First episode psychosis in the over 35s: Is there a role for early intervention?

TY - JOUR

T1 - First episode psychosis in the over 35s

T2 - Is there a role for early intervention?

AU - Greenfield, Philippa

AU - Joshi, Snehita

AU - Christian, Suneel

AU - Lekkos, Petros

AU - Gregorowicz, Anna

AU - Fisher, Helen L.

AU - Johnson, Sonia

PY - 2016/3/28

Y1 - 2016/3/28

N2 - Aim: The early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range. Methods: Data were collected on all patients aged 36-65years who were referred to an inner London EI service from 2011-2014 using the MiData 2 tool at entry and at 1-year follow up. Results: People aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1-year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission. Conclusions: These findings indicate that admitting over 35-year-olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.

AB - Aim: The early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range. Methods: Data were collected on all patients aged 36-65years who were referred to an inner London EI service from 2011-2014 using the MiData 2 tool at entry and at 1-year follow up. Results: People aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1-year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission. Conclusions: These findings indicate that admitting over 35-year-olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.

KW - Early intervention

KW - Older patients

KW - Outcome

KW - Psychosis

UR - http://www.scopus.com/inward/record.url?scp=84962214258&partnerID=8YFLogxK

U2 - 10.1111/eip.12322

DO - 10.1111/eip.12322

M3 - Article

AN - SCOPUS:84962214258

SN - 1751-7885

JO - Early Intervention in Psychiatry

JF - Early Intervention in Psychiatry

ER -