title: Assertive outreach for "difficult to engage" patients: A useful tool for a subgroup of patients in specialized early psychosis intervention programs.
abstract: Most specialized Early Psychosis (EP) programs include assertive outreach (AO) principles, either for all patients or as an intensive case management (ICM) subprogram in selected situations. The objective of this study is to examine prevalence, characteristics and outcomes of patients who needed additional ICM in a specialized EP program.
  
  
  
  In a 3-year prospective naturalistic study of 229 consecutive EP patients treated at TIPP-Lausanne we compared characteristics of those who needed ICM and those who did not.
  
  
  
  60 (26.2%) TIPP patients needed ICM. At baseline, ICM-patients showed a poorer academic premorbid functioning (p=0.019); lower level of insight (p<0.001); had a previous history of alcohol (p=0.043) and cannabis (p=0.040) use. ICM-patients were less likely to be adherent to medication during the early phase of treatment but differences disappeared during follow-up. ICM-patients showed globally a poorer functional level and higher level of positive and negative symptoms during the follow-up.
  
  
  
  About one quarter of EP patients needed a combination of ICM and assertive outreach. Despite the high treatment adherence in both groups, psychotic symptoms remained higher in ICM-patients. In a real live setting with limited resources, combination of ICM and AO in selected situations seems a valid solution.
authors.affiliation: Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland. Electronic address: Luis.alameda-fernandez@chuv.ch.
authors.forename: Luis
authors.initials: L
authors.lastname: Alameda
authors.affiliation: Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland; Service of community Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Golay
authors.affiliation: Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Baumann
authors.affiliation: Service of community Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Morandi
authors.affiliation: Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland.
authors.forename: Carina
authors.initials: C
authors.lastname: Ferrari
authors.affiliation: Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Conus
authors.affiliation: Service of community Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland.
authors.forename: Charles
authors.initials: C
authors.lastname: Bonsack
mesh_terms: D000328:Adult; D019090:Case Management; D003156:Community Mental Health Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011369:Professional-Patient Relations; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D055815:Young Adult
keywords: Assertive community treatment; Early psychosis; First episode psychosis; Outcome; Prospective; Psychosocial interventions