Services for people at high risk improve outcomes in patients with first episode psychosis

Abstract

ObjectiveAbout one‐third of patients referred to services for people at high risk for psychosis may have already developed a first episode of psychosis (FEP). We compared clinical outcomes in FEP patients who presented to either high risk or conventional mental health services.MethodRetrospective study comparing duration of hospital admission, referral‐to‐diagnosis time, need for compulsory hospital admission and frequency of admission in patients with FEP who initially presented to a high‐risk service (n = 164) to patients with FEP who initially presented to conventional mental health services (n = 2779). Regression models were performed, controlling for several confounders.Results FEP patients who had presented to a high‐risk service spent 17 fewer days in hospital [95% CI: −33.7 to (−0.3)], had a shorter referral‐to‐diagnosis time [B coefficient −74.5 days, 95% CI: −101.9 to −(47.1)], a lower frequency of admission [IRR: 0.49 (95% CI: 0.39–0.61)] and a lower likelihood of compulsory admission [OR: 0.52 (95% CI: 0.34–0.81)] in the 24 months following referral, as compared to FEP patients who were first diagnosed at conventional services.ConclusionServices for people at high risk for psychosis are associated with better clinical outcomes in patients who are already psychotic.

Does an integrated outreach intervention targeting multiple stages of early psychosis improve the identification of individuals at clinical high risk?

“…Given the noted difficulties experienced by referral sources in distinguishing between stages of early psychosis (Fusar-Poli et al, 2016;Jordan et al, 2018), and the value of close linkages between CHR and FEP services, a more generalized outreach approach for all stages may be warranted. Given the noted difficulties experienced by referral sources in distinguishing between stages of early psychosis (Fusar-Poli et al, 2016;Jordan et al, 2018), and the value of close linkages between CHR and FEP services, a more generalized outreach approach for all stages may be warranted.…”

Why ultra high risk criteria for psychosis prediction do not work well outside clinical samples and what to do about it

“…Network members were appointed by Member States and represented widely diverse geographical regions, political systems, and cultures. The Network's input for the Commission's preparation of UNGASS 2016 provided the scientific support for the concept that substance use disorders are brain disorders 1 ; that they can be treated; that people with even the most severe forms can recover with access to evidence-based treatment and social supports 2 ; and that criminal sanctions are ineffective at preventing or addressing these disorders. It also highlighted evidence-based approaches to drug policy based on public health principles, emphasizing social protection and health care instead of conviction and punishment.…”

“…The UHR paradigm can additionally reduce the duration of untreated psychosis 1 and provide extended benefits to patients who are experiencing a first episode of psychosis 2 . Because of these potentials, there is a great interest in the use of UHR outside clinical samples, such as in the general population.…”

“…The use of ultra high risk (UHR) criteria in selected helpseeking samples is the only clinical possibility to alter the course of psychosis by preventing its onset. The UHR paradigm can additionally reduce the duration of untreated psychosis 1 and provide extended benefits to patients who are experiencing a first episode of psychosis 2 .…”

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

“…However, the most recent randomized controlled trials suggest the efficacy of preventive interventions may have been over-estimated (Fusar-Poli, McGorry & Kane, 2017). About one third of those referred for CHR-P assessment meet intake criteria, one third have other mental disorders and can be referred to other services at early stages (Fusar-Poli, Byrne, Badger, Valmaggia, & McGuire, 2013) and one third have already reached threshold for psychosis and therefore benefit from early detection and treatment (Fusar-Poli, Diaz-Caneja et al, 2016). CHR-P services are cost effective both over short and longer terms (Amos, 2012;Knapp et al, 2011;Phillips et al, 2009;Valmaggia et al, 2009) with net National Health Service (NHS) savings by end of second year as well as to other areas including employment (Knapp et al, 2011).…”