loneliness is an important public health problem with established adverse effects on physical and mental health. Although, people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions.Methods: Semi-structured face-to-face interviews were conducted with mental health practitioners (n=20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted.Results: Participants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development. Conclusions: This study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions.

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 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.

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