One‐year outcome of an early intervention in psychosis service: a naturalistic evaluation

Aim: We conducted a 1‐year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home‐based Outreach Service (ETHOS)) during its first 3 years of operation in South‐west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1‐year follow‐up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non‐randomized parallel cohort (comparison group) of first‐episode patients treated by community mental health teams. Results: The Early Treatment and Home‐based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit.     

Establishing and operating an early intervention service for psychosis in a defined catchment area of northwestern Greece within the context of the local mental health network

Aim: The study aims to present briefly the development of an early intervention service (EIS) for psychosis in a rural catchment area of north‐western Greece within the context of the local mental health network, its structure and procedures, and the results of its operation 2 years after its establishment. Method: Established in December 2007, our EIS is the first service in Greece for patients with a first‐episode psychosis. The context and the local mental health network are described, and the EIS operation, including clinical, educational, community and research activities, is outlined. Assessment measures are presented to evaluate the EIS progress 2 years after its establishment. Results: Between December 2007 and December 2009, EIS received 45 referrals, retaining 38 patients in its caseload. The mean duration of untreated psychosis was 26.6 ± 41.0 months (median = 12 months). Thirty‐seven patients (82.2%) were hospitalized after their first referral, 14 under a compulsory order (31.1%). The duration of hospitalization ranged from 2 to 69 days, with a median of 13 days. Mean (±SD) duration of the follow‐up was 14.8 ± 8.5 months, indicating adequate adherence to EIS, with particularly low relapse rates (20%). Conclusions: Our EIS seems to be successfully established within the local mental health network. Our collaboration with the local mobile mental health unit enabled our communication with rural primary healthcare centers. The collaboration of patients' family and the participation of the mobile mental health unit to the continuity of care contributed greatly to the brief duration of hospitalization and the high adherence to follow‐up rates.     

Outcomes post‐discharge from an early intervention in psychosis service

Aim: To investigate the effectiveness of an early intervention in psychosis (EIP) service on engagement and hospital bed usage, post‐discharge. A secondary aim was to identify if there was a subgroup of patients with ‘poor outcomes’. Method: A naturalistic study comparing engagement and hospital bed day usage of individuals who received treatment from an EIP service (n = 75) with those who presented before the service was established (n = 113). Results: The EIP service demonstrated better engagement with service users in year 5 (P = 0.001). No significant differences were observed on hospital bed day usage. When ‘poor outcome’ cases were removed, a trend towards lower bed usage in EIP services emerged (P = 0.139). Conclusion: EIP services improve engagement with service users. There was not a significant reduction in hospital bed usage. However, advantages could be masked by a relatively small number of individuals with ‘poor outcomes’.     

The service for Monitoring and Early Intervention against psychoLogical and mEntal suffering in young people (SMILE) at the University of L'Aquila: first year experience

Aim: To establish a comprehensive early intervention service for young people with mental suffering in L'Aquila, Italy, and to evaluate its effectiveness in delivering user friendly integrated interventions. Methods: The S ervice for M onitoring and early I ntervention against psycho L ogical and m E ntal suffering in young people (SMILE) began operation in November 2005 under the auspices of the Department of Mental Health, University of L'Aquila, Italy. It is the mission of our service to reduce the burden of mental suffering in young people by means of an earlier recognition of signs and symptoms, systematic evaluation of psychological distress and promotion of attitudes that encourage young people to seek care. We also aim to reduce the delays that young people at incipient risk of severe psychiatric illness experience in accessing appropriate psychiatric care. Results: Between November 2005 and November 2006, 216 young people (127 women, 89 men; mean age 21.8 ± 5.7 years) were referred for assessment. Thirty‐five per cent of patients had a diagnosis of severe mental illness (schizophrenia, bipolar disorder, incipient risk of psychosis). In addition, 80.5% of patients were admitted to the service more than once, totalling 685 admissions. Treatment modalities comprised cognitive behavioural treatment (61.5%), integrated psychosocial treatment (25.5%) and psychopharmacotherapy (15.9%). Conclusions: The SMILE service provides most of the mental health service requirements for young people with various forms of psychological suffering in Italy. Moreover, it offers appropriate case management with an early multimodal approach.     

Early detection and intervention in first-episode schizophrenia: a critical review

OBJECTIVE: To review the literature on early intervention in psychosis and to evaluate relevant studies. Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention). RESULTS: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow-up data showing a positive effect on prognosis have been presented. CONCLUSION: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic.