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Retrospective study of first episode psychosis in the Dublin Southwest Mental Health Service: demographics, clinical profile and service evaluation of treatment

Published online by Cambridge University Press:  12 September 2017

A.-M. Clarke ,
P. McLaughlin ,
J. Staunton ,
K. Kerins ,
B. Power ,
K. Kearney ,
M. McGuinness  and
P. Whitty
A.-M. Clarke*
Affiliation:
Department of Psychiatry, Tallaght Hospital, Tallaght, Dublin, Ireland
P. McLaughlin
Affiliation:
Lewisham Promoting Recovery, South London and Maudsley NHS Foundation Trust, London, UK
J. Staunton
Affiliation:
Ballyfermot Mental Health Team, Cherry Orchard, Dublin, Ireland
K. Kerins
Affiliation:
Linn Dara, Child & Adolescent Mental Health Services, Cherry Orchard Hospital Campus, Ballyfermot, Dublin, Ireland
B. Power
Affiliation:
Ballyfermot Mental Health Team, Cherry Orchard, Dublin, Ireland
K. Kearney
Affiliation:
Mental Health, Roscommon Primary Care, Roscommon, Ireland
M. McGuinness
Affiliation:
Linn Dara, Child & Adolescent Mental Health Services, Cherry Orchard Hospital Campus, Ballyfermot, Dublin, Ireland
P. Whitty
Affiliation:
Department of Psychiatry, Tallaght Hospital, Tallaght, Dublin, Ireland
*
*Address for correspondence: Dr A.-M. Clarke, Department of Psychiatry, Tallaght Hospital, Tallaght, Dublin 24, Ireland (Email: [email protected])
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Abstract

Objective

In Ireland, National Clinical Programmes are being established to improve and standardise patient care throughout the Health Service Executive. In line with internationally recognised guidelines on the treatment of first episode psychosis the Early Intervention in Psychosis (EIP) programme is being drafted with a view to implementation by mental health services across the country. We undertook a review of patients presenting with a first episode of psychosis to the Dublin Southwest Mental Health Service before the implementation of the EIP. This baseline information will be used to measure the efficacy of our EIP programme.

Methods

Patients who presented with a first episode psychosis were retrospectively identified through case note reviews and consultation with treating teams. We gathered demographic and clinical information from patients as well as data on treatment provision over a 2-year period from the time of first presentation. Data included age at first presentation, duration of untreated psychosis, diagnosis, referral source, antipsychotic prescribing rates and dosing, rates of provision of psychological interventions and standards of physical healthcare monitoring. Outcome measures with regards to rates of admission over a 2-year period following initial presentation were also recorded.

Results

In total, 66 cases were identified. The majority were male, single, unemployed and living with their family or spouse. The mean age at first presentation was 31 years with a mean duration of untreated psychosis of 17 months. Just under one-third were diagnosed with schizophrenia. Approximately half of the patients had no contact with a health service before presentation. The majority of patients presented through the emergency department. Two-thirds of all patients had a hospital admission within 2 years of presentation and almost one quarter of patients had an involuntary admission. The majority of patients were prescribed antipsychotic doses within recommended British National Formulary guidelines. Most patients received individual support through their keyworker and family intervention was provided in the majority of cases. Only a small number received formal Cognitive-Behavioural Therapy. Physical healthcare monitoring was insufficiently recorded in the majority of patients.

Conclusions

There is a shortage of information on the profile and treatment of patients presenting with a first episode of psychosis in Ireland. This baseline information is important in evaluating the efficacy of any new programme for this patient group. Many aspects of good practice were identified within the service in particular with regards to the appropriate prescribing of antipsychotic medication and the rates of family intervention. Deficiencies remain however in the monitoring of physical health and the provision of formal psychological interventions to patients. With the implementation of an EIP programme it is hoped that service provision would improve nationwide and to internationally recognised standards.

Keywords

Demographicearly interventionIrelandoutcomespsychosis
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 36 , Issue 4: Psychosis: from early intervention to treatment resistance , December 2019 , pp. 249 - 258
Copyright
© College of Psychiatrists of Ireland 2017 

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Footnotes

†

Joint first authorship.

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