Predictors of service disengagement in first-admitted adolescents with psychosis.
OBJECTIVE
To assess the risk and predictors of service disengagement in adolescents with first-episode psychosis (FEP) receiving their first treatment in a long-standing early intervention and prevention centre.


METHODS
The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 157 adolescents, ages 15 to 18, with FEP from January 1998 to December 2000. Treatment at EPPIC spans an average of 18-months. Data were collected from patients' charts using a standardized questionnaire; 134 charts were available. Time to service disengagement was the outcome of interest. Baseline and treatment predictors of service disengagement were examined via Cox proportional hazards model.


RESULTS
Kaplan-Meier 18-month risk of service disengagement was 0.28. A lower severity of illness at baseline (hazard ratio [HR] = 0.2; 95% confidence interval [CI] 0.1-0.4), living without family during treatment (HR = 4.8; 95% CI 2.1-11.2), and persistent substance use during treatment (HR = 2.6; 95% CI 1.1-5.9) contributed significantly to predicting service disengagement. Neither initial substance use nor insight at baseline was related to service disengagement.


CONCLUSIONS
Clinicians should focus on treating substance use and establishing a social network if family support is missing in adolescents with FEP. In addition, clinicians should apply strategies to keep in touch with those adolescents who might not see the necessity of continuous treatment because of a moderate severity of illness.
Schimmelmann
Benno Graf
BG
Dr. Schimmelmann is with the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany; Dr. Lambert is with the Psychosis Early Detection and Intervention Centre (PEDIC), Department of Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Ms. Schacht is with PEDIC, Department of Child and Adolescent Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Dr. Conus is with the Département Universitaire de Psychiatrie Adulte, Prilly, Switzerland; and Dr. McGorry is with the Orygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre, Melbourne, Australia.. Electronic address: bschimme@aol.com.
Conus
Philippe
P
Dr. Schimmelmann is with the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany; Dr. Lambert is with the Psychosis Early Detection and Intervention Centre (PEDIC), Department of Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Ms. Schacht is with PEDIC, Department of Child and Adolescent Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Dr. Conus is with the Département Universitaire de Psychiatrie Adulte, Prilly, Switzerland; and Dr. McGorry is with the Orygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre, Melbourne, Australia.
Schacht
Melanie
M
Dr. Schimmelmann is with the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany; Dr. Lambert is with the Psychosis Early Detection and Intervention Centre (PEDIC), Department of Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Ms. Schacht is with PEDIC, Department of Child and Adolescent Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Dr. Conus is with the Département Universitaire de Psychiatrie Adulte, Prilly, Switzerland; and Dr. McGorry is with the Orygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre, Melbourne, Australia.
McGORRY
Patrick
P
Dr. Schimmelmann is with the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany; Dr. Lambert is with the Psychosis Early Detection and Intervention Centre (PEDIC), Department of Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Ms. Schacht is with PEDIC, Department of Child and Adolescent Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Dr. Conus is with the Département Universitaire de Psychiatrie Adulte, Prilly, Switzerland; and Dr. McGorry is with the Orygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre, Melbourne, Australia.
Lambert
Martin
M
Dr. Schimmelmann is with the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany; Dr. Lambert is with the Psychosis Early Detection and Intervention Centre (PEDIC), Department of Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Ms. Schacht is with PEDIC, Department of Child and Adolescent Psychiatry and Psychotherapy, University-Hospital Medical Center Hamburg-Eppendorf, Germany; Dr. Conus is with the Département Universitaire de Psychiatrie Adulte, Prilly, Switzerland; and Dr. McGorry is with the Orygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre, Melbourne, Australia.
D000293:Adolescent; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution*; D011618:Psychotic Disorders / Q000534:rehabilitation*; D012944:Social Support; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors