The over-35s: early intervention in psychosis services entering uncharted territory

Clay, Felix; Allan, Sophie; Lai, Serena; Laverty, Siona; Jagger, Grace; Treise, Cate; Pérez, Jesús

doi:10.1192/bjb.2018.28

Cited by 18 publications

(16 citation statements)

References 9 publications

(30 reference statements)

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“…The operational definition of first-episode psychosis may exclude potential clients based on the duration of psychotic symptoms, duration of antipsychotic medication, or prior help-seeking contacts (Breitborde et al ., 2009), and in the case of the EPI program in the current study, exclusions are also made if there is an affective presentation at first onset. Our findings suggest that only 40% of people identified by our case-finding algorithm who were screened by the EPI program were ultimately admitted, which is in line with reported estimates from some programs (O'Donoghue et al ., 2012; Clay et al ., 2018), but much lower than others (Kirkbride et al ., 2017). A recent study used electronic medical records to ‘confirm’ whether cases identified in health administrative data would meet the case definition for first-episode psychosis.…”

Section: Discussionmentioning

confidence: 54%

Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services

et al. 2018

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BackgroundDiscrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates.MethodsWe constructed a retrospective cohort (1997–2015) of incident cases of non-affective psychosis aged 16–50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach.ResultsOur case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4–35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4–20.3).ConclusionsCase ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.

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Section: Discussionmentioning

confidence: 54%

Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services

et al. 2018

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“…Additional support should be given to patients aged 39-64 who are at greatest risk of dying by external causes v. their community-treated counterparts with SMIs. From 2016, EIP services were expanded to support patients aged over 35 years (Clay et al, 2018). Further research investigating the impact of widening the eligible age range for this service on risk of dying by external causes is needed.…”

Section: Discussionmentioning

confidence: 99%

Suicide and death by other causes among patients with a severe mental illness: cohort study comparing risks among patients discharged from inpatient carev. those treated in the community

Musgrove

Carr

Kapur

et al. 2022

Epidemiol Psychiatr Sci

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Aims People diagnosed with a severe mental illness (SMI) are at elevated risk of dying prematurely compared to the general population. We aimed to understand the additional risk among people with SMI after discharge from inpatient psychiatric care, when many patients experience an acute phase of their illness. Methods In the Clinical Practice Research Datalink (CPRD) GOLD and Aurum datasets, adults aged 18 years and older who were discharged from psychiatric inpatient care in England between 2001 and 2018 with primary diagnoses of SMI (schizophrenia, bipolar disorder, other psychoses) were matched by age and gender with up to five individuals with SMI and without recent hospital stays. Using survival analysis approaches, cumulative incidence and adjusted hazard ratios were estimated for all-cause mortality, external and natural causes of death, and suicide. All analyses were stratified by younger, middle and older ages and also by gender. Results In the year after their discharge, the risk of dying by all causes examined was higher than among individuals with SMI who had not received inpatient psychiatric care recently. Suicide risk was 11.6 times (95% CI 6.4–20.9) higher in the first 3 months and remained greater at 2–5 years after discharge (HR 2.3, 1.7–3.2). This risk elevation remained after adjustment for self-harm in the 6 months prior to the discharge date. The relative risk of dying by natural causes was raised in the first 3 months (HR 1.6, 1.3–1.9), with no evidence of elevation during the second year following discharge. Conclusions There is an additional risk of death by suicide and natural causes for people with SMI who have been recently discharged from inpatient care over and above the general risk among people with the same diagnosis who have not recently been treated as an inpatient. This mortality gap shows the importance of continued focus, following discharge, on individuals who require inpatient care.

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“…This suggests that acute onset and presentation of psychosis may be a significant indicator for accessing specialist service. This is reflected in findings from recent studies, following the implementation of Access and Waiting Time standard, which suggest that patients aged > 35 years present with complex needs [ 58 , 59 ]. However, further research is needed to shed light on which factors influence pathways to care for patients over 35 years.…”

Section: Discussionmentioning

confidence: 99%

Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study

Oduola

Craig

Morgan

2020

Soc Psychiatry Psychiatr Epidemiol

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Objectives There is inconsistent evidence on the influence of ethnicity on duration of untreated psychosis (DUP). We investigated ethnic differences in DUP in a large epidemiological dataset of first episode psychosis patients in an inner city area of south London, UK. Methods We analysed data on 558 first episode psychosis patients at the South London and Maudsley NHS Trust, between 2010 and 2012. We performed multivariable logistic regression to estimate the odds of a short DUP (≤ 6 months) by ethnic group, controlling for confounders. Results There was no evidence that ethnicity is associated with duration of untreated psychosis. However, we found evidence that a short DUP was strongly associated with age, living circumstances, and pathways to care variables (involuntary admission, out of office hour contact, accident and emergency referral, criminal justice agency referral and family involvement in help-seeking). Conversely, a long DUP was associated with report of social isolation, living alone, being single and General Practitioner referral. Conclusion Our findings suggest that indicators of social isolation were associated with long DUP. Our data also show that pathways into care characteristics play significant role in DUP. Thus, the challenge of tackling the issue of timely access to EI under the new Access and Waiting Time standard for psychosis requires a multilevel approach, including joint working with communities, public awareness of psychosis, less restrictive referral pathways and adequate resourcing of early intervention for psychosis services. These will go a long way in addressing patients' needs rather than be determined by service structures.

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The over-35s: early intervention in psychosis services entering uncharted territory

Cited by 18 publications

References 9 publications

Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services

Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services

Suicide and death by other causes among patients with a severe mental illness: cohort study comparing risks among patients discharged from inpatient carev. those treated in the community

Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study

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