Early Detection, Intervention Prevent Conversion to Psychosis

Megan Brooks

May 22, 2013

SAN FRANCISCO — Identifying young people at high risk for psychosis and providing rapid access to multifaceted treatment is highly effective in preventing a first episode of psychosis, new research shows.

A unique program developed by investigators at the Center for Psychiatric Research at Maine Medical Center in Portland significantly reduced hospitalization rates for initial psychosis by one third.

"What's most exciting is that we seemed to have developed not only a method for finding these kids but also offering them a treatment rehabilitation program that keeps them engaged in life and prevents conversion to psychosis," William R. McFarlane, MD, director of the Center for Psychiatric Research, who presented the research, told Medscape Medical News.

The study was presented here at the American Psychiatric Association's 2013 Annual Meeting.

"Remarkably" Successful

Developed by Dr. McFarlane and colleagues, the goal of the Portland Identification and Early Referral (PIER) multidisciplinary program is to identify individuals at very early stages of the illness and provide them and their families with a multidimensional treatment approach designed to delay or prevent onset of an acute psychotic disorder.

"PIER trained over 7300 health, education, and youth-related professionals to identify young people age 12 to 25 years at high risk for psychosis within and throughout a defined catchment area — greater Portland, Maine," Dr. McFarlane said.

"We quickly learned that with an hour or 2 of training, these people could relatively accurately identify young people at risk for psychosis. It's pretty easy to identify psychosis, but the earlier stages are more difficult," he added.

As part of the program, at-risk youth, identified with the Structured Interview for the Prodromal Syndromes (SIPS), are offered a comprehensive package of treatment consisting of family education, assertive community treatment, supported education/employment, and low-dose psychotropic medication.

"None of these things are new. They've all been adapted and tested in psychosis, and so there was every reason to believe they would be effective in these early stages of illness," Dr. McFarlane said.

And they were. "The bottom line is it's been remarkably successful. In Portland, we have lowered hospitalizations for initial psychosis by about 32%," said Dr. McFarlane.

Program Replicated

The success of the PIER program has been replicated in 5 other locations across the country. Outside of Portland, Maine, the program is called the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP).

"The other 5 sites for the most part were able to replicate the Portland findings quite precisely, which is remarkable," Dr. McFarlane said.

In a combined analysis looking at all 6 sites, rates of conversion to psychosis were "almost identical" between a prodromal group and a control group, Dr. McFarlane said.

Perhaps the "most meaningful finding," he said, "is that about 83% of the young people in the study at risk for psychosis were working or in school, and at the end of the study 2 years later, 83% were still working or in school."

Dr. McFarlane said that 5 counties in California now have an EDIPPP up and running, and they are "turning in results identical to ours. It's not that easy to implement, there is a lot of training involved, but it looks like results can be replicated."

The University of California, Davis (UC Davis), has an EDIPPP, and Cameron S. Carter, MD, professor of psychiatry and psychology and director of the Center for Neuroscience and the Imaging Research Center at UC Davis is involved it.

"As predicted, the EDIPPP intervention led to an improved clinical outcome in the intervention group...at our site in California with its rich cultural diversity," Dr. Carter told Medscape Medical News.

"This is consistent with other data from studies around the world and supports the conclusion that this approach to prevention and early intervention for psychosis is generalizable to a broad range of communities and can lead to better outcomes for young people experiencing distressing symptoms that place them at increased risk for serious mental illness," he said.

Dr. McFarlane said that early detection and intervention for psychosis "is a little bit like what's happening with cancer and heart disease. We've done a very poor job of curing cancer and heart disease, but we've had spectacular success with early intervention in cancer, and now heart disease too, with dropping rates in both areas."

The PIER program and EDIPPP are sponsored by the Robert Wood Johnson Foundation. The authors report no relevant financial relationships.

The American Psychiatric Association's 2013 Annual Meeting. Abstracts SCR33-3 and SCR33-4. Presented May 22, 2013.

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