Deborah Windell

Impact of a specialized early intervention service for psychotic disorders on patient characteristics, service use, and hospital costs in a defined catchment area.

Objective: To evaluate the impact of a new early intervention service for first-episode psychosis on patient characteristics, service use, and hospital costs. Method: We examined clinical records of all first admissions to hospitals of patients diagnosed with first-episode psychoses (nonaffective) over a 3-year period before and after the introduction of an early intervention service, the Prevention and Early Intervention Program for Psychosis (PEPP), in a defined catchment area. We examined demographic, clinical, and service use indices covering a 2-year period subsequent to the index admission for each patient. Results: Patients in the post-PEPP phase were significantly younger (P < 0.01), were more often male (P < 0.05), and were less likely to be admitted to hospital with an involuntary status (P < 0.05) or with injuries (P < 0.05) at the time of their first hospital admission. Over the 2 years following the initial admission, post-PEPP patients had significantly fewer admissions to a regular psychiatric service (P < 0.001) and made significantly fewer visits to the hospital emergency department (P < 0.01). There was a significant mean reduction in costs per case of regular hospital bed use (

The Personal Meaning of Recovery Among Individuals Treated for a First Episode of Psychosis

1028.49, SD 528.02, compared with

Does treatment delay predict occupational functioning in first-episode psychosis?

792. 28, SD 528.02; P < 0.01) and emergency visits (

A multisite Canadian study of outcome of first-episode psychosis treated in publicly funded early intervention services.

519.18, SD 353.79, compared with

Examining differences in the stigma of depression and schizophrenia

353.79, SD 345.0; P < 0.01). Time series analyses followed by Chow tests failed to confirm that these cost changes could be attributed specifically to the introduction of an early intervention service. Conclusion: Introduction of a specialized early intervention program may be beneficial to patients and to the health care system. To evaluate the cost–benefit ratio of early intervention services, longer term and more detailed data may be required.

A qualitative analysis of influences on recovery following a first episode of psychosis

OBJECTIVEnThere is little understanding of service users conceptions of recovery in the early phase of psychotic disorders. An enhanced understanding of personal notions of recovery may help with the development and evaluation of interventions that address the concerns of service users. This study examined personal definitions of recovery among individuals recently treated in a specialized early-intervention service in Canada.nnnMETHODSnSemistructured interviews were carried out with 30 individuals three to five years after initial treatment of a first episode of psychosis. Interpretative phenomenological analysis was used to examine participants personal meanings of recovery. A typology of recovery definitions was constructed.nnnRESULTSnA majority of individuals considered themselves to be recovered. Responses indicated that recovery is a multidimensional experience and is often a personalized and achievable goal at this early stage in treatment. Individuals described recovery as improvement in one or more of three domains: illness recovery, psychological and personal recovery, and social and functional recovery. There was variation in the extent to which individuals perceived that recovery involved alleviation of symptoms and elimination of underlying vulnerability to illness.nnnCONCLUSIONSnThere were several components of the personal meanings of recovery from a first episode of psychosis and variations in the emphasis that individuals placed on each component. An overall positive outlook may be a function of younger age, shorter duration of illness, and receipt of client-centered comprehensive and phase-specific treatment. Improved understanding of personal notions of recovery can guide clinical practices to address service users recovery goals.

Status of first-episode psychosis patients presenting for routine care in a defined catchment area.

Although duration of untreated psychosis (DUP) predicts treatment outcome as assessed by symptoms in first-episode psychosis, there is much less evidence concerning its relation to social functioning. We present the results of a prospective study of 163 first-episode psychosis patients examining occupational activity at three years, after initiation of treatment. Both shorter DUP and higher social support were significantly associated with more full time occupational activity at follow-up. The findings suggest the importance of reducing treatment delay and increasing social support in order to improve occupational outcomes for those with first-episode psychosis.

Social support and functional outcomes in an early intervention program

Objective: The aim of this study was to determine 1-year symptomatic outcome and its predictors in patients with first-episode psychosis (FEP) treated at 3 different publicly funded sites. Method: We evaluated FEP patients (n = 172) treated in specialized programs in 2 medium-sized centres and 1 large urban centre with an identical protocol for demographic variables, diagnosis, and duration of untreated psychosis (DUP) at entry, and positive, negative, and general psychopathology symptoms at entry, 6 months, and 1 year. We used a mixed model analysis of variance, with time and centre and interaction between time and centre as fixed effects and sex and DUP as covariates, to analyze data. Results: A significant effect of time and time x centre interaction on positive, negative, and general symptom outcome was shown after controlling for ethnicity, education, and diagnosis. Patients showed significantly better outcome on all dimensions of symptoms in the 2 medium-sized centres, compared with the 1 large urban centre. Sex had a significant effect on negative and general symptoms, while DUP had no effect on any outcome measure. Conclusions: Similarly enriched early intervention services may produce different outcomes, even within a relatively homogeneous mental health system.

Correlates of subjective recovery in an early intervention program for psychoses

Background: Although there is evidence of greater stigmatization of schizophrenia in comparison to depression, there has been little investigation of the reasons for this difference. Aims: To examine the role of beliefs about depression and schizophrenia in mediating the difference in preferred social distance towards individuals with these two disorders. Methods: In Study I, 200 undergraduates completed questionnaires concerning beliefs about depression or schizophrenia and willingness to interact with an individual who has one of the two disorders. In Study II, 103 members of a community service club completed similar measures. Results: For both samples, beliefs about likely appropriateness of social behaviour showed evidence of mediating differences in preferred level of social distance. In addition, differences in perceived danger may have been a mediator for the undergraduate sample and perceived prognosis for the service club respondents. Conclusions: Beliefs about social appropriateness, danger and prognosis, which have implications for likely costs and benefits of interaction, are more likely to mediate differences in social distance towards the disorders than beliefs concerning causation or continuity with normal experience.

Subjective experiences of illness recovery in individuals treated for first-episode psychosis

Background: Understanding perceived influences on recovery following a first episode of psychosis could help improve services. Material: Thematic analysis was used to examine important influences on early recovery identified by 30 individuals receiving services in an early intervention programme. Discussion: Social support, medication, meaningful activities and lifestyle modification were identified as helpful, and stigma, substance abuse and medication side effects as harmful. Perceptions of benefits of social support and the negative effects of stigma were particularly prominent. Conclusions: Results suggest the importance of assistance with engagement in valued activities and relationships, and provision of messages of worth and hope for recovery.