No abstract

This study aimed to determine if, following two years of early intervention service for first-episode psychosis, three-year extension of that service was superior to three years of regular care. We conducted a randomized single blind clinical trial using an urn randomization balanced for gender and substance abuse. Participants were recruited from early intervention service clinics in Montreal. Patients (N5220), 18-35 years old, were randomized to an extension of early intervention service (EEIS; N5110) or to regular care (N5110). EEIS included case management, family intervention, cognitive behaviour therapy and crisis intervention, while regular care involved transfer to primary (community health and social services and family physicians) or secondary care (psychiatric outpatient clinics). Cumulative length of positive and negative symptom remission was the primary outcome measure. EEIS patients had a significantly longer mean length of remission of positive symptoms (92.5 vs. 63.6 weeks, t54.47, p<0.001), negative symptoms (73.4 vs. 59.6 weeks, t52.84, p50.005) and both positive and negative symptoms (66.5 vs. 56.7 weeks, t52.25, p50.03) compared to regular care patients. EEIS patients stayed in treatment longer than regular care patients (mean 131.7 vs. 105.3 weeks, t53.98, p<0.001 through contact with physicians; 134.8 6 37.7 vs. 89.8 6 55.2, t56.45, p<0.0001 through contact with other health care providers) and received more units of treatment (mean 74.9 vs. 39.9, t54.21, p<0.001 from physicians, and 57.3 vs. 28.2, t54.08, p<0.001 from other health care professionals). Length of treatment had an independent effect on the length of remission of positive symptoms (t52.62, p50.009), while number of units of treatment by any health care provider had an effect on length of remission of negative symptoms (t522.70, p50.008) as well as total symptoms (t522.40, p50.02). Post-hoc analysis showed that patients randomized to primary care, based on their better clinical profile at randomization, maintained their better outcome, especially as to remission of negative symptoms, at the end of the study. These data suggest that extending early intervention service for three additional years has a positive impact on length of remission of positive and negative symptoms compared to regular care. This may have policy implications for extending early intervention services beyond the current two years.

Objectives: To assess current attitudes, practices, and knowledge of Canadian psychiatrists regarding fitness to drive in individuals with mental illness and to explore variations according to provincial legislation. Method:We carried out a national cross-sectional survey, using a random sample of psychiatrists. We used a mail survey to collect data. Results:In total, 248 psychiatrists participated; the response rate was 54.2% on traced subjects. The majority (64.1%) reported that they strongly agreed or agreed that addressing patients' fitness to drive is an important issue. However, only 18.0% of respondents were always aware of whether their patients were active drivers. One-fourth strongly agreed or agreed that they were confident in their ability to evaluate fitness to drive. In discretionary provinces, 29.3% of psychiatrists reported not knowing their provincial legislation, as did 14.6% of psychiatrists in mandatory provinces; of those responding, 54.0% from discretionary provinces and 2.8% from mandatory provinces gave incorrect answers. Discussion:Psychiatrists' responses demonstrate a broad range of attitudes, practices, and knowledge. There appears to be a large gap between what is expected of psychiatrists and their readiness and self-perceived ability to make informed clinical decisions related to driving safety. Conclusion:There is a clear need for education and guidelines to assist psychiatrists in decision making about driving fitness. (Can J Psychiatry 2006;51:836-846) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications· It is important for psychiatrists to consider their patients' fitness to drive. · Education and guidelines are needed to assist psychiatrists in determining fitness to drive. Limitations· The small sample size decreased the statistical power. · The findings may have limited generalizability. · There is a possible refusal bias.