Factors predicting disengagement from psychosis early intervention identified

By Afsaneh Gray, medwireNews Reporter

A study of first-episode psychosis patients in Hong Kong has found that those with fewer negative symptoms at presentation and poor medication compliance were more likely than others to disengage from an early intervention program.

“We have confirmed reports in previous studies, which were mostly conducted in western populations, that diagnosis of a non-schizophrenia-spectrum psychotic disorder, lower baseline negative symptom severity, poor medication compliance and substance abuse history predicted service disengagement,” write study author Wing Chang (The University of Hong Kong) and colleagues.

The team identified 700 patients aged 15 to 25 years who were enrolled in the Early Assessment Service for Young People with Psychosis (EASY) programme between 2001 and 2003.

Data on each patient were retrieved from clinical records, and the Clinical Global Impressions–Severity Scale was used to determine symptom severity. Information on medication compliance was derived from sources including case management notes, medical records and information from caregivers.

Disengagement was defined as missing all outpatient appointments until the end of the 2-year service despite therapeutic need and active follow-up from staff, and occurred in 94 patients.

The mean age of participants was 20.65 years and the median duration of untreated psychosis was 91 days. Most (69.14%) patients had a diagnosis of a schizophrenia spectrum disorder (ie, schizophrenia or schizoaffective disorder).

Multivariate analysis identified three factors that were independently associated with disengagement. Patients were 56% less likely to disengage if they had schizophrenia-spectrum disorders, rather than other types of psychosis. They were 63% less likely to disengage if they were adherent to their medication, and they were 24% less like to disengage if they had high baseline negative symptom scores (>3).

Substance abuse history within the initial 6 months of the programme increased the chances of disengagement, but, due to the small number of patients affected, was not included in the final multivariate analysis.

The team also found that 63% of disengaged patients were in symptomatic remission during the month in which they left the EASY programme.

“Early intervention teams should pay attention to factors associated with disengagement, and monitor at risk patients closely to detect signs of non-adherence,” Chang and colleagues conclude in Schizophrenia Research.

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