In the Journals

Early psychosis intervention lowers mortality risk

Kelly K. Anderson, PhD
Kelly K. Anderson
 

Study findings showed that individuals with first-episode psychosis who used early psychosis intervention services had significantly lower rates of all-cause mortality, faster access to psychiatric services and less ED use compared with those who did not use these services.

“We have robust evidence from a number of large randomized trials that show that early psychosis intervention programs are effective,” Kelly K. Anderson, PhD, of the department of psychiatry, University of Western Ontario, Canada, told Healio Psychiatry. “However, findings from randomized trials don’t always translate into the real world due to factors such as the stringency of the inclusion criteria or fidelity to the early intervention model.”

The researchers compared indicators of health service use, self-harm, suicide and mortality between people with first-episode psychosis who used early psychosis intervention services and a propensity score-matched group of controls who were not accessing these services. The Prevention and Early Intervention Program for Psychoses in London, Ontario, offers team-based specialty care for people with early-stage psychosis that focuses on early detection, an open-referral policy, rapid assessment, a flexible therapy plan, education and an aggressive case-management approach.

The results showed that individuals with first-episode psychosis who used early psychosis intervention services had mortality rates four times lower than those who did not use these services. In the 2-year period after program admission, people who used intervention services showed substantially lower rates of all-cause mortality (HR = 0.24; 95% CI, 0.11-0.53). Researchers also observed lower rates of ED visits (HR = 0.71; 95% CI, 0.6-0.83), but after 2 years, when the psychosis intervention care typically moves to medical management, these benefits waned.

There was no significant difference in self-harm (HR = 0.86; 95% CI, 0.18-4.24) or suicide (HR = 0.73; 95% CI, 0.29-1.8) seen between the people with psychosis who received intervention services and those who did not. Furthermore, early psychosis intervention users had higher rates of hospitalization (HR = 1.42; 95% CI, 1.18–1.71).

“Our study demonstrates the effectiveness of these services in the real world when they are implemented as part of a broader health system,” Anderson told Healio Psychiatry. “The take-home message for clinicians is that these programs can have a huge impact on patient outcomes — our data suggest that we need to treat 40 people in one of these programs to prevent one death. Our data also suggest that not all people with early psychosis are using these services — clinicians should help facilitate access to these programs for people with the signs of first-episode psychosis to ensure that everyone has the opportunity to benefit from early intervention.” – by Savannah Demko

Disclosures: Anderson reports no relevant financial disclosures.

Kelly K. Anderson, PhD
Kelly K. Anderson
 

Study findings showed that individuals with first-episode psychosis who used early psychosis intervention services had significantly lower rates of all-cause mortality, faster access to psychiatric services and less ED use compared with those who did not use these services.

“We have robust evidence from a number of large randomized trials that show that early psychosis intervention programs are effective,” Kelly K. Anderson, PhD, of the department of psychiatry, University of Western Ontario, Canada, told Healio Psychiatry. “However, findings from randomized trials don’t always translate into the real world due to factors such as the stringency of the inclusion criteria or fidelity to the early intervention model.”

The researchers compared indicators of health service use, self-harm, suicide and mortality between people with first-episode psychosis who used early psychosis intervention services and a propensity score-matched group of controls who were not accessing these services. The Prevention and Early Intervention Program for Psychoses in London, Ontario, offers team-based specialty care for people with early-stage psychosis that focuses on early detection, an open-referral policy, rapid assessment, a flexible therapy plan, education and an aggressive case-management approach.

The results showed that individuals with first-episode psychosis who used early psychosis intervention services had mortality rates four times lower than those who did not use these services. In the 2-year period after program admission, people who used intervention services showed substantially lower rates of all-cause mortality (HR = 0.24; 95% CI, 0.11-0.53). Researchers also observed lower rates of ED visits (HR = 0.71; 95% CI, 0.6-0.83), but after 2 years, when the psychosis intervention care typically moves to medical management, these benefits waned.

There was no significant difference in self-harm (HR = 0.86; 95% CI, 0.18-4.24) or suicide (HR = 0.73; 95% CI, 0.29-1.8) seen between the people with psychosis who received intervention services and those who did not. Furthermore, early psychosis intervention users had higher rates of hospitalization (HR = 1.42; 95% CI, 1.18–1.71).

“Our study demonstrates the effectiveness of these services in the real world when they are implemented as part of a broader health system,” Anderson told Healio Psychiatry. “The take-home message for clinicians is that these programs can have a huge impact on patient outcomes — our data suggest that we need to treat 40 people in one of these programs to prevent one death. Our data also suggest that not all people with early psychosis are using these services — clinicians should help facilitate access to these programs for people with the signs of first-episode psychosis to ensure that everyone has the opportunity to benefit from early intervention.” – by Savannah Demko

Disclosures: Anderson reports no relevant financial disclosures.