Early intervention in psychosis in emerging countries: Findings from a first‐episode psychosis programme in the Ribeirão Preto catchment area, southeastern Brazil

Abstract

Aim: People presenting with first-episode psychosis (FEP) can benefit from early intervention programmes. However, such programmes are scarce in low-and middleincome countries (LMICs). In Brazil, there are a few programmes, but they are unequally distributed across the country. We aimed to describe the implementation and performance of the Ribeirão Preto Early Intervention in Psychosis Programme (Ribeirão Preto-EIP), an outpatient service for patients presenting with FEP residing in the Ribeirão Preto catchment area in Southeastern Brazil.Methods: A detailed description of the service, staff and theoretical framework was compiled. Furthermore, a retrospective cohort study of patients attending the programme throughout 4 years (2015-2018) was conducted. Data were obtained by analysing the medical records of all patients, and sociodemographic and diagnostic stability information for this period was recorded.Results: The Ribeirão Preto-EIP had 358 new referrals during the study period. Among them, 237 patients were assessed for an average (median) duration of 14 months. Most patients were male (64.1%) and single (84.8%). The median age was 23.5 years (range, 9-86 years). Schizophrenia was the main diagnosis (43.4%), followed by substance-induced (25.7%) and affective (18.6%) psychosis. Referrals occurred from emergency, inpatient, community-based mental health and primary care services.Conclusions: Programmes such as the Ribeirão Preto-EIP demonstrate that early intervention in psychosis is feasible in LMICs despite significant challenges for their access and integration in the health system. Strategic scale-up policies could be undertaken to offer better short-and long-term outcomes for individuals presenting with FEP and their families.

A systematic review of factors prolonging or reducing the duration of untreated psychosis for people with psychosis in low‐ and middle‐income countries

“…Early intervention for people with psychosis in developing countries is high on the agenda of the World Psychiatric Association (Vaitheswaran et al, 2021). Despite unique challenges, such as limited funding and scarcity of specialized mental health workers (Singh & Javed, 2020), EIS have been implemented across LMICs (Corrêa-Oliveira et al, 2021). However, benefits of EIS may not be fully exploited if little attention is given to reducing DUP (Dama et al, 2019).…”