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Predictors of disengagement from Early Intervention in Psychosis services

  • Francesca Solmi (a1), Abdolali Mohammadi (a2), Jesus A. Perez (a3), Yasir Hameed (a4), Peter B. Jones (a5) and James B. Kirkbride (a6)...

Abstract

Background

The effectiveness of Early Intervention in Psychosis (EIP) services for individuals with a first episode of psychosis (FEP) could be thwarted by high rates of early disengagement.

Aims

To investigate which factors predict disengagement with EIP services.

Method

Using data from a naturalistic cohort of 786 EIP clients in East Anglia (UK), we investigated the association between sociodemographic and clinical predictors and disengagement using univariable and multivariable Cox proportional hazards models.

Results

Over half (54.3%) of our sample were discharged before receiving 3 years of EIP care, with 92 (11.7%) participants discharged due to disengagement. Milder negative symptoms, more severe hallucinations, not receiving an FEP diagnosis, polysubstance use and being employed were associated with greater disengagement.

Conclusions

Our findings highlight heterogeneous reasons for disengagement with EIP services. For some patients, early disengagement may hinder efforts to sustain positive long-term EIP outcomes. Efforts to identify true FEP cases and target patients with substance use problems and more severe positive symptoms may increase engagement.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence Dr Francesca Solmi, PsyLife group, Division of Psychiatry, University College London, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, N1T 7NF, London, UK. Email: francesca.solmi@ucl.ac.uk

References

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1National Institute for Health and Care Excellence (NICE). Psychosis and Schizophrenia in Adults: Prevention and Management. NICE, 2014. Available at: http://nice.org.uk/guidance/cg178.
2National Institute for Health and Care Excellence (NICE). Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance. NHS England, 2016.
3Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients. Arch Gen Psychiatry 2005; 62: 975–83.
4McGorry, PD. Early intervention in psychosis. J Nerv Ment Dis 2015; 203: 310–8.
5Stafford, MR, Jackson, H, Mayo-Wilson, E, Morrison, AP, Kendall, T. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346: f762.
6Mihalopoulos, C, Harris, M, Henry, L, Harrigan, S, McGorry, P. Is early intervention in psychosis cost-effective over the long term? Schizophr Bull 2009; 35: 909–18.
7McCrone, P, Craig, TKJ, Power, P, Garety, PA. Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 2010; 196: 377–82.
8Chan, TCW, Chang, WC, Hui, CLM, Chan, SKW, Lee, EHM, Chen, EYH. Rate and predictors of disengagement from a 2-year early intervention program for psychosis in Hong Kong. Schizophr Res 2014; 153: 204–8.
9Stowkowy, J, Addington, D, Liu, L, Hollowell, B, Addington, J. Predictors of disengagement from treatment in an early psychosis program. Schizophr Res 2012; 136: 712.
10Turner, M, Smith-Hamel, C, Mulder, R. Prediction of twelve-month service disengagement from an early intervention in psychosis service. Early Interv Psychiatry 2007; 1: 276–81.
11Conus, P, Lambert, M, Cotton, S, Bonsack, C, McGorry, PD, Schimmelmann, BG. Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort. Schizophr Res 2010; 118: 256–63.
12Albert, N, Melau, M, Jensen, H, Emborg, C, Jepsen, JRM, Fagerlund, B, et al. Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II). BMJ 2017; 356: j1015.
13Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlæger, J, le Quach, P, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness. Arch Gen Psychiatry 2008; 65: 762.
14Chang, WC, Chan, GHK, Jim, OTT, Lau, ESK, Hui, CLM, Chan, SKW, et al. Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. Br J Psychiatry 2015; 206: 492500.
15Chang, WC, Kwong, VWY, Lau, ESK, So, HC, Wong, CSM, Chan, GHK, et al. Sustainability of treatment effect of a 3-year early intervention programme for first-episode psychosis. Br J Psychiatry 2017; 211: 3744.
16Leclerc, E, Noto, C, Bressan, RA, Brietzke, E. Determinants of adherence to treatment in first-episode psychosis: a comprehensive review. Rev Bras Psiquiatr 2015; 37: 168–76.
17Kreyenbuhl, J, Nossel, IR, Dixon, LB. Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophr Bull 2009; 35: 696703.
18Kirkbride, JB, Hameed, Y, Ankireddypalli, G, Ioannidis, K, Crane, CM, Nasir, M, et al. The epidemiology of first-episode psychosis in early intervention in psychosis services: findings from the social epidemiology of psychoses in East Anglia [SEPEA] study. Am J Psychiatry 2016; 174: 143–53.
19McGuffin, P, Farmer, A, Harvey, I. A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Arch Gen Psychiatry 1991; 48: 764–70.
20Williams, J, Farmer, AE, Ackenheil, M, Kaufmann, CA, McGuffin, P. A multicentre inter-rater reliability study using the OPCRIT computerized diagnostic system. Psychol Med 1996; 26: 775–83.
21StataCorp. Stata Statistical Software version 13. 2013.
22Doyle, R, Turner, N, Fanning, F, Brennan, D, Renwick, L, Lawlor, E, et al. First-episode psychosis and disengagement from treatment: a systematic review. Psychiatr Serv 2014; 65: 603–11.
23Lal, S, Malla, A. Service engagement in first-episode psychosis: current issues and future directions. Can. J. Psychiatry 2015; 60: 341–5.
24Anderson, KK, Fuhrer, R, Schmitz, N, Malla, AK. Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 125–36.
25Craig, TKJ, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M, et al. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ 2004; 329: 1067.
26Schimmelmann, BG, Conus, P, Schacht, M, Mcgorry, P, Lambert, M. Predictors of service disengagement in first-admitted adolescents with psychosis. J Am Acad Child Adolesc Psychiatry 2006; 45: 990–9.
27Gafoor, R, Nitsch, D, McCrone, P, Craig, TKJ, Garety, PA, Power, P, et al. Effect of early intervention on 5-year outcome in non-affective psychosis. Br J Psychiatry 2010; 196: 372–6.
28Tait, L, Birchwood, M, Trower, P. A new scale (SES) to measure engagement with community mental health services. J Ment Heal 2002; 11: 191–8.
29Tetley, A, Jinks, M, Huband, N, Howells, K. A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment. J Clin Psychol 2011; 67: 927–41.
30Gronholm, PC, Thornicroft, G, Laurens, KR, Evans-Lacko, S. Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. Psychol Med 2017; 47: 1867–79.

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Predictors of disengagement from Early Intervention in Psychosis services

  • Francesca Solmi (a1), Abdolali Mohammadi (a2), Jesus A. Perez (a3), Yasir Hameed (a4), Peter B. Jones (a5) and James B. Kirkbride (a6)...
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