Transitioning to age inclusive early intervention for psychosis

Abstract

Aim: Early Intervention in psychosis Services (EIS) have previously restricted access based on age. However, there is now a move to age inclusive service. We aimed to examine differences between early and late onset (>35 years) psychosis to see if a threshold was valid. We also investigated the potential of a statistical modelling method to identify group characteristics which may be missed using a descriptive approach. Method: Routine clinical data (n=343), from an EIS, comprising sociodemographic, clinical, phys ical, and treatment variables, were examined using descriptive and classification and regression tree (CART) analysis. Results: The findings suggest that age differences were best explained by social factors. There was no emerging evidence that the differences exhibited had a fundamental impact on the clinical outcomes of the clients in terms of support beyond EIS (i.e., hospitalisation and home treatment team involvement) and pharmacological and psychological interventions. CART analysis revealed distinct service user characteristics associated with the clinical outcomes. Conclusion: There was no evidence to support a clinical cut off based on age providing support for age inclusive services. However, in the transition to age inclusive service delivery, EIS need to consider social / life stage variables, adapting provision where service delivery may operate a youth focused model. Routine analysis of clinical data should employ methods to identify groups of service users who may require adjusted service provision..

Psychosis Early Intervention Across the Life Span: A Service Perspective

“…While only a small proportion of both age groups had HoNOS data available at pre-and post-service use, those who did showed significant improvement in HoNOS scores overall, and for the individual items including self-injury, cognitive problems, hallucinations, other mental health problems, relationship problems and occupational problems. This finding is in line with previous research suggesting EI services are beneficial (Bird et al, 2010;Correll et al, 2018;Fusar-Poli et al, 2017), and studies demonstrating improved outcomes following EI service use for both under and over 35s (Lappin et al, 2016;Lasalvia et al, 2017;O'Driscoll et al, 2019).…”

“…care coordinators), interpreted to indicate more complexity, and greater clinical and social needs (Jagger et al, 2019). Another found no differences in clinical outcomes, despite variation in social factors between the age groups (O'Driscoll et al, 2019).…”

“…Evidence suggests that individuals with later psychosis onset may have different clinical complexities including comorbid physical health difficulties, higher levels of unemployment, more dependents, and a higher likelihood of affective presentations (Chen et al, 2018 ; Greenfield et al, 2018 ; O’Driscoll et al, 2019 ; Selvendra et al, 2014 ). Removing age-related criteria for EI services may consequently require substantial adaptation of the care provided and of staff skillset.…”

One year prevalence of psychotic disorders among first treatment contact patients at the National Psychiatric Referral and Teaching Hospital in Uganda

“…Long durations of untreated psychosis have been reported in Sub-Saharan Africa compared to high income countries and have been associated with poorer outcomes [54][55][56]. Late onset of psychotic illnesses is often associated with a less severe course and better outcomes [57]. This is important for future intervention programs given that both DUP and late onset illness psychosis have different outcome trajectories [14,53,58].…”

Profiles and trajectories of mental health service utilisation during early intervention in psychosis

“…Substance misuse, being male, low socioeconomic status and belonging to an ethnic minority, are risk factors associated with poorer functioning over time. A previous EIS study (O'Driscoll et al, 2019) exploring intensive care identified living in supported accommodation and specific healthrelated factors (BMI, smoking status and age) were related to increased utilisation (hospitalisations and crisis team episodes). The literature to date has explored trajectories across short time scales (one to two years) rather than covering the 3-years of EIS support and pertain to social functioning as an outcome rather than care provision.…”