Relapse rates in an early psychosis treatment service

To examine the relapse rate achievable in a real-life early psychosis treatment service. METHOD: A 2-year longitudinal cohort study of consecutive admissions to an early psychosis programme which served the entire population in a catchment area. The primary outcome measure was relapse. RESULTS: One hundred and forty-eight consecutive consenting admissions were recruited, 124 (83.8%) of whom were followed for 1 year and 116 (78.4%) for 2 years. Relapse was assessed by clinicians using structured criteria. The 2-year relapse rate among subjects with complete data collection was 34/95 (35.7%, 95% CI 26.2-46.3). A Kaplan-Meier life table censoring subjects lost to follow-up yielded a comparable estimate of the proportion not relapsing: 68% (95% CI 58-76%). CONCLUSION: These estimates compare favourably with a published range of 2-year relapse from 55% to 70% in the older literature and are comparable with the results in recent clinical trials.     

A descriptive study of 'non-cases' and referral rates to an early intervention for psychosis service

Aim: Despite there being approximately 200 early intervention services for psychosis worldwide, little is known about the referral rates to these services, the diagnoses and needs of individuals found not to have a first episode of psychosis (FEP). Firstly, we aimed to describe the diagnoses for individuals who were found not to have a FEP (non‐cases) following an assessment using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV (SCID). We then aimed to examine the referral rates of cases and non‐cases to an early intervention service. Methods: All individuals referred to the early intervention service underwent a clinical assessment using the SCID. Results: In a 4‐year period, there were 632 referrals to the early intervention service for psychosis, and of these, 53% (n = 338) were found to have a FEP, 5% (n = 34) were found to have an at‐risk mental state for psychosis and 41% (n = 260) were found to be ‘non‐cases’. This represents a ratio of 1.9:1 of referrals to cases, or approximately 2:1. Of the non‐cases, 27% (n = 62) satisfied criteria for a mood disorder, with major depressive disorder the commonest diagnosis. A further 18% (n = 42) of non‐cases satisfied criteria for an anxiety disorder and nearly half of these were diagnosed with social phobia. The ratio of referrals to cases was not consistent over time and rose from 1.3:1 in the first year to 2:1 in the fourth year. Conclusion: A large proportion of individuals referred to an early intervention for psychosis service were found not to have psychotic disorder, however they still have significant needs regarding their mental health.     

Outcomes post‐discharge from an early intervention in psychosis service

Aim: To investigate the effectiveness of an early intervention in psychosis (EIP) service on engagement and hospital bed usage, post‐discharge. A secondary aim was to identify if there was a subgroup of patients with ‘poor outcomes’. Method: A naturalistic study comparing engagement and hospital bed day usage of individuals who received treatment from an EIP service (n = 75) with those who presented before the service was established (n = 113). Results: The EIP service demonstrated better engagement with service users in year 5 (P = 0.001). No significant differences were observed on hospital bed day usage. When ‘poor outcome’ cases were removed, a trend towards lower bed usage in EIP services emerged (P = 0.139). Conclusion: EIP services improve engagement with service users. There was not a significant reduction in hospital bed usage. However, advantages could be masked by a relatively small number of individuals with ‘poor outcomes’.     

Implementing telepsychiatry in an early psychosis service during COVID-19: Experiences of young people and clinicians and changes in service utilization

Aim

In response to the COVID-19 pandemic, our early psychosis program rapidly transitioned to telepsychiatry. This study examined the change in health service utilization and experiences of young people and clinicians in response to the implementation of telepsychiatry.

Methods

Mixed methodology and triangulation of evidence drawn from health service databases and survey data. Using a retrospective observational design, health service data from pre- (Time 1) and post-(Time 2) telepsychiatry periods were compared. Surveys were also conducted with representation from clinicians and young people.

Results

The number of appointments increased between Time 1 and 2, although this was accompanied by a near-doubling in missed appointments (8% to 13%). Young people had mixed views about telepsychiatry. While convenience was a frequently cited benefit, clients reported technological issues, isolation and lack of human connection. A preference for face-to-face appointments was linked to younger age and anxiety when using telepsychiatry. Clinicians reported improved workplace satisfaction and efficiency but noted some limitations in the use of telepsychiatry including difficulty interviewing and managing unwell clients remotely and called for greater skill development.

Conclusions

The introduction of telepsychiatry in response to COVID-19 was associated with an increase in service activity; however, there was an increase missed appointments by young people. Although clinicians and clients reported positive experiences, telepsychiatry was not completely endorsed as a replacement for face-to-face interactions.     

One‐year outcome of an early intervention in psychosis service: a naturalistic evaluation

Aim: We conducted a 1‐year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home‐based Outreach Service (ETHOS)) during its first 3 years of operation in South‐west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1‐year follow‐up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non‐randomized parallel cohort (comparison group) of first‐episode patients treated by community mental health teams. Results: The Early Treatment and Home‐based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit.     

Prediction of twelve‐month service disengagement from an early intervention in psychosis service

Aim: The aim is to examine disengagement in an early psychosis treatment service and contrast clinical and demographic variables of patients who disengage against those who do not. Methods: Those with termination of treatment, despite therapeutic need within 12 months of entry (disengagers) (n = 57; 24.6%), were compared with those who remained in treatment at 12 months (n = 175) on a range of clinical and demographic variables collected at admission. After testing the difference between proportions, data analysis was conducted using methods of logistic regression. Results: Alcohol and/or cannabis abuse/dependence, initial diagnosisother than mood disorder, long duration of untreated psychosis, lower Positive and Negative Syndrome Scale total symptoms, and lower insight at referral accounted for 27% of variance in patient ‘disengagement’ within 12 months. Conclusion: A significant proportion of patients with first episode psychosis disengage from treatment within 12 months. Despite a number of factors being associated with disengagement, prediction using admission factors was poor. Early Intervention in Psychosis Services would benefit from increased attention to alcohol and drug problems, trying to reduce the duration of untreated psychosis, improving psychiatric symptoms and increasing insight in all patients to decrease service disengagement.     

Family peer support work in an early intervention youth mental health service

This paper describes the evolution of a family peer support programme in an early intervention service in Melbourne, Australia. In response to policy directions from Federal and State governments calling for carer participation in public mental health services, and feedback from the families of young people at Orygen Youth Health, the ‘Families Helping Families’ project was developed. The positive acceptance by families of this innovative programme also warrants further exploration. The programme has overcome many organizational hurdles associated with specifically trained and employed family carers working alongside professional mental health clinicians. This article describes the change processes involved in implementing this programme and documents preliminary expressions of the benefits of family peer support. The contribution of lived experience in treatment and consumer care plans needs rigorous research and evaluation.     

Help-seeking pathways in early psychosis

Introduction Understanding the help-seeking pathways of patients with a putative risk of developing psychosis helps improving development of specialised care services. This study aimed at obtaining information about: type of health professionals contacted by patients at putative risk for psychosis on their help-seeking pathways; number of contacts; type of symptoms leading to contacts with health professionals; interval between initial contact and referral to a specialised outpatient service. Method The help-seeking pathways were assessed as part of a prospective study in 104 patients with suspected at-risk states for psychosis. Results The mean number of contacts prior to referral was 2.38. Patients with psychotic symptoms more often contacted mental health professionals, whereas patients with insidious and more unspecific features more frequently contacted general practitioners (GPs). Conclusions GPs have been found to under-identify the insidious features of emerging psychosis (Simon et al. (2005) Br J Psychiatry 187:274–281). The fact that they were most often contacted by patients with exactly these features calls for focussed and specialised help for primary care physicians. Thus, delays along the help-seeking pathways may be shortened. This may be of particular relevance for patients with the deficit syndrome of schizophrenia.