Clinical remission in first episode of psychosis: results from a cohort in Northern Italy.
Poster A38,
Maria Ferrara1,2, Fangyong Li3, Flavia Baccari2, Sinan Guloksuz1,4, Shadie Burke1, Manuela Miselli2, Alessio Saponaro5, Mila Ferri5, Vinod Srihari1, Fabrizio Starace2, for the Regional Early Intervention Group5; 1STEP Program, Yale University, 2Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy, 3Yale Center for Analytical Sciences (YCAS), Yale School of Public Health, New Haven, CT, 4Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands, 5Servizio assistenza territoriale, Area Salute Mentale e Dipendenze Patologiche, Regione Emilia-Romagna
Background Early interventions services (EIS) for psychosis are not uniformly available in Italy. From 2012, Region Emilia Romagna has funded a program to deliver EIS, embedded within a network of community mental health services. Method Health records of the EIS (2013-2016) were analyzed. Inclusion criteria were: residence in Region, age 18–35, presence of non-organic, affective or non-affective psychosis within two years of onset, fluency in Italian, no comorbid severe intellectual disability. Clinical remission was defined as Health of Nation Outcome Scale (HoNOS) score < or = 8. Results Of 689 patients in EIS, 460 (66.7%) had 6-month HoNOS assessment. Of those, 70% were male, mean age was 23.8 (SD=5.1), and 421 (91.5%) were diagnosed with non-affective psychosis. Median duration of untreated psychosis (DUP) was 5 months (range=0-72). At 6 months, HoNOS total score was significantly reduced by 35.6%. The 6-month remission rate was 33.7%. In the unadjusted analysis, past psychiatric treatment, single status, unemployment, comorbid personality disorder, longer DUP, and higher HoNOS baseline scores were associated with lower clinical remission. In the multivariate analysis, only comorbid personality disorder (OR=0.51, p=0.03), longer DUP (OR=0.97, p=0.02), and baseline HoNOS scores (OR=0.86, p<.0001) remained significant. Discussion This study reports promising results of a regional network of EIS, with shared data elements allowing benchmarking across sites. Patients at EIS showed significant clinical improvement at 6-month assessment. Targeted interventions should also address comorbid personality disorder. Overall, early detection is essential to increase the rates of clinical remission through decreasing DUP and clinical severity at admission.
Topic Area: First Episode Psychosis