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Brief Reports   |    
Mode of Entry to an Early Intervention Service for Psychotic Disorders: Determinants and Impact on Outcome
Shamira Pira, M.Sc.; Georges Durr, M.D.; Nicole Pawliuk, M.A.; Ridha Joober, M.D., Ph.D.; Ashok Malla, M.B.B.S., F.R.C.P.C.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200474
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Ms. Pira, Ms. Pawliuk, Dr. Joober, and Dr. Malla are affiliated with the Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada. Ms. Pira, Dr. Joober, and Dr. Malla are also with the Department of Psychiatry, McGill University. When this work was done, Dr. Durr was a medical student. He is now a resident in the Department of Ophthalmology, University of Montréal, Quebec. Send correspondence to Dr. Malla at McGill University, Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada (e-mail: ashok.malla@douglas.mcgill.ca). A poster version of this report was presented at the International Early Psychosis Association Conference, San Francisco, October 10–13, 2012.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Specialized early intervention services for first-episode psychosis should treat a proportion of patients without using inpatient beds. This study compared such service users by their initial mode of treatment before entry—inpatient (N=157) or outpatient (N=102).

Methods  On entry to a Montreal early intervention service, the groups were compared on baseline clinical and functional variables and on hospitalizations during two years of treatment.

Results  Initial presentation at an emergency service, shorter duration of untreated psychosis, lower functioning level, and aggressive and bizarre behavior were associated with the inpatient entry mode to early intervention services. During follow-up, individuals entering as inpatients spent more days hospitalized than those entering as outpatients, and their time to rehospitalization was shorter.

Conclusions  Results suggest that entry into early intervention services via the hospital emergency department and presentation with behavioral and functional disturbances were more predictive than core psychotic symptoms of hospital inpatient status on referral to an early intervention service.

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Table 1Analyses predicting hospitalization status on entry to an early intervention service among 259 service users
Table Footer Note

a Variables initially entered into the backward logistic regression model were primary diagnosis, duration of untreated psychosis (log transformed), aggressive and bizarre behavior, elevated mood, unusual thought content, Brief Psychiatric Rating Scale total score, and Global Assessment of Functioning (GAF) score.

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References

Castle  DJ;  Phelan  M;  Wessely  S  et al:  Which patients with non-affective functional psychosis are not admitted at first psychiatric contact? British Journal of Psychiatry 165:101–106, 1994
[CrossRef] | [PubMed]
 
Mihalopoulos  C;  Harris  M;  Henry  L  et al:  Is early intervention in psychosis cost-effective over the long term? Schizophrenia Bulletin 35:909–918, 2009
[CrossRef] | [PubMed]
 
Goldberg  K;  Norman  R;  Hoch  JS  et al:  Impact of a specialized early intervention service for psychotic disorders on patient characteristics, service use, and hospital costs in a defined catchment area.  Canadian Journal of Psychiatry 51:895–903, 2006
 
Harvey  PO;  Lepage  M;  Malla  A:  Benefits of enriched intervention compared with standard care for patients with recent-onset psychosis: a meta-analytic approach.  Canadian Journal of Psychiatry 52:464–472, 2007
 
Petersen  L;  Jeppesen  P;  Thorup  A  et al:  A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness.  BMJ (Clinical Research Ed) 331:602–605, 2005
[CrossRef] | [PubMed]
 
Cassidy  CM;  Schmitz  N;  Norman  R  et al:  Long-term effects of a community intervention for early identification of first-episode psychosis.  Acta Psychiatrica Scandinavica 117:440–448, 2008
[CrossRef] | [PubMed]
 
Malla  A;  Norman  R;  McLean  T  et al:  A Canadian programme for early intervention in non-affective psychotic disorders.  Australian and New Zealand Journal of Psychiatry 37:407–413, 2003
[CrossRef] | [PubMed]
 
Malla  AK;  Norman  RMG;  Manchanda  R  et al:  Status of patients with first-episode psychosis after one year of phase-specific community-oriented treatment.  Psychiatric Services 53:458–463, 2002
[CrossRef] | [PubMed]
 
Sipos  A;  Harrison  G;  Gunnell  D  et al:  Patterns and predictors of hospitalisation in first-episode psychosis: prospective cohort study.  British Journal of Psychiatry 178:518–523, 2001
[CrossRef] | [PubMed]
 
Payne  J;  Malla  A;  Norman  R  et al:  Status of first-episode psychosis patients presenting for routine care in a defined catchment area.  Canadian Journal of Psychiatry 51:42–47, 2006
 
Opjordsmoen  S;  Friis  S;  Melle  I  et al:  A 2-year follow-up of involuntary admission’s influence upon adherence and outcome in first-episode psychosis.  Acta Psychiatrica Scandinavica 121:371–376, 2010
[CrossRef] | [PubMed]
 
Nicholl  D;  Akhras  KS;  Diels  J  et al:  Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective.  Current Medical Research and Opinion 26:943–955, 2010
[CrossRef] | [PubMed]
 
Verdoux  H;  Liraud  F;  Gonzales  B  et al:  Predictors and outcome characteristics associated with suicidal behaviour in early psychosis: a two-year follow-up of first-admitted subjects.  Acta Psychiatrica Scandinavica 103:347–354, 2001
[CrossRef] | [PubMed]
 
Norman  RM;  Malla  AK;  Manchanda  R  et al:  Social support and three-year symptom and admission outcomes for first episode psychosis.  Schizophrenia Research 80:227–234, 2005
[CrossRef] | [PubMed]
 
Morken  G;  Widen  JH;  Grawe  RW:  Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia.  BMC Psychiatry 8:1–7, 2008
[CrossRef] | [PubMed]
 
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