Subthreshold psychotic symptoms before a first episode: Do they play a significant role in service engagement?

Poster A117, Monday, October 8, 11:30 am - 1:00 pm, Essex Ballroom

Jean-Gabriel Daneault1,2, Anika Maraj2, Rachel Rosengard2, Anne Crawford2, Sally Mustafa2, Martin Lepage2, Srividya Iyer2, Ashok Malla2, Jai Shah2; 1Clinique J.-P. Mottard, Hôpital en santé mentale Albert-Prévost, Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada, 2Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Québec, Canada

Most patients experience subthreshold psychotic symptoms (STPS+) before onset of first episode psychosis (FEP), while a significant portion do not (STPS-). These pre-onset states are associated with differential outcomes over treatment. However, we lack explanations for why outcomes might vary between these two groups. In this analysis, we explored whether dimensions of service engagement might explain these differences. 303 FEP participants were included in a time-to-event analysis with Cox proportional hazards regression models. STPS status, sociodemographic and early clinical variables were tested as predictors of medication adherence over 24 months. We also examined other dimensions of engagement (alliance, attendance, adherence to treatment, and preparation) using exploratory and confirmatory factor analysis with data from 179 FEP participants to identify underlying factor structure. Composite scores were compared between STPS+ and STPS- groups over time. Overall, 75.5% of participants were nonadherent at some point. Adherence was poorer in FEP participants who had experienced STPS+, although with no difference in the mean time to nonadherence. Greater severity of positive symptoms (HR 0.987), stronger alliance (HR 0.970) and involvement of relatives (HR 1.803) were significant predictors of poor medication adherence. However, predictors of medication nonadherence differed between STPS+ and STPS- subgroups. Using multidimensional service engagement data, a two-factor structure for engagement was identified: alliance and availability. In contrast to medication adherence, these two factors were not different between STPS+ and STPS- subgroups. FEP programs should continue to emphasize the development of therapeutic alliance and involvement of relatives to optimize medication adherence and improve outcomes.

Topic Area: Psychopharmacology

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