Early intervention in psychotic disorders: faith before facts?

Bosanac, Peter; Patton, George C.; Castle, David

doi:10.1017/s0033291709990341

Cited by 65 publications

(60 citation statements)

References 51 publications

(60 reference statements)

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“…We did not consider specific psychotic disorders because EIS deliberately avoid diagnostic classification at service entry to accommodate the dynamic phenomenology seen in this setting and to avoid stigma ; this is a weakness from the point of view of research and comparability with other studies that could be addressed in future work. However, we can be certain that our results are not due to the inclusion of false-positive cases ; that is, people with subclinical ARMS, such as those identified in the general, non-clinical population, who have uncertain predictive value in terms of future psychotic disorder and associated morbidity (Bosanac et al 2010). Neither funded nor designed to accommodate people with ARMS, our EIS deliberately screened out any such cases, which were subsequently referred to other parts of the health system.…”

Section: Methodological Considerationsmentioning

confidence: 99%

“…A further follow-up study suggested that any gains were not sustained at 5 years (Bertelsen et al 2008). A decade since their introduction in England, EIS remain controversial (Marshall & Rathbone, 2008 ;Bosanac et al 2010 ;Kuehn, 2010 ;McGorry et al 2010 ;Pelosi & Birchwood, 2003) but are the front line for young people who develop psychotic illness.…”

Section: Introductionmentioning

confidence: 99%

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Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting

et al. 2010

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Background. Early Intervention in Psychosis Services (EIS) for young people in England experiencing first-episode psychosis (FEP) were commissioned in 2002, based on an expected incidence of 15 cases per 100 000 person-years, as reported by schizophrenia epidemiology in highly urban settings. Unconfirmed reports from EIS thereafter have suggested higher than anticipated rates. The aim of this study was to compare the observed with the expected incidence and delineate the clinical epidemiology of FEP using epidemiologically complete data from the CAMEO EIS, over a 6-year period in Cambridgeshire, for a mixed rural-urban population.Method. A population-based study of FEP (ICD-10, F10-39) in people aged 17-35 years referred between 2002 and 2007 ; the denominator was estimated from mid-year census statistics. Sociodemographic variation was explored by Poisson regression. Crude and directly standardized rates (for age, sex and ethnicity) were compared with pre-EIS rates from two major epidemiological FEP studies conducted in urban English settings.Results. A total of 285 cases met FEP diagnoses in CAMEO, yielding a crude incidence of 50 per 100 000 personyears [95 % confidence interval (CI) 44.5-56.2]. Age-and sex-adjusted rates were raised for people from black ethnic groups compared with the white British [incidence rate ratio (IRR) 2.1, 95 % CI 1.1-3.8]. Rates in our EIS were comparable with pre-EIS rates observed in more urban areas after age, sex and ethnicity standardization.Conclusions. Our findings suggest that the incidence observed in EIS is far higher than originally anticipated and is comparable to rates observed in more urban settings prior to the advent of EIS. Sociodemographic variation due to ethnicity and other factors extend beyond urban populations. Our results have implications for psychosis aetiology and service planning.

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Section: Methodological Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting

et al. 2010

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“…A review not long afterwards 13 argued that early interventions had produced 'an embryonic evidence-base, notably in terms of any long-term benefits'. However, another study showed some advantages for 'bed days' and readmissions over six years, compared with treatment as usual.…”

Section: Evidence Effectmentioning

confidence: 99%

Early intervention in psychosis: another triumph of hope over experience?

Mortimer¹,

Brown²

2015

Prog. Neurol. Psychiatry

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Evidence that longer duration of untreated psychosis (DUP) was associated with poor premorbid functioning in the year before onset, insidious onset and more negative symptoms at onset, led to the assumption that reducing DUP could improve long‐term outcome – hence the development of early intervention in psychosis (EIP) services. The authors investigate the evidence for and against EIP services and discuss how societal/family issues can also strongly influence mental health.

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“…This second issue opens a can of worms regarding funding: although EPPIC claims to save money (Mihalopoulos 2009), we have seen no dividends returned to mainstream mental health services from such savings, and the fact that so much money is going into such services results in other parts of the health system being depleted: certainly this is occurring in Australia, with restrictions on new psychiatric medications and on access to psychologist services. We need a much better informed and equitable response to the mental health problems of our communities, not one built on faith rather than facts (Bosanac 2010), nor one that is simply a political response to intense lobbying by a few 'true believers'. …”

Section: Propping Up the Paradigmmentioning

confidence: 99%