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What needs to follow early intervention? Predictors of relapse and functional recovery following first-episode psychosis

Authors

  • Shi Mei Kam,

    1. College of Medical and Dental Sciences, The University of Birmingham
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  • Swaran P. Singh,

    1. Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham
    2. Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, UK
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  • Rachel Upthegrove

    Corresponding author
    1. College of Medical and Dental Sciences, The University of Birmingham
    2. Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham
    • Corresponding author: Dr Rachel Upthegrove, College of Medical and Dental Sciences, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Email: r.upthegrove@bham.ac.uk

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Abstract

Aim

As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis (FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning.

Method

An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service (EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning.

Results

Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive ‘Not in Education Employment or Training’ status at end-point include being in a minority ethnic group, substance misuse and number of relapses.

Conclusions

Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery.

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