title: Outcomes following first-episode psychosis - Why we should intervene early in all ages, not only in youth.
abstract: OBJECTIVE
  To compare baseline demographics and 10-year outcomes of a first-episode psychosis patient incidence cohort in order to establish whether current youth-focussed age-based criteria for early intervention services are justified by patient needs. The patients in this cohort were treated prior to the establishment of early intervention services. The study aimed to test the hypothesis that those who develop psychosis at a younger age have worse outcomes than those who develop psychosis at an older age.
  
  
  METHODS
  Data on first-episode psychosis patients from the ÆSOP-10 longitudinal follow-up study were used to compare baseline characteristics, and 10-year clinical, functional and service use outcomes between those patients who would and would not have met age-based criteria for early intervention services, in Australia or in the United Kingdom.
  
  
  RESULTS
  In total, 58% men and 71% women with first-episode psychosis were too old to meet current Australian-early intervention age-entry criteria (χ2= 9.1, p = 0.003), while 21% men and 34% women were too old for UK-early intervention age-entry criteria (χ2= 11.1, p = 0.001). The 10-year clinical and functional outcomes did not differ significantly between groups by either Australian- or UK-early intervention age-entry criteria. Service use was significantly greater among the patients young enough to meet early intervention age-criteria (Australia: incidence rate ratio = 1.35 [1.19, 1.52], p < 0.001; United Kingdom: incidence rate ratio = 1.65 [1.41, 1.93], p < 0.001).
  
  
  CONCLUSIONS
  Current early intervention services are gender- and age-inequitable. Large numbers of patients with first-episode psychosis will not receive early intervention care under current service provision. Illness outcomes at 10-years were no worse in first-episode psychosis patients who presented within the age range for whom early intervention has been prioritised, though these patients had greater service use. These data provide a rationale to consider extension of early intervention to all, rather than just to youth.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia j.lappin@unsw.edu.au.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Lappin
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Heslin
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
authors.affiliation: Department of Psychiatry, The University of Nottingham, Nottingham, UK.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Doody
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Reininghaus
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Arsime
authors.initials: A
authors.lastname: Demjaha
authors.affiliation: School of Nursing and Health Sciences University of Dundee, Dundee, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Croudace
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jamieson-Craig
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Kim
authors.initials: K
authors.lastname: Donoghue
authors.affiliation: Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Lomas
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Fearon
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
mesh_terms: D000328:Adult; D017668:Age of Onset; D061345:Early Medical Intervention / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000628:therapy*; D006113:United Kingdom; D055815:Young Adult
keywords: Psychosis; early intervention; outcomes; schizophrenia; women