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Articles   |    
First-Episode Psychosis and Disengagement From Treatment: A Systematic Review
Roisin Doyle, B.A., M.Sc.; Niall Turner, B.Sc., M.Sc.; Felicity Fanning, B.A., M.Sc.; Daria Brennan, M.L.I.S., Ph.D.; Laoise Renwick, B.N.S., Ph.D.; Elizabeth Lawlor, B.A., M.Sc.; Mary Clarke, M.D., F.R.C.Psych.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200570
View Author and Article Information

With the exception of Dr. Brennan, the authors are with Dublin and East Treatment and Early Care Team Services, Blackrock, Ireland (e-mail: roisin.doyle@sjog.ie). Dr. Brennan is with St. John of God Hospital, Ltd., Stillorgan, Ireland, where Ms. Lawlor is also affiliated. Prof. Clarke is also with St. John of God Community Services, Ltd., Blackrock.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  This review examined rates and definitions of disengagement among services for first-episode psychosis (FEP) and identified the most relevant demographic and clinical predictors of disengagement.

Methods  A comprehensive search for and review of published studies that reported rates and predictors of disengagement within FEP services were conducted. The databases PubMed (1966–2012) and PsycINFO (1882–2012) were searched. Relevant terms were used to search the Internet and the reference sections of relevant papers for other pertinent studies. Independent searches for recent publications by leading researchers in the field were also conducted.

Results  Ten articles were included in the review. There was a lack of consensus on a clear definition of engagement and disengagement. However, despite differences in definitions and study settings, the evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Variables that were consistently found to exert an influence on disengagement across studies were duration of untreated psychosis, symptom severity at baseline, insight, substance abuse and dependence, and involvement of a family member.

Conclusions  Given the importance of continuity of care for FEP, there is a need for a clearly defined and agreed measurement of service engagement and disengagement across FEP services. In particular, those who enter an FEP program without family involvement and support as well as those who maintain persistent substance abuse are at higher risk of disengagement. Early identification of such individuals and the development of approaches to reduce risk of service disengagement are likely to increase the effectiveness of these services.

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Table 1Results of studies that reported rates of disengagement from services for first-episode psychosis (FEP)a
Table Footer Note

a FEP services include services for early intervention in psychosis. All studies were limited to patients with diagnoses of FEP or first-episode schizophrenia.

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Table 2Studies that reported predictors of disengagement from treatment for first-episode psychosis, by reference numbera
Table Footer Note

a All studies except reference 5 included only patients with first-episode psychosis. +=significant; –=not significant

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b GAF, Global Assessment of Functioning

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c CDSS, Calgary Depression Scale for Schizophrenia

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d QLS, Quality of Life Scale

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e PANSS, Positive and Negative Syndrome Scale

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f PAS, Premorbid Adjustment Scale

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g HoNOS, Health of the Nation Outcome Scales

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