Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-28T17:58:01.644Z Has data issue: false hasContentIssue false

Early psychosis treatment in an integrated model within an adult mental health service

Published online by Cambridge University Press:  15 April 2020

M. Petrakis*
Affiliation:
St Vincent's Mental Health Service, Hawthorn Community Mental Health Service, 642, Burwood Road, Hawthorn East3123, Melbourne, Australia Monash University, Department of Social Work, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
S. Penno
Affiliation:
St Vincent's Mental Health Service, Hawthorn Community Mental Health Service, 642, Burwood Road, Hawthorn East3123, Melbourne, Australia
J. Oxley
Affiliation:
St Vincent's Mental Health Service, Hawthorn Community Mental Health Service, 642, Burwood Road, Hawthorn East3123, Melbourne, Australia
H. Bloom
Affiliation:
St Vincent's Mental Health Service, Clarendon Community Mental Health Service, 52 Albert Street, East Melbourne3002, Melbourne, Australia
D. Castle
Affiliation:
St Vincent's Mental Health Service, Mental Health Service Administration, 2nd floor, 46 Nicholson Street, Fitzroy3065, Melbourne, Australia University of Melbourne, Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, Australia
*
*Corresponding author. Tel.: +03 9882 9299; fax: +03 9882 9637. E-mail address:Melissa.Petrakis@svhm.org.au
Get access

Abstract

Objective

To compare the treatment of patients with early psychosis, 2 years after the introduction of an integrated model of enhanced management within a public adult mental health service, with an historic cohort from the same service.

Method

Variables examined in the 2001 cohort were compared with 2008 patients. Computer database review and a file audit were conducted for all patients with early psychosis across the first 2 years of the program.

Results

Compared to the historic cohort, patients in the current cohort were 24% less likely to have been admitted (P = 0.004). There were statistically significant reductions in involuntary status and use of a locked unit. Rates of police involvement in admission and use of seclusion were also reduced, though this trend was not significant. Average length of stay was reduced. Median duration of untreated psychosis was 3 months in both 2001 and 2008 cohorts.

Conclusions

The introduction of an integrated model of management within an area mental health service for patients with early psychosis contributed to significant reductions in admissions, involuntary status and use of a locked ward. The data suggests that enhanced treatment of early psychosis patients can be offered within generic services.

Type
Original articles
Copyright
Copyright © European Psychiatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J.International clinical practice guidelines for early psychosis. Br J Psychiatry. 2005; 187 suppl. 48: s120s124.Google Scholar
American Psychiatric Association 4th edDiagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Press; 1994.Google Scholar
Amminger, G.P.Duration of untreated psychosis and cognitive deterioration in first-episode schizophrenia. Schizophr Res. 2002; 54(3): 223230.CrossRefGoogle ScholarPubMed
Archie, S.Hobbs, H.Menezes, N.Translating best practices into service: implementing early intervention for psychosis across Canada. Psychiatr Ann. 2008; 38(8): 544558.CrossRefGoogle Scholar
Benton, D.C.Clinical effectiveness.Hamer, S.Collinson, G.Achieving evidence-based practice: a handbook for practitioners. LondonBalliere Tindall, an imprint of Harcourt Publishers Limited 1999.Google Scholar
Bosanac, P.Patton, G.C.Castle, D.J.Early intervention in psychotic disorders: faith before facts?. Psychol Med. 2010; 40(3): 353358.CrossRefGoogle ScholarPubMed
Carbone, S.Harrigan, S.McGorry, P.Curry, C.Elkins, K.Duration of untreated psychosis and 12-month outcome in first-episode psychosis: the impact of treatment approach. Acta Psychiatr Scand. 1999; 100(2): 96104.CrossRefGoogle ScholarPubMed
Chong, S.A.The Early Psychosis Intervention Programme in Singapore: a balanced scorecard approach to quality care. J Mental Health. 2008; 17(1): 7991.CrossRefGoogle Scholar
Conus, P.Cotton, S.Schimmelmann, B.G.McGorry, P.D.Lambert, M.The First-Episode Psychosis Outcome Study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patients. Early Intervent Psychiatry. 2007; 1(2): 191200.CrossRefGoogle Scholar
Craig, T.A step too soon or a step too far? Early intervention in psychosis. J Ment Health. 2003; 12: 335339.CrossRefGoogle Scholar
Craig, T.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. Br Med J. 2004; 329: 1067.CrossRefGoogle ScholarPubMed
Edwards, J.Maude, McGorry, P.Harrigan, S.Cocks, J.Prolonged recovery in first episode psychosis. Br J Psychiatry. 1998; 172 suppl. 33: 107116.CrossRefGoogle ScholarPubMed
Fennig, S.Bramet, E.Jandorf, L.Schwartz, R.Lavelle, J.Ram, R.Eliciting psychotic symptoms using a semi-structured diagnostic interview. The importance of collateral sources of information in a first-admission sample. J Nerv Ment Dis. 1994; 182: 2026.CrossRefGoogle Scholar
Fisher, H, Kate, T, Paddy, P, Brock, C, Jo, F, Karl, M, et al. Routine evaluation in first episode psychosis services: feasibility and results from the MiData project. Soc Psychiatry Psychiatr Epidemiol 2008;43 (12):960–67.CrossRefGoogle ScholarPubMed
Friis, S.Vaglum, P.Haahr, U.Johannessen, J.Larsen, T.Melle, I.et al.Effect of an early detection programme on duration of untreated psychosis: part of the Scandinavian TIPS study. Br J Psychiatry. 2005; 48 Supplementum s29s32.CrossRefGoogle ScholarPubMed
Gafoor, R.Craig, T.Garety, P.Power, P.McGuire, P.Do the benefits of early intervention (EI) treatments persist? 5-year follow-up. Schizophr Res. 2008; 98: 8388.CrossRefGoogle Scholar
Garland, G.Corfield, F.Audit. Hamer, S.Collinson, G.Achieving evidence-based practice: a handbook for practitioners. LondonBalliere Tindall, an imprint of Harcourt Publishers Limited 1999.Google Scholar
Ho, B.C.Andreasen, N.Flaum, M.Nopoulos, P.Miller, D.Untreated initial psychosis: its relation to quality of life and symptom remission in first episode schizophrenia. Am J Psychiatry. 2000; 157: 808815.CrossRefGoogle ScholarPubMed
Joanna Briggs Institute Acute care clinical auditing manual. Adelaide: Joanna Briggs Institute; 2002.Google Scholar
Johannessen, J.Larsen, T.McGlashan, T.Vaglum, P.Early intervention in psychosis: the TIPS project, a multi-centre study in Scandinavia.Bateman, A.Psychosis: psychological approaches alld their effectiveness. LondonGaskell 2000 p. 210–34.Google Scholar
Larsen, T.Melle, I.Auestad, B.Friis, S.Haahr, U.Johannessen, J.et al.Early detection of first-episode psychosis: the effect on 1-year outcome. Schizophr Bull. 2006; 32: 758764.CrossRefGoogle ScholarPubMed
Lieberman, J.Fenton, W.Delayed detection of psychosis: causes, consequences and effect on public health. Am J Psychiatry. 2000; 157: 17271730.CrossRefGoogle ScholarPubMed
Lincoln, C.McGorry, P.D.Pathways to care in early psychosis: clinical and consumer perspectives. McGorry, P.D.Jackson, H.J.The recognition and management of early psychosis – a preventive approach. New York, NYCambridge University Press 1999 p. 51–81.Google Scholar
Linszen, D.Lenoir, M.De Huan, L.Dingemans, P.Gersons, B.Early intervention, untreated psychosis and the course of recent onset schizophrenia. Br J Psychiatry. 1998; 172 suppl. 33: 8489.CrossRefGoogle Scholar
Loebel, A.Lieberman, J.Alvir, J.Mayerhoff, D.Geisler, S.Szymanski, S.Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry. 1992; 149: 11831188.Google ScholarPubMed
McCay, E.Ryan, K.Meeting the patient's emotional needs.Zipursky, R.Schulz, S.The early stages of schizophrenia. Washington DCAmerican Psychiatric Press 2002 p. 107–29.Google Scholar
McGlashan, T.Duration of untreated psychosis in first episode schizophrenia: marker or determinant of course. Biol Psychiatry. 1999; 46: 729739.CrossRefGoogle ScholarPubMed
McGorry, P.Early intervention in psychosis: an overdue reform. Aust N Z J Psychiatry. 2003; 37(4): 393398.CrossRefGoogle Scholar
McGorry, P.The recognition and optimal management of early psychosis: applying the concept of staging in the treatment of psychosis.Johannessen, J.O.Martindale, B.V.Cullberg, J.Evolving Psychosis. New York, NY, USRoutledge/Taylor & Francis Group 2006 p. 19–34.Google Scholar
McGorry, P.Chanen, A.McCarthy, E.Van Riel, R.McKenzie, D.Singh, B.Posttraumatic stress disorder following recent-onset psychosis. An unrecognized post-psychotic syndrome. J Nerv Ment Dis. 1991; 179: 253258.CrossRefGoogle Scholar
McGorry, P.Copolov, D.Singh, B.Current concepts in functional psychosis: the case for a loosening of associations. Schizophr Res. 1990; 3: 221234.CrossRefGoogle ScholarPubMed
McGorry, P.Edwards, J.The feasibility and effectiveness of early intervention in psychotic disorders: the Australian experience. Int Clin Psychopharmacol. 1998; 13(1): S47S52.CrossRefGoogle Scholar
McGorry, P.Killackey, E.Lambert, T.Lambert, M.Jackson, H.Codyre, D.et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust N Z J Psychiatry. 39 1–2: 2005 130.Google Scholar
Meyer, H.Taiminen, T.Vuori, T.Aijala, A.Helenius, H.Posttraumatic stress disorder symptoms related to psychosis and acute involuntary hospitalization in schizophrenic and delusional patients. J Nerv Ment Dis. 1999; 187: 343352.CrossRefGoogle ScholarPubMed
Moscarelli, M.Cpri, S.Neri, L.Cost evaluation of chronic schizophrenic patients during the first 3 years after first contact. Schizophr Bull. 1991; 17: 421426.CrossRefGoogle ScholarPubMed
National Early Psychosis Clinical Guidelines Working Party Australian clinical guidelines for early psychosis. Melbourne: University of Melbourne; 1998.Google Scholar
Early Psychosis Guidelines Writing Group. (2010). Australian Clinical Guidelines for Early Psychosis (2nd ed.). Melbourne: Orygen Youth Health.Google Scholar
Norman, R.Townsend, L.Malla, A.Duration of untreated psychosis and cognitive functioning in first-episode patients. Br J Psychiatry. 2001; 179: 340345.CrossRefGoogle ScholarPubMed
Pelosi, A.Is early intervention in the major psychiatric disorders justified? No. Br Med J. 2009; 337: a710.CrossRefGoogle Scholar
Petersen, L.Jeppesen, P.Thorup, A.Abel, M.B.Ohlenschlaeger, J.Christensen, T.O.et al.A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. Br Med J. 2005; 331: 602.CrossRefGoogle ScholarPubMed
Petrakis M, Hamilton B, Penno S, Selvendra A, Laxton S, Doidge G, et al. Fidelity to clinical guidelines using a care pathway in the treatment of first episode psychosis. J Eval Clin Pract 2010:17: no. doi:10.1111/j.1365-2753.2010.01548.x.CrossRefGoogle Scholar
Reed, S.I.First-episode psychosis: a literature review. Int J Mental Health Nurs. 2008; 17(2): 8591.CrossRefGoogle ScholarPubMed
Shaw, K.McFarlane, A.BookJess, C.The phenomenology of traumatic reaclions to psychotic illness. J Nerv Ment Dis. 1997; 185: 434441.CrossRefGoogle ScholarPubMed
Szymanski, S.Cannon, T.Gallacher, P.Erwin, R.Gurr, R.Course of treatment response in first episode and chronic schizophrenia. Am J Psychiatry. 1996; 153: 519525.Google ScholarPubMed
Wiersma, D.Nienhuls, F.CJ, S.R, G.Natural course of schizophrenic disorders: a 15-year follow-up of a Dutch incidence cohort. Schizophr Bull. 1998; 24: 7585.CrossRefGoogle ScholarPubMed
Yung, A.R.Organ, B.A.Harris, M.G.Management of early psychosis in a generic adult mental health service. Aust N Z J Psychiatry. 2003; 37: 429436.CrossRefGoogle Scholar
Yung, A.Phillips, U.Drew, L.Promoting access to care in early psychosis.McGorry, P.Jackson, H.The recognition and management of early psychosis: a preventive approach. CambridgeCambridge University Press 1999 p. 81–115.Google Scholar
Submit a response

Comments

No Comments have been published for this article.