Early intervention services are effective and must be defended

Nordentoft, Merete; Albert, Nikolai

doi:10.1002/wps.20452

Cited by 3 publications

(7 citation statements)

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“…Further, psychosis has a significant social and economic dimension as people suffering from acute psychotic phases have difficulties in fulfilling their family and work commitments [ 25 , 49 ]. Intervening early has shown to improve outcome prospects in various dimensions and corresponding EIP services have emerged worldwide [ 29 , 32 ]. However, many countries report insufficient access to EIP services nowadays [ 34 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although EIP services are well-established in many countries [31,32], the universal availability of services is still lacking [33][34][35][36]. England has had a nationwide EIP implementation strategy from the early 2000s onwards [37].…”

Section: Clinical and Institutional Backgroundmentioning

confidence: 99%

“…Treating first-episode psychosis requires a multidisciplinary approach including pharmacological, psychological, social, occupational and educational interventions [ 30 ]. Early intervention in psychosis (EIP) services have been developed to promote timely access to evidence-based care for first-episode psychosis patients [ 31 , 32 ]. EIP services are stand-alone multidisciplinary teams within the community, specialised to promote early detection and treatment of first-episode psychosis and improve outcomes for affected patients.…”

Section: Clinical and Institutional Backgroundmentioning

confidence: 99%

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Improving access to services for psychotic patients: does implementing a waiting time target make a difference

Kreutzberg

Jacobs

2020

Eur J Health Econ

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Objective In April 2015, the English National Health Service started implementing the first waiting time targets in mental health care. This study aims to investigate the effect of the 14-day waiting time target for early intervention in psychosis (EIP) services after the first six months of its implementation. Study design We analyse a cohort of first-episode psychosis patients from the English administrative Mental Health and Learning Disabilities Dataset 2011 to 2015. We compare patients being treated by EIP services (treatment) with those receiving care from standard community mental health services (control). We combine non-parametric matching with a difference-indifference approach to account for observed and unobserved group differences. We analyse the probability of waiting below target and look at different percentiles of the waiting time distribution. Results EIP patients had an 11.6-18.4 percentage point higher chance of waiting below target post-policy compared to standard care patients. However, post-policy trends at different percentiles of the waiting time distribution were not different between groups. Conclusions Mental health providers seem to respond to waiting time targets in a similar way as physical health providers. The increased proportion waiting below target did not, however, result in an overall improvement across the waiting time distribution.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical and Institutional Backgroundmentioning

confidence: 99%

Section: Clinical and Institutional Backgroundmentioning

confidence: 99%

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Improving access to services for psychotic patients: does implementing a waiting time target make a difference

Kreutzberg

Jacobs

2020

Eur J Health Econ

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“…The definition of DUP is not precisely operationalized and still subject to variable ascertainment. 16 , 53 Defining onset psychometrically using the PANSS or with positive symptoms using a clinical instrument was linked with a significant reduction in DUP while other definitions were not ( figure 5 ). This suggests the usefulness of psychometric and clinical instruments as a way of reliably defining the onset of DUP.…”

Section: Discussionmentioning

confidence: 99%

“…However, beyond their effectiveness on DUP reduction, early psychosis services have been crucial in changing how mental health and mental healthcare are viewed worldwide. 53 Even if not (yet) robustly justified by meta-analytical data, such initiatives provide humane, trust-engendering support to patients and families at a difficult moment in their lives. 64 …”

Section: Discussionmentioning

confidence: 99%

Can We Reduce the Duration of Untreated Psychosis? A Systematic Review and Meta-Analysis of Controlled Interventional Studies

Oliver

Davies

Crossland

et al. 2018

Schizophrenia Bulletin

107

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Reduction of duration of untreated psychosis (DUP) is the key strategy of early interventions for improving the outcomes of first-episode psychosis. Although several controlled interventional studies have been conducted with the aim of reducing DUP, the results are highly inconsistent and conflicting. The current study systematically searches Web of Science and Ovid for English original articles investigating interventions adopted to reduce DUP, compared to a control intervention, up to April 6, 2017. Sixteen controlled interventional studies were retrieved, including 1964 patients in the intervention arm and 1358 in the control arm. The controlled intervention studies were characterized by standalone first episode psychosis services, standalone clinical high risk services, community interventions, healthcare professional training, and multifocus interventions. Random effects meta-analyses were conducted. There was no summary evidence that available interventions are successful in reducing DUP during the first episode of psychosis (Hedges’ g = −0.12, 95% CI = −0.25 to 0.01). Subgroup analyses showed no differences within each subgroup, with the exception of clinical high risk services (Hedges’ g = −0.386, 95% CI = −0.726 to −0.045). These negative findings may reflect a parceled research base in the area, lack of prospective randomized controlled trials (only 2 randomized cluster designed studies were present) and small sample sizes. There was substantial heterogeneity (I2 = 66.4%), most of which was accounted by different definitions of DUP onset (R2 = .88). Psychometric standardization of DUP definition, improvement of study design, and implementation of preventative strategies seem the most promising avenues for reducing DUP and improving outcomes of first-episode psychosis.

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Duration of Untreated Psychosis and Outcomes in First-Episode Psychosis: Systematic Review and Meta-analysis of Early Detection and Intervention Strategies

Salazar de Pablo,

Guinart,

Armendariz

et al. 2024

Schizophrenia Bulletin

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Background The role of duration of untreated psychosis (DUP) as an early detection and intervention target to improve outcomes for individuals with first-episode psychosis is unknown. Study Design PRISMA/MOOSE-compliant systematic review to identify studies until February 1, 2023, with an intervention and a control group, reporting DUP in both groups. Random effects meta-analysis to evaluate (1) differences in DUP in early detection/intervention services vs the control group, (2) the efficacy of early detection strategies regarding eight real-world outcomes at baseline (service entry), and (3) the efficacy of early intervention strategies on ten real-world outcomes at follow-up. We conducted quality assessment, heterogeneity, publication bias, and meta-regression analyses (PROSPERO: CRD42020163640). Study Results From 6229 citations, 33 intervention studies were retrieved. The intervention group achieved a small DUP reduction (Hedges’ g = 0.168, 95% CI = 0.055–0.283) vs the control group. The early detection group had better functioning levels (g = 0.281, 95% CI = 0.073–0.488) at baseline. Both groups did not differ regarding total psychopathology, admission rates, quality of life, positive/negative/depressive symptoms, and employment rates (P > .05). Early interventions improved quality of life (g = 0.600, 95% CI = 0.408–0.791), employment rates (g = 0.427, 95% CI = 0.135–0.718), negative symptoms (g = 0.417, 95% CI = 0.153–0.682), relapse rates (g = 0.364, 95% CI = 0.117–0.612), admissions rates (g = 0.335, 95% CI = 0.198–0.468), total psychopathology (g = 0.298, 95% CI = 0.014–0.582), depressive symptoms (g = 0.268, 95% CI = 0.008–0.528), and functioning (g = 0.180, 95% CI = 0.065–0.295) at follow-up but not positive symptoms or remission (P > .05). Conclusions Comparing interventions targeting DUP and control groups, the impact of early detection strategies on DUP and other correlates is limited. However, the impact of early intervention was significant regarding relevant outcomes, underscoring the importance of supporting early intervention services worldwide.

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Early intervention services are effective and must be defended

Cited by 3 publications

References 9 publications

Improving access to services for psychotic patients: does implementing a waiting time target make a difference

Improving access to services for psychotic patients: does implementing a waiting time target make a difference

Can We Reduce the Duration of Untreated Psychosis? A Systematic Review and Meta-Analysis of Controlled Interventional Studies

Duration of Untreated Psychosis and Outcomes in First-Episode Psychosis: Systematic Review and Meta-analysis of Early Detection and Intervention Strategies

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