Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort

Conus, Philippe; Lambert, Martin; Cotton, Sue; Bonsack, Charles; McGorry, Patrick D; Schimmelmann, Benno G

doi:10.1016/j.schres.2010.01.032

« Previous Next »Schizophrenia Research
Volume 118, Issue 1 , Pages 256-263, May 2010

Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort

Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département Universitaire de Psychiatrie Adulte, Université de Lausanne, Clinique de Cery, Switzerland
- Orygen Youth Health and Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Corresponding author. Département Psychiatrie CHUV, Teatment and Early Intervention in Psychosis Program (TIPP), Clinique de Cery, 1008 Prilly, Switzerland. Tel.: +41 21 643 61 11; fax: +41 21 643 64 69.
Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Centre for Psychosocial Medicine, Department for Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany
Sue Cotton
- Orygen Youth Health and Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
Charles Bonsack
- Treatment and Early Intervention in Psychosis Program (TIPP), Département Universitaire de Psychiatrie Adulte, Université de Lausanne, Clinique de Cery, Switzerland
Patrick D McGorry
- Orygen Youth Health and Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
Benno G Schimmelmann
- Child and Adolescent Psychiatry, University of Bern, Switzerland

Received 29 October 2009; received in revised form 13 January 2010; accepted 29 January 2010. published online 08 March 2010.

Abstract

Objectives

To assess the prevalence and predictors of service disengagement in a treated epidemiological cohort of first-episode psychosis (FEP) patients.

Methods

The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 786 FEP patients from January 1998 to December 2000. Treatment at EPPIC is scheduled for 18months. Data were collected from patients' files using a standardized questionnaire. Seven hundred four files were available; 44 were excluded, because of a non-psychotic diagnosis at endpoint (n=43) or missing data on service disengagement (n=1). Rate of service disengagement was the outcome of interest, as well as pre-treatment, baseline, and treatment predictors of service disengagement, which were examined via Cox proportional hazards models.

Results

154 patients (23.3%) disengaged from service. A past forensic history (Hazard ratio [HR]=1.69; 95%CI 1.17–2.45), lower severity of illness at baseline (HR=0.59; 95%CI 0.48–0.72), living without family at discharge (HR=1.75; 95%CI 1.22–2.50) and persistence of substance use disorder during treatment (HR=2.30; 95%CI 1.45–3.66) were significant predictors of disengagement from service.

Conclusions

While engagement strategies are a core element in the treatment of first-episode psychosis, particular attention should be paid to these factors associated with disengagement. Involvement of the family in the treatment process, and focusing on reduction of substance use, need to be pursued in early intervention services.

Keywords: First-episode psychosis, Disengagement, Treatment adherence, Schizophrenia