Compulsory admission as access to early intervention service for patients with first episode psychosis: What relevance for clinical outcomes? Further findings from the Pr-EP program

Abstract

Purpose: Patients with psychosis have a higher risk of compulsory admission. However, knowledge about its prognostic relevance in First Episode Psychosis (FEP) is poor. The aims of this study were to calculate its baseline prevalence rate in FEP individuals treated within an "Early Intervention" (EI) service, and to longitudinally compare clinical outcomes between FEP patients with and without baseline compulsory admission across 2 years of follow-up.

Methods: 500 FEP youths completed the PANSS and the GAF. Chi-squared/Mann-Whitney tests, mixed-design ANOVA, logistic regression, and Kaplan-Meier survival analysis were used for inter-group comparisons.

Results: 53 (10.6 %) FEP participants were compulsory admitted at entry. They were likely to be unemployed and to have lower baseline GAF score and more severe positive symptoms. They showed significant "time x group" effects for improvements in GAF and PANSS uncooperativeness scores. No inter-group difference in terms of service disengagement and new compulsory admission was found.

Conclusion: A non-negligible portion (1/10) of FEP participants entered the EI program through compulsory admission. However, this did not negatively impact on longitudinal outcomes, suggesting the beneficial effect of EI intervention in longitudinally promoting functional recovery and treatment adherence also in FEP recruited though compulsory admission.

Keywords: Compulsory admission; First episode psychosis; Follow-up; Hospitalization; Outcome; Treatment.