1
|
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] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Schlief M, Rich N, Rains LS, Baldwin H, Rojas-Garcia A, Nyikavaranda P, Persaud K, Dare C, French P, Lloyd-Evans B, Crawford M, Smith J, Kirkbride JB, Johnson S. Ethnic differences in receipt of psychological interventions in Early Intervention in Psychosis services in England - a cross-sectional study. Psychiatry Res 2023; 330:115529. [PMID: 37926056 DOI: 10.1016/j.psychres.2023.115529] [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] [Received: 05/03/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
There is some evidence of differences in psychosis care provision by ethnicity. We investigated variations in the receipt of Cognitive Behavioural Therapy for psychosis (CBTp) and family intervention across ethnic groups in Early Intervention in Psychosis (EIP) teams throughout England, where national policy mandates offering these interventions to all. We included data on 29,610 service users from the National Clinical Audit of Psychosis (NCAP), collected between 2018 and 2021. We conducted mixed effects logistic regression analyses to examine odds ratios of receiving an intervention (CBTp, family intervention, either intervention) across 17 ethnic groups while accounting for the effect of years and variance between teams and adjusting for individual- (age, gender, occupational status) and team-level covariates (care-coordinator caseload, inequalities strategies). Compared with White British people, every minoritized ethnic group, except those of mixed Asian-White and mixed Black African-White ethnicities, had significantly lower adjusted odds of receiving CBTp. People of Black African, Black Caribbean, non-African/Caribbean Black, non-British/Irish White, and of "any other" ethnicity also experienced significantly lower adjusted odds of receiving family intervention. Pervasive inequalities in receiving CBTp for first episode psychosis exist for almost all minoritized ethnic groups, and family intervention for many groups. Investigating how these inequalities arise should be a research priority.
Collapse
Affiliation(s)
- Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Nathalie Rich
- PsyLife Research Group, Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Antonio Rojas-Garcia
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK; Department of Psychiatry, University of Granada, Granada, Spain
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK; Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Karen Persaud
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Ceri Dare
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Paul French
- National Clinical Audit of Psychosis (NCAP), Royal College of Psychiatrists, London, UK; Manchester Metropolitan University, Manchester, UK; Pennine Care NHS Foundation Trust, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Mike Crawford
- Division of Psychiatry, Imperial College London, London, UK
| | - Jo Smith
- National Clinical Audit of Psychosis (NCAP), Royal College of Psychiatrists, London, UK; School of Allied Health and Social Care, University of Worcester, Worcester, UK
| | - James B Kirkbride
- PsyLife Research Group, Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, UK
| |
Collapse
|
4
|
Taylor KM, Orucu E, Nandha S, Cella M. Psychosis Early Intervention Across the Life Span: A Service Perspective. Community Ment Health J 2023; 59:266-274. [PMID: 35922655 PMCID: PMC9859847 DOI: 10.1007/s10597-022-01004-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/26/2022] [Indexed: 01/25/2023]
Abstract
Previously youth-orientated, UK early intervention in psychosis (EI) services expanded care in 2016 to adults of any age. To compare EI care offering, clinical characteristics, and potential benefits for under-35s and over-35s, an observational study considering anonymised data for users of London-based EI services between April 2016 and December 2019 was conducted. Descriptive statistics and between groups comparisons are reported. The analysis considered 692 service users (32.5% over-35). Over-35s were more likely to be female, of poorer physical health, with severer problems at intake (Health of the Nation Outcome Scale, HoNOS). Under-35s had poorer appointment attendance, required increased use of inpatient facilities, and demonstrated greater risks to themselves and others. At discharge, HoNOS ratings indicated improvements for both groups. Over-35s constitute a considerable proportion of EI service-users, their care may involve less crisis management, more recovery-oriented intervention and physical health needs consideration. Care offering should reflect these needs.
Collapse
Affiliation(s)
- Kathryn M Taylor
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ela Orucu
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sunil Nandha
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Thakrar V, Bardhan M, Chakraborty N. Early intervention in psychosis: An analysis of the characteristics and service needs of patients over the age of 35. Early Interv Psychiatry 2023; 17:177-182. [PMID: 35739609 DOI: 10.1111/eip.13318] [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] [Received: 12/23/2021] [Revised: 05/04/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
AIM In 2016 NICE updated its guidance, extending the age to which early intervention in psychosis (EIP) services treat patients following their first episode of psychosis, to 65 years, from the previous cut-off of 35 years. The aim of this service evaluation was to identify differences in the demographic details, diagnoses, and treatments between patients below and above 35 years to identify any unmet needs in the latter age category. METHODS A total of 100 patients from the caseload were randomly selected, with 50 from each age group, to analyse in further detail. Descriptive statistics was predominantly used due to the relatively small sample size. RESULTS The over 35 s were predominantly female (62%), whilst the under 35 s were predominantly male (66%). There was a statistically significantly higher rate of substance misuse in the under 35 s. Whilst schizophrenia was the most common diagnosis in both groups, higher rates of delusional disorders and psychosis NOS were observed in the over 35 s. In both age groups, a median of two different medications was used per patient. However, amongst the over 35 s there is less use of psychological therapy and of support, time and recovery workers (STR workers). CONCLUSION There are distinct differences between the two age groups including demographic and diagnostic features. Being historically youth based, EIP services needs to ensure that treatments offered are tailored to meet the need of the older age demographic who have different needs.
Collapse
Affiliation(s)
- Vedas Thakrar
- Psychosis Intervention & Early Recovery (PIER) Team, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Acute Medicine, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Mainak Bardhan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Nandini Chakraborty
- Psychosis Intervention & Early Recovery (PIER) Team, Leicestershire Partnership NHS Trust, Leicester, UK
| |
Collapse
|
6
|
Mwesiga EK, Nakasujja N, Nakku J, Nanyonga A, Gumikiriza JL, Bangirana P, Akena D, Musisi S. One year prevalence of psychotic disorders among first treatment contact patients at the National Psychiatric Referral and Teaching Hospital in Uganda. PLoS One 2020; 15:e0218843. [PMID: 31995567 PMCID: PMC6988969 DOI: 10.1371/journal.pone.0218843] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Hospital based studies for psychotic disorders are scarce in low and middle income countries. This may impact on development of intervention programs. Objective We aimed to determine the burden of psychotic disorders among first treatment contact patients at the national psychiatric referral hospital in Uganda. Methods A retrospective patient chart-file review was carried out in March 2019 for all patients presenting to the hospital for the first time in the previous year. Patients were categorised into those with and without psychotic disorders. We collected sociodemographic data on age, gender, occupation, level of education, ethnicity, religion and home district. We determined the one year prevalence of psychotic disorders among first treatment contact patients. Using logistic regression models, we also determined the association between psychotic disorders and various exposure variables among first treatment contact patients. Results In 2018, 63% (95% CI: 60.2–65.1) of all first time contact patients had a psychosis related diagnosis. Among the patients with psychotic disorders, the median age was 29 years (IQR 24–36). Most of the patients were male (62.8%) and unemployed (63.1%). After adjusting for patients’ residence, psychotic disorders were found to be more prevalent among the female gender [OR 1.58 (CI1.46–1.72)] and those of Pentecostal faith [OR 1.25 (CI 1.10–1.42)]. Conclusion Among first treatment contact patients in Uganda, there is a large burden of psychotic disorders. The burden was more prevalent among females as well as people of Pentecostal faith who seemed to use their church for faith-based healing. Incidence studies are warranted to determine if this phenomenon is replicated at illness onset.
Collapse
Affiliation(s)
- Emmanuel Kiiza Mwesiga
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Juliet Nakku
- National Psychiatric Teaching and Referral Hospital of Uganda, Kampala, Uganda
| | - Annet Nanyonga
- National Psychiatric Teaching and Referral Hospital of Uganda, Kampala, Uganda
| | - Joy Louise Gumikiriza
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Paul Bangirana
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Dickens Akena
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| |
Collapse
|