Cases, Non-Cases, or Non-Non-Cases: An Examination of Spillover Effects of a Targeted Early Identification Intervention for First Episode Psychosis
Poster C110, Wednesday, October%2010, 11:30%20am%20-%201:00%20pm, Essex%20Ballroom
Sarah McIlwaine1,2, Gerald Jordan1,2, Marita Pruessner2,3, Miriam Kinkaid1,2, Karen Goldberg2, Srividya Iyer1,2, Ridha Joober1,2, Ashok Malla1,2, Jai Shah1,2; 1Department of Psychiatry, McGill University, Montreal, Québec, Canada, 2Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada, 3Department of Clinical Psychology, University of Konstanz, Konstanz, Germany
PURPOSE: Targeted case identification (TCI) efforts in first episode psychosis (FEP) aim to simplify the referral pathways of people experiencing an FEP, and to provide rapid access to treatment during the illness’ initial phases. Nonetheless, TCIs may have unintended consequences. Here we explore the spillover effects of a TCI for FEP on a) referral pathways for “non-cases” and b) those at clinical high-risk for psychosis (CHR). METHODS: Using a historical control design, referral information from the pre-TCI (from January 2003 to December 2006) and post-TCI (from June 2006 to May 2009) phases was collected via administrative data and clinician notes from a catchment-based early psychosis service in Montreal, Canada. RESULTS: The TCI led to a 17% increase in eligible FEP referrals (“cases”), with a disproportionately large increase (55%) in referrals who were ineligible for FEP services (“non-cases”). Of 334 non-cases, 125 (37%) did not meet FEP diagnostic criteria, and 39 (11%) were eventually referred to an adjacent CHR service. Of these 39, 10 (26%) were lost to follow-up after initial screening for FEP, while 29 (74%) were successfully screened. Twenty-four (83%) of those screened had a CHR state (“non-non-cases”), and were followed for an average of 13 months. CONCLUSIONS: TCIs may have spillover effects, whether for narrowly-defined non-cases or expanded definitions of caseness that include CHR. These findings bring to question whether outreach strategies for psychosis should be specific to disorders and stages, or whether their targets should span across the psychosis spectrum.
Topic Area: Service System Development and Reform