Early Intervention: The International Perspective Paddy Power "A Stitch in Time Saves Nine"Slide 2
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 NetworkSlide 3
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 organizationsSlide 4
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 periodSlide 5
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 AgeSlide 6
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 AgeSlide 7
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 AgeSlide 8
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 AgeSlide 9
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 TeamSlide 10
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 KopalaSlide 11
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)Slide 12
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) . . . . .Slide 13
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 ProjectSlide 14
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 bedsSlide 15
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 SupportSlide 16
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 testSlide 17
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)Slide 18
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)Slide 19
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)Slide 20
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)Slide 21
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, 2004Slide 22
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 administrationsSlide 23
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 £1MSlide 24
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)Slide 25
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)Slide 26
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)Slide 27
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 - 2004-2005Slide 28
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 exchangeSlide 29
Economic Benefits of Intervening Early: Comparison of LEO versus Evaluation of S
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