Pattern and correlates of inpatient admission during the initial acute phase of first-episode psychosis
ABSTRACT The first aim of this study was to examine the rate, pattern and correlates of inpatient admission during the first 3 months of treatment for first-episode psychosis (FEP). The second aim was to determine whether the pattern of inpatient admission during this period was associated with remission of psychotic symptoms or inpatient service use at 15-month follow-up.
One hundred and four consecutive patients with FEP at a specialist treatment service were approached to participate in a follow-up study. Patients were grouped on the basis of the pattern of inpatient admission (none, one, or multiple) during the first 3 months of treatment. Clinical ratings at baseline and 3-month follow-up, and ratings of remission of psychotic symptoms at 3 and 15-month follow-up, were available for two-thirds of the patients. Inpatient data for the 15-month follow-up period were derived from an electronic database for most patients (n = 98).
Eighty (76.9%) of the 104 patients were admitted to an inpatient unit during the first 3 months of treatment. Fifty-nine (56.7%) patients had a single admission and 21 (20.2%) had multiple admissions. At baseline, inpatient admission was associated with a diagnosis of affective psychosis and more severe behavioural and functional disturbance but not positive psychotic symptoms. Multiple admissions were associated with risks to self or others at baseline and 3-month follow-up, and lack of remission of positive symptoms at 3 and 15-month follow-up. There was no association between the pattern of inpatient admission during the initial 3-month period and inpatient service use during the following 12-month period.
The substantial proportion of young patients with FEP admitted to hospital emphasizes the need for youth-friendly treatment environments and practices. Although patients with multiple admissions during the initial treatment period are less likely to achieve remission, these patients are no more likely to establish a pattern of revolving-door hospitalizations compared with other patients.
- SourceAvailable from: Grant SaraSchizophrenia Research 01/2013; DOI 10.1016/j.schres.2013.04.017. · 4.43 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Few studies have examined the impact of stimulant use on outcome in early psychosis. Ceasing substance use may lead to positive outcomes in psychosis. To examine whether baseline cannabis or stimulant disorders and ongoing drug use predict readmission within 2 years of a first psychosis admission. Predictors of readmission were examined with Cox regression in 7269 people aged 15-29 years with a first psychosis admission. Baseline cannabis and stimulant disorders did not predict readmission. A stimulant disorder diagnosis prior to index psychosis admission predicted readmission, but a prior cannabis disorder diagnosis did not. Ongoing problem drug use predicted readmission. The lowest rate of readmission occurred in people whose baseline drug problems were discontinued. Prior admissions with stimulant disorder may be a negative prognostic sign in first-episode psychosis. Drug use diagnoses at baseline may be a good prognostic sign if they are identified and controlled.The British journal of psychiatry: the journal of mental science 02/2014; 204(6). DOI:10.1192/bjp.bp.113.135145 · 7.34 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: Reductions in cannabis use have been observed during the first year following treatment entry for first-episode psychosis (FEP), but there is little indication of the pattern of cannabis and substance misuse generally in the very early course of treatment.Methods: Patterns of cannabis and other substance use (including alcohol) were examined prospectively among 130 FEP patients assessed at treatment entry and again at early follow up (median 9 weeks 4 days). Differences between cannabis users and non-users at both time-points were compared on descriptive features, psychopathology, social functioning and functional disability.Results: Of 72 patients using cannabis at treatment entry, 29 (40.3%)were abstinent at follow up. Notably, almost half (41%) of those cannabis users who were abstaining at follow up had been using on a daily or multiple daily basis. Among 58 individuals abstinent at treatment entry, 11 (19%) had commenced cannabis use at follow up. There were no significant differences between cannabis users and non-users on any psychopathology measure at treatment entry, however, those using cannabis at early follow up scored significantly higher than non-users on general psychopathology and positive symptomatology, and lower on health functioning.Conclusions: This study demonstrates significant fluctuation in cannabis use in the context of receiving specialist treatment for FEP, and suggests that a substantial proportion of young patients are contemplating changing harmful patterns of use in this critical early phase.Early Intervention in Psychiatry 10/2007; 1(3):259 - 266. DOI:10.1111/j.1751-7893.2007.00035.x · 1.74 Impact Factor