The development of the Early Intervention in Psychosis (EIP) outpatient unit of Eginition University Hospital into an EIP Network

Over the past 25 years, in the field of psychosis there is an increased interest in early detection of symptoms and treatment provision for people who are either at Ultra High Risk (UHR) of developing psychosis or with First Episode Psychosis (FEP). Extensive research has proved, that by engaging quickly into treatment and addressing the needs of each case individually, clinical outcomes could be improved substantially. The above evidence-based argument has resulted in the establishment of specialized Early Intervention in Psychosis (EIP) services worldwide. Eginition University Hospital (EUH) in Athens has been providing care for Early Psychosis through a specialized outpatient EIP service since 2012, which receives all early psychosis cases. Initially clinical focus was mainly directed towards UHR cases, since EUH had long been providing standard care for FEP. However, over the last 4 years, the EIP Unit has evolved incrementally into a network of directly linked services, involving the EIP outpatient service, an Inpatient Unit for prompt hospitalization and a Day Clinic for partial hospitalization, to address acute treatment, follow-up and recovery/relapse prevention phases. Diagnostic evaluation is made through specialized instruments along with the typical psychiatric interview. The therapeutic approach follows the international guidelines for EIP, namely symptom-based and phase-specific treatment, which includes supportive counselling, coping strategies and psychoeducation both for subjects and family members, as well as pharmacotherapy when needed and preferably in low doses. Regarding our results, in the first 3 years (3/2012-3/2015) the EIP unit received 26 (60%) UHR subjects and 17 (40%) FEP patients. Over the last 4 years (3/2015-3/2019) the referrals rose to 167 with 35 (21%) UHR and 132 (79%) FEP cases. All of the UHR subjects were from the outset followed by the specialized outpatient EIP service for up to 3 years. As to the FEP patients, seventy-seven (60%) were acutely hospitalized for less than a month, and 10 (8%) attended the Day Clinic for 6 - 12 months, before being referred to the outpatient service. Concluding, the development of the EIP network of specialized services has cohesively enabled a broader therapeutic framework, shifting the clinical focus towards FEP, although UHR subjects are still being assessed systematically. However, there is still considerable work to be done, in order to enhance the full potential of all units and promote the interconnection with potential community settings.