Assertive outreach for "difficult to engage" patients: A useful tool for a subgroup of patients in specialized early psychosis intervention programs

Luis Alameda; Philippe Golay; Philipp Baumann; Stéphane Morandi; Carina Ferrari; Philippe Conus; Charles Bonsack

doi:10.1016/j.psychres.2016.03.010

Assertive outreach for "difficult to engage" patients: A useful tool for a subgroup of patients in specialized early psychosis intervention programs

Psychiatry Res. 2016 May 30:239:212-9. doi: 10.1016/j.psychres.2016.03.010. Epub 2016 Mar 5.

Authors

Luis Alameda¹, Philippe Golay², Philipp Baumann³, Stéphane Morandi⁴, Carina Ferrari³, Philippe Conus⁵, Charles Bonsack⁴

Affiliations

¹ Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland. Electronic address: Luis.alameda-fernandez@chuv.ch.
² Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland; Service of community Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland.
³ Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland.
⁴ Service of community Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland.
⁵ Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland.

PMID: 27016880
DOI: 10.1016/j.psychres.2016.03.010

Abstract

Purpose: Most specialized Early Psychosis (EP) programs include assertive outreach (AO) principles, either for all patients or as an intensive case management (ICM) subprogram in selected situations. The objective of this study is to examine prevalence, characteristics and outcomes of patients who needed additional ICM in a specialized EP program.

Methods: In a 3-year prospective naturalistic study of 229 consecutive EP patients treated at TIPP-Lausanne we compared characteristics of those who needed ICM and those who did not.

Results: 60 (26.2%) TIPP patients needed ICM. At baseline, ICM-patients showed a poorer academic premorbid functioning (p=0.019); lower level of insight (p<0.001); had a previous history of alcohol (p=0.043) and cannabis (p=0.040) use. ICM-patients were less likely to be adherent to medication during the early phase of treatment but differences disappeared during follow-up. ICM-patients showed globally a poorer functional level and higher level of positive and negative symptoms during the follow-up.

Conclusions: About one quarter of EP patients needed a combination of ICM and assertive outreach. Despite the high treatment adherence in both groups, psychotic symptoms remained higher in ICM-patients. In a real live setting with limited resources, combination of ICM and AO in selected situations seems a valid solution.

Keywords: Assertive community treatment; Early psychosis; First episode psychosis; Outcome; Prospective; Psychosocial interventions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Case Management*
Community Mental Health Services / methods*
Female
Humans
Male
Outcome Assessment, Health Care*
Professional-Patient Relations*
Prospective Studies
Psychotic Disorders / psychology
Psychotic Disorders / therapy*
Young Adult