First episode psychosis in the over 35 s: is there a role for early intervention?

Abstract

AimThe early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range.MethodsData were collected on all patients aged 36–65 years who were referred to an inner London EI service from 2011–2014 using the MiData 2 tool at entry and at 1‐year follow up.ResultsPeople aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1‐year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission.ConclusionsThese findings indicate that admitting over 35‐year‐olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.

Age at the time of onset of psychosis: A marker of specific needs rather than a determinant of outcome?

“…One third of the sample had an onset after age 26, which is comparable to previous reports in similar programs [14,15]. In line with other studies [33,34], LO patients displayed a shorter DUP, which may be explained by a better social integration at the time of onset and hence a swifter reaction from close relatives or professional colleagues when symptoms became manifest.…”

“…Greenfield et al [15] highlighted that the majority of patients over 35 years had experienced trauma, but suggested this may have been linked to the higher proportion of female patients in their later onset subgroup, an observation confirmed in other studies [14,[35][36][37][38]. However, when adjusting all analysis for gender, the differences we observed remained significant, suggesting exposure to trauma is indeed an important characteristic of such patients.…”

Dimensional structure of first episode psychosis

“…Of the overall sample, only subjects with age under 35 years were evaluated in the present study. This decision was taken following recommendations of most treatment guidelines (eg, Initiative to Reduce the Impact of Schizophrenia (IRIS), Mental Health Policy Implementation Guide, Orygen and Somerset Team for Early Psychosis (STEP)) (Greenfield et al, ), and it was based on the following reasons: (a) about three quarters of men and two thirds of women experience their first episode by age 35 (Kirkbride et al, ); (b) most cases of depression with psychotic features present a late onset (notably patients over 40); with age, there are trends towards an increase in metabolic comorbidity (Selvendra, Baetens, Trauer, Petrakis, & Castle, ).…”

Applying economic models to estimate local economic benefits of improved coverage of early intervention for psychosis

“…Since this time, several configuration changes have occurred to EIP but not CHR‐P services in the United Kingdom including the upper age limit for early intervention services increasing to 65. Apart from the need to increase service capacity to meet this extra caseload demand estimated to be around 30% in a recent study of a London EIPS, effectiveness of EIPS model is still required for older people (Greenfield et al, ).…”

“…Apart from the need to increase service capacity to meet this extra caseload demand estimated to be around 30% in a recent study of a London EIPS, effectiveness of EIPS model is still required for older people (Greenfield et al, 2016).…”