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Ferrara M, Domenicano I, Marchi A, Zaffarami G, Onofrio A, Benini L, Sorio C, Gentili E, Murri MB, Toffanin T, Little J, Grassi L. First episode psychoses in people over-35 years old: uncovering potential actionable targets for early intervention services. Psychiatry Res 2024; 339:116034. [PMID: 38906051 DOI: 10.1016/j.psychres.2024.116034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/25/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
The traditional youth-oriented design of Early Intervention Services (EIS) may lead to the exclusion of patients who have their psychotic onset later in life. A retrospective study was conducted to compare first-episode psychosis (FEP) patients who accessed treatment when aged ≤ 35 years with those ≥36+. A total of 854 patients were identified among 46,222 individuals who had access to community psychiatric services from 1991 to 2021. FEP were aged 18-65, received care between 2012 and 2021 and had a diagnosis of affective or non-affective FEP. Two groups were identified (FEP diagnosed at age ≤ 35 vs ≥ 36) and compared for sociodemographic and clinical characteristics. Most patients were diagnosed when aged ≥ 36+ (61.8%). Compared to the ≤ 35 group, older patients were more likely to be women, married and diagnosed with affective psychosis, and they were less frequently hospitalized. Long-acting injectables antipsychotics (LAI) were less frequently prescribed in the ≥ 36+ group, whereas antidepressants were more frequently prescribed compared to those aged ≤ 35. In both age groups, women were less frequently prescribed LAIs compared to men. These findings highlight the need to reorient EIS to accommodate the needs of older FEP, especially women.
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Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Department of Psychiatry, Yale School of Medicine, New Haven CT, USA; Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy.
| | - Ilaria Domenicano
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Aurora Marchi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giulia Zaffarami
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Alice Onofrio
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Lorenzo Benini
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Cristina Sorio
- Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | | | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
| | - Julian Little
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Department of Mental Health and Pathological Addiction, Local Health Trust (AUSL) Ferrara, Ferrara, Italy
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Fayyaz S, Nkire N, Nwosu B, Amjad N, Kinsella A, Gill M, McDonough C, Russell V, Waddington JL. Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan-Monaghan early intervention service. Ir J Psychol Med 2024; 41:23-36. [PMID: 34353408 DOI: 10.1017/ipm.2021.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan-Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. METHODS COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. RESULTS During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. CONCLUSIONS COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.
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Affiliation(s)
- S Fayyaz
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - N Nkire
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Nwosu
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - N Amjad
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - A Kinsella
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Gill
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - C McDonough
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Louth Mental Health Service, St. Brigid's Hospital, Ardee, Ireland
| | - V Russell
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - J L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions. BMC Psychiatry 2024; 24:96. [PMID: 38317157 PMCID: PMC10840293 DOI: 10.1186/s12888-024-05577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. METHODS A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. RESULTS There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. CONCLUSIONS This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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Connolly P, Carey C, Staunton J, Harney B, Chambers L, Clarke AM, McLaughlin P, Kerins K, Kearney K, Whitty P. Service evaluation of an embedded Early Intervention in Psychosis programme. Ir J Psychol Med 2024:1-5. [PMID: 38305032 DOI: 10.1017/ipm.2023.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND An average of 1300 adults develop First Episode Psychosis (FEP) in Ireland each year. Early Intervention in Psychosis (EIP) is now widely accepted as best practice in the treatment of conditions such as schizophrenia. A local EIP programme was established in the Dublin South Central Mental Health Service in 2012. METHODS This is a cross-sectional study of service users presenting to the Dublin South Central Mental Health Service with FEP from 2016 to 2022 following the introduction of the EIP programme. We compared this to a previously published retrospective study of treatment as usual from 2002 to 2012. RESULTS Most service users in this study were male, single, unemployed and living with their partner or spouse across both time periods. Cognitive Behavioural Therapy for psychosis was provided to 12% (n = 8) of service users pre-EIP as compared to 52% (n = 30) post-programme introduction (p < 0.001), and 3% (n = 2) of service users engaged with behavioural family therapy pre-EIP as opposed to 15% (n = 9) after (p < 0.01). Rates of composite baseline physical healthcare monitoring improved significantly (p < 0.001). CONCLUSION Exclusive allocation of multidisciplinary team staff to EIP leads to improved compliance with recommended guidelines, particularly CBT-p, formal family therapy and physical health monitoring.
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Affiliation(s)
- Paula Connolly
- Department of Psychiatry, Tallaght Hospital, Dublin, Ireland
| | - Cornelia Carey
- Department of Psychiatry, Tallaght Hospital, Dublin, Ireland
| | - John Staunton
- Ballyfermot Community Mental Health Team, Dublin, Ireland
| | - Bridget Harney
- Ballyfermot Community Mental Health Team, Dublin, Ireland
| | - Liah Chambers
- Department of Psychiatry, Tallaght Hospital, Dublin, Ireland
| | - Ana-Maria Clarke
- Naas General Hospital, Kildare and West Wicklow Mental Health Service, Naas, Ireland
| | | | - Kathy Kerins
- Child & Adolescent Mental Health Services, Dublin, Ireland
| | - Katrina Kearney
- Galway Roscommon Mental Health Services, Merlin Park Hospital, Galway, Ireland
| | - Peter Whitty
- Department of Psychiatry, Tallaght Hospital, Dublin, Ireland
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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Barriers and facilitators to the implementation of an early intervention in psychosis service in three demonstration sites in Ireland. BMC Health Serv Res 2023; 23:653. [PMID: 37337176 DOI: 10.1186/s12913-023-09585-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Programmes for early intervention (EIP) in psychosis for people experiencing a first episode of psychosis (FEP) have been found to be both clinically and cost effective. Following the publication of a new EIP model of care (MoC) in Ireland, the aim of this research is to describe how people participated in and responded to the MoC including service users, family members, HSE clinical staff and HSE management. METHODS Qualitative design using the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were used. A total of N = 40 key informant semi-structured interviews were completed which included clinical staff (N = 22), health service managers and administrators (N = 9), service users (N = 8) and a family member (N = 1). Thematic analyses were conducted. RESULTS Unique features of the EIP service (e.g., speed of referral/assessment, multidisciplinary approach, a range of evidence-based interventions and assertive MDT follow up) and enthusiasm for EIP were identified as two key factors that facilitated implementation. In contrast, obstacles to staff recruitment and budget challenges emerged as two primary barriers to implementation. CONCLUSIONS The findings from this research provide real world insights into the complexity of implementing an innovative service within an existing health system. Clear and committed financial and human resource processes which allow new innovations to thrive and be protected during their initiation and early implementation phase are paramount. These elements should be considered in the planning and implementation of EIP services both nationally in Ireland and internationally.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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Broughan J, McCombe G, Lim J, O'Keeffe D, Brown K, Clarke M, Corcoran C, Hanlon D, Kelly N, Lyne J, McGorry P, O' Brien S, O' Connor K, O' Mahony K, Scott S, Wycherley E, Cullen W. Keyworker mediated enhancement of physical health in patients with first episode psychosis: A feasibility/acceptability study. Early Interv Psychiatry 2022; 16:883-890. [PMID: 34716662 DOI: 10.1111/eip.13234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/08/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
AIM Early intervention for people experiencing first episode psychosis is a priority, and keyworkers are vital to such services. However, keyworkers' roles in addressing first episode psychosis patients' physical health are under researched. This study addresses this knowledge gap by evaluating a keyworker-mediated intervention promoting physical health among first episode psychosis patients. METHODS The study was informed by the Medical Research Council's Framework for Complex Interventions to Improve Health. First episode psychosis participants were recruited from three Irish mental health services. The intervention was evaluated in terms of its feasibility/acceptability. RESULTS Feasibility outcomes were mixed (recruitment rate = 24/68 [35.3%]; retention rate = 18/24 [75%]). The baseline sample was predominantly male (M:F ratio = 13:6; Med age = 25 y; IQR = 23-42 y). Common health issues among participants included overweightness/obesity (n = 11) and substance use (smoking/alcohol consumption [n = 19]). Participants' initial health priorities included exercising more (n = 10), improving diet (n = 6), weight loss (n = 7) and using various health/healthcare services. The intervention's acceptability was evidenced by the appreciation participants had for physical health keyworkers' support, as well as the healthy lifestyle, which the intervention promoted. Acceptability was somewhat compromised by a low-recruitment rate, variable linkages between keyworkers and general practitioners (GPs) and COVID-19 restrictions. CONCLUSIONS Physical health-oriented keyworker interventions for first episode psychosis patients show promise and further evaluation of such initiatives is warranted. Future interventions should be mindful of participant recruitment challenges, strategies to enhance relationships between keyworkers and GPs, and if necessary, they should mitigate COVID-19 restrictions' impacts on care.
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Affiliation(s)
- John Broughan
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
| | - Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
| | - Jayleigh Lim
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
| | - Donal O'Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin, Leinster, Ireland
| | | | - Mary Clarke
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland.,DETECT Early Intervention in Psychosis Service, Dublin, Leinster, Ireland
| | - Ciarán Corcoran
- Longford Westmeath Mental Health Service, Health Service Executive, Dublin, Leinster, Ireland
| | - David Hanlon
- Health Service Executive, Dublin, Leinster, Ireland
| | - Ned Kelly
- Health Service Executive, Dublin, Leinster, Ireland
| | - John Lyne
- Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland.,Wicklow Mental Health Services, Wicklow, Leinster, Ireland
| | - Patrick McGorry
- Center for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen Youth Health, Parkville, VIC, Australia
| | | | - Karen O' Connor
- Cork University Hospital, Health Services Executive, Cork, Munster, Ireland
| | - Karen O' Mahony
- Cork Kerry Mental Health Services, Health Service Executive South, Munster, Ireland
| | - Seamus Scott
- Longford Westmeath Mental Health Service, Health Service Executive, Dublin, Leinster, Ireland
| | - Elizabeth Wycherley
- Cork Kerry Mental Health Services, Health Service Executive South, Munster, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
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Llanes-Álvarez C, Alberola-López C, Andrés-de-Llano JM, Álvarez-Navares AI, Pastor-Hidalgo MT, Roncero C, Garmendia-Leiza JR, Franco-Martín MA. Hospitalization trends and chronobiology for mental disorders in Spain from 2005 to 2015. Chronobiol Int 2020; 38:286-295. [PMID: 32869668 DOI: 10.1080/07420528.2020.1811719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rhythm research has had a long tradition in psychiatry, especially in affective disorders. The study of trends in incidence plays a central role in epidemiology and public health. The aims of this research were to describe the socio-demographic and clinical characteristics of persons admitted for psychiatric hospitalization and their trends and periodicity in cases (global and by groups) in Spain over the 11 year study span. We conducted a cross-sectional study of the hospital discharge database of Castilla y León from 2005 to 2015, selecting hospitalizations for psychiatric reasons. Trends in the rates of hospitalization were studied by joinpoint regression analysis. Time series analysis for periodicities was done by spectral analysis, fast Fourier transform, and cosinor analysis. Some 49501 hospitalizations due to psychiatric disorders, out of 2717192 hospital admissions, took place during the study span. Hospitalizations for psychosis were frequent (15949, 32.2%), while such for eating disorders were infrequent, but showed the highest average stay (28 days) and DRG relative weight (2.41). The general trend was a statistically significant 2% annual increase in psychiatric hospitalizations over the 11 year span; substance abuse was the only exception to this trend. The whole population and the subgroups of psychosis and bipolar disorders showed significant circannual (one-year) variation in admissions. The rhythm percentage of the global group was 11.4%, while the rhythm percentages of the psychosis, bipolar, and eating disorders were 17.1%, 17.5%, and 9.6%, respectively (p < .05).
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Affiliation(s)
| | - Carlos Alberola-López
- Image Processing Laboratory, ETSI Telecommunication, University of Valladolid , Valladolid, Spain
| | | | - Ana I Álvarez-Navares
- Department of Psychiatry, Salamanca University Health Care Complex , Salamanca, Spain
| | | | - Carlos Roncero
- Department of Psychiatry, Salamanca University Health Care Complex , Salamanca, Spain
| | - José R Garmendia-Leiza
- General Direction of Information Systems, Quality and Pharmaceutical Provision at Castilla y León Health Authority, Regional Health Management , Valladolid, Spain
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Abstract
In the last three decades, early intervention for psychosis (EIP) services have been established worldwide and have resulted in superior symptomatic and functional outcomes for people affected by psychotic disorders. These improved outcomes are a result of reducing delays to treatment and the provision of specialised, holistic interventions. The COVID-19 pandemic poses significant challenges to the delivery of these services, such as undetected cases or long delays to treatment. Furthermore, the COVID-19 pandemic will likely increase the mental health needs of communities, including the incidence of psychotic disorders. In this perspective piece, we provide suggestions as to how EIP services can adapt within this environment, such as utilising novel technologies. Finally, we argue that despite the economic consequences of the pandemic, the funding for mental health services, including EI services, should be increased in line with the need for these services during and beyond the pandemic.
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