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Irish researchers conducted a comprehensive search for and review of published studies that reported rates and predictors of disengagement within first-episode psychosis services using the databases PubMed (1966–2012) and PsycINFO (1882–2012). Relevant terms were used to search the Internet and the reference sections of papers for other pertinent studies. Independent searches for recent publications by leading researchers in the field were also conducted.
Ten articles were included in the review. The review revealed a lack of consensus on a clear definition of engagement and disengagement, but evidence from the review indicates that approximately 30 percent of individuals with FEP disengage from services. Some of the variables that were consistently found to exert an influence on disengagement were duration of untreated psychosis, symptom severity at baseline, insight, substance abuse and dependence, and involvement of a family member.
“Given the importance of continuity of care for FEP, there is a need for a clearly defined and agreed measurement of service engagement and disengagement across FEP services,” the researchers stated. “In particular, those who enter an FEP program without family involvement and support as well as those who maintain persistent substance abuse are at higher risk of disengagement. Early identification of such individuals and the development of approaches to reduce risk of service disengagement are likely to increase the effectiveness of these services.”
For more on first-episode psychosis, see the Psychiatric News article "Threat Delusions Linked to Violence in First-Episode Psychosis."
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