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First episode psychosis in the over 35 s: is there a role for early intervention?
Philippa Greenfield1, Snehita Joshi1, Suneel Christian1
1Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.
Insights
Extending early intervention (EI) services to individuals over 35 with first episode psychosis (FEP) significantly increases workload. While some patients show recent onset, evidence on EI effectiveness in this older demographic is needed.
Area of Science:
- Psychiatry
- Clinical Psychology
- Public Health
Background:
- Early intervention (EI) models have demonstrated efficacy in improving outcomes for younger individuals experiencing psychosis.
- There is growing interest in adapting EI for older populations, aligning with UK National Institute of Clinical Excellence recommendations for first episode psychosis (FEP) accessibility.
Purpose of the Study:
- To investigate the potential impact of extending the age range for early intervention services on clinical workloads and patient populations.
- To explore the characteristics and outcomes of individuals aged 36-65 referred to an early intervention service.
Main Methods:
- Retrospective data collection from an inner London early intervention service (2011-2014).
- Inclusion of all patients aged 36-65 years referred during the study period.
- Utilized the MiData 2 tool for data collection at intake and 1-year follow-up.
Main Results:
- Individuals aged 36-65 constituted 30% of all referrals.
- The sample exhibited high rates of past trauma (62.5%), parental responsibilities (58.3%), and physical comorbidities (48.6%).
- While inpatient admission rates were lower than in younger cohorts, only 15% achieved full remission after a single episode.
Conclusions:
- Expanding early intervention services to individuals over 35 substantially increases service workload.
- A significant proportion of older referrals presented with recent onset of illness, suggesting potential benefit from early intervention.
- Further research is required to establish the effectiveness of early intervention models for psychosis in this older age group.
Aim:
The early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range.
Methods:
Data were collected on all patients aged 36-65 years who were referred to an inner London EI service from 2011-2014 using the MiData 2 tool at entry and at 1-year follow up.
Results:
People aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1-year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission.
Conclusions:
These findings indicate that admitting over 35-year-olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.
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