Predictors of Service Disengagement in First-Admitted Adolescents With Psychosis

• NCJ Number: 215175
• Journal: Journal of the American Academy of Child & Adolescent Psychiatry Volume: 45 Issue: 8 Dated: August 2006 Pages: 990-999
• Author(s): Benno Graf Schimmelmann M.D.; Philippe Conus M.D.; Melanie Schacht M.Sc.; Patrick McGorry M.D.; Martin Lambert M.D.
• Date Published: August 2006
• Length: 10 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

This study assessed the risk and predictors of dropping out of treatment ("disengagement") for adolescents with first-episode psychosis (FEP) who received their first treatment in a long-standing early intervention and prevention center.

Abstract

The risk of disengagement over 18 months from the start of treatment was 0.28, with an estimated median time in treatment of 15.6 months before disengagement. This disengagement rate was comparable to the rate reported by other specialized services for young adults with FEP or services that offered assertive community treatment; however, it was lower than the disengagement rate in a nonspecialized psychiatric service during an 18-month followup period. Adolescents with persistent substance use had a 2.6-fold increased risk of disengagement, and those with lack of family support during treatment had a 4.8-fold increased risk of disengagement. Regarding baseline predictors, only low severity of illness was linked to disengagement. Those who were moderately ill at baseline with minimal improvement during treatment were at higher risk for disengagement. These findings suggest that in treating adolescents with FEP, clinicians should focus on treating substance use and establishing a social network if family support is absent. Clinicians should also keep in touch with those adolescents who may not appreciate the importance of continuous treatment because of a moderate severity of illness. The study involved 157 adolescents (ages 15 to 18) with FEP who were admitted to the Early Psychosis Prevention and Intervention Center (EPPIC) in Australia from January 1998 to December 2000. Treatment at EPPIC spans an average of 18 months. Data were obtained from patients' charts by using a standardized questionnaire; 134 charts were available. Baseline and treatment predictors of service disengagement were examined with the Cox proportional hazards model. 2 tables, 2 figures, and 25 references