Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven. OBJECTIVE: To study whether 1-year outcome will be better in a health care sector with early detection (ED) of psychosis compared with sectors with no early detection (no-ED). DESIGN: A quasi-experimental study with ED in 2 experimental sectors and no-ED in 2 control sectors. ED was achieved through low-threshold ED teams and information campaigns about psychosis for the public, schools, and primary health care providers. The ED and no-ED health care areas offered an equivalent assessment and treatment program during the first year. Two hundred and eighty-one patients were included; 88% were reassessed after 1 year. RESULTS: The ED-area patients (N = 141) had a median duration of untreated psychosis of 5 weeks at baseline compared with 16 weeks for patients in the no-ED area (N = 140). Positive and general symptoms, global assessment of functioning, quality of life, time to remission, and course of psychosis at 1 year after the start of treatment were not different between ED and no-ED groups. Outcome was significantly better for the ED area for negative symptoms. CONCLUSIONS: The ED, no-ED differences at baseline become attenuated by 1 year but not the difference in negative symptoms, suggesting secondary prevention in this domain of psychopathology. However, this possibility requires further testing by follow-up and replication.
Most countries allow for the use of involuntary admission of patients. While some countries have stable or declining rates of involuntary admission, this type of coercion is now on the increase in several European countries.
To increase understanding of the antecedents of involuntary admission.
The importance of various predictors of involuntary admission were analysed in univariate analyses and in a logistic regression model, involving approximately 2000 admissions to a Norwegian hospital.
Involuntary admission was positively associated with the diagnostic category of psychosis and negatively associated with the category of anxiety. Emergency referrals were also more likely to be coerced.
Diagnostic category seems to be a central factor with respect to involuntary admission. Patients that were admitted in an emergency were also more likely to be coerced.
Certain groups of patients are more likely to be admitted involuntarily. Increasing attention to these groups could possibly also contribute to the reduction of coercion.
Concepts and definitions pertaining to the early course of schizophrenia are reviewed, along with recent illustrative studies of first-episode schizophrenia. Early course parameters of a Norwegian first-episode sample are presented. This sample (n = 43) demonstrated strong gender differences, with male patients having significantly higher frequency of single marital status, lower educational status, schizophrenia, early age at onset, and lower Global Assessment of Functioning scores the last year before hospitalization. The duration of untreated psychosis (DUP) was long (mean = 114 weeks), as in other studies. Longer DUP was associated with poorer work, social, and global functioning in the year before admission, with more insidious onset of psychosis, and with more negative symptoms at first clinical presentation. Longer DUP was not associated with the age at onset of psychosis. These findings were mostly gender independent. The data help to frame questions about why patients can be psychotic for so long before getting help. Finally, suggestions are offered for the definition and measurement of early course parameters for schizophrenia.
To investigate the relationship between anomalous self-experiences and duration of untreated psychosis in a sample of patients with first-episode schizophrenia spectrum disorders.
Anomalous self-experiences were assessed by means of the Examination of Anomalous Self-Experience manual in 55 patients referred to their first adequate treatment for schizophrenia. Diagnoses, symptom severity, functioning and childhood trauma were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Premorbid Adjustment Scale, Social Functioning Scale and Childhood Trauma Questionnaire. Substance misuse was measured with the Drug Use Disorder Identification Test, and alcohol use was measured with the Alcohol Use Disorder Identification Test. Duration of untreated psychosis was measured in accordance with a standardized procedure.
High levels of anomalous self-experiences are significantly associated with longer duration of untreated psychosis, an association which held after correcting for other variables associated with long duration of untreated psychosis.
The field of early detection in psychosis is in need of additional clinical perspectives to make further progress. Improved understanding and assessment of anomalous self-experiences may help clinicians to detect these important phenomena and provide earlier help, and thus reduce treatment delay.
The following paper utilizes the DSM-IV suggested clinical and cultural formulation to present an example of how First Nations and western treatment methods can work together to treat a First Nation's woman with a serious mental disorder. The formulation provides reflections on cultural elements in the diagnosis and what distinct and common elements are present in the First Nations and western explanatory models for etiology and treatment.
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead It has been my privilege to work in partnership with hundreds of patients experiencing emergent psychosis, in Hamilton, Ontario during the course of my lengthy nursing career. Indeed, the knowledge I have gleaned from both the courageous individuals who have experienced serious mental illness and their resilient families has been monumental. When I first began my career, I was utterly naïve and most certainly held the misguided assumption that to be a mental health nurse required an adherence to a strict set of nursing principles and that the nurse-patient relationship was approached from an objective and 'safe' distance. Reflecting on this now, many years later I understand that the therapeutic relationship between nurses and those they serve is foundational to the delivery of safe and ethical mental health care. Although increasingly clinical practice guidelines and evidence-based interventions serve to inform nursing practice, in my mind it is the embodied experience of relationship that is the real instrument of healing and transformation. Recognizing that early intervention provides an unprecedented opportunity to begin anew with young patients who have no prior experiences with the mental health care system, the purpose of this paper is to serve as a vehicle for discussion and potentially inspire a group of thoughtful, committed nurses to change the world of mental health services by creating a respectful moral community. I propose that relational ethics form the values and ideals of a fully humane early psychosis intervention community in Ontario. Using the foundational tenets of the nurse-patient relationship illustrated through the use of a clinical narrative, I will suggest ways that nurses can proactively take up the early intervention challenge and contribute to an overall culture of optimism and hope. Intervening early is simply not enough. We must first commit to developing comprehensive recovery-oriented treatments in a coordinated and thoughtful way.