title: Community Treatment Order: Identifying the need for more evidence based justification of its use in first episode psychosis patients.
abstract: Community Treatment Order (CTO) is a legal regime that obliges patients suffering mental disorder to adhere to treatment in the community and allows for a swift admission to hospital if necessary. Study aims were to: (i) determine CTO frequency in a large representative sample of first episode psychosis (FEP) patients; (ii) compare the characteristics of patients with or without CTO before entry, during treatment and at discharge from an early psychosis program.
  
  
  
  Information on 660 patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000 was collected from medical files.
  
  
  
  19.2% of patients were under CTO at least once during treatment and they differed on most pre-treatment, baseline, treatment and service discharge variables. They were less educated, more likely to have a history of offending behavior, had lower pre-morbid functioning, longer duration of untreated psychosis, increased prevalence and more persistent substance use disorders, greater severity of symptoms, lower functioning, poorer insight at any time during treatment and were more likely to be admitted to hospital.
  
  
  
  CTO frequency was high, likely related to the representativeness of the cohort. Characteristics of patients on CTO are comparable to those with serious and persistent mental illness. Considering the absence of solid evidence regarding the effectiveness of this form of compulsion, it is crucial to study the use of CTO in FEP patients in order to explore its impact and identify patients for whom it may be beneficial.
authors.affiliation: Service of Community Psychiatry, Department of Psychiatry, University Hospital of Lausanne (CHUV), Place Chauderon 18, 1003 Lausanne, Switzerland. Electronic address: stephane.morandi@chuv.ch.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Morandi
authors.affiliation: Service of Community Psychiatry, Department of Psychiatry, University Hospital of Lausanne (CHUV), Place Chauderon 18, 1003 Lausanne, Switzerland; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), University Hospital of Lausanne (CHUV), Place Chauderon 18, 1003 Lausanne, Switzerland. Electronic address: philippe.golay@chuv.ch.
authors.forename: Philippe
authors.initials: P
authors.lastname: Golay
authors.affiliation: Psychosis Centre, Department for Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany. Electronic address: lambert@uke.uni-hamburg.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Lambert
authors.affiliation: University Hospital of Child and Adolescent Psychiatry, University of Bern, Bollingerstrasse 110, 3000 Bern 60, Switzerland. Electronic address: bschimme@aol.com.
authors.forename: Benno G
authors.initials: BG
authors.lastname: Schimmelmann
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia. Electronic address: pat.mcgorry@orygen.org.au.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia. Electronic address: sue.cotton@orygen.org.au.
authors.forename: Sue M
authors.initials: SM
authors.lastname: Cotton
authors.affiliation: Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), University Hospital of Lausanne (CHUV), Place Chauderon 18, 1003 Lausanne, Switzerland. Electronic address: philippe.conus@chuv.ch.
authors.forename: Philippe
authors.initials: P
authors.lastname: Conus
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000379:methods* / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Community Treatment Order; Compulsion; Compulsory outpatient treatment; Early psychosis; First episode schizophrenia disorder