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Articles   |    
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

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% (26% 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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Figure 1 Ratio of the rates of first hospital admission for psychosis in Greater Portland versus the urban control areas before and after introduction of PIERa

a PIER, Portland Identification and Early Referral program. Rates are per 100,000 population of persons age 12–35.

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Table 1Mean annual rates of first hospital admission for psychosis before and after introduction of the PIER programa
Table Footer Note

a Rates are per 28-day month. PIER, Portland Identification and Early Referral

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Table 2Mean monthly rates of first hospital admission for psychosis before and after introduction of the PIER program, by diagnostic groupa
Table Footer Note

a PIER, Portland Identification and Early Referral

Table Footer Note

b Change in mean as a percentage of the control period mean

Table Footer Note

c Percentage change in the Greater Portland area minus the percentage change in the urban control area

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Table 3Mean annual rates of first hospital admission for psychosis per 100,000 population
Table Footer Note

a Change in mean as a percentage of the control period mean

Table Footer Note

b Percentage change in the Greater Portland area minus the percentage change in the urban control area

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References

Murray  CJL;  Vos  T;  Lozano  R  et al:  Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.  Lancet 380:2197–2223, 2012
[CrossRef] | [PubMed]
 
Wu  EQ;  Birnbaum  HG;  Shi  L  et al:  The economic burden of schizophrenia in the United States in 2002.  Journal of Clinical Psychiatry 66:1122–1129, 2005
[CrossRef] | [PubMed]
 
Lehman  AF;  Steinwachs  DM:  Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations.  Schizophrenia Bulletin 24:1–10, 1998
[CrossRef] | [PubMed]
 
Fusar-Poli  P;  Bonoldi  I;  Yung  AR  et al:  Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk.  Archives of General Psychiatry 69:220–229, 2012
[CrossRef] | [PubMed]
 
Fusar-Poli  P;  Meneghelli  A;  Valmaggia  L  et al:  Duration of untreated prodromal symptoms and 12-month functional outcome of individuals at risk of psychosis.  British Journal of Psychiatry 194:181–182, 2009
[CrossRef] | [PubMed]
 
O'Connell  ME;  Boat  T;  Warner  KE (eds):  Preventing Mental, Emotional and Behavioral Disorders Among Young People .  Washington, DC,  National Academies Press, 2009
 
Ruhrmann  S;  Schultze-Lutter  F;  Salokangas  RK  et al:  Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study.  Archives of General Psychiatry 67:241–251, 2010
[CrossRef] | [PubMed]
 
McGlashan  TH;  Zipursky  RB;  Perkins  D  et al:  Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis.  American Journal of Psychiatry 163:790–799, 2006
[CrossRef] | [PubMed]
 
Morrison  AP;  French  P;  Walford  L  et al:  Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial.  British Journal of Psychiatry 185:291–297, 2004
[CrossRef] | [PubMed]
 
Nordentoft  M;  Thorup  A;  Petersen  L  et al:  Transition rates from schizotypal disorder to psychotic disorder for first-contact patients included in the OPUS trial: a randomized clinical trial of integrated treatment and standard treatment.  Schizophrenia Research 83:29–40, 2006
[CrossRef] | [PubMed]
 
Amminger  GP;  Schäfer  MR;  Papageorgiou  K  et al:  Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial.  Archives of General Psychiatry 67:146–154, 2010
[CrossRef] | [PubMed]
 
Bechdolf  A;  Wagner  M;  Ruhrmann  S  et al:  Preventing progression to first-episode psychosis in early initial prodromal states.  British Journal of Psychiatry 200:22–29, 2012
[CrossRef] | [PubMed]
 
van der Gaag  M;  Nieman  DH;  Rietdijk  J  et al:  Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial.  Schizophrenia Bulletin 38:1180–1188, 2012
[CrossRef] | [PubMed]
 
McGorry  PD;  Yung  AR;  Phillips  LJ  et al:  Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms.  Archives of General Psychiatry 59:921–928, 2002
[CrossRef] | [PubMed]
 
Addington  J;  Epstein  I;  Liu  L  et al:  A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis.  Schizophrenia Research 125:54–61, 2011
[CrossRef] | [PubMed]
 
McGorry  PD;  Nelson  B;  Phillips  LJ  et al:  Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: twelve-month outcome.  Journal of Clinical Psychiatry 74:349–356, 2013
[CrossRef] | [PubMed]
 
Fusar-Poli  P;  Borgwardt  SJ;  Bechdolf  A  et al:  The psychosis high-risk state: a comprehensive state-of-the-art review.  JAMA Psychiatry 70:107–120, 2013
[CrossRef] | [PubMed]
 
Francey  SMNB;  Nelson  B;  Thompson  A  et al:  Who needs antipsychotic medication in the earliest stages of psychosis? A reconsideration of benefits, risks, neurobiology and ethics in the era of early intervention.  Schizophrenia Research 119:1–10, 2010
[CrossRef] | [PubMed]
 
Falloon  IR:  Early intervention for first episodes of schizophrenia: a preliminary exploration.  Psychiatry 55:4–15, 1992
[PubMed]
 
McFarlane  WR;  Cook  WL;  Downing  D  et al:  Portland identification and early referral: a community-based system for identifying and treating youths at high risk of psychosis.  Psychiatric Services 61:512–515, 2010
[CrossRef] | [PubMed]
 
Kirkbride  JB;  Fearon  P;  Morgan  C  et al:  Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study.  Archives of General Psychiatry 63:250–258, 2006
[CrossRef] | [PubMed]
 
Joly  BM;  Pukstas  BK;  Elbaum  WM  et al:  Promoting early detection of psychosis: the role of community outreach.  Journal of Public Mental Health 11:195–208, 2012
[CrossRef]
 
McGlashan TH, Miller, T, Woods, S, et al: Structured Interview for Prodromal Syndromes. New Haven, Conn, Yale School of Medicine, 2003
 
McFarlane  WR:  Family-based treatment in prodromal and first-episode psychosis; in  Early Intervention in Psychotic Disorders . Edited by Miller  T.  Amsterdam,  Kluwer Academic, 2001
 
McCleary  R;  McDowall  D:  Time series designs; in  Handbook of Research Methods in Psychology . Edited by Cooper  H.  Washington, DC,  American Psychological Association, 2012
 
Box  GEP;  Tiao  GC:  Intervention analysis with applications to economic and environmental problems.  Journal of the American Statistical Association 349:70–79, 1975
[CrossRef]
 
Liu L-M, Hudak GB, Box GEP, et al: Forecasting and Time Series Analysis Using the SCA Statistical System.Chicago, Scientific Computing Associates Corp, 1997
 
McGlashan  TH:  Early detection and intervention in schizophrenia: research.  Schizophrenia Bulletin 22:327–345, 1996
[CrossRef] | [PubMed]
 
Salokangas  RKR;  Helminen  M;  Koivisto  A-M  et al:  Incidence of hospitalised schizophrenia in Finland since 1980: decreasing and increasing again.  Social Psychiatry and Psychiatric Epidemiology 46:343–350, 2011
[CrossRef] | [PubMed]
 
Thorup  A;  Waltoft  BL;  Pedersen  CB  et al:  Young males have a higher risk of developing schizophrenia: a Danish register study.  Psychological Medicine 37:479–484, 2007
[CrossRef] | [PubMed]
 
Cannon  TD;  Cadenhead  K;  Cornblatt  B  et al:  Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America.  Archives of General Psychiatry 65:28–37, 2008
[CrossRef] | [PubMed]
 
Cornblatt  B;  Lencz  T;  Obuchowski  M:  The schizophrenia prodrome: treatment and high-risk perspectives.  Schizophrenia Research 54:177–186, 2002
[CrossRef] | [PubMed]
 
McFarlane  WR;  Cook  WL;  Downing  D  et al:  Early Detection, Intervention and Prevention of Psychosis Program: rationale, design, and sample description.  Adolescent Psychiatry 2:112–124, 2012
[CrossRef]
 
Nelson  B;  Yuen  HP;  Wood  SJ  et al:  Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study.  JAMA Psychiatry 70:793–802, 2013
[CrossRef] | [PubMed]
 
Klosterkötter  J;  Hellmich  M;  Steinmeyer  EM  et al:  Diagnosing schizophrenia in the initial prodromal phase.  Archives of General Psychiatry 58:158–164, 2001
[CrossRef] | [PubMed]
 
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