Psychotic disorders clinic and first-episode psychosis: a program evaluation.
BACKGROUND
There is growing recognition that people presenting with psychotic symptoms for the first time need specialized treatment. The Hamilton Health Sciences Corporation, McMaster Hospital, offers one such program, the Psychotic Disorders Clinic (PDC); it addresses some of the problems posed by long waiting lists, lack of family interventions, and long-term hospitalizations. The PDC is affiliated with the Department of Psychiatry and Behavioural Neurosciences at McMaster University. The program's goals are to provide comprehensive outpatient care and early interventions for persons in the early stages of illness and, consequently, to improve symptom control and functioning and reduce hospitalizations. Key service components include providing low dosages of antipsychotics, offering specialized family education, and supporting return to school and work settings.


OBJECTIVE
This study compared outcomes before and after enrolment in the PDC to determine whether first-episode patients achieved improved symptom control and functioning and fewer hospitalizations.


METHODS
For a 12-month period, we followed 40 patients, aged between 16 and 45 years, who experienced their first episode of psychotic illness between 1997 and 2000. Prospective longitudinal data were collected at baseline, 3, 6, and 12 months. Outcome measures included symptoms, global functioning, employment rates, duration of untreated psychosis, and number of bed-days.


RESULTS
Of the patients, 37 completed the study at 6 months, and 31 at 12 months. Over the 12 months, significant improvements occurred in psychiatric symptoms (P < 0.001), global functioning (P < 0.001), and the mean number of hospital bed-days (P < 0.001).


CONCLUSIONS
It is feasible for small outpatient services to provide early intervention strategies and obtain good outcomes among first-episode patients.
Archie
Suzanne
S
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. archies@mcmaster.ca
Wilson
Jane Hamilton
JH
Woodward
Kevin
K
Hobbs
Heather
H
Osborne
Shelley
S
McNiven
Jean
J
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D010054:Brief Psychiatric Rating Scale; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000534:rehabilitation*; D013997:Time Factors
D014150:Antipsychotic Agents