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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


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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