Thursday, May 16, 2019

Hospitalization for Psychosis Tied to Substance Misuse, Treatment Delays, Medication Nonadherence

The hospitalization rate for patients with first-episode psychosis (FEP) may be reduced by avoiding delays in initial treatment, preventing substance misuse, and enhancing medication adherence, according to a study published Tuesday in Psychiatric Services in Advance.

Even with current, evidence-based treatment, at least one-third of individuals with FEP will be hospitalized within two years of diagnosis, increasing treatment costs, disrupting schooling, and often, resulting in stress and trauma, wrote Delbert G. Robinson, M.D., of the Center for Psychiatric Neuroscience at the Feinstein Institutes for Medical Research and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and colleagues.

To identify risk factors for hospitalization, researchers evaluated data from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared outcomes in patients experiencing a first episode of psychosis who received early intervention services versus usual care. (Patients in the early intervention group received personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported education and employment. Those in the usual-care group received psychosis treatment determined by individual and clinician choice and service availability. The study found that those in the early intervention program remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school, compared with those in the usual-care group.)

As part of the original study, researchers conducted a Structured Clinical Interview for DSM-IV at baseline and assessed various other clinical measures every six months thereafter. Every month during the trial, researchers asked participants about their use of inpatient and emergency mental health services and assessed drug and alcohol use. At multiple times throughout the trial, the participants also rated their mental and emotional health and took various other evaluations.

Based on these data, Robinson and colleagues found that patients with longer duration of untreated psychosis, more hospitalizations before study entry, positive psychosis symptoms such as hallucinations and delusions, illegal drug use, and doubts about the value of medication were more likely to be hospitalized during the two-year treatment period.

The study findings could assist clinicians in developing more effective early intervention services. “Individuals enter outpatient treatment with an already fixed number of prior hospitalizations and [duration of untreated psychosis]. Changing these factors will require public health initiatives and innovative outreach strategies to facilitate earlier entry into treatment,” the researchers wrote. “Current [early intervention services] models include interventions to help individuals decrease substance misuse, achieve symptom reduction, and understand medications and adherence. Some of these interventions have low participation … suggesting that more effort may be needed to motivate individuals to use available services.”

For more information, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis” and the American Journal of Psychiatry article “Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program.”

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