Search

Aims: For over 30 years, combined research and treatment settings in the US have been critical to conceptualizing care for first-episode psychosis (FEP). Here we describe an early example of such a context, the Services for the Treatment of Early Psychosis (STEP) clinic, which is affiliated with the University of Pittsburgh., Methods: We describe STEP's historical roots and establishment in the early 1990s; STEP's research and treatment contributions, alongside its growth and ongoing leadership., Results: Research-based clinics, like STEP, preceded and helped pave the way for the Recovery After an Initial Schizophrenia Episode project in the US and the ensuing Coordinated Specialty Care (CSC) approach, now widely adopted in the US. Early clinic-based research at STEP helped establish protocols for psychopharmacology, the relevance of effective early treatment, including psychosocial approaches, and highlighted disparities in treatment outcomes across race/ethnicity. Multidisciplinary collaboration and dialogue with consumers contributed to early treatment, combining psychosocial and pharmacological approaches. STEP adopted CSC and is situated within a bi-state Learning Health System. STEP has retained a relatively unique 5-year treatment model and exists within continuum of care ideally suited to studying psychotic illness and treatment outcomes., Conclusions: STEP remains the largest academic FEP clinic in Pennsylvania. Academic FEP clinics like STEP will have a critical role within Learning Health Systems nationally to model participatory approaches, sustain early intervention treatment quality and ongoing treatment developments., (© 2024 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Aim: Many individuals with schizophrenia discontinue initially prescribed antipsychotics. Knowledge on reasons for discontinuation among individuals with first‐episode schizophrenia is sparse. We aimed to describe reasons for discontinuation and continuation, differences between individuals discontinuing and continuing, and factors predicting reasons for discontinuation or continuation. Methods: This was a prospective cohort study with a post hoc design. Individuals with first‐episode schizophrenia were included from early intervention teams in Denmark from 2009–2012. Sociodemographic and clinical variables were collected at baseline and reasons for discontinuation and continuation of antipsychotics were assessed at 3.5‐year follow‐up. Results: Among 215 patients, 76 reported reasons for discontinuation and 139 for continuation. The most frequent reasons for discontinuation were "side effects" and "patient believed he/she no longer needed the medication because he/she was now better". The most frequent reasons for continuation were "benefits for positive symptoms" and "another person told them to". Individuals who discontinued antipsychotics were at baseline younger, had longer DUP, less negative symptoms, better social function, lower compliance, higher self‐belief of coping, and fewer used antipsychotics compared to those continuing antipsychotics. Conclusions: The effect of antipsychotics is the main reason to continue, whereas side effects were the main reason to discontinue. Knowledge of reasons to discontinue or continue is helpful in shared decision‐making, identifying individuals with high odds of discontinuation, improving adherence, and helping with safe discontinuation. [ABSTRACT FROM AUTHOR]

Aim: Pennsylvania (PA) first-episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA-OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6- and 12-month outcomes., Methods: Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re-administered at 6- and 12-month follow-up, and data were analysed for individuals (n = 230) who had completed 12-months of treatment. Domains assessed via clinician report and/or self-report included symptoms, role and social functioning, self-perceived recovery and service utilization., Results: PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self-perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school-enrolment. Nearly all improvements were observed at 6-month follow-up, with earlier gains maintained at 12-months., Conclusions: PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society., (© 2020 John Wiley & Sons Australia, Ltd.)

Aim: Early intervention services are the established and evidence-based treatment option for individuals with first-episode psychosis. They are time-limited, and care pathways following discharge from these services have had little investigation. We aimed to map care pathways at the end of early intervention treatment to determine common trajectories of care., Methods: We collected health record data for all individuals treated by early intervention teams in two NHS mental health trusts in England. We collected data on individuals' primary mental healthcare provider for 52 weeks after the end of their treatment and calculated common trajectories of care using sequence analysis., Results: We identified 2224 eligible individuals. For those discharged to primary care we identified four common trajectories: Stable primary care, relapse and return to CMHT, relapse and return to EIP, and discontinuity of care. We also identified four trajectories for those transferred to alternative secondary mental healthcare: Stable secondary care, relapsing secondary care, long-term inpatient and discharged early. The long-term inpatient trajectory (1% of sample) accounted for 29% of all inpatient days in the year follow-up, with relapsing secondary care (2% of sample and 21% of inpatient days), and Relapse and return to CMHT (5% of sample, 15% of inpatient days) the second and third most frequent., Conclusions: Individuals have common care pathways at the end of early intervention in psychosis treatment. Understanding common individual and service features that lead to poor care pathways could improve care and reduce hospital use., (© 2023 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Aim: Among different types of poly unsaturated fatty acids, omega‐3 fatty acids (FA) play a substantial role in brain development and functioning. This review was designed to evaluate and synthesize available evidence regarding omega‐3 FAs and functional outcome in the ultra‐high‐risk (UHR) population. Methods: An electronic search in PubMed, EMBASE, PSYCINFO and COCHRANE search engines has been performed for all articles published until January 2019. The studies that have data regarding omega‐3 FAs and functional outcome in UHR population were included. Results: Out of 397 nonduplicate citations, 19 articles met selection criteria. These articles were from four different primary studies, namely the Program of Rehabilitation and Therapy (PORT), the North American Prodromal Longitudinal Studies (NAPLS), Vienna High Risk study (VHR) and the NEURAPRO. The data from the NAPLS study found a positive correlation between functional improvement and frequency of dietary intake omega‐3 FA. Moreover, among the erythrocyte omega‐3 FA only eicosapentaenoic acid (EPA) showed a positive correlation with functional score. The VHR study found long‐term improvement in functional outcome in omega‐3 group compared to control, whereas such difference was noticed in the NEURAPRO. In the VHR study both omega‐3 and omega‐6 together predicted the functional improvement at 12 weeks. Conclusions: The number of studies available remains insufficient and more studies with standardized outcome measures in a clinically comparable UHR population would be of more value to understand the clinical benefits of omega‐3 FA in the UHR population. [ABSTRACT FROM AUTHOR]

Aim: Suicidal thoughts and behaviours are prevalent in individuals with schizophrenia. However, research examining the prevalence and predictors of suicidality and self‐harm in participants at clinical high‐risk for psychosis (CHR‐P) is limited and mostly focuses on help‐seeking participants recruited through clinical pathways. The current study sought to assess the prevalence of suicidality and self‐harm and identify predictors of current suicidal ideation in community‐recruited CHR‐P participants. Methods: Data were available for 130 CHR‐P participants, 15 participants with first‐episode psychosis (FEP), 47 participants not fulfilling CHR‐P criteria (CHR‐Ns) and 53 healthy controls. Current and lifetime suicidality and self‐harm were assessed using the Mini‐International Neuropsychiatric Interview and the Comprehensive Assessment of At‐Risk Mental States (CAARMS). Multivariable logistic regression analysis was used to determine predictors of current suicidal ideation in the CHR‐P group. Results: A considerable proportion of CHR‐P participants disclosed current suicidal ideation (34.6%). Overall, FEP individuals were at greatest risk, with considerably high prevalence rates for current suicidal ideation (73.3%), lifetime self‐harm behaviour (60.0%) and lifetime suicide attempt (60.0%). In the CHR‐P sample, current suicidal ideation was predicted by lifetime suicide attempts, lower CAARMS severity, impaired social functioning and greater comorbidity. Conclusions: Our findings suggest that suicidality and self‐harm are highly prevalent in community‐recruited CHR‐P and FEP individuals. Accordingly, these results highlight the importance of further research into the determinants of suicidality and self‐harm during at‐risk and early stages of psychosis, and the implementation of intervention strategies to reduce adverse outcomes in these populations. [ABSTRACT FROM AUTHOR]

Objective: NAVIGATE is a comprehensive treatment program for first episode psychosis developed and implemented in the US that has been found to be effective. The purpose of the present study was to describe the first initiative of NAVIGATE's implementation outside the US, and to present data collected in Israel from the first two clinics focusing on NAVIGATE clients' characteristics, components utilization and retrospective clinician ratings of change. Methods: Administrative data for 61 NAVIGATE clients in Israel and retrospective ratings of NAVIGATE clinicians were analysed. Results: The duration of untreated psychosis was 4.4 months (SD = 6.8). Clients were mostly referred to NAVIGATE from psychiatric hospitals (n = 29, 50.9%) and community mental health agencies (n = 20, 35.1%). The individualized resiliency training (IRT) component had the highest client utilization rate (n = 53, 98.1%) with a monthly average of M = 2.32 sessions (SD = 2.75). Clinicians' retrospective ratings indicated that 66% of the clients (n = 33) had improved in at least one life domain, with the most common improvement in employment (n = 28, 56%), recovery (n = 24, 50%), and symptoms severity (n = 23, 47%). Conclusions: Our findings reveal that NAVIGATE can be implemented outside the US within a different social and cultural context and different mental health system. The utilization rates of the program components and clinicians' retrospective ratings indicated positive change among most of NAVIGATE clients, pointing to the potential value of NAVIGATE above and beyond different countries and health systems. [ABSTRACT FROM AUTHOR]

Aim: Studies have demonstrated that a majority of the decline in health status and functioning emerges during the first few years following the onset of psychosis. This knowledge led to the development of specialized early intervention services (EIS) targeting patients experiencing their first episode of psychosis (FEP). The central component of EIS is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. The aim of this scoping review was to examine how key workers can enhance the physical health outcomes in people with FEP by addressing the factors associated with increased mortality in this population. Methods: The scoping review framework comprised a five‐stage process developed by Arksey and O'Malley. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Results: A total of 27 studies conducted across 10 countries were analysed. These studies discussed the various ways in which key workers can mediate enhancements in the various factors contributing to the increased mortality rates in FEP patients. Conclusions: A broad range of key worker‐mediated outcomes was identified, which were broadly classified into three themes: influences on lifestyle, influences on effects of psychosis and influences on organizational barriers. Our findings suggest that key workers primarily mediated the amelioration of psychosis‐induced effects and the reduction of organizational barriers. Further trials of key worker interventions to enhance physical health outcomes in this cohort are warranted. [ABSTRACT FROM AUTHOR]

Aim: To examine the degree to which youth identified as ready for discharge from three Canadian early psychosis intervention (EPI) programs had achieved optimal outcomes (ie, symptom remission, quality of life, self‐esteem and functioning). Methods: This cross‐sectional descriptive study is part of a larger study assessing the effectiveness of an evidence‐based intervention to sustain the gains acquired in EPI programs in two Canadian provinces (Ontario and Nova Scotia), as youth transition from EPI services to community‐based care. Baseline data collected from 39 participants receiving usual treatment in these three EPI programs comprised the comparison group. Participants completed measures to assess symptoms, quality of life, self‐esteem and functional level just prior to discharge. Results: Participants demonstrated lower levels of symptoms, greater quality of life, greater self‐esteem and greater levels of functioning, following EPI treatment when compared to similar youth described in the literature. These findings suggest that study participants had achieved optimal outcomes following EPI treatment. Conclusion: The study findings have laid the ground work for the current Canadian Institutes of Health Research partnership study in which our research group is assessing the effectiveness of an evidence‐based transitional intervention in order to address critical psychosocial issues of identity, stigma, effective relationships and meaningful life goals, along with the development of an individualized 'passport for transition'. It is anticipated that implementing an evidence‐based transitional intervention will support participants to maintain the gains made in EPI programs once they transition to community‐based care and will inform future research addressing this challenging issue. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the clinical characteristics and psychosocial factors associated with depression in patients with early psychosis according to stage of illness. Methods: The present study includes patients who fulfil the DSM‐5 criteria for schizophrenia spectrum and other psychotic disorders. Patients were divided into two groups according to illness stage (the acute stage of first‐episode psychosis and stabilization phase of recent‐onset psychosis). Clinically meaningful depression was defined as moderate or severe on the depression dimension of the Clinician‐Rated Dimensions of Psychosis Symptom Severity scale in the DSM‐5. Results: In total, 340 (207 first‐episode and 133 recent‐onset) patients were recruited in this study. Patients with comorbid depression were characterized by frequent suicidal ideation, a past suicide attempt, and lower scores on the Subjective Well‐being Under Neuroleptics and Brief Resilience Scale in both groups. Long duration of untreated psychosis and higher scores on the Early Trauma Inventory Self Report were associated with depression in the acute stage of first‐episode psychosis. In the stabilization phase of recent‐onset psychosis group, a monthly income and scores for sexual desire and on the Family Adaptability and Cohesion Evaluation Scale‐III were significantly lower in patients with depression than in those without depression. Conclusion: Comorbid depression was associated with high suicidality, lower quality of life and poor resilience in patients with first‐episode and recent‐onset psychosis. Depression was associated with factors that had been present before the initiation of treatment in patients with first‐episode psychosis and with environmental factors in those in the stabilization phase. [ABSTRACT FROM AUTHOR]

Aim: Clinical staging in psychiatry aims to classify patients according to the severity of their symptoms, from stage 0 (increased risk, asymptomatic) to stage 4 (severe illness), enabling adapted treatment at each stage of the illness. The staging model would gain specificity if one or more quantifiable biological markers could be identified. Several biomarkers reflecting possible causal mechanisms and/or consequences of the pathophysiology are candidates for integration into the clinical staging model of psychiatric illnesses. Methods: This review covers the evolution (from stage 0 to stage 4) of the most important brain functioning impairments as measured with electroencephalography (EEG), in psychosis spectrum and in severe mood disorders. Results: The present review of the literature demonstrates that it is currently not possible to draw any conclusion with regard to the state or trait character of any of the EEG impairments in both major depressive disorder and bipolar disorder. As for schizophrenia, the most promising markers of the stage of the illness are the pitch mismatch negativity as well as the p300 event‐related potentials, as these components seem to deteriorate with increasing severity of the illness. Conclusions: Given the complexity of major psychiatric disorders, and that not a single impairment can be observed in all patients, future research should most likely consider combinations of markers in the quest for a better identification of the stages of the psychiatric illnesses. [ABSTRACT FROM AUTHOR]

Aim: Coupling data on future resource consumption with baseline characteristics can provide vital information of future consumption patterns for newly diagnosed patients. This study tested whether higher need (as measured by severity of illness) and other baseline characteristics of newly diagnosed patients were associated with higher future service costs. Method: Five hundred forty‐seven patients between 18 and 45 years randomized to the OPUS trial was analysed in the study. Multiple regression analysis was applied to estimate the impact of the explanatory variables on mean total costs, which consisted of total health care costs and costs of supportive living facilities. Results: Lower age, higher level of symptoms (global assessment of functioning), alcohol or cannabis misuse, and being homeless were associated with higher total costs over 5 years, whereas sex, duration of untreated psychosis, and educational level did not show any impact on future resource consumption. Conclusion: The association between future costs and severity of illness suggests that higher needs among patients were associated with higher resource input level. Our results also indicate that other factors than need might affect future costs, for example, parents who serve as advocates for young patients had impact on future health costs. We also found indications of potential barriers among patients with other citizenship in access to health‐care services. The strength of the study is that resource data were extracted from official Danish registers and interviewers collected information on clinical characteristics. The results are likely to be context‐specific but can be generalized to settings with similar treatment practices. [ABSTRACT FROM AUTHOR]

Aim: Transition from early intervention in psychosis services (EIPS) to ongoing care can be challenging for staff and service users. This study aims to explore staff views of the barriers and facilitators to transition from EIPS. Methods: Eighteen EIPS staff were interviewed about their experiences of discharge processes and interviews were analysed thematically. Results: Four themes were identified: (1) "nowhere to go": illustrated how service users remained in EIPS because other teams lacked capacity to take them; (2) "collaboration between agencies" highlights the challenges of working across boundaries; (3) "therapeutic relationships": reflects the loss service users and staff experienced at discharge; (4) "advanced planning" relates to the necessity for advanced planning and service user empowerment to facilitate the discharge process. Conclusions: This is the first in‐depth exploration of EIPS staff views on discharge processes. To ensure seamless transitions throughout care pathways, services need better inter‐agency collaboration and more adequate preparation for transition. [ABSTRACT FROM AUTHOR]

Aim: This post hoc analysis of a double‐blind (DB), randomized, placebo‐controlled, relapse‐prevention study evaluated the effects of paliperidone palmitate once‐every‐3‐months (PP3M) in a subpopulation of adults with early illness schizophrenia (duration ≤5 years) from a clinical trial. Methods: Patients received either PP3M or placebo every 3 months in the DB phase. The primary efficacy variable was time from randomization to first relapse. Symptom severity, patient functioning, and safety were also assessed. Results: A total of 119 patients who entered the DB phase met the criteria for early illness schizophrenia (PP3M, n = 62; placebo, n = 57). PP3M significantly delayed time to relapse vs placebo (P = .035; hazard ratio, 3.08; 95% CI, 1.08‐8.80). Symptomatic control and patient functioning were maintained in the PP3M group but significantly worsened in the placebo group. There were no unexpected tolerability findings. Conclusions: PP3M reduced relapse risk and maintained symptomatic and functional improvements compared with placebo in patients with early illness schizophrenia. [ABSTRACT FROM AUTHOR]

Aim: Psychotic experiences, including delusions and hallucinations, and their attenuated forms have been recently suggested as a significant but under‐recognized marker of suicide risk. However, the relationship between attenuated positive symptoms and suicide has not yet been clearly demonstrated in individuals at ultra‐high risk (UHR) for psychosis. Here, we investigated the effect of attenuated positive symptoms on suicidal ideation in UHR individuals. Methods: Fifty‐three healthy controls (HCs) and 74 UHR individuals participated in the present study. All participants were assessed for the intensity of suicidal ideation and depressive symptoms at baseline. The effect of attenuated positive symptoms on suicidal ideation in the UHR group was examined using a multiple linear regression analysis after adjustment for concurrent depressive symptoms. Results: UHR participants were found to have significantly greater suicidal ideation and more severe depressive symptoms compared to those of HCs. The regression model demonstrated that suspiciousness significantly increased suicidal ideation in UHR participants, independent of the severity of depressive symptoms. Conclusion: The findings of the present study suggest that suspiciousness may serve as a risk indicator for suicide in clinical practice for UHR individuals. It is crucial to focus on the risk of suicide in the UHR population, as they require sufficient clinical attention and proper management for crises related to their unusual and confusing experiences. [ABSTRACT FROM AUTHOR]

Aim: Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1‐year follow‐up. Methods: Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first‐episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1‐year follow‐up. Multiple imputation (N = 50) was conducted to account for missing follow‐up data. Results: Baseline NS were associated with male gender (B = −1.63, P < .05), younger age at onset (B = −.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = −.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = −3.05, P <. 001) and unemployment at baseline (B = −.93, P <. 01). At 1‐year follow‐up, NS at presentation were associated with worse Global Assessment of Functioning Scale for symptom (B = −.28, P < .01) and disability (B = −.27, P <. 05) and with hospital admission (OR = 1.06, P < .01). Conclusions: Negative symptoms at presentation to EIS were associated with worse functioning at entry and poorer outcomes 1 year later. Future research is required to better understand the aetiology and trajectories of NS in early psychosis and propose novel targeted interventions. [ABSTRACT FROM AUTHOR]

Background: This aims of this study were: (1) to determine the prevalence of co‐occurring borderline personality disorder (BPD) in a first‐episode psychosis (FEP) sample; (2) to determine differences between patients with and without BPD on demographics, comorbidities and clinical risks and other variables; and (3) to examine whether BPD comorbidity influenced treatment received by patients for FEP during their first 3 months after service entry to a specialist early psychosis service. Methods: A file audit was conducted for 100 consecutive admissions to an early psychosis service. Patients with a clinician‐rated co‐occurring diagnosis of BPD were compared with patients without clinician‐rated BPD on a range of variables. Results: Twenty‐two percent of the FEP sample was diagnosed with co‐occurring BPD by clinician ratings. The FEP group with co‐occurring BPD was found to be younger, more likely to have other comorbidities, and were at higher risk of suicide and violent behaviour. Group differences were found in treatment received for FEP, whereby patients with co‐occurring BPD had poorer access to standard treatment, including guideline concordant antipsychotic medication prescription. Conclusion: Young people with co‐occurring clinician‐rated BPD and FEP experienced greater difficulty accessing standard care for FEP and received relatively different treatment, including different pharmacotherapy, compared with those FEP patients without BPD. There is a need to develop new clinical guidelines and effective treatments for this specific subgroup with early psychosis and co‐occurring BPD that take into account interpersonal and "premorbid" aspects of their presenting problems. [ABSTRACT FROM AUTHOR]

Aim: Previous research indicates that preventive intervention is likely to benefit patients “at risk” of psychosis, in terms of functional improvement, symptom reduction and delay or prevention of onset of threshold psychotic disorder. The primary aim of the current study is to test outcomes of ultra high risk (UHR) patients, primarily functional outcome, in response to a sequential intervention strategy consisting of support and problem solving (SPS), cognitive‐behavioural case management and antidepressant medication. A secondary aim is to test biological and psychological variables that moderate and mediate response to this sequential treatment strategy. Methods: This is a sequential multiple assignment randomised trial (SMART) consisting of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). The intervention is of 12 months duration in total and participants will be followed up at 18 months and 24 months post baseline. Conclusion: This paper reports on the rationale and protocol of the Staged Treatment in Early Psychosis (STEP) study. With a large sample of 500 UHR participants this study will investigate the most effective type and sequence of treatments for improving functioning and reducing the risk of developing psychotic disorder in this clinical population. [ABSTRACT FROM AUTHOR]

This commentary refers to the article by D. Addington, p 1235–1242 of this issue EIP 12:6. [ABSTRACT FROM AUTHOR]

Background: Patient adherence to follow-up after a first episode of psychosis (FEP) is currently a major challenge. Patient's early adherence reduces the risk of relapse and improves their prognosis in the short and long term. The primary goal of our study was to determine the incidence of treatment disengagement at 1-year follow-up in patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder. The secondary goal was to assess the factors associated with treatment disengagement in this patient population., Methods: We conducted a monocentric retrospective study of 136 patients in France. Relevant information was collected on sociodemographic, pre-morbidities and co-morbidities data, as well as the management and treatment characteristics at 1.3 and 12 months. Survival analysis was used to assess the association between clinical variables, management and treatment disengagement., Results: Eighty-four patients (62%) have interrupted their medical follow-up at 1 year, 16% at 1 month and 34% at 3 months. A higher number of out-patient appointments after a FEP was associated with better adherence (HR:0.85 p < .0001 95% IC = [0.0-0.9]). Initial management seems to play an important role. Involuntary admissions (HR:7.14 p = .015 95% IC = [1.48-34.52]) and total number of admissions (HR:6.86 p < .0001 95% IC = [2.47-19.05]) predict disengagement at 1 month while an increased number of out-patient appointments at 3 months predicts adherence (HR:0.60 p < .0001 95% IC = [0.00-0.74]). Being a single parent is associated with disengagement at 3 months (HR:15.51 p = .022 95% IC = [1.49-161.65])., Conclusions: Incidence of disengagement is high. It might be necessary to change our management in order to develop out-patient or day-admission care and intensify care for patients at risk., (© 2020 John Wiley & Sons Australia, Ltd.)

Aim: It has been hypothesized that the first 5 years are critical in determining long‐term recovery from psychotic disorders. We examine stability in recovery indices after 5 years for 56 patients treated in an early intervention programme for psychosis. Methods: Assessments of symptom remission and functional recovery were carried out 5 and 10 years after initiation of treatment. Results: Although overall rates of recovery were comparable at both times, there were significant changes for individuals reflecting both improvement and deterioration. Conclusions: Evidence concerning the critical period hypothesis should examine stability in individuals rather than relying on cumulative indices. [ABSTRACT FROM AUTHOR]