Patterns and correlates of inpatient admission during the acute phase of first-episode psychosis
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.
Available from: Svein Friis
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ABSTRACT: Within an early detection sector, to compare the 1- and 2-year course and outcome of first-episode psychosis patients coming into the treatment system via active outreach detection teams (DTs) versus those achieving help via ordinary referral channels (not-DT).
Longitudinal, comparative study of two parallel consecutive samples using structured clinical interview for the DSM-IV, Positive and Negative Syndrome Scale Score, Global Assessment of Functioning Scale and Premorbid Assessment of Functioning Scale.
The DT group had significantly better functioning at baseline, but this was reversed after 3 months. At 2 years the groups had similar outcome. The DT group developed a more serious diagnostic pattern, had more cases of schizophrenia, and was more frequently treated on an outpatient basis only.
The DTs recruited more chronic patients with poorer prognostic features, but fewer symptoms and better functioning at baseline. At 2 years the DT-patients did as well as the not-DT patients. They recovered more slowly, but given sufficient time, responded as well to therapy as the not-DT group.
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ABSTRACT: While persons with multiple hospitalizations for schizophrenia have been found to differ from those with fewer, it remains unclear whether differences exist in illness awareness (personal understanding of psychopathology) or therapeutic alliance with inpatient staff (treatment involvement). This cross-sectional descriptive study therefore examined whether inpatients with more extensive hospitalization history 1) have less illness awareness and therapeutic alliance (perhaps contributing to the recidivism), 2) have more awareness and alliance (possibly because they have learned from experience), or 3) do not differ relative to persons with fewer inpatient stays. Results from staff and patient interviews (N=307) suggest that illness awareness is greater in persons with more hospitalizations, while therapeutic alliance appears to weaken. Individuals with greater recidivism may therefore need less help than others in building a self-knowledge of psychopathology that may already have developed. Instead, enhanced engagement in care may be more important after multiple disappointing relapses.
Available from: Susy Harrigan
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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.
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