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Reduction in Incidence of Hospitalizations for Psychotic Episodes Through Early Identification and Intervention
William R. McFarlane, M.D.; Ezra Susser, M.D., Dr.P.H.; Richard McCleary, Ph.D.; Mary Verdi, M.A.; Sarah Lynch, L.C.S.W.; Deanna Williams, B.S.; Ian W. McKeague, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300336
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Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: mcfarw@mmc.org). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.

Copyright © 2014 by the American Psychiatric Association

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Abstract

Objective  This study examined whether the incidence of hospitalization for psychosis was reduced by a communitywide system of early identification and intervention to prevent onset of psychosis.

Methods  The Portland Identification and Early Referral program (PIER) was initiated in 2001. Youths and young adults ages 12–35 were identified by professionals in a wide variety of educational, health, and mental health settings. PIER program staff assessed, confirmed risk of psychosis, and provided treatment for 24 months to eligible and consenting young people (N=148). The monthly rate of first hospital admission for psychosis was the outcome measure for efficacy of identification and intervention. Admission rates before and after the program began accepting referrals were compared, both in the experimental area (Greater Portland) and in aggregated urban areas of Maine (control areas). Autoregressive integrated moving-average (ARIMA) models were used to assess the effect.

Results  On the basis of ARIMA models, the rate of first hospital admission for psychosis decreased significantly by 26% (95% confidence interval [CI]=–64% to –11%) in the Greater Portland area. The rate increased by 8% (CI=–5% to 36%) in the control areas. Taking into account the increase in the control areas, the actual percentage reduction in Greater Portland during the intervention period was 34% (24% plus 8%). The reduction in admissions was largest for individuals with nonaffective nonschizophrenic psychosis.

Conclusions  PIER has demonstrated that populationwide early identification is feasible. Preventive intervention can reduce rates of initial hospitalizations for psychosis in a midsized city.

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