scholarly journals Invited commentary on … Ethnic variations in pathways into early intervention services for psychosis

2013 ◽  
Vol 202 (4) ◽  
pp. 284-285 ◽  
Author(s):  
Richard Warner
Keyword(s):  
Early Intervention ◽  
Duration Of Untreated Psychosis ◽  
Early Intervention Services ◽  
Poor Outcome ◽  
Long Duration ◽  
Intervention Services ◽  
Ethnic Variations ◽  
Early Intervention In Psychosis

SummaryAdvocates of early intervention in psychosis choose to treat the association between long duration of untreated psychosis (DUP) and poor outcome as evidence that reducing DUP will improve outcomes. I question this view and argue that DUP does not predict outcome but rather that mode of onset of psychosis predicts DUP and outcome.

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.

scholarly journals Understanding Components of Duration of Untreated Psychosis and Relevance for Early Intervention Services in the Canadian Context: Comprendre les Composantes de la Durée de la Psychose Non Traitée et la Pertinence de Services D’intervention Précoce Dans le Contexte Canadien

2021 ◽  
pp. 070674372199267
Author(s):  
Ashok Malla ◽  
Manish Dama ◽  
Srividya Iyer ◽  
Ridha Joober ◽  
Norbert Schmitz ◽  
...  
Keyword(s):  
Early Intervention ◽  
Help Seeking ◽  
Multivariate Analyses ◽  
Patient Characteristics ◽  
Pathways To Care ◽  
Duration Of Untreated Psychosis ◽  
Present Sample ◽  
Early Intervention Services ◽  
Rapid Access ◽  
Intervention Services

Background: Clinical, functional, and cost-effectiveness outcomes from early intervention services (EIS) for psychosis are significantly associated with the duration of untreated psychosis (DUP) for the patients they serve. However, most EIS patients continue to report long DUP, while a reduction of DUP may improve outcomes. An understanding of different components of DUP and the factors associated with them may assist in targeting interventions toward specific sources of DUP. Objectives: To examine the components of DUP and their respective determinants in order to inform strategies for reducing delay in treatment in the context of an EIS. Methods: Help-seeking (DUP-H), Referral (DUP-R), and Administrative (DUP-A) components of DUP, pathways to care, and patient characteristics were assessed in first episode psychosis ( N = 532) patients entering an EIS that focuses on systemic interventions to promote rapid access. Determinants of each component were identified in the present sample using multivariate analyses. Results: DUP-H (mean 25.64 ± 59.00) was longer than DUP-R (mean = 14.95 ± 45.67) and DUP-A (mean 1.48 ± 2.55). Multivariate analyses showed that DUP-H is modestly influenced by patient characteristics (diagnosis and premorbid adjustment; R 2 = 0.12) and DUP-R by a combination of personal characteristics (age of onset and education) and systemic factors (first health services contact and final source of referral; R 2 = 0.21). Comorbid substance abuse and referral from hospital emergency services have a modest influence on DUP-A ( R 2 = 0.08). Patients with health care contact prior to onset of psychosis had a shorter DUP-H and DUP-R than those whose first contact was after psychosis onset (F(1, 498) = 4.85, P < 0.03 and F(1, 492) = 3.34, P < 0.07). Conclusions: Although much of the variance in DUP is unexplained, especially for help-seeking component, the systemic portion of DUP may be partially determined by relatively malleable factors. Interventions directed at altering pathways to care and promote rapid access may be important targets for reducing DUP. Simplifying administrative procedures may further assist in reducing DUP.

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.

scholarly journals Outcome measures in early psychosis

2007 ◽  
Vol 191 (S50) ◽  
pp. s58-s63 ◽  
Author(s):  
Swaran P. Singh
Keyword(s):  
Early Intervention ◽  
Clinical Outcome ◽  
Recent Literature ◽  
Duration Of Untreated Psychosis ◽  
Short Term ◽  
Detection Function ◽  
Early Intervention Services ◽  
Time Points ◽  
Intervention Services ◽  
Precise Time

BackgroundDuration of untreated psychosis (DUP) is considered an important predictor of short-term clinical outcomeAimsTo explore the evolution of the concept of DUP, synthesise the evidence for its predictive value, highlight the problems in measurement, and consider the potential pitfalls of using DUP as a measure of the effectiveness of early intervention servicesMethodA survey of recent literature was conductedResultsSeveral studies and two systematicreviews confirm that DUP has a robust but moderate effecton outcome in schizophrenia. Studies vary widely in how DUP is defined and measured, since identifying precise time points when psychosis emerges and remits is conceptually ambiguous and clinically difficultConclusionsStandardised measurement of DUP is a vital first step in allowing comparisons between studies. Duration of untreated psychosis is a relevant measure only of the early detection function of early intervention services

Comparative analysis of pathways to early intervention services and duration of untreated psychosis in two Canadian cities

2016 ◽  
Vol 11 (6) ◽  
pp. 517-521 ◽  
Author(s):  
Nina Flora ◽  
Kelly K. Anderson ◽  
Manuela Ferrari ◽  
Andrew Tuck ◽  
Suzanne Archie ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Early Intervention ◽  
Duration Of Untreated Psychosis ◽  
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.

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.

scholarly journals Psychosis incidence through the prism of early intervention services

2012 ◽  
Vol 200 (2) ◽  
pp. 156-157 ◽  
Author(s):  
J. B. Kirkbride ◽  
C. Stubbins ◽  
P. B. Jones
Keyword(s):  
Early Intervention ◽  
Rural Communities ◽  
Social Epidemiology ◽  
First Episode ◽  
Asian Origin ◽  
East Anglia ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Intervention Services ◽  
Early Intervention In Psychosis

SummaryWe know little about first-episode psychosis epidemiology beyond cities or when measured through early intervention in psychosis services. We present results from 18 months of the 3-year Social Epidemiology of Psychoses in East Anglia (SEPEA) study of incepted incidence observed through five early intervention services. We identified 378 eligible individuals (incidence: 45.1/100 000 person-years, 95% CI 40.8–49.9). Rates varied across these services, but were 2–3 times higher than those on which services were commissioned. Risk decreased with age, was nearly doubled among men and differed by ethnic group; doubled in people of mixed ethnicity but lower for those of Asian origin, compared with White British people. Psychosis risk among ethnic minorities was lower than reported in urban settings, which has potential implications for aetiology. Our data suggest considerable psychosis morbidity in diverse, rural communities.

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