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Yee A, Greene S, Weiss A, Chaudhry S, Steadman S. Hospitalization and help-seeking among first episode psychosis patients. Discov Ment Health 2024; 4:10. [PMID: 38568391 PMCID: PMC10992493 DOI: 10.1007/s44192-024-00064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To examine hospitalization as part of a complex pathway to care in first episode psychosis (FEP), exploring help-seeking episodes (HSE) and their relationship to hospitalization. METHODS Data from 66 patients at the Early Psychosis Intervention Clinic New Orleans (EPIC-NOLA), a coordinated specialty care (CSC) clinic, was obtained from Pathways to Care (PTC) assessments, which documents elements of help seeking. A chart review was performed identifying hospitalizations. RESULTS Most patients were hospitalized multiple times (n = 37, M = 2.98, SD = 2.14). On average, patients had more hospitalizations prior to starting treatment at EPIC-NOLA (M = 1.72, SD = 1.35) than after (M = 1.27, SD = 1.79). Patients whose first HSE resulted in intake at EPIC-NOLA were significantly less likely to be hospitalized after intake than patients with multiple HSE (F(1,52.3) = 12.9, p < .001). There was a significant correlation (N = 42) between HSE and hospitalizations after intake (τb = .327 p < .05); patients seeking help more often were more likely to be hospitalized after intake. No significant correlations were found between duration of untreated psychosis (DUP) and hospitalization. CONCLUSION While results are correlational, several key relationships were noted. Fewer hospitalizations occurred after intake into EPIC-NOLA. Starting treatment after the first HSE was related to fewer future hospitalizations, compared to intake after multiple HSEs. Intake into a CSC clinic after a single HSE may reduce hospitalization. Additionally, increased HSE, not DUP, impacted patients' likelihood of hospitalization. This prompts treatment engagement during a first HSE to reduce hospitalization.
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Affiliation(s)
- Anna Yee
- School of Medicine, Tulane University, New Orleans, LA, USA.
| | - Sarah Greene
- School of Medicine, Tulane University, New Orleans, LA, USA
| | - Ashley Weiss
- School of Medicine, Tulane University, New Orleans, LA, USA
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Anderson KK, Rodrigues R. Differences in clinical presentation at first hospitalization and the impact on involuntary admissions among first-generation migrant groups with non-affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1329-1341. [PMID: 36922459 DOI: 10.1007/s00127-023-02465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Some migrant and ethnic minority groups have a higher risk of coercive pathways to care; however, it is unclear whether differences in clinical presentation contribute to this risk. We sought to assess: (i) whether there were differences in clinician-rated symptoms and behaviours across first-generation immigrant and refugee groups at the first psychiatric hospitalization after psychosis diagnosis, and (ii) whether these differences accounted for disparities in involuntary admission. METHODS Using population-based health administrative data from Ontario, Canada, we constructed a sample (2009-2013) of incident cases of non-affective psychotic disorder followed for two years to identify first psychiatric hospitalization. We compared clinician-rated symptoms and behaviours at admission between first-generation immigrants and refugees and the general population, and adjusted for these variables to ascertain whether the elevated prevalence of involuntary admission persisted. RESULTS Immigrants and refugee groups tended to have lower ratings for affective symptoms, self-harm behaviours, and substance use, as well as higher levels of medication nonadherence and poor insight. Immigrant groups were more likely to be perceived as aggressive and a risk of harm to others, and both groups were perceived as having self-care issues. Adjustment for perceived differences in clinical presentation at admission did not attenuate the higher prevalence of involuntary admission for immigrant and refugee groups. CONCLUSIONS First-generation migrant groups may differ in clinical presentation during the early course of psychotic illness, although these perceived differences did not explain the elevated rates of involuntary admission. Further research using outpatient samples and tools with established cross-cultural validity are warranted.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada.
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
- ICES, London, ON, Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada
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Wiener JC, Rodrigues R, Reid JNS, Archie S, Booth RG, Cheng C, Jan SH, Kurdyak P, MacDougall AG, Palaniyappan L, Ryan BL, Anderson KK. Patient and Physician Factors Associated with First Diagnosis of Non-affective Psychotic Disorder in Primary Care. Adm Policy Ment Health 2023; 50:212-224. [PMID: 36403173 DOI: 10.1007/s10488-022-01233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/21/2022]
Abstract
Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate that primary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. For physicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be provided to support them in caring for patients with early psychosis.
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Affiliation(s)
- Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. .,Western Centre for Public Health and Family Medicine, 1465 Richmond Street, London, ON, N6G 2M1, Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Suzanne Archie
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Richard G Booth
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Chiachen Cheng
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Saadia Hameed Jan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Paul Kurdyak
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Arlene G MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Robarts Research Institute, Western University, London, ON, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Paschalidou A, Anastasaki M, Zografaki A, Krasanaki CK, Daskalaki M, Chatziorfanos V, Giakovidou A, Basta M, Vgontzas AN. Mobile Mental Health Units in Heraklion Crete 2013–2022: Progress, Difficulties and Future Challenges. Psych 2022; 5:26-37. [DOI: 10.3390/psych5010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Mobile mental health units (MMHUs) have been proposed as an effective model to serve the mental health needs of remote underserved areas. In 2013, the Department of Psychiatry, University of Crete, started a pilot MMHU to cover the needs of remote rural areas of the Heraklion Prefecture. The main objectives were early detection, prevention and therapy of patients with severe psychiatric disorders, without access to regular psychiatric care. In addition to regular visits to primary care health centers, a community support network was established. During this 10-year period, the MMHU has evaluated 3343 patients and performed 19,935 visits. The most frequent diagnoses are depression and anxiety (52.7%) whereas psychosis and bipolar disorders are the third (12.7%) and fifth most frequent diagnoses (4.7%). Half of the patients with depression/anxiety were older than 65 years and one third were living alone. Furthermore, the first visit with the MMHU of severely mentally ill was about 15 years later from the self-reported onset of psychotic symptoms. We discuss how to improve our ability to detect and intervene earlier in patients with severe mental illness, and how to address effectively, both pharmacologically and psychosocially, the depression and loneliness of older individuals living in small remote communities.
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Rotenberg M, Tuck A, Anderson KK, McKenzie K. The Incidence of Psychotic Disorders and Area-level Marginalization in Ontario, Canada: A Population-based Retrospective Cohort Study. Can J Psychiatry 2022; 67:216-225. [PMID: 33896210 PMCID: PMC8935600 DOI: 10.1177/07067437211011852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario. METHODS We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices. RESULTS There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs. CONCLUSIONS There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration.
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Affiliation(s)
- Martin Rotenberg
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada.,Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Maguire J, Sizer H, Mifsud N, O'Donoghue B. Outcomes for migrants with a first episode of psychosis: A systematic review. Schizophr Res 2020; 222:42-48. [PMID: 32561236 DOI: 10.1016/j.schres.2020.05.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Migrants are at a greater risk of developing a psychotic disorder, but knowledge about their outcomes has not yet been collated. We reviewed the literature concerning outcomes (symptomatic, functional, morbidity and mortality and service utilisation) for migrants with first-episode psychosis. Medline, EMBASE and PsycINFO were systematically searched for studies whose population included first- or second-generation migrants with first-episode psychosis, where outcome measures were examined after a minimum follow-up period of 6 months. Fourteen of the 1554 articles identified in the search fulfilled the inclusion criteria. Remission and disengagement rates in migrants were equal or greater than those in non-migrants. Migrants experienced more negative and fewer positive symptoms at follow-up. Functioning scores varied, with studies reporting lower, equivalent or higher functioning at follow-up for migrants. Migrants were less likely to die by suicide compared to native-born individuals affected by first-episode psychosis. Most included studies showed greater rates of involuntary hospitalisation among migrant populations but there were mixed findings regarding number of hospitalisations. Level of insight at follow-up and occupational outcomes for migrants was not found to be different than for non-migrants. No studies were identified which examined relapse rates or physical health outcomes. Migrants affected by psychotic disorders have been shown to be more likely to achieve remission, and often experience higher rates of involuntary admission and disengagement. For all other outcomes, migrants have largely similar outcomes to native-born populations.
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Affiliation(s)
- James Maguire
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Holly Sizer
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Nathan Mifsud
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
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