Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-22T16:48:25.217Z Has data issue: false hasContentIssue false
  • English
  • Français

Analysis of the initial treatment phase in first-episode psychosis

Published online by Cambridge University Press:  06 August 2018

Paddy Power ,
Kathryn Elkins ,
Steven Adlard ,
Christina Curry ,
Patrick McGorry  and
Susan Harrigan
Paddy Power*
Affiliation:
Early Psychosis Prevention and Intervention Centre, Parkville, Victoria
Kathryn Elkins
Affiliation:
Early Psychosis Research Centre, Department of Psychiatry, University of Melbourne
Steven Adlard
Affiliation:
Early Psychosis Prevention and Intervention Centre, Parkville, Victoria
Christina Curry
Affiliation:
Early Psychosis Research Centre, Department of Psychiatry, University of Melbourne
Patrick McGorry
Affiliation:
Early Psychosis Prevention and Intervention Centre, Parkville, Victoria
Susan Harrigan
Affiliation:
Centre for Young People's Mental Health, Parkville, Department of Psychiatry, University of Melbourne, Australia
*
Correspondence: Dr Paddy Power, Early Psychosis Research Centre, Centre for Young People's Mental Health, 35 Poplar Road, Parkville, Victoria, 3052, Australia. Fax: 613 9342 2858; e-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background The Early Psychosis Prevention and Intervention Centre (EPPIC) commenced operation in Melbourne, Australia, in 1992. It offers a model for management of first-episode psychosis, utilising principles of early detection, low-dose medication and comprehensive psychosocial interventions within the least restrictive setting.

Method Data were examined from the first three months of treatment for all consecutive people with first-episode psychosis (n=231) accepted in the programme in 1995–1996. A subsample of patients (n=120) was assessed comparing clinical ratings with variables of gender, diagnosis, hospitalisation, and medication.

Results Hospitalisations were brief, and avoided for a third of the people. Low-dose antipsychotic medication was maintained in both in-patient and community settings. Those people with manic psychosis were more likely to be hospitalised. Hospitalised people received higher antipsychotic dosages, and had a greater rate of reduction in Brief Psychiatric Rating Scale psychotic sub-scale scores at three months follow-up. Eighty per cent of a representative subsample had responded to treatment and 63% were in remission by the end of the three months.

Conclusion This naturalistic study suggests that the feasibility of implementing the EPPIC model in a range of clinical settings is promising and applicable in practice.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 172 , Issue S33: Verging on reality , June 1998 , pp. 71 - 76
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albiston, D. J., Francey, S. M. & Harrigan, S. M. (1998) Group programme for recovery from early psychosis. British Journal of Psychiatry, 172 (suppl. 33), 117–121.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.Google Scholar
Andreasen, N. C. (1982) Negative symptoms in schizophrenia. Archives of General Psychiatry, 39, 784–788.Google Scholar
Atakan, Z. (1995) Violence on psychiatric in-patient units: what can be done? Psychiatric Bulletin, 19, 593–597.CrossRefGoogle Scholar
Australian Bureau of Statistics (1991) Census of Population and Housing, Expanded Community Profile. Canberra: Australian Government Printing Service.Google Scholar
Birchwood, M. & MacMillan, J. F. (1993) Early intervention in schizophrenia. Australian and New Zealand Journal of Psychiatry, 27, 374–378.Google Scholar
Castle, D. J., Phelan, M., Wesseley, S., et al (1994) Which patients with functional psychosis are not admitted at first psychiatric contact? British Journal of Psychiatry, 165, 101–106.Google Scholar
Edwards, J., Maude, D., McGorry, P. D., et al (1998) Prolonged recovery in first-episode psychosis. British Journal of Psychiatry, 172 (suppl. 33), 107–116.Google Scholar
Fennig, S., Craig, T., Tanenberg-Karant, M., et al (1994) Comparison of facility and research diagnosis in first admission psychotic patients. American Journal of Psychiatry, 151, 1423–1429.Google Scholar
A., Fisher,W. (1994) Restraint and seclusion: A review of the literature. American Journal of Psychiatry, 151, 1584–1591.Google Scholar
Häfner, H., Maurer, K., Löffler, W., et al (1995) Onset and early course of schizophrenia. In Search for the Causes of Schizophrenia, Vol. Ill (eds Hafner, H. & Gattaz, W. F.), pp. 43–66. New York: Springer.CrossRefGoogle Scholar
Jackson, H. J., McGorry, P. D., Edwards, J., et al (1996) Cognitively oriented psychotherapy for early psychosis (COPE). In Early Intervention and Prevention in Mental Health (eds Cotton, P. & Jackson, H.J.), pp. 131–154. Melbourne: Australian Psychological Society.Google Scholar
Kane, J. (1994) The use of higher dose antipsychotic medication. British Journal of Psychiatry, 164, 431–432.Google Scholar
Kopala, L. C., Fredrikson, D., Good, K. P., et al (1996) Symptoms in neuroleptic-naive first-episode schizophrenia: response to risperidone. Biological Psychiatry, 39, 296–298.CrossRefGoogle ScholarPubMed
Krauzs, M., Muller-Thomsen, T. & Maasen, C. (1995) Suicide among schizophrenic adolescents in the long-term course of illness. Psychopathology, 28, 95–103.Google Scholar
Lieberman, J. A., Alvir, J., Woerner, M., et al (1992) Prospective study of psychobiology in first episode schizophrenia at Hillside Hospital. Schizophrenia Bulletin, 18, 351–371.Google Scholar
Loebel, A. D., Lieberman, J. A., Alvir, J. M. J., et al (1992) Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry, 149, 1183–1188.Google ScholarPubMed
McEvoy, J. P., Hogarty, G. E. & Steinguard, S. (1991) Optimal dose of neuroleptic in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose. Archives of General Psychiatry, 48, 739–745.Google Scholar
McGorry, P. D., Goodwin, R. & Stuart, G. W. (1988) The development, use, and reliability of the Brief Psychiatric Rating Scale (nursing modification). An assessment procedure for the nursing team in clinical and research settings. Comprehensive Psychiatry, 29, 575–587.CrossRefGoogle ScholarPubMed
McGorry, P. D., Chanen, A., McCarthy, E., et al (1991) Post-traumatic stress disorder following recent onset psychosis. Journal of Nervous and Mental Disease, 179, 253–258.Google Scholar
McGorry, P. D., Edwards, J., Mihalopoulos, C., et al (1996) EPPIC: An evolving system of early detection and optimal management. Schizophrenia Bulletin, 22, 305–326.CrossRefGoogle ScholarPubMed
Meltzer, H. & Okayli, G. (1995) The reduction of suicidality during clozapine treatment in neuroleptic resistant schizophrenics. American Journal of Psychiatry, 152, 183–190.Google Scholar
Parker, G., Roy, K., Hadzi-Pavlovic, D., et al (1992) Psychotic depression: A meta-analysis of physical treatments. Journal of Affective Disorders, 24, 17–24.CrossRefGoogle ScholarPubMed
Roy, A. (1986) Suicide in schizophrenia. In Suicide (ed. Roy, A.), pp. 97–112. Baltimore, MD: Williams & Wilkins.Google ScholarPubMed
Szymanski, S. R., Masiar, S., Mayerhoff, D., et al (1994) Clozapine response in treatment refractory first episode schizophrenia. Biological Psychiatry, 35, 278–280.CrossRefGoogle ScholarPubMed
Szymanski, S. R., Tyrone, D. C., Gallacher, F., et al (1996) Course of treatment response in first-episode and chronic schizophrenia. American Journal of Psychiatry, 153, 519–525.Google Scholar
Thomson, C. (1994) The use of high-dose antipsychotic medication. British Journal of Psychiatry, 164, 448–458.Google Scholar
Wadeson, H. & Carpenter, W. (1976) Impact of the seclusion room experience. Journal of Nervous and Mental Disorders, 163, 318–328.Google Scholar
Wing, J. K., Beevor, A. S., Curtis, R. H., et al (1998) Health of the Nation Outcome Scales (HONOS). Research and development. British Journal of Psychiatry, 172, 11–18.Google Scholar
Yung, A. & McGorry, P. D. (1996) The prodromal phase of first episode psychosis. Schizophrenia Bulletin, 22, 353–370.Google Scholar
Yung, A., McGorry, P. D., McFarlane, C. A., et al (1996) Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22, 283–303.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.