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Published Online: 1 October 2014

Reduction in Incidence of Hospitalizations for Psychotic Episodes Through Early Identification and Intervention

Abstract

First hospital admissions for psychosis dropped by one-third among young residents of Portland, Maine, following the introduction of an aggressive early intervention program that involves the whole city. Since 2001, the Portland Identification and Early Referral program has trained more than 7,200 local physicians, school and college counselors, community mental health practitioners, and community agency staff to recognize youths at high risk for psychosis and refer them to family-aided assertive community treatment. The authors are currently testing the same system in six cities with more diverse populations.

Abstract

Objective

This study examined whether the incidence of hospitalization for psychosis was reduced by a communitywide system of early identification and intervention to prevent onset of psychosis.

Methods

The Portland Identification and Early Referral program (PIER) was initiated in 2001. Youths and young adults ages 12–35 were identified by professionals in a wide variety of educational, health, and mental health settings. PIER program staff assessed, confirmed risk of psychosis, and provided treatment for 24 months to eligible and consenting young people (N=148). The monthly rate of first hospital admission for psychosis was the outcome measure for efficacy of identification and intervention. Admission rates before and after the program began accepting referrals were compared, both in the experimental area (Greater Portland) and in aggregated urban areas of Maine (control areas). Autoregressive integrated moving-average (ARIMA) models were used to assess the effect.

Results

On the basis of ARIMA models, the rate of first hospital admission for psychosis decreased significantly by 26% (95% confidence interval [CI]=–64% to –11%) in the Greater Portland area. The rate increased by 8% (CI=–5% to 36%) in the control areas. Taking into account the increase in the control areas, the actual percentage reduction in Greater Portland during the intervention period was 34% (26% plus 8%). The reduction in admissions was largest for individuals with nonaffective nonschizophrenic psychosis.

Conclusions

PIER has demonstrated that populationwide early identification is feasible. Preventive intervention can reduce rates of initial hospitalizations for psychosis in a midsized city.

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Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Shamrock Ranch, by Peter Hurd, 1962. Watercolor, 12 × 16 inches. New Mexico Museum of Art, Santa Fe. Gift of the family of Edythe C. Mattone, 2005.

Psychiatric Services
Pages: 1194 - 1200
PubMed: 24632857

History

Published online: 1 October 2014
Published in print: October 2014

Authors

Details

William R. McFarlane, M.D.
Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: [email protected]). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.
Ezra Susser, M.D., Dr.P.H.
Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: [email protected]). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.
Richard McCleary, Ph.D.
Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: [email protected]). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.
Mary Verdi, M.A.
Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: [email protected]). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.
Sarah Lynch, L.C.S.W.
Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: [email protected]). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.
Deanna Williams, B.S.
Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: [email protected]). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.
Ian W. McKeague, Ph.D.
Dr. McFarlane, Ms. Verdi, Ms. Lynch, and Ms. Williams are with the Maine Medical Center Research Institute, Portland (e-mail: [email protected]). Dr. Susser and Dr. McKeague are with the Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York City. Dr. McCleary is with the School of Social Ecology, University of California, Irvine. Results of this study were presented at the International Early Psychosis Conference, San Francisco, October 11–13, 2012, and at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.

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