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Prodromal services improve clinical outcomes in people who present with an established first episode of psychosis

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Rashmi Patel ; Paolo Fusar-Poli ; Covadonga M Díaz-Caneja ; Lucia Valmaggia ; Majella Byrne ; Steven Badger ; Philippa Garety ; Hitesh Shetty ; Matthew Broadbent ; Robert Stewart ; Philip McGuire

Original languageEnglish
Article number2098271
Pages (from-to)S150-S151
Number of pages2
JournalSchizophrenia Bulletin
Volume41
Issue numberS1
DOIs
StatePublished - 1 Mar 2015

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Abstract

Background: Over the last two decades, specialised prodromal clinical services have been developed for people at high risk for psychosis. Around one third of people referred to these services are found to already be in the first episode of psychosis (FEP) when they are assessed. They are usually referred on directly to a specialised first episode clinical service. The impact of this ‘fast-tracking’ to specialised treatment is unknown. We investigated clinical outcomes among this group compared to those presenting to standard mental health services.

Methods: Retrospective study comparing outcomes of people with FEP who presented to the OASIS prodromal service (n=164) to those who presented to conventional mental health services (n=2779) in the South London and Maudsley NHS Trust (UK). The primary outcome measure was duration of hospital admission; secondary outcome measures were time to diagnosis, need for compulsory hospital admission and frequency of admissions. Regression models were performed to analyse the effect of presentation to the prodromal clinic on clinical outcomes. Age, gender, ethnicity, marital and employment status, borough of residence, diagnosis, and exposure to antipsychotics were included as covariates.

Results: People with FEP presenting to the prodromal service were more likely to be male (68.3%), younger (mean age 23.6 years) and from a Black and Minority Ethnic (BME) group (68.9%) compared to those presenting to conventional mental health services (59.8% male; mean age 25.1 years; 55.5% BME). People with FEP who had initially presented to a high risk service spent 17 fewer days in hospital (95% CI -33.7,-0.3), had a shorter time to diagnosis (B coefficient -74.5 days, 95% CI -101.9, -47.1), a lower frequency of hospital admission (IRR: 0.49 [95% CI 0.39, 0.61]), and a lower likelihood of compulsory admission (OR: 0.52 [95% CI 0.34, 0.81]) in the 24 months following referral, as compared to first episode psychosis patients who were first diagnosed at conventional services.

Conclusion: Prodromal services for people at high risk for psychosis may improve clinical outcomes in patients who are already psychotic. These findings suggest a potential role for prodromal clinics to facilitate access to healthcare for people with FEP who may otherwise face difficulties in engaging with traditional mental health services.

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