scholarly journals Prevalence of treatment resistance and clozapine use in early intervention services

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Imogen Stokes ◽  
Siân Lowri Griffiths ◽  
Rowena Jones ◽  
Linda Everard ◽  
Peter B. Jones ◽  
...  
Keyword(s):  
Early Intervention ◽  
Treatment Resistance ◽  
Prescribing Patterns ◽  
Positive Symptoms ◽  
Treatment Resistant ◽  
Medication History ◽  
Early Intervention Services ◽  
Intervention Services ◽  
Definition Of ◽  
Early Intervention In Psychosis

Background Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics. Aims This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services. Method Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points. Results A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine. Conclusions Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.

scholarly journals Early intervention in psychosis: strengths and limitations of services

2011 ◽  
Vol 17 (6) ◽  
pp. 401-407 ◽  
Author(s):  
Brendan P. Murphy ◽  
Warrick J. Brewer
Keyword(s):  
Early Intervention ◽  
Treatment Resistance ◽  
Duration Of Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Early Intervention Services ◽  
Iatrogenic Damage ◽  
Intervention Services ◽  
Multicomponent Interventions ◽  
Early Intervention In Psychosis

SummaryEarly intervention services were established on the basis of a number of fundamental principles, including the notions that intervening in the early stages of psychosis alters illness trajectory and prognosis, that multicomponent interventions promote psychosocial recovery and reduce iatrogenic damage, and that early targeting of non-responders reduces treatment resistance. There is growing evidence of the benefits of specialised early intervention services. These include improved clinical, social and vocational outcomes, reduced in-patient stays and better engagement. Early intervention services can also significantly reduce the risk of a second episode and are highly valued by service users and carers. Duration of treatment appears to determine long-term outcome and there remains uncertainty about how long such intensive intervention should last and whether all patients need the same length of care. Budgetary constraints are pervasive and are particularly likely to affect prodrome clinics and community awareness programmes.

scholarly journals Early intervention in psychosis: obstacles and opportunities

2005 ◽  
Vol 11 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Swaran P. Singh ◽  
Helen L. Fisher
Keyword(s):  
Early Intervention ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Early Intervention Services ◽  
Department Of Health ◽  
Short And Long Term ◽  
Intervention Services ◽  
The Uk ◽  
Early Intervention In Psychosis

By focusing therapeutic effort on the early stages of psychotic disorders, effective early intervention should improve short- and long-term outcomes. Strategies include pre-psychotic and prodromal interventions to prevent emergence of psychosis, detecting untreated cases in the community and facilitating recovery in established cases of psychosis. The evidence base for each of these strategies is currently limited, although several international trials are under way. The Department of Health in the UK has announced the intention of setting up 50 early intervention services nationally, several of which are already operational. In this article, we briefly discuss the differing ways in which early intervention is conceptualised, summarise the evidence supporting it in established cases of psychosis, suggest appropriate service models and describe two early intervention services in south-west London.

Early intervention in psychosis: service models worldwide and the Irish experience

2010 ◽  
Vol 27 (4) ◽  
pp. 210-214 ◽  
Author(s):  
Sami Omer ◽  
Caragh Behan ◽  
John L Waddington ◽  
Eadbhard O'Callaghan
Keyword(s):  
Early Intervention ◽  
Secondary Prevention ◽  
Current Evidence ◽  
Early Intervention Service ◽  
Primary And Secondary Prevention ◽  
Early Intervention Services ◽  
Intervention Service ◽  
Service Models ◽  
Intervention Services ◽  
Early Intervention In Psychosis

AbstractThis paper examines the concept of early intervention in psychosis at primary and secondary prevention levels. Examples of early intervention service models from different countries are presented and we discuss current evidence for efficacy. We highlight the Irish experience of early intervention to date, and discuss future implementation of early intervention services in Ireland.

scholarly journals Psychosis incidence through the prism of early intervention services

2012 ◽  
Vol 200 (2) ◽  
pp. 156-157 ◽  
Author(s):  
J. B. Kirkbride ◽  
C. Stubbins ◽  
P. B. Jones
Keyword(s):  
Early Intervention ◽  
Rural Communities ◽  
Social Epidemiology ◽  
First Episode ◽  
Asian Origin ◽  
East Anglia ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Intervention Services ◽  
Early Intervention In Psychosis

SummaryWe know little about first-episode psychosis epidemiology beyond cities or when measured through early intervention in psychosis services. We present results from 18 months of the 3-year Social Epidemiology of Psychoses in East Anglia (SEPEA) study of incepted incidence observed through five early intervention services. We identified 378 eligible individuals (incidence: 45.1/100 000 person-years, 95% CI 40.8–49.9). Rates varied across these services, but were 2–3 times higher than those on which services were commissioned. Risk decreased with age, was nearly doubled among men and differed by ethnic group; doubled in people of mixed ethnicity but lower for those of Asian origin, compared with White British people. Psychosis risk among ethnic minorities was lower than reported in urban settings, which has potential implications for aetiology. Our data suggest considerable psychosis morbidity in diverse, rural communities.

scholarly journals Invited commentary on … Ethnic variations in pathways into early intervention services for psychosis

2013 ◽  
Vol 202 (4) ◽  
pp. 284-285 ◽  
Author(s):  
Richard Warner
Keyword(s):  
Early Intervention ◽  
Duration Of Untreated Psychosis ◽  
Early Intervention Services ◽  
Poor Outcome ◽  
Long Duration ◽  
Intervention Services ◽  
Ethnic Variations ◽  
Early Intervention In Psychosis

SummaryAdvocates of early intervention in psychosis choose to treat the association between long duration of untreated psychosis (DUP) and poor outcome as evidence that reducing DUP will improve outcomes. I question this view and argue that DUP does not predict outcome but rather that mode of onset of psychosis predicts DUP and outcome.

scholarly journals Early intervention in psychosis: a map of clinical and research initiatives in Latin America

2011 ◽  
Vol 33 (suppl 2) ◽  
pp. s213-s224 ◽  
Author(s):  
Elisa Brietzke ◽  
Ary Gadelha Araripe Neto ◽  
Álvaro Dias ◽  
Rodrigo Barbachan Mansur ◽  
Rodrigo Affonseca Bressan
Keyword(s):  
Early Intervention ◽  
Latin American ◽  
Urban Areas ◽  
Community Based ◽  
Early Intervention Services ◽  
The Public ◽  
Tertiary Hospitals ◽  
Intervention Services ◽  
Research Initiatives ◽  
Early Intervention In Psychosis

OBJECTIVE: This article aims to review Latin America's early intervention services in psychosis and to shed light into their challenges and particularities. METHOD: An internet-based search comprising medical societies' websites, published articles, and major universities' websites was conducted and the results were critically discussed. RESULTS: Latin American countries are profoundly deficient in specialized early intervention services. Our search found seven target services, four of which are based in urban areas of Brazil, inside tertiary hospitals or universities. Among the initiatives advanced by these centers, there are partnerships with the public educational system and other community-based efforts toward knowledge transfer. On the other hand, several challenges remain to be overcome, especially in relation to their expansion, which is necessary to match the existing demand.

scholarly journals Early intervention in psychosis: Still the ‘best buy’?

2015 ◽  
Vol 207 (4) ◽  
pp. 288-292 ◽  
Author(s):  
David J. Castle ◽  
Swaran P. Singh
Keyword(s):  
Early Intervention ◽  
Integrated Approach ◽  
High Quality ◽  
Early Intervention Services ◽  
Intervention Services ◽  
Early Intervention In Psychosis

SummaryHigh-quality services for people with psychosis are essential. However, in this debate David Castle questions whether separate early intervention services are the best option and argues instead for an integrated approach. Swaran Singh responds, robustly defending the value of early intervention services.

Early Intervention in Psychosis: An Overdue Reform

2003 ◽  
Vol 37 (4) ◽  
pp. 393-398 ◽  
Author(s):  
Patrick D. McGorry ◽  
Alison R. Yung
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Young People ◽  
Psychotic Disorders ◽  
Public Mental Health ◽  
Psychotic Episode ◽  
Public Health Burden ◽  
Early Intervention Services ◽  
Intervention Services ◽  
Early Intervention In Psychosis

Objective: To discuss the rationale for early intervention in psychotic disorders and to explore why the widespread implementation of early intervention services has stalled. Method: Four central questions are explored regarding early intervention in psychosis: (i) what is the rationale for early intervention services in psychosis and is it justified? (ii) what are the obstacles to the implementation of early intervention services throughout Australia? (iii) how could some of these obstacles be overcome? and (iv) what else needs to occur? Results: Early intervention in psychosis aims to improve recognition and access, promote recovery from the initial psychotic episode, minimize secondary morbidity and reduce collateral damage. It may also prevent some brain dysfunction and damage, which may otherwise occur later in the illness. Despite the now growing body of evidence supporting the idea of early intervention, obstacles remain to its widespread adoption in policy and implementation, principally related to chronic under-funding of the public mental health system. Among the solutions proposed is the need to develop services with a youth focus, able to cater for young people with both psychotic and non-psychotic psychiatric disorders. These services should be well integrated with primary care and other youth orientated agencies. Conclusions: We are hopeful that strong investment in early intervention and better services for young people will be among the highest priorities of the Third National Mental Health Plan. This is not only where the greatest public health burden lies, but also where costeffectiveness of intervention is likely to be maximal.

Bottom Line: Who Pays the Bill for Early Intervention Services?

ASHA Leader ◽  
2013 ◽  
Vol 18 (2) ◽  
pp. 26-27
Author(s):  
Janet McCarty ◽  
Laurie Havens
Keyword(s):  
Early Intervention ◽  
Private Insurance ◽  
Infants And Toddlers ◽  
Bottom Line ◽  
Early Intervention Services ◽  
Intervention Services

Medicaid, federal education funds and private insurance all cover the costs of speech-language and hearing services for infants and toddlers. Learn who pays for what.

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