Description, evaluation and scale‐up potential of a model for rapid access to early intervention for psychosis

MacDonald, Kathleen; Malla, Ashok; Joober, Ridha; Shah, Jai; Goldberg, Karen A.; Abadi, Sherezad; Doyle, Madeline B.; Iyer, Srividya N.

doi:10.1111/eip.12564

Cited by 13 publications

(12 citation statements)

References 28 publications

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“…This may be attributed partly to the focus on reducing DUP-R through promoting rapid access. 29 The EIS being situated in the same institution as the only psychiatric emergency service in the catchment area, the RAC being the first point of contact in the EIS and an established protocol for facilitating rapid access for emergency staff, may have facilitated a short DUP-R. However, entry through a hospital emergency may still be undesirable due to potential for a traumatic experience for a young treatment naive patient as well as an increased risk of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Understanding Components of Duration of Untreated Psychosis and Relevance for Early Intervention Services in the Canadian Context: Comprendre les Composantes de la Durée de la Psychose Non Traitée et la Pertinence de Services D’intervention Précoce Dans le Contexte Canadien

et al. 2021

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Background: Clinical, functional, and cost-effectiveness outcomes from early intervention services (EIS) for psychosis are significantly associated with the duration of untreated psychosis (DUP) for the patients they serve. However, most EIS patients continue to report long DUP, while a reduction of DUP may improve outcomes. An understanding of different components of DUP and the factors associated with them may assist in targeting interventions toward specific sources of DUP. Objectives: To examine the components of DUP and their respective determinants in order to inform strategies for reducing delay in treatment in the context of an EIS. Methods: Help-seeking (DUP-H), Referral (DUP-R), and Administrative (DUP-A) components of DUP, pathways to care, and patient characteristics were assessed in first episode psychosis ( N = 532) patients entering an EIS that focuses on systemic interventions to promote rapid access. Determinants of each component were identified in the present sample using multivariate analyses. Results: DUP-H (mean 25.64 ± 59.00) was longer than DUP-R (mean = 14.95 ± 45.67) and DUP-A (mean 1.48 ± 2.55). Multivariate analyses showed that DUP-H is modestly influenced by patient characteristics (diagnosis and premorbid adjustment; R 2 = 0.12) and DUP-R by a combination of personal characteristics (age of onset and education) and systemic factors (first health services contact and final source of referral; R 2 = 0.21). Comorbid substance abuse and referral from hospital emergency services have a modest influence on DUP-A ( R 2 = 0.08). Patients with health care contact prior to onset of psychosis had a shorter DUP-H and DUP-R than those whose first contact was after psychosis onset (F(1, 498) = 4.85, P < 0.03 and F(1, 492) = 3.34, P < 0.07). Conclusions: Although much of the variance in DUP is unexplained, especially for help-seeking component, the systemic portion of DUP may be partially determined by relatively malleable factors. Interventions directed at altering pathways to care and promote rapid access may be important targets for reducing DUP. Simplifying administrative procedures may further assist in reducing DUP.

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Section: Discussionmentioning

confidence: 99%

Understanding Components of Duration of Untreated Psychosis and Relevance for Early Intervention Services in the Canadian Context: Comprendre les Composantes de la Durée de la Psychose Non Traitée et la Pertinence de Services D’intervention Précoce Dans le Contexte Canadien

et al. 2021

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“…This is likely related to our active attempts at reducing DUP . This includes having a rapid assessment (within 72 h) and an open referral system in our service , both of which have enabled patients to circumvent the usual delays encountered through negotiating the complex pathways of a healthcare system.…”

Section: Discussionmentioning

confidence: 99%

“…There is now growing recognition, including through funding and policy mechanisms, that the benefits of EIS may in fact have been underutilized by not reducing DUP concurrently with providing packages of evidence‐based treatments . This has been buttressed by data showing that EIS providing best practice interventions for rapid access to care tend to have patients entering treatment with relatively low DUP . Furthermore, having a shorter DUP has been shown to be associated with improved short‐ and long‐term outcomes .…”

Section: Introductionmentioning

confidence: 99%

Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis

Dama

Shah

Norman

et al. 2019

Acta Psychiatr Scand

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A, Malla A. Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis Objective: To test whether duration of untreated psychosis (DUP) < 3 months, recommended by the World Health Organization/ International Early Psychosis Association, enhances the effects of an extended early intervention service (EEIS) on symptom remission. Method: We examined data from a randomized controlled trial in which patients who received 2 years of treatment in EIS for psychosis were subsequently randomized to either 3 years of EEIS or 3 years of regular care (RC). Using a DUP cut-off ≤ 12 weeks (approximately < 3 months), patients were split into two groups. Length of positive, negative and total symptom remission were the outcomes. Results: Patients (N = 217) were mostly male (68%) with schizophrenia spectrum disorder (65%); 108 (50%) received EEIS (58 had DUP ≤12 weeks; 50 had DUP >12 weeks). Interaction between treatment condition (EEIS vs. RC) and DUP cut-off ≤ 12 weeks was only significant in multiple linear regression model examining length of negative symptom remission as the outcome (adjusted b = 36.88 [SE = 15.88], t = 2.32, P = 0.02). EEIS patients with DUP ≤12 weeks achieved 25 more weeks of negative symptom remission than EEIS patients with DUP >12 weeks. Conclusion: Having a short DUP may be critical in deriving long-term benefits from EIS for psychosis, including EEIS settings. This work empirically supports policy recommendations of reducing DUP <3 months. Significant outcomes• Having a short DUP of 12 weeks or less may increase the length of negative symptom remission by 25 more weeks among patients receiving treatment in an extended early intervention service for psychosis • These results are independent of known confounds including the age at onset of psychosis, premorbid functioning, having a diagnosis of schizophrenia spectrum disorder and the severity of negative symptoms at the time of randomization • This work provides important empirical support for the World Health Organization and International Early Psychosis Association's recommendation of having a DUP of less than 3 months in early intervention services for psychosis Limitations • Certain patient characteristics not included in this study (e.g. degree of insight and migration status) may have the potential to influence our findings.

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“…See Table 1 for descriptive statistics and clinical information. Importantly, FEP patients had a median duration of untreated psychosis of ~20 weeks, highlighting the efforts that have been put forth by the PEPP-clinic to minimize patients' pathways to care within our early intervention service (Iyer et al ., 2015; MacDonald et al ., 2018). This also emphasizes that our FEP patients are indeed highly representative of the first-episode time period.…”

Section: Resultsmentioning

confidence: 99%

Intersection of verbal memory and expressivity on cortical contrast and thickness in first episode psychosis

et al. 2019

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Background Longitudinal studies of first episode of psychosis (FEP) patients are critical to understanding the dynamic clinical factors influencing functional outcomes; negative symptoms and verbal memory (VM) deficits are two such factors that remain a therapeutic challenge. This study uses white-gray matter contrast at the inner edge of the cortex, in addition to cortical thickness, to probe changes in microstructure and their relation with negative symptoms and possible intersections with verbal memory. Methods T1-weighted images and clinical data were collected longitudinally for patients (N = 88) over a two-year period. Cognitive data were also collected at baseline. Relationships between baseline VM (immediate/delayed recall) and rate of change in two negative symptom dimensions, amotivation and expressivity, were assessed at the behavioral level, as well as at the level of brain structure. Results VM, particularly immediate recall, was significantly and positively associated with a steeper rate of expressivity symptom decline (r = 0.32, q = 0.012). Significant interaction effects between baseline delayed recall and change in expressivity were uncovered in somatomotor regions bilaterally for both white-gray matter contrast and cortical thickness. Furthermore, interaction effects between immediate recall and change in expressivity on cortical thickness rates were uncovered across higher-order regions of the language processing network. Conclusions This study shows common neural correlates of language-related brain areas underlying expressivity and VM in FEP, suggesting deficits in these domains may be more linked to speech production rather than general cognitive capacity. Together, white-gray matter contrast and cortical thickness may optimally inform clinical investigations aiming to capture peri-cortical microstructural changes.

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Description, evaluation and scale‐up potential of a model for rapid access to early intervention for psychosis

Cited by 13 publications

References 28 publications

Understanding Components of Duration of Untreated Psychosis and Relevance for Early Intervention Services in the Canadian Context: Comprendre les Composantes de la Durée de la Psychose Non Traitée et la Pertinence de Services D’intervention Précoce Dans le Contexte Canadien

Understanding Components of Duration of Untreated Psychosis and Relevance for Early Intervention Services in the Canadian Context: Comprendre les Composantes de la Durée de la Psychose Non Traitée et la Pertinence de Services D’intervention Précoce Dans le Contexte Canadien

Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis

Intersection of verbal memory and expressivity on cortical contrast and thickness in first episode psychosis

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