scholarly journals Audit of early intervention in psychosis service development in England in 2005

2007 ◽  
Vol 31 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Vanessa Pinfold ◽  
Jo Smith ◽  
David Shiers
Keyword(s):  
Early Intervention ◽  
Self Report ◽  
Service Development ◽  
Clinical Implications ◽  
Intervention Fidelity ◽  
Audit Tool ◽  
Service Model ◽  
Early Intervention Services ◽  
Critical Phase ◽  
Early Intervention In Psychosis

Aims and MethodThis study provides an overview of the development of early intervention services for psychosis across England in February 2005. A bespoke self-report audit tool was completed by key informants across the eight regional development centres of the National Institute for Mental Health in England.ResultsOut of 117 teams identified, 86 have funding, of which 63 are operational with case-managed patients (as of February 2005). Only 3 teams meet all 10 audited early intervention fidelity requirements and there are variations in service model, delivery setting and resources across teams.Clinical ImplicationsCurrent inequity of access and the early, fragile nature of service development means that early intervention in England has reached a critical phase requiring consolidation.

scholarly journals Early intervention services for psychosis in Ireland: are we there yet?

2019 ◽  
Vol 36 (4) ◽  
pp. 243-248 ◽  
Author(s):  
P. Power
Keyword(s):  
Early Intervention ◽  
Urban Areas ◽  
Psychotic Disorders ◽  
Cost Savings ◽  
Model Of Care ◽  
Service Model ◽  
Health Service Executive ◽  
Early Intervention Services ◽  
Early Intervention In Psychosis ◽  
Roll Out

Early intervention in psychosis (EIP) services are now a priority for Ireland’s Health Service Executive (HSE). A Model of Care for EIP services has been completed after wide consultation. It has just been launched by the Minister for Mental Health and the aim now is to roll out EIP services throughout the country. The Model of Care outlines the rational, configuration, resources, governance, and quality assurance required to operate EIP services. Two models are recommended. The first is a Hub & Spoke service model for rural and smaller urban areas. The second is a Stand-Alone service model for large urban and metropolitan areas. Introducing EIP services is going to be a challenge but there are plenty of good examples overseas. They have been shown to greatly enhance local services’ ability to meet the needs of people developing psychotic disorders. They bring with them better outcomes, service satisfaction and cost savings.

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.

scholarly journals Research and practice for ultra-high risk for psychosis: A national survey of early intervention in psychosis services in England

2017 ◽  
Vol 41 (S1) ◽  
pp. S191-S192
Author(s):  
H. Stain ◽  
L. Mawn ◽  
S. Common ◽  
M. Pilton ◽  
T. Andrew
Keyword(s):  
Early Intervention ◽  
High Risk ◽  
Clinical Guidelines ◽  
Online Survey ◽  
Family Intervention ◽  
Behavioural Therapy ◽  
Self Report ◽  
Family Work ◽  
Ultra High Risk ◽  
Early Intervention In Psychosis

ObjectivesEvidence from meta-analyses of randomised clinical trials shows interventions for young people at ultra-high risk (UHR) of developing psychosis are effective both clinically and economically. While research evidence has begun to be integrated into clinical guidelines, there is a lack of research on the implementation of these guidelines. This paper examines service provision for UHR individuals in accordance with current clinical guidelines within the National Health Service (NHS) in England.MethodA self-report online survey was completed by clinical leaders of Early Intervention in Psychosis (EIP) teams (n = 50) within the NHS across the UK.ResultsOf the 50 EIP teams responding (from 30 NHS Trusts), 53% reported inclusion of the UHR group in their service mandate, with age range predominantly 14–5 years (81%) and service provided for at least 12 months (53%). Provision of services according to NICE clinical guidelines showed 50% of services offered cognitive behavioural therapy (CBT) for psychosis, and 42% offered family intervention. Contrary to guidelines, 50% of services offered antipsychotic medication. Around half of services provided training in assessment by CAARMS, psycho-education, CBT for psychosis, family work and treatment for anxiety and depression.ConclusionsDespite clear evidence for the benefit of early intervention in this population, current provision for UHR within EIP services in England does not match clinical guidelines. While some argue this is due to a lack of allocated funding, it is important to note the similar variable adherence to clinical guidelines in the treatment of people with established schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Service user perspectives of an early intervention in psychosis service: a service evaluation

2018 ◽  
Vol 23 (3) ◽  
pp. 156-164
Author(s):  
Simon Watkins ◽  
Chris Sanderson ◽  
Victoria Richards
Keyword(s):  
Early Intervention ◽  
Thematic Analysis ◽  
Service Evaluation ◽  
Therapeutic Relationships ◽  
Service Development ◽  
Content Type ◽  
Individual Interviews ◽  
Open Questions ◽  
Early Intervention In Psychosis ◽  
Inductive Thematic Analysis

Purpose The purpose of this paper is to gather the perspectives of individuals accessing an early intervention in psychosis service (EIPS), in order to inform service development. Design/methodology/approach Individual interviews (n=9) and one focus group (n=7) were conducted. Discussions focused on open questions pertaining to service users’ (SU’s) experiences of accessing the EIPS. The results were analysed using inductive thematic analysis. Findings Inductive thematic analysis was used and three main themes were generated: consistency and communication, facilitating therapeutic relationships between EIPS staff and SU’s; pushing boundaries, relating to the importance of services taking a graded approach to developing therapeutic relationships and (re)engaging in activities; and normalising and validating experiences of psychosis. Participants emphasised the importance of relationships with EIPS staff and fellow SUs and highlighted how SUs can feel fearful and vulnerable when staff are not accessible or they view their care as inconsistent. Participants further emphasised the need for practitioners to balance an approach that de-stigmatises psychotic experiences whilst validating distress. Practical implications Consistency of support from EIPSs can be as important as flexibility. Clinicians should carefully consider the balance between validating and normalising distressing experiences associated with psychosis. Offering social activities with other SUs can facilitate therapeutic relationships and recovery but the results suggest that this should be facilitated in a graded way. Originality/value The paper addresses current need in the literature to understand the experiences of people using services in order to improve the quality of the services provided.

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 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 The over-35s: early intervention in psychosis services entering uncharted territory

2018 ◽  
Vol 42 (4) ◽  
pp. 137-140 ◽  
Author(s):  
Felix Clay ◽  
Sophie Allan ◽  
Serena Lai ◽  
Siona Laverty ◽  
Grace Jagger ◽  
...  
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Mental Health Services ◽  
Health Services ◽  
Service Planning ◽  
Clinical Implications ◽  
Mental Health Difficulties ◽  
Early Intervention In Psychosis

Aims and methodFollowing the introduction of new standards for early intervention in psychosis (EIP) in England, EIP services are accepting referrals for people aged 35–65. The Cambridgeshire and Peterborough EIP service (CAMEO) aimed to explore the immediate implications for the service, especially with regards to referral numbers and sources. Data were collected from April 2016 to June 2017.ResultsReferrals for over-35s represented 25.7% of all new referrals. Fifty per cent of referrals for over-35s were accepted onto caseload (40.2% for under-35s). The over-35s were more likely to be referred from acute and secondary mental health services (P < 0.01) and had longer durations of untreated psychosis than the under-35s (P = 0.02).Clinical implicationsCAMEO has received a significantly higher number of referrals as a result of age inclusivity, with an increased proportion of patients suffering from severe, acute psychotic presentations and existing mental health difficulties. This has implications for service planning.Declaration of interestNone.

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 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 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.

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