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A community intervention for early identification of first episode psychosis: impact on duration of untreated psychosis (DUP) and patient characteristics.

https://arctichealth.org/en/permalink/ahliterature174741
Source
Soc Psychiatry Psychiatr Epidemiol. 2005 May;40(5):337-44
Publication Type
Article
Date
May-2005
Author
Ashok Malla
Ross Norman
Derek Scholten
Rahul Manchanda
Terry McLean
Author Affiliation
McGill University, Montréal (QC), Canada. ashok.malla@douglas.mcgill.ca
Source
Soc Psychiatry Psychiatr Epidemiol. 2005 May;40(5):337-44
Date
May-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Community Mental Health Services
Early Diagnosis
Female
Follow-Up Studies
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Ontario
Outcome Assessment (Health Care)
Prospective Studies
Psychotic Disorders - diagnosis - epidemiology - psychology - therapy
Referral and Consultation - statistics & numerical data
Abstract
The aim of this study was to assess the impact of a community case identification program on duration of untreated psychosis (DUP) (a measure of delay in treatment) and characteristics of patients entering treatment for a first episode of psychosis.
Using a quasi-experimental historical control design, patients within a defined geographic catchment area who met DSM-IV criteria for a first episode of a psychotic disorder (FEP) were assessed on a number of demographic and clinical variables including DUP, length of prodromal period and symptoms at initial presentation, for 2 years prior to and 2 years after the introduction of a community-wide Early Case Identification Program (ECIP). The ECIP was designed to promote early recognition and referral of individuals with a FEP from any possible source of referral including self-referrals. Treatment interventions offered were the same throughout the two phases.
In all, 88 and 100 patients met criteria respectively in phases I and II. There were no significant differences in rates of treated incidence or DUP between the two phases. Patients recruited in phase II had significantly longer prodromal periods and higher level of psychotic and disorganization symptoms. There were no differences in level of negative symptoms or pre-morbid adjustment.
A community-wide approach to early case identification may not be the most effective way to reduce delay in treatment of psychosis, but may bring into treatment patients who have been ill for long periods of time and have a higher level of psychopathology. A more targeted approach directed at primary care and emergency services may achieve different results in reducing delay in treatment.
PubMed ID
15902403 View in PubMed
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Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis.

https://arctichealth.org/en/permalink/ahliterature120720
Source
Soc Psychiatry Psychiatr Epidemiol. 2013 Jan;48(1):125-36
Publication Type
Article
Date
Jan-2013
Author
Kelly K Anderson
Rebecca Fuhrer
Norbert Schmitz
Ashok K Malla
Author Affiliation
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada. kelly.anderson@mail.mcgill.ca
Source
Soc Psychiatry Psychiatr Epidemiol. 2013 Jan;48(1):125-36
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada
Community Mental Health Services - utilization
Female
Health Services Accessibility - statistics & numerical data
Humans
Logistic Models
Male
Outcome Assessment (Health Care)
Patient Acceptance of Health Care - statistics & numerical data
Proportional Hazards Models
Psychiatric Status Rating Scales
Psychotic Disorders - diagnosis - epidemiology - psychology - therapy
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Time Factors
Young Adult
Abstract
Although there have been numerous studies on pathways to care in first-episode psychosis (FEP), few have examined the determinants of the pathway to care and its impact on subsequent engagement with mental health services.
Using a sample of 324 FEP patients from a catchment area-based early intervention (EI) program in Montréal, we estimated the association of several socio-demographic, clinical, and service-level factors with negative pathways to care and treatment delay. We also assessed the impact of the pathway to care on time to disengagement from EI services.
Few socio-demographic or clinical factors were predictive of negative pathways to care. Rather, service-level factors, such as contact with primary care providers, have a stronger impact on patterns of health service use across multiple indicators. Patients who were in contact with primary care had a reduced likelihood of negative pathways to care, but also had longer referral delays to EI services. Socio-demographic and clinical factors were more relevant for predicting subsequent engagement with EI services, and indicators of negative pathways to care were not associated with service disengagement.
Primary care providers may be an efficacious target for interventions aimed at reducing overall treatment delay. Increasing the uptake of primary care services may also reduce the likelihood of negative pathways to care. Our findings draw attention to the need for further investigations of the role that the primary care system plays in early intervention for FEP, and strategies for supporting service providers in this role.
PubMed ID
22976337 View in PubMed
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Early criminal recidivism among mentally disordered offenders.

https://arctichealth.org/en/permalink/ahliterature132594
Source
Int J Offender Ther Comp Criminol. 2012 Aug;56(5):749-68
Publication Type
Article
Date
Aug-2012
Author
Christina Lund
Anders Forsman
Henrik Anckarsäter
Thomas Nilsson
Author Affiliation
Forensic Psychiatric Research Group, University of Gothenburg, Sweden. christina.lund@neuro.gu.se
Source
Int J Offender Ther Comp Criminol. 2012 Aug;56(5):749-68
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Causality
Cohort Studies
Comorbidity
Crime - legislation & jurisprudence - psychology - statistics & numerical data
Diagnosis, Dual (Psychiatry)
Humans
Law Enforcement
Male
Mental Disorders - diagnosis - epidemiology - psychology - therapy
Personality Disorders - diagnosis - epidemiology - psychology - therapy
Prisoners - legislation & jurisprudence - psychology - statistics & numerical data
Prisons
Psychotherapy
Psychotic Disorders - diagnosis - epidemiology - psychology - therapy
Recurrence
Referral and Consultation
Substance-Related Disorders - diagnosis - epidemiology - psychology - therapy
Sweden
Abstract
Criminal recidivism was studied during 2 years in a Swedish population-based cohort (N = 318) of mentally disordered male offenders who had undergone a pretrial forensic psychiatric investigation, been convicted in subsequent trials, and been sentenced to forensic psychiatric treatment (FPT; n = 152), prison (n = 116), or noncustodial sanctions (n = 50). Recidivism was analysed in relation to index sanctions, levels of supervision, diagnoses, and criminological factors. Significantly lower recidivism in the FPT group was related to lower crime rates during periods at conditional liberty in this group alone, and recidivism was significantly more common among offenders with at least one of the two diagnoses of substance abuse disorder and personality disorder than among those with psychotic or other mental disorders alone. Age at index crime and number of previous crimes emerged as significant predictors of recidivism. The results of this study suggest that the relapse rates depend as much on level of supervision as on individual characteristics.
PubMed ID
21803759 View in PubMed
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Early identification of non-remission in first-episode psychosis in a two-year outcome study.

https://arctichealth.org/en/permalink/ahliterature141450
Source
Acta Psychiatr Scand. 2010 Nov;122(5):375-83
Publication Type
Article
Date
Nov-2010
Author
Erik Simonsen
S. Friis
S. Opjordsmoen
E L Mortensen
U. Haahr
I. Melle
I. Joa
J O Johannessen
T K Larsen
J I Røssberg
B R Rund
P. Vaglum
T H McGlashan
Author Affiliation
Psychiatric Research Unit, Zealand Region Psychiatry Roskilde, Roskilde University and University of Copenhagen, Copenhagen, Denmark. es@regionsjaelland.dk
Source
Acta Psychiatr Scand. 2010 Nov;122(5):375-83
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Chi-Square Distribution
Denmark - epidemiology
Female
Humans
Logistic Models
Male
Marital status
Middle Aged
Norway - epidemiology
Psychotherapy
Psychotic Disorders - diagnosis - epidemiology - psychology - therapy
Remission Induction
Sex Factors
Social Adjustment
Statistics, nonparametric
Substance-Related Disorders - psychology
Treatment Outcome
Young Adult
Abstract
To identify predictors of non-remission in first-episode, non-affective psychosis.
During 4 years, we recruited 301 patients consecutively. Information about first remission at 3 months was available for 299 and at 2 years for 293 cases. Symptomatic and social outcomes were assessed at 3 months, 1 and 2 years.
One hundred and twenty-nine patients (43%) remained psychotic at 3 months and 48 patients (16.4%) remained psychotic over 2 years. When we compared premorbid and baseline data for the three groups, the non-remitted (n = 48), remitted for
Notes
Comment In: Acta Psychiatr Scand. 2011 Jun;123(6):49421219270
PubMed ID
20722632 View in PubMed
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Predictors of psychiatric aftercare among formerly hospitalized adolescents.

https://arctichealth.org/en/permalink/ahliterature119008
Source
Can J Psychiatry. 2012 Nov;57(11):666-76
Publication Type
Article
Date
Nov-2012
Author
Corine E Carlisle
Muhammad Mamdani
Russell Schachar
Teresa To
Author Affiliation
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. corine.carlisle@camh.ca
Source
Can J Psychiatry. 2012 Nov;57(11):666-76
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Aftercare - psychology - utilization
Cohort Studies
Female
Health Services Accessibility - statistics & numerical data
Hospitalization
Humans
Likelihood Functions
Male
Mental Disorders - diagnosis - epidemiology - psychology - therapy
Ontario
Primary Health Care - utilization
Psychiatry - statistics & numerical data
Psychotic Disorders - diagnosis - epidemiology - psychology - therapy
Retrospective Studies
Rural Population - statistics & numerical data
Self-Injurious Behavior - diagnosis - epidemiology - psychology - therapy
Socioeconomic Factors
Substance-Related Disorders - diagnosis - epidemiology - psychology - therapy
Suicide, Attempted - prevention & control - psychology - statistics & numerical data
Utilization Review - statistics & numerical data
Abstract
Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization.
We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge.
Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P
PubMed ID
23149282 View in PubMed
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