The evaluation of an early intervention service for psychosis & the relationship of life events to symptoms and outcome

Abstract

AIMS & METHODS: There were two aims to this study. The first was to evaluate the effectiveness of an early intervention for psychosis service (EIS). The evaluation involved analysing the changes in symptom severity scores (PANSS) and the level of global functioning (HoNOS) scores for 100 EIS clients over time. The study also investigated whether client characteristics were associated with a better outcome. The clients' level of satisfaction with the service was ascertained through questionnaires and interviews. The second aim was to test the hypothesis that histories of child abuse (CA) were associated with positive symptoms of psychosis, increased symptom severity and less improvement over time. In the process of testing these hypotheses the extent to which CA was inquired about and recorded in the medical files was assessed. Also collected from medical files was the degree of Expressed Emotion (EE) in the clients' families, the level of stressful life events prior to onset, and childhood loss and adult loss. It was hypothesised that these variables would also be associated with symptom severity and less improvement over time. RESULTS: The EIS clients' PANSS and HoNOS scores improved significantly within the first three months and continued to improve significantly over time. High levels of client engagement with the service and high medication compliance were associated with better outcome. Female clients had higher levels of engagement and medication compliance compared to male clients. Factors associated with client drop out were low medication compliance and the clients' ethnicity. A collaborative therapeutic relationship was associated with client satisfaction more than any treatment modality. With regards to the second aim only 30% of medical files recorded information on the clients' abuse history. The hypotheses regarding abuse histories, EE, stressors, and loss being related to symptom severity and less improvement over time were not supported. However, child sexual abuse (CSA) and child physical abuse (CPA) were significantly correlated with decreased levels of medication compliance and CPA was significantly correlated with decreased levels of engagement. A history of CSA was significantly correlated with a longer duration spent In hospital prior to involvement with the EIS. CSA was also associated with an increased likelihood of experiencing grandiose delusions and thoughts of suicide and self-harm. This association was particularly strong for clients with a history of incest. CONCLUSION: It was recommended that the gender differences be investigated further in the effort to improve the engagement, compliance and symptom improvement of male clients. Further research with a larger sample size is also required to determine whether the service is more effective in treating women and clients from certain cultures. It was suggested that the rate of asking about and recording abuse for EIS clients should be increased, together with the abuse histories being incorporated into psychological formulations and treatment plans.