Reduction in Incidence of Hospitalizations for Psychotic Episodes Through Early Identification and Intervention

Abstract

Objective This study tested whether the incidence of hospitalization for psychosis was reduced by a community-wide system of early identification and intervention to prevent onset of psychosis. Method The Portland Identification and Early Referral (PIER) program was initiated in 2001. Youth and young adults ages 12-35 were identified by professionals in a wide variety of educational, health and mental health settings. PIER staff assessed, confirmed risk for psychosis and provided treatment for 24 months to eligible and consenting young people (N=148). The monthly rate of hospital admissions for first episode psychosis was the outcome measure for efficacy of identification and intervention. Admission rates before and after the program began accepting referrals were compared, both in the experimental area and in aggregated urban areas of Maine. ARIMA models were used to assess the effect. Results Based on ARIMA models, the rate of hospitalized psychosis decreased significantly by 26% (95% C.I., -64% to -11%) in the Greater Portland area. Conversely, it increased by 8% (95% C.I. -5% to +36%) in the Urban Control area. Including increases in the control area, the actual vs. expected difference (-26% -8%) was -34%. The change was largest for non-affective-non-schizophrenic Disorders. Conclusions PIER demonstrated that population-wide early identification is feasible. Preventive intervention can reduce rates of initial hospitalizations for psychosis in a mid-sized city. Clinical trial registration The study was reviewed and approved by the Maine Medical Center Institutional Review Board and registered at ClinicalTrials.gov (NCT01597141). All research subjects gave informed consent prior to participating.

Family Interventions for Schizophrenia and the Psychoses: A Review

“…Similar early psychosis work is now being done in the United States. The Portland Identification and Early Referral (PIER) is a community‐wide public health system for preventing psychosis (McFarlane et al., , ). It shares many elements of the TIPS, OPUS, and other early intervention studies, including MFG‐FPE, FACT, psychotropic medications by symptom indication, and supported employment and education.…”

Early Detection, Intervention and Prevention of Psychosis Program: Community Outreach and Early Identification at Six U.S. Sites

“…In a prior study, PIER was able through community outreach to promote early referrals for individuals at risk (21). PIER educated more than 7,000 professionals and found a 34% reduction in incidence of hospitalizations for first-episode psychosis (22). The EDIPPP study included this outreach model at six replication sites: PIER, Portland, Maine; Early Assessment and Support Team (EAST), Salem, Oregon; Michigan Prevents Prodromal Progression (M3P), Ypsilanti; Recognition and Prevention (RAP), Queens, New York; Early Detection and Preventive Treatment (EDAPT), Sacramento, California; and Early Assessment and Resource Linkage for Youth (EARLY), Albuquerque, New Mexico.…”

A focus on adolescence to reduce neurological, mental health and substance-use disability

“…1). Early identification of psychosis by a range of non-specialists followed by intervention may mitigate the severity of the disease and the need for hospitalization 28 . Family approaches have also shown promise for young adults at high risk 29 .…”