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
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.
Available from: Lex Wunderink
- "Entering early intervention services through emergency services has previously been associated with poorer engagement . Although Singh et al. stated that there is no robust evidence for an association between cultural aspects and differences in pathways to care , the present study demonstrates a relation between immigration status and pathway to care. "
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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.
Available from: Alicia Spidel
- "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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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.
Available from: Annette C Trunzo
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