Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T10:35:21.778Z Has data issue: false hasContentIssue false
  • English
  • Français

Early intervention in psychosis in the North Lee Mental Health Services programme: a 5-year review

Published online by Cambridge University Press:  21 June 2019

G. Lalevic ,
M. Scriven  and
S. O’Brien
G. Lalevic*
Affiliation:
Acute Mental Health Unit, Cork University Hospital (HSE), Wilton, Cork, Ireland
M. Scriven
Affiliation:
Acute Mental Health Unit, Cork University Hospital (HSE), Wilton, Cork, Ireland
S. O’Brien
Affiliation:
St. Michael’s Unit, Mercy University Hospital (HSE), Cork, Ireland
*
*Address for correspondence: Dr G. Lalevic, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, Ireland (Email: grozdana.lalevic@hse.ie)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

An Early Intervention in Psychosis (EIP) programme aims to engage patients in early assessment and phase-specific interventions which are the key elements of the Irish National Clinical Programme for psychosis. This study aims to describe and review the EIP programme offered by Cork’s North Lee Mental Health Services over a 5-year period.

Methods

A retrospective descriptive study design was adopted to describe and review the EIP programme, patient demographics and treatments offered in the service over a 5-year period.

Results

A total of 139 patients were accepted into the programme over the 5-year period. The mean age of onset was 30 years (median = 28, SD = 9.9), and the mean duration of untreated psychosis was 8 months (median = 2.5, SD = 15.3). Two-thirds of patients were single on initial assessment, had a history of substance misuse and were unemployed. The majority of the cohort engaged with the keyworkers and occupational therapy but did not complete the full psychological or family programmes offered. Hospital admission was required for 12% of the cohort.

Conclusions

Patients experiencing their first episode of psychosis can successfully be treated in the community with appropriate professional and family support. However, deficiencies were noted in physical health monitoring, as well as in the availability and engagement with family and psychological therapies. Properly resourced early interventions in psychosis teams are necessary to deliver services at internationally recognised standards.

Keywords

Firstepisodeearlyinterventionpsychosis
Type
Short Report
Information
Irish Journal of Psychological Medicine , Volume 36 , Issue 4: Psychosis: from early intervention to treatment resistance , December 2019 , pp. 271 - 277
Copyright
© College of Psychiatrists of Ireland 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arciniegas, DB (2015). Psychosis. Continuum (Minneapolis, Minn.), 21, 715–736.Google ScholarPubMed
Auquier, P, Lancon, C, Rouillon, F, Lader, M (2007). Mortality in schizophrenia. Pharmacoepidemiology and Drug Safety, 16, 1308–1312.CrossRefGoogle Scholar
Baldwin, P, Browne, D, Scully, PJ, Quinn, JF, Morgan, MG, Kinsella, A, Owens, JM, Russel, V, O’Callaghan, E, Waddington, JL (2005). Epidemiology of first-episode psychosis: illustrating the challenges across diagnostic boundaries through the Cavan-Monaghan study at 8 years. Schizophrenia Bulletin, 31, 624–638.CrossRefGoogle ScholarPubMed
Barnes, TRE, Bhatti, SF, Adroer, R, Paton, C (2015). Screening for the metabolic side effects of antipsychotic medication: findings of a 6-year quality improvement programme in the UK. BMJ Open, 5, e007633.CrossRefGoogle ScholarPubMed
Bird, V, Premkumar, P, Kendall, T, Whittington, C, Mitchell, J, Kuipers, E (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. The British Journal of Psychiatry, 197, 350–356.CrossRefGoogle ScholarPubMed
Blanchard, JJ, Brown, SB (1998). 4.05 – Structured diagnostic interview schedules. In Comprehensive Clinical Psychology (ed. Bellack, A. S. and Hersen, M.). Oxford: Pergamon.Google Scholar
BNF (2011). British National Formulary (BNF) British Medical Association and the Royal Pharmaceutical Society of Great Britain. London: Pharmaceutical Press.Google Scholar
Byrne, P (2007). Managing the acute psychotic episode. BMJ (Clinical research ed.), 334, 686–692.CrossRefGoogle ScholarPubMed
Cantwell, R, Brewin, J, Glazerbrook, C, Dalkin, T, Fox, R, Medley, I, Harrison, G (1999). Prevalence of substance misuse in first-episode psychosis. The British Journal of Psychiatry, 174, 150–153.CrossRefGoogle ScholarPubMed
Castillo, R, Carlat, D, Millon, T, Millon, C, Meagher, S, Grossman, S, Rowena, R, Morrison, J, Association, AP (2007). Diagnostic and statistical manual of mental disorders, Washington, DC: American Psychiatric Association Press.Google Scholar
Cavalcante, D, Ortiz, B, Noto, M, Cordeiro, Q, Coutinho, L, Ota, V, Belangero, S, Bressan, R, Gadelha, A, Noto, C (2018). Duration of Untreated Psychosis (DUP) is associated with worse response to treatment in antypsychotic naive first episode psychosis. Schizophrenia Bulletin, 44(suppl_1), S96.CrossRefGoogle Scholar
Clarke, AM, Mclaughlin, P, Staunton, J, Kerins, K, Power, B, Kearney, K, MCcguinness, M, Whitty, P (2017). Retrospective study of first episode psychosis in the Dublin Southwest Mental Health Service: demographics, clinical profile and service evaluation of treatment. Irish Journal of Psychological Medicine, 34, 1–10.CrossRefGoogle Scholar
DETECT (2011). Report on the DETECT service-An Irish Early Intervention for Psychosis Service. [Online] (http://www.detect.ie/documents/5YEARDETECTREPORT2011_000.pdf). Accessed 28 January 2018.Google Scholar
Geoff, S, Michael, P (2011). Measuring the costs and benefits of promoting social inclusion. Mental Health and Social Inclusion, 15, 165–174.Google Scholar
Heckers, S (2009). Who is at risk for a psychotic disorder? Schizophrenia Bulletin, 35, 847–850.CrossRefGoogle ScholarPubMed
Higashi, K, Medic, G, Littlewood, KJ, Diez, T, Granstrom, O, De Hert, M (2013). Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic advances in psychopharmacology, 3, 200–218.CrossRefGoogle ScholarPubMed
HSE (2011). National Mental Health Programme Plan: Consultation Document. Health Service Executive. [Online] (https://health.gov.ie/wpcontent/uploads/2014/04/National_Mental_Health_Programme_Plan_Nov2011_draft.pdf) Accessed 10 April 2018.Google Scholar
Ising, HK, Smit, F, Veling, W, Rietdijk, J, Dragt, S, Klaassen, RMC, Savelsberg, NSP, Boonstra, N, Nieman, DH, Linszen, DH, Wunderink, L, Van Der Gaag, M (2014). Cost-effectiveness of preventing first-episode psychosis in ultra-high-risk subjects: multi-centre randomized controlled trial. Psychological Medicine, 45, 1435–1446.CrossRefGoogle ScholarPubMed
Miller, JT, Mcglashan, T, Rosen, LJ, Cadenhead, K, Cannon, T, Ventura, J, Mcfarlane, W, Perkins, D, Pearlson, G, Woods, S (2003). Prodromal Assessment with the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms: Predictive Validity, Interrater Reliability, and Training to Reliability. Schizophrenia Bulletin, 29, 703–715.CrossRefGoogle ScholarPubMed
Jones, S, Howard, L, Thornicroft, G (2008). ‘Diagnostic overshadowing’: worse physical health care for people with mental illness. Acta Psychiatrica Scandinavica, 118, 169–171.CrossRefGoogle ScholarPubMed
Spitzer, LR, Williams, J, Gibbon, M, First, M (1990). User’s guide for the structured clinical interview for DSM-IV Axis II personality disorders (SCID-II). Washington DC, American Psychiatric Press.Google Scholar
Laursen, TM, Nordentoft, M, Mortensen, PB (2014). Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 10, 425–448.CrossRefGoogle Scholar
Lloyd-Evans, B, Crosby, M, Stockton, S, Pilling, S, Hobbs, L, Hinton, M, Johnson, S (2018). Initiatives to shorten duration of untreated psychosis: systematic review. British Journal of Psychiatry, 198, 256–263.CrossRefGoogle Scholar
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry, 62, 975–983.CrossRefGoogle ScholarPubMed
Marshall, M, Rathbone, J (2011). Early intervention for psychosis. The Cochrane Database of Systematic Reviews, CD004718–CD004718.Google Scholar
Mcfarlane, WR, Levin, B, Travis, L, Lucas, FL, Lynch, S, Verdi, M, et al. (2015). Clinical and functional outcomes after 2 years in the early detection and intervention for the prevention of psychosis multisite effectiveness trial. Schizophrenia Bulletin, 41, 30–43.CrossRefGoogle ScholarPubMed
NICE (2014). Psychosis and schizophrenia in adults: prevention and management. National Institute for Healthcare and Excellence. [Online] (https://www.nice.org.uk/guidance/cg178). Accessed 10 April 2018.Google Scholar
Osterberg, L, Blaschke, T (2005). Adherence to medication. New England journal of medicine, 353, 487–497.CrossRefGoogle ScholarPubMed
Pentillä, M, Jääskeläinen, E, Hirvonen, N, Isohanni, M, Miettunen, J (2014). Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. The British Journal of Psychiatry, 205, 88–94.CrossRefGoogle Scholar
Perez, J, Jin, H, Russo, DA, Stochl, J, Painter, M, Shelley, G, Jackson, E, Crane, C, Graffy, JP, Croudace, TJ, Byford, S, Jones, PB (2015). Clinical effectiveness and cost-effectiveness of tailored intensive liaison between primary and secondary care to identify individuals at risk of a first psychotic illness (the LEGs study): a cluster-randomised controlled trial. The Lancet Psychiatry, 2, 984–993.CrossRefGoogle ScholarPubMed
Randall, JR, Vokey, S, Loewen, H, Martens, PJ, Brownell, M, Katz, A, Nickel, NC, Burland, E, Chateau, D (2015). A systematic review of the effect of early interventions for psychosis on the usage of inpatient services. Schizophrenia Bulletin, 41, 1379–1386.CrossRefGoogle ScholarPubMed
Read, J, Van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330–350.CrossRefGoogle ScholarPubMed
Reininghaus, U, Dutta, R, Dazzan, P, Doody, GA, Fearon, P, Lappin, J, Heslin, M, Onyejiaka, A, Donoghue, K, Lomas, B, Kirkbride, JB, Murray, RM, Croudace, T, Morgan, C, Jones, PB (2015). Mortality in schizophrenia and other psychoses: a 10-year follow-up of the ÆSOP first-episode cohort. Schizophrenia Bulletin, 41, 664–673.CrossRefGoogle Scholar
Rodrigues, R, Anderson, KK 2017. The traumatic experience of first-episode psychosis: a systematic review and meta-analysis. Schizophrenia Research, 189, 27–36.CrossRefGoogle ScholarPubMed
Scully, PJ, Quinn, JF, Morgan, MG, Kinsella, A, O’Callaghan, E, Owens, JM, Waddington, JL (2002). First-episode schizophrenia, bipolar disorder and other psychoses in a rural Irish catchment area: incidence and gender in the Cavan–Monaghan study at 5 years. The British Journal of Psychiatry, 181, s3–s9.CrossRefGoogle Scholar
Segal, DL, Hersen, M, Van Hasselt, VB (1994). Reliability of the structured clinical interview for DSM-III-R: an evaluative review. Comprehensive Psychiatry, 35, 316–327.CrossRefGoogle Scholar
Thornicroft, G (2011). Physical health disparities and mental illness: the scandal of premature mortality. The British Journal of Psychiatry, 199, 441–442.CrossRefGoogle ScholarPubMed
Tsiachristas, A, Thomas, T, Leal, J, Lennox, BR (2016). Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England. BMJ Open, 6, e012611.CrossRefGoogle ScholarPubMed
Wahlbeck, K, Westman, J, Nordentoft, M, Gissler, M, Laursen, TM (2018). Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry, 199, 453–458.CrossRefGoogle Scholar