title: First episode psychosis in the over 35 s: is there a role for early intervention?
abstract: The early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range.
  
  
  
  Data were collected on all patients aged 36-65 years who were referred to an inner London EI service from 2011-2014 using the MiData 2 tool at entry and at 1-year follow up.
  
  
  
  People aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1-year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission.
  
  
  
  These findings indicate that admitting over 35-year-olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.
authors.affiliation: Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Greenfield
authors.affiliation: Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.
authors.forename: Snehita
authors.initials: S
authors.lastname: Joshi
authors.affiliation: Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.
authors.forename: Suneel
authors.initials: S
authors.lastname: Christian
authors.affiliation: Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.
authors.forename: Petros
authors.initials: P
authors.lastname: Lekkos
authors.affiliation: Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Gregorowicz
authors.affiliation: MRC Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Fisher
authors.affiliation: Camden & Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.|Division of Psychiatry, University College London, London, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D061345:Early Medical Intervention / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000453:epidemiology*; D061665:Time-to-Treatment; D016526:Workload / Q000706:statistics & numerical data*
keywords: early intervention; older patients; outcome; psychosis