Early intervention in psychiatry

Christodoulou, George N.; Christodoulou, Nikos

doi:10.1111/j.1751-7893.2007.00018.x

Cited by 14 publications

(10 citation statements)

References 9 publications

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“…[5,6,7]]. This latter point is critically important for intervention, as there is only a short time window when patients still have sufficient energy and insight to seek professional support and to start a therapy.…”

Section: Introductionmentioning

confidence: 99%

In Need of Psychiatric Help - Leave a Message after the Beep

et al. 2012

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Background/Aim: Every day, a substantial proportion of the general population experiences the distressing and frightening signs of an upcoming psychiatric illness. The consequences can be enormous because severe psychiatric disorders typically cause the loss of the ability to work and often mean a long-term burden for both the patients and their families. Even though most developed countries have an exceptionally high density of general practitioners and psychiatrists in private practice, getting a mental health appointment and seeing a doctor is often very difficult for patients with acute psychiatric symptoms. This study aimed at quantifying the time delay involved in seeking medical attendance when psychiatric disorders begin to develop. Methods: Two female actors with well-proven experiences of realistically simulating the clinical presentation of depression and psychotic disorders made systematic phone calls to 106 psychiatrists in private practice and 106 general practitioners (GPs) of the Zurich City area. The actors asked for an appointment at the doctor's earliest convenience due to acute psychiatric symptoms. We assessed (1) the number of phone calls it took to reach each doctor; (2) the time it took to book an appointment; (3) the time span between the first phone call and the earliest available appointment, and (4) the possibility of personal contact with a doctor prior to booking the appointment. Results: A total of 383 phone calls were made by the two actors (227 to psychiatrists and 156 to GPs) which resulted in analyzable data from 102 psychiatrist and 106 GP practices. Two thirds (68%) of the phone calls to the psychiatrists in private practice were answered by voice mail, compared to 21% among the GPs. A personal contact was established with 56% of the psychiatrists and 95% of the GPs. On average, 7.3 phone calls were necessary to successfully book an appointment with a psychiatrist. Almost half of the psychiatrists (45.6%) were not accepting new patients so appointments were able to be booked in less than one third of cases (30.4%). The situation was significantly better with GPs (p < 0.002) but depended on clinical diagnosis (p < 0.01). The waiting time to seeing a psychiatrist often far exceeded 7 days. Conclusions: A high density of psychiatrists in private practice does not necessarily improve the long and troublesome circumstances of obtaining a mental health appointment in acute psychiatric situations. Under these circumstances, a considerable proportion of patients might give up prior to seeing a doctor. This has important implications - many patients could miss the potential benefits from timely therapeutic interventions which can significantly modify both the acute and long-term course of the illness. The situation might be improved if psychiatrists and GPs joined forces in the form of group practices or networks as this would readily ensure (1) a rapid mental health triage by assessing and categorizing the urgency of mental health-related problems, and (2) timely therapeutic intervent...

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Section: Introductionmentioning

confidence: 99%

In Need of Psychiatric Help - Leave a Message after the Beep

et al. 2012

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“…The goal of early intervention in psychiatry is to reduce and/or prevent the morbidity and mortality that often accompanies psychiatric illnesses 1 . Using current nomenclature for the different levels of prevention strategies in public health, 2 this work can range from ‘health promotion’ in which one attempts to reduce or eliminate the presence of risk factors for a disease in the environment to ‘primary prevention’ in which one attempts to reduce the incidence rate of a disease among healthy individuals who possess one or more major risk factor for developing the disease to ‘secondary prevention’ in which one attempts to prevent or minimize the loss of functioning among individuals already diagnosed with a disease.…”

Section: Mediators and Moderators In Early Intervention Researchmentioning

confidence: 99%

“…1 Using current nomenclature for the different levels of prevention strategies in public health, 2 this work can range from ‘health promotion’ in which one attempts to reduce or eliminate the presence of risk factors for a disease in the environment to ‘primary prevention’ in which one attempts to reduce the incidence rate of a disease among healthy individuals who possess one or more major risk factor for developing the disease to ‘secondary prevention’ in which one attempts to prevent or minimize the loss of functioning among individuals already diagnosed with a disease. Although early intervention has been a mainstay within most disciplines of medicine, psychiatry has only more recently come to embrace an early intervention perspective.…”

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confidence: 99%

Mediators and moderators in early intervention research

Breitborde

Srihari

Pollard

et al. 2010

Early Intervention Psych

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Aim The goal of this paper is to provide clarification with regard to the nature of mediator and moderator variables and the statistical methods used to test for the existence of these variables. Particular attention will be devoted to discussing the ways in which the identification of mediator and moderator variables may help to advance the field of early intervention in psychiatry. Methods We completed a literature review of the methodological strategies used to test for mediator and moderator variables. Results Although several tests for mediator variables are currently available, recent evaluations suggest that tests which directly evaluate the indirect effect are superior. With regard to moderator variables, two approaches (‘pick-a-point’ and regions of significance) are available, and we provide guidelines with regard to how researchers can determine which approach may be most appropriate to use for their specific study. Finally, we discuss how to evaluate the clinical importance of mediator and moderator relationships as well as the methodology to calculate statistical power for tests of mediation and moderation. Conclusion Further exploration of mediator and moderator variables may provide valuable information with regard to interventions provided early in the course of a psychiatric illness.

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“…Delay in psychiatric treatment for people with mental health problems not only prolongs the course of treatment, but also has a profound impact on long‐term costs . In contrast, early detection and intervention can reduce the suffering of individuals and their family members, and prevent problems from developing into chronic conditions …”

Section: Introductionmentioning

confidence: 99%

“…3 In contrast, early detection and intervention can reduce the suffering of individuals and their family members, and prevent problems from developing into chronic conditions. 4 As a service practice in mental health care in the West for many years, the effectiveness of early community detection and intervention programmes has been well demonstrated. It was reported to be able to identify people with various mental health problems; 5 to lower hospital admission rate; 6 to significantly reduce the risk of developing psychosis and schizophrenia; [7][8][9] to reduce the duration of untreated psychosis.…”

Section: Introductionmentioning

confidence: 99%