Early intervention service for first episode psychosis in Modena, Northern Italy: The first hundred cases

Abstract

Aim To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. Methods The 2‐year service was offered to people aged 18‐35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a “specialist within generalist” model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. Results One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non‐affective psychosis, yielding an estimated treated incidence of 19.1/105. General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self‐referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. Conclusions An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the “specialist within generalist” model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region.

The ‘Parma‐Early Psychosis’ programme: Characterization of help‐seekers with first episode psychosis

“…The majority (approximately 37%) of subjects enrolled in the Pr‐EP protocol was referred by general practitioners. This finding is in line with what reported in both the ReARMS studies (about 33% [Pelizza et al, 2019d, 2019a]) and in the Modena EIP protocol [38% (Ferrara et al, 2019)]. Otherwise, in the ‘Programma 2000’ research, patients were more likely to contact the EIP programme through the referral of a mental health care professional (68.9%) (Cocchi et al, 2013).…”

“…A total of 279 patients with FEP, aged 12 to 54 years, entered the Pr‐EP programme in the first 6 years after its implementation. In Italy, this finding is substantially in line with what reported in studies on the ‘Reggio Emilia At‐Risk Mental State’ (ReARMS) project [ie, almost 300 help‐seeking adolescents and young adults with FEP or at ultra‐high risk (UHR) of psychosis, aged 13‐35 years, in 5 years of clinical activity) (Azzali et al, 2018; Pelizza et al, 2019a; Scazza et al, 2018) and within a specialized EIP programme implemented in the Modena Department of Mental Health, in Northern Italy (ie, approximately 100 FEP adults, aged 18‐35 years, during the first 4 years from its implementation) (Ferrara et al, 2019). However, it must be noted that a wide age range (ie, up to 54 years) has been included into the Pr‐EP protocol, in order to provide an evidence‐based EIP intervention to as many patients as possible (ie, also late‐onset affective and non‐affective psychoses), and to consequently identify any possible FEP phenotypical subtype (Leuci et al, 2019).…”

Granular analysis of pathways to care and durations of untreated psychosis: A marginal delay model

“…Contrary to reports, mainly from the UK, that primary care providers (PCPs) were the most common first PTC contact [29], and/or the main source of referrals to FEP [30], in our sample only 12% of participants attributed PCP involvement in their PTC, despite 25/30(83%) consecutive participants surveyed (for internal audit purposes) reporting visiting a PCP within the two years prior to enrollment. This finding points to PCPs as a focus for improvement in clinical node outreach, with lessons available from other countries [31,32].…”

The ‘Parma At‐Risk mental states’ (PARMS) program: General description and process analysis after 5 years of clinical activity

“…The PARMS protocol was implemented in all the Parma CAMHS and AMHS as a diffused EIP model for young adult and adolescent help‐seekers (aged 12–25 years) meeting well‐defined CHR‐P psychometric criteria. In Italy, diffused EIP services for FEP patients (Belvederi Murri et al, 2021; Ferrara et al, 2019; Landi et al, 2021) showed to be as effective in identifying and addressing health needs of people with early psychosis as standalone EIP programs (Pelizza, Azzali, Paterlini, et al, 2019b). And this was also with the obvious advantages of better disseminating EIP knowledge and best practice in all departmental CAMHS and AMHS, and of implementing specialized EIP interventions in close proximity with community social and healthcare services (e.g., school, social agencies, primary care settings) (Pelizza, Leuci, et al, 2020).…”