Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort

Conus, Philippe; Lambert, Martin; Cotton, Sue; Bonsack, Charles; McGorry, Patrick D.; Schimmelmann, Benno G.

doi:10.1016/j.schres.2010.01.032

Cited by 116 publications

(66 citation statements)

References 25 publications

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“…We observed a very high rate of inclusion of families in services, with over 90% of participants having at least one service that included families. Previous research suggests the importance of family support and family involvement in care for engagement in treatment (Stowkowy et al, 2012; Conus et al, 2010). It is notable that participants’ ratings of family-related subjective quality of life were estimated to improve significantly over the study period.…”

Section: Discussionmentioning

confidence: 99%

“…A recent review article exploring service disengagement within the FEP population estimates that approximately 30% of individuals drop out of treatment (Doyle et al, 2014). Two studies in the review found that disengagement was significantly associated with a lower severity illness at baseline (Conus et al, 2010; Schimmelmann et al, 2006). Conus et al, postulates that this could be explained by the fact the individuals with more severe illness, along with their families, may be more motivated for treatment and, similarly to our assessment above, treatment teams may also focus their efforts on individuals with more severe symptoms (Conus et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Two studies in the review found that disengagement was significantly associated with a lower severity illness at baseline (Conus et al, 2010; Schimmelmann et al, 2006). Conus et al, postulates that this could be explained by the fact the individuals with more severe illness, along with their families, may be more motivated for treatment and, similarly to our assessment above, treatment teams may also focus their efforts on individuals with more severe symptoms (Conus et al, 2010). Participants in the RAISE Connection Program maintained high levels of engagement, on average 91% of the total possible time they could receive services.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The RAISE Connection Program for Early Psychosis

Marino¹,

Nossel²,

Choi³

et al. 2015

Journal of Nervous &Amp; Mental Disease

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The aims of this study were to explore secondary outcomes of a coordinated specialty care program for persons with early psychosis, including quality of life and recovery, as well as to explore mediators and moderators of improvement in occupational and social functioning and symptoms. Sixty-five individuals across two sites were enrolled and received services for up to two years. Trajectories for individuals’ outcomes, over time were examined using linear and quadratic mixed-effects models with repeated measures. In addition, baseline prognostic factors of participant improvement in social and occupational functioning were explored based on previous literature and expert opinion of the analytic team. Results demonstrate that the program was effective in improving quality of life and recovery, over time. Furthermore, processing speed was identified as a significant moderator of improvement in occupational GAF, and treatment fidelity, engagement, and family involvement were identified as mediators of improvement in social and occupational functioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The RAISE Connection Program for Early Psychosis

Marino¹,

Nossel²,

Choi³

et al. 2015

Journal of Nervous &Amp; Mental Disease

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“…Despite evidence of clear benefit, EI services like many others, struggle to engage and retain young patients in their services, with data from two such programs indicating dropout rates of 23 % at 18 months [6] and 31 % at 30 months [7]. A relatively recent review exploring rates of disengagement in a variety of mental health settings reports that although varying, on average around one third of patients disengage with treatment at some point in the course of their care [8].…”

Section: Introductionmentioning

confidence: 99%

“…Specific risk factors for poor treatment engagement that have been identified including positive symptom severity, childhood exposure to violence, lower scores on ratings for negative symptoms and substance abuse [7, 9]. A large study conducted at a FES in Australia found that the primary predictors of disengagement were a prior forensic history, not living with family at the time of discharge from hospital, less severe illness at the time of diagnosis, and persistent substance use [6]. While such approaches can direct clinical attention to particular subgroups, they are less able to illuminate the interaction amongst several factors that determine engagement with care.…”

Section: Introductionmentioning

confidence: 99%

Too Late and Too Little: Narratives of Treatment Disconnect in Early Psychosis

2015

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Schizophrenia and other psychotic disorders are a source of significant morbidity, both for patients and caregivers. The first 2–5 years after the onset of psychosis are a critical period wherein treatment might effect disproportionate improvements in long-term outcomes. Specialized services have been developed with the goal of providing early and effective treatment—however, engaging young patients in these services remains a challenge. In this study we sought to uncover possible reasons for this finding by collecting participants’ narratives of their early treatment experience. We conducted in-depth, semi-structured interviews with 11 patients currently enrolled in a first episode psychosis program in Connecticut. Transcripts were analyzed using inductive thematic analysis. Participants reported that prior to them entering specialized treatment services, their initial contact with psychiatric care was brought about by abrupt behavioral changes that were noticed by others, and that this lead to treatment that was disconnected from their own concerns, which centered around more everyday challenges. This initial contact did not serve to engender trust or facilitate engagement in further treatment. Additional examples of disconnect were noted even after participants had entered specialized services, and these centered around the patients preference for conceptualizing their difficulties, treatment and recovery in multi-dimensional terms that emphasized social inclusion and vocational achievement. Participants in our study highlighted several areas of disconnect in the course of their early treatment. There is an opportunity to enhance early engagement by offering patients concrete evidence that their treatment priorities are understood and will be addressed.

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Current Topics

Moritz

2012

Current Schizophrenia

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Yet another step forward appears to liave been made in the task of differentiating the still unknown "pyrexias of uncertain origin." In the R. A. M. C. Journal (March 1910) Lt.-Col. C. Birt, R a.mc., lias an excellent article on what he calls " Phlebotomus fever in Malta and Crete." The symptoms are not in themselves remarkable: fever 3 or 4 days, frontal headache, flushed face, heavy half open eyes, pains in back and limbs, white-coated tongue and constipation. The disease in Crete among the soldiers obtained the slang name of " pink eye.Apparently great use is made in army returns of the Nomenclature heading " pyrexias of uncertain origin," as in 1909 out of 269 cases of fever only 1 was Malta fever (happily banished), 12 were enteric and 256 are returned as "of uncertain origin," and the vast majority of these fevers were of short duration, lasting 2 to 5 days only, and 65 per cent, of such cases were in men who had lived less than a year in Malta.Serum agglutination examinations made in 47 instances excluded the well-known continued fevers.The history is that of being bitten by "sandflies."The common sandfly of Malta and Crete is P. papatasi, and is common from April throughout the summer. These phlebotomi have been caught in numbers gorged with the soldiers' blood, they have been kept in cages, and finally, the pluck and public spirit of, the gunners of the 99th Co. R. G. Artillery has enabled'a series of voluntary experiments to be made, with infected phlebotomi, showing that this insect could and did convey the disease. Lt. H. G. Gibson, li.A.M.c., and Lt. H. S. Ranken, r.a.m.c., also volunteered to be experimented upon.We refer our readers to the article from which we quote for details of the experiments in Malta and in London. Lt.-Col. Birt sums up his able article by taking it as " proved" (1) that the blood of a person suffering from phlebotomus fever is virulent during the first day ;(2) that the virus can pass through a Pasteur- May, 1910.] IDENTIFICATION OF HUMAN BLOOD-STAINS. 183 Chamberland Candle " F ; (3) that the phlebotomus papatasii can convey the infection; (4)

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Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort

Cited by 116 publications

References 25 publications

The RAISE Connection Program for Early Psychosis

The RAISE Connection Program for Early Psychosis

Too Late and Too Little: Narratives of Treatment Disconnect in Early Psychosis

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