A statewide evaluation system for early psychosis.
OBJECTIVE
We describe a system of outcome evaluation for early psychosis programmes and present preliminary data. The Early Psychosis Outcome Evaluation System (EPOES) was designed for use in a naturalistic, prospective study of a cohort of early-episode psychosis patients. We describe patients in terms of symptoms, substance use, social functioning and family burden, and examine the effectiveness of treatment programmes.


METHODS
Four sites in Perth, Western Australia, participated. Outcome was evaluated from three sources: case manager (CM), patient (P) and family member (FM). Seven clinical outcome measures were used: the Brief Psychiatric Rating Scale (CM), Brief Symptom Inventory (P), Substance Use (CM); Social Functioning Scale (P); Global Assessment Scale (CM); Burden Assessment Scale (FM), and the General Health Questionnaire-12 (FM). Measures were collected at intake (baseline) into a specialist early psychosis service and thereafter every 6 months until discharge from the service.


RESULTS
After the first year of data capture, 84 baseline assessments have been completed, and 23 patients have been followed up at 6 months. Clinicians and patients reported significantly less psychopathology at 6 months. Sixty per cent of patients reported marijuana use within 3 months of baseline assessment, and 30% amphetamine, ecstasy or cocaine use. Increased levels of psychopathology were recorded for substance-using patients. Family members (59%) reported psychological distress at baseline; this was reduced at 6 months. Patient social functioning and family burden did not improve measurably.


CONCLUSIONS
The EPOES is an effective system that provides feedback on the clinical status of early-episode psychosis patients. Both observed and self-rated psycho-pathology and family psychological distress, is improved after 6 months of intervention. Family burden and patient social functioning did not demonstrate improvement. Patient social functioning is an important area for treatment. Substance use is associated with poorer psychopathology. EPOES provides a feasible system of measuring outcome in early psychosis intervention.
Preston
Neil J
NJ
Early Intervention Psychosis Program, Directorate of Mental Health, Fremantle Hospital and Health Service, PO Box 480, Fremantle, Western Australia 6959, Australia. neil.preston@health.wa.gov.au
Stirling
Maree L
ML
Perera
Kanthi
K
Bell
Richard J
RJ
Harrison
Tracey J
TJ
Whitworth
Lisa
L
Castle
David J
DJ
D000328:Adult; D000704:Analysis of Variance; D001315:Australia; D005190:Family / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D015397:Program Evaluation / Q000592:standards*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000523:psychology; D016896:Treatment Outcome