Barriers to initial outpatient treatment engagement following first hospitalization for a first episode of nonaffective psychosis: a descriptive case series.
ABSTRACT Due to the increasingly recognized importance of adequate treatment early in the course of schizophreniform disorder and schizophrenia, this report addresses the dearth of hypothesis-generating case series describing facilitators and barriers to engagement in initial outpatient care. This case series included six single, African-American first-episode patients. Narratives describing the initial hospitalization and the first outpatient appointments in an urban community mental health setting are presented. Several barriers to outpatient treatment engagement emerged from this relatively homogenous series of first-episode patients. Apparent barriers included inadequate remission of paranoia, impaired insight, and involvement with the criminal justice system between hospital discharge and the first outpatient appointment. Good family support appeared to be an important facilitator of treatment engagement during the first several months of outpatient treatment. A variety of other potential barriers, such as involuntary status at the time of hospital discharge, are considered. Though these are preliminary findings from a small case series, further research, based at least in part on the hypotheses generated here, is warranted. Many factors, at the level of the patient, the family, and the system of care, likely affect treatment engagement early in the course of schizophreniform disorder and schizophrenia. Clinicians should give special attention to this issue when caring for first-episode patients.
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ABSTRACT: Several factors may contribute to duration of untreated psychosis (DUP): patient-delay, referral-delay and treatment-delay caused by mental health care services (MHS-delay). In order to find the most effective interventions to reduce DUP, it is important to know what factors in these pathways to care contribute to DUP. To examine the relationship of the constituents of treatment delay, migration status and urbanicity. In first episode psychotic patients (n=182) from rural, urban and highly urbanized areas, DUP, migration status and pathways to care were determined. Mean DUP was 53.6 weeks (median 8.9, SD=116.8). Patient-delay was significantly longer for patients from highly urbanized areas and for first generation immigrants. MHS-delay was longer for patients who were treated already by MHS for other diagnoses. Specific interventions are needed focusing on patients living in highly urbanized areas and first generation immigrants in order to shorten patient delay. MHS should improve early detection of psychosis in patients already in treatment for other diagnosis.European Psychiatry 06/2011; 27(7):500-5. DOI:10.1016/j.eurpsy.2011.05.001 · 3.21 Impact Factor
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ABSTRACT: CBT for psychosis has recently been called a best practice, suggesting that studies have demonstrated its efficacy with many populations. Community settings are encouraged to implement best practices such as CBT yet many factors can make the implementation of CBT challenging. Issues such as clinician resistance, setting, as well as client variables (refusal, denial of symptoms, etc.) come into play. Examples of successes and challenges of a community based study of CBT groups for first episodes will be described. The strategies used to overcome these challenges and the successes of the program will be presented.Journal of Contemporary Psychotherapy 03/2006; 36(1):51-58. DOI:10.1007/s10879-005-9006-5