Wednesday, March 8, 2023

Entering Treatment After First Episode of Psychosis May Reduce Risk of Self-Harm

Young people who began treatment within 14 days of being diagnosed with first-episode psychosis (FEP) were less likely to deliberately harm themselves than those who did not initiate treatment, according to a report in Psychiatric Services. The findings were based on data collected from Ohio Medicaid claims for more than 6,300 youth with FEP.

“Given the high rates of suicide in this population, our findings suggest a great need for suicide-specific interventions for individuals in the early course of a psychotic disorder,” wrote Heather Wastler, Ph.D., an assistant professor of psychiatry at the Early Psychosis Intervention Center at Ohio State University Medical Center, and colleagues.

Wastler and colleagues focused their analysis on 6,349 adolescents and young adults aged 15 to 24 years who were enrolled in Ohio Medicaid and were diagnosed with FEP between June 30, 2010, and December 31, 2017. They compared deliberate self-harm among those who did and did not initiate treatment after being diagnosed with FEP and among those who engaged or did not engage in treatment after initiation. Treatment initiation was defined as an inpatient admission or at least one psychotherapy session (individual, family, or group), medication management visit, or partial hospitalization within 14 days of an FEP diagnosis. Treatment engagement was defined as at least two of the same forms of treatment within 90 days of treatment initiation.

A total of 4,419 (69.6%) of the youth initiated treatment within 14 days of their FEP diagnosis; 55% of these youth engaged in treatment during the 90-day period. The researchers tracked the outcomes of the youth up to 365 days from the end of the initiation or engagement period, with follow-up ending at the first deliberate self-harm claim, the end of Medicaid enrollment, death, or the end of the study period (December 31, 2017).

A total of 229 individuals deliberately harmed themselves during the follow-up period. Of the 4,419 youth who initiated treatment, 134 (3.0%) deliberately harmed themselves at least once; among the 1,930 youth who did not initiate treatment, 95 (4.9%) deliberately harmed themselves.

“Given the established relationship between positive symptoms and suicide-related outcomes, it’s possible that this initial contact reduces DSH [deliberate self-harm] through the stabilization of psychotic symptoms with antipsychotic medication,” Wastler told Psychiatric News. “Another potential explanation is that providers might deliver brief evidence-based interventions such as crisis response planning, safety planning, or lethal-means counseling during the first treatment contact.”

Among the 2,431 who continued treatment, 64 (2.6%) deliberately harmed themselves during the follow-up period compared with 42 (2.1%) of those who discontinued treatment.

Wastler said that more sessions may be needed to reduce deliberate self-harm. She also noted that other factors, such as the quality of care received or the patients’ motivation for treatment, may have influenced the findings.

For related information, see the Psychiatric News article “New Network Collects Real-Time Data to Improve Treatment of Early Psychosis.”

(Image: iStock/Dziggyfoto)

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