Barriers to Initial Outpatient Treatment Engagement Following First Hospitalization for a First Episode of Nonaffective Psychosis: A Descriptive Case Series

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA 30303, USA.
Journal of Psychiatric Practice (Impact Factor: 1.34). 02/2005; 11(1):62-9. DOI: 10.1097/00131746-200501000-00010
Source: PubMed


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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    • "Entering early intervention services through emergency services has previously been associated with poorer engagement [7]. Although Singh et al. stated that there is no robust evidence for an association between cultural aspects and differences in pathways to care [22], the present study demonstrates a relation between immigration status and pathway to care. "
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    • "As a result of this technique, in some settings an informal parent group started in the waiting room, where parents could share with each other their experiences, concerns, and successful strategies. The ability to involve the parents in treatment of the clients is of particular importance as it has been found that good family support is an important facilitator in outpatient treatment (Compton, 2005; McGorry, 2004). In terms of schedules we did our best to accommodate clients' schedules and managed to not have anyone excluded due to schedule conflicts. "
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