Early Intervention: The International Perspective Paddy Power .

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Early Intervention: The International Perspective Paddy Power. “A Stitch in Time Saves Nine”. Development of Early Psychosis Programs. Melbourne, mid-80’s Buckinghamshire, mid-80’s North Birmingham UK early 90’s Germany, 1990’s (research1970’s) USA & Canada, early 90’s
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Early Intervention: The International Perspective Paddy Power "A Stitch in Time Saves Nine"

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Development of Early Psychosis Programs Melbourne, mid-80\'s Buckinghamshire, mid-80\'s North Birmingham UK mid 90\'s Germany, 1990\'s (research1970\'s) USA & Canada, mid 90\'s Scandinavia, mid-90s Switzerland mid - 90s Amsterdam, late 90\'s Australia late 90\'s UK 1999/2000 Far East & South East Asia, 2001 Networks: IEPA & European FE Schizophrenia Network

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Types of Early Intervention Model Option 1: Basis? (CAMHS, Adult, 1° Care, Youth administration) Option 2: Service model? (Authority versus non specific) Specialist EI administrations Stand alone EI administration Hub and Spoke model Piggy-back supplementary EI model Tertiary interview EI administrations/center Generic Based Services Top up with inserted EI laborer/s Top up with EI preparing and clinical rules Research based intercessions Option 3: Degree of group combination Public wellbeing advancement crusades mix with social administrations, training, work, lodging, A&D administrations, administration client organizations

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Aims of an Early Intervention administration Reduce delays (& DUP) by: advancing early discovery and communitarian engagement in the group Optimize appraisal & conclusion by: Comprehensive Bio/psycho/social evaluation Maximize recuperation by: giving coordinated bio/psycho/social group Rx concentrate on practical and also symptomatic variables tending to co-horribleness and treatment resistance early Prevent backslide by: guaranteeing self-assured followup and psychoed. amid basic period

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Intervening to Maximize Recovery & Prevent Relapse Normal advancement Early intercession Prodrome Functioning Assertive follow-up Community Team First scene of psychosis second scene of psychosis 16 20 24 Age

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Optimizing Inpatient Care and Treatment in Early Psychosis? Typical advancement Prodrome Functioning First scene of psychosis second scene of psychosis FEP Inpatient administrations 16 20 24 Age

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Intervening to diminish the Duration of Untreated Psychosis (DUP) Normal improvement Early mediation Functioning Prodrome First scene of psychosis Early discovery & Crisis Assessment Team second scene of psychosis 16 20 24 Age

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Intervening in the Prodrome Phase of Early Psychosis Prodrome center Normal advancement Early intercession Prodrome Functioning First scene of psychosis second scene of psychosis 16 20 24 Age

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Configuration of LEO Service Primary Care insane prodromal OASIS LEO-CAT Prodrome facility Early recognition & emergency evaluation group 2 year follow-up LEO Inpatient Unit LEO Community Team

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Canada\'s Early Intervention Services Newfoundland N&L EPP British Columbia: EP Initiative of British Columbia EPIVMHC,Victoria Vancouver EPIP, White Rock Quebec: Levis Montreal Quebec City Alberta: EPT&PP, Calgary (930,000) Nova Scotia: NSEPP Halifax - Saskatchewan: EIPP, Saskatoon Ontario: PEPP, London FEPP, Toronto Psychotic Disorders U., Hamilton Ottawa FEPP KPP&TP, Kingston Key figures: Jean Addington Bob Zipursky Ashok Malla Lili Kopala

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Early Psychosis Programs in the USA Portland, Maine PIER administration (McFarlane) Salem, Oregon: Early Assessment & Support Team (EAST) (pop 600,000) Managed care financed Yale, New Haven: PRIMHE (T. McGlashan) Bethseda, MD: NIMH research: (Wyatt and so on) New York: Prodrome (Cornblatt) Pittsburg: EI program (Keshevan) LA California: UCLA (Ventura, Neuchterlien and so forth) N. Carolina: FEP & prodrome examines (Lieberman)

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New Zealand\'s Early Intervention Services New Zealand National Early Intervention Group Auckland : EPI Center, Kari Center, Taylor Center, Manaaki CMHT - FEP, St Lukes FEP, Hartford House EPI, Campbell group Lodge EI group Wellington : Wellington EI administration (400,000) Christchurch : Tatara House EIP administration (380,000) Dunedin : Aspiring House EI administration (150,000) . . . . .

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Early Psychosis Programs in Australia National Early Psychosis Project (based at EPPIC) Queensland: Uni of Brisbane concentrates New South Wales: YPPI administration, Gosford EP program, Marouba EP program, North Sydney EPIP-SWAHS, Liverpool EPIC, Penrith Western Sydney FEPP . . . . Western Australia: First Psychosis Liaison Unit, Bentley EPOES, Fremantle EEPP, Rockingham/Kwinana . . ACT: Canberra EI administration . . South Australia: Noarlunga EP Program Victoria: EPPIC Dandenong EP Program, Alfred Hosp. Focal East EP Project

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EPPIC administration Western Region of Melbourne (pop = 850,000) 4 parts Inner West: (145,000) North West: (266,700) Mid west: (208,000) South West: (237,600) (Each segment has 20 CCU beds for long-stay patients) 21 Western Melbourne 24 EPPIC 16 21 24 South west Area = Acute grown-up = EPPIC beds

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Overview of Mental Health Services For Kids & Youth Western Region of Melbourne (800,000) Youth Assessment Team Prodrome PACE Clinic Non-crazy Ages 15 - 19 Psychotic Ages 15-30 Older Adolescent Service (follow-up to age 19) EPPIC (18 month development) Acute Inpatient Care Day Group Program Family work Cognitive Therapies Outpatient Case Management Intensive Outreach Support

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PACE Treatment Trial (Phillips et al 2000, McGorry et al, 2002) (n= 59) Transition Rate to Psychosis RCT of CBT + low measurements Risperidone X 6/12 versus steady psychosocial treatment (NSI) Both gatherings ~ half got SSRIs Those completely consistent with Risperidone managed most noteworthy security at 6 months (5.6%) and follow-up after meds stopped 2 suicides in refusal bunch (n=33) (N=28) 35.7% (N=31) 9.7% P = 0.026 Fisher Exact test

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South East Asian Early Psychosis Network South Korea Tokyo, Osaka Hong Kong : EASY - 4 groups spread 7M (Eric Chen et al) Singapore: EPIP 1 group covers 4 M (S. Chong et al) Palau, Miconesia (South Africa)

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Swiss Early Psychosis Programs Bern : Uni Hosp. of Social & Comm. Psych. (Gekle) (Merlo - moved to Geneva) Geneva & Zurich: Swiss Early Psychosis Project SWEPP (Simon, Umbricht & Merlo) Basil : Uni Hosp. Basil: Basil FEPSY screening study (Gschwandtner et al)

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German Early Psychosis Programs Dusseldorf: RCT of mental Rx in FEP (Klinberg) . . Heidelberg: Heidelberg Early Adolescent & Adult Recognition & Therapy Center for Psychosis (HEART) EI administration since 1994 (Franz Resch et al) . Cologne: Cologne early Recognition study (Klosterkotter, Schultze-lutter et al) . . . Bonn: Prodrome Rx (Hambrecht et al) Vienna, Austria: Adolescent EI program at University Hosp. of Vienna (Amminger, Edwards) Mannheim: Central Insitute of Mental Health (Hafner, Maurer et al)

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Scandinavian Early Psychosis Services Finland : Turku: Detection of early Psychosis venture (Suomela et al) Norwegian Services : TIPS - Roskilde/Stravanger (Larsen, Johannessen and so on) UNA-projektet, Oslo EOP, Skien Swedish Services : Parachute Project (1.5 M), Stockholm Sodertalja Psykiatriska Sektor, Sodetalje TUPP Project, Stockholm (Cleland) Control DUP middle (weeks)

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OPUS study (Nordentoft et al ) RCT of Assertive Community Follow-up in First Episode Psychosis 582 patients (18 - 45 year olds) with non full of feeling first scene psychosis Mean Bed days/persistent % cases with mod/serious side effects (p <0.05) The cost put something aside for in-patient consideration/year = € 600,000 for 100 patients = wages of 10 staff Merete Nordentoft, Bispebjerg Hospital, Department of Psychiatry, 2004

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Dutch & Belgian EI Programs Netherlands: Academic Medical Center (Don Linszen) University of Maastricht: NEMESIS (Van Os, J.) University Med Center, Utrecht (Dutch Prediction of Psychosis Study-DUPS) Belgian Projects : PECC (Janssen-Cilag) Other European Projects: European Prediction of Psychosis (EPOS) study (6 focuses: Birmingham, Amsterdam, Cologne, Turku, Santander, Dannstadt) Dublin: SJOG Hospital (E. O\'Callaghan) Bordeaux: (Helen Verdoux) Barcelona, Madrid, Santander: 4 prodrome research programs Lisbon: arranging EI administration Eastern European, Russian & Middle East: examine programs & plans for administrations

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Early Intervention Services in England Edinburgh YPU @ Royal Edinburgh Hosp. Edinburgh High Risk study (E. Johnstone) Glasgow: EI administration (A Blair) NHS arrangement: PIG IRIS: Newcastle assertion 50 groups by 2005 -23 EI groups to date EI groups include: North Birmingham EI administration LEO & OASIS administration Plymouth administration Manchester Tower Hamlets ETHOS COAST Sheffield EI administration STEPS, Poole £1M

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RCT of LEO Community Team Engagement with Services at year and a half (N=138) % Clients as yet going to at year and a half At 6 months: African Caribbean engagement: = 89% versus 27 %: LEO versus Control p<0.02 (Craig et al, 2004)

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Adherence to recommended antipsychotic prescription more than 6 months 1 Proportion taking drug 0.61 LEO 0.5 0.28 OTHER 0 1 3 4 5 6 2 Months post randomisation (Craig et al, 2004)

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LEO Trial Results Relapse at year and a half, from full or fractional recuperation (N=122) Significant better upgrades @ year and a half development: : Positive and Negative side effects Insight & treatment adherence GAF score Satisfaction with administrations % of customers who backslid p<0.05 (Craig, Garety et al, 2004)

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Hospitalization rates for LEO patients LEO Ward opens (n=73) (n=71) (n=63) (n=73) (n=156) Control bunch (standard consideration) LEO Trial Group Inter study LEO bunch % LEO patients conceded first LEOCAT Trial 2000 - 2001 - 2003 - 2004-2005

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Discharges Destinations following 2 years Follow-up with LEO (n=269) 136 LEO customers released to date: 37 to Out of Area administrations 17 abroad 20 extra customers late release 14 holding up CMHT exchange

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Economic Benefits of Intervening Early: Comparison of LEO versus Evaluation of S

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