Korean J Schizophr Res.  2013 Apr;16(1):32-37. 10.16946/kjsr.2013.16.1.32.

The Analysis of Community-Based Identification, Assessment and Allocation System for Early Psychosis

• Lee MS
• Ahn SR

• KMID: 2288302
• DOI: http://doi.org/10.16946/kjsr.2013.16.1.32

Abstract

OBJECTIVES
The purpose of this study was to make empirical evidence of community based detection, assessment and allocation system for early psychosis.
METHODS
We analysed 222 youths who were referred to Seoul Early Management and Improvement Services (SEMIS) for early psychosis during six years from 2007 to 2012.
RESULTS
44% of referrals were from suicide hotline, 23% from web-based SEMIS assessment program, 20% from other service areas such as military services and 11% were self referred. Among 222 youths, 139 (62.6%) were completed Structured Interview for Prodromal Syndrome (SIPS). After SIPS, 23% had untreated or early psychosis, another 17% were found to be at high risk of psychosis and 18% of completed SIPS were found to have other mental illness such as depression, yielding an efficiency ratio of 58%. 70% of youths who were categorized as psychosis or high risk of psychosis or other mental illness were referred to psychiatric hospital or case management services.
CONCLUSION
This study shows the effectiveness and limitations of community-based assessment and intervention system for early psychosis. Integrated community program is necessary to improve the efficiency of early intervention and for the better outcomes.

Keyword

Early psychosis; Community-based assessment and allocation

MeSH Terms

Adolescent
Case Management
Depression
Early Intervention (Education)
Hospitals, Psychiatric
Hotlines
Humans
Military Personnel
Prodromal Symptoms
Psychotic Disorders
Referral and Consultation
Suicide

Figure

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  Fig. 1. Seoul mental health service spectrum of services for early psychosis.

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  Fig. 2. Pathways and categorization after SIPS. CMHC : Community Mental Health Center, SEMIS : Seoul Early Management and Improvement System.

Reference

1). Johnstone EC, Crow TJ, Johnson AL, MacMillan JF. The northwick park study of first episode of schizophrenia: presentation of the illness and problems relating to admission. Br J Psychiatry. 1986; 148:115–120.

2). Moscarelli M, Capri S, Neri L. Cost evaluation of chronic schizophrenia patients during the first 3 years after the first contact. Schizophr Bull. 1991; 17:421–426.

3). Wyatt RJ. Early intervention with neuroleptics may decrease the longterm morbidity of schizophrenia. Schizophr Res. 1991; 5:201–202.

4). McGlashan TH, Johannessen JO. Early detection and intervention with schizophrenia: rationale. Schizophr Bull. 1996; 22:201–222.

5). Lim HS, Choi JS, Shin YM, Jho KH. The impact of duration of untreated psychosis on clinical outcome in firstepisode schizophrenia: retrospective study. Schizophrenia Clinics. 2004; 7:9–14.

6). Jung JC, Cho GH, Lee KH, Lee CR, Chung YC. Longterm outcomes of patients with firstepisode schizophrenia spectrum disorder and effects of duration of untreated psychosis on them. Schizophrenia Clinics. 2005; 8:64–73.

7). Yung AR, McGorry PD, Francey SM, Melson BN, Baker K, Phillips LJ, et al. PACE: a specialised service for young people at risk of psychotic disorders. Med J Aust. 2007; 187:S43–S46.

8). Wong GHY, Hui CLM, Wong DY, Tang JYM, Chang WC, Chan SKW, et al. Developments in early intervention for psychosis in hong kong. East Asian Arch Psychiatry. 2012; 22:100–104.

9). Yoo JM, Ahn SR, Cho YS, Lee MS. A study of duration of untreated psychosis (DUP) for first episode psychosis. The Mental Health. 2011; 2:12–16.

10). Yoo SY, Lee KJ, Kang DH, Lee SJ, Ha TH, Wee W, et al. Characteristics of subjects at Clinical high risk for Schizophrenia: natural follow up study in ‘seoul youth clinic'- pilot study. J Korean Neuropsychiatr Assoc. 2007; 46:19–28.

11). 이수영, 김경란, 강지인, 김보라, 최수희, 박진영 등. GRAPE 인지 치료. 학지사;2010.

12). Chung YC,Kang NI, Im YJ, Kim SW, Cho IH, Lee YM, et al. Validation of the korean version of the eppendorf schizophrenia inventory as a screening measure to detect adolescents at ultra-high risk for psychosis. Early Intervention in Psychiatry. 2013; 7:71–79.

13). Hahn HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A standardization study of beck depression inventory in korea. J Korean Neuropsychiatr Assoc. 1986; 25:487–500.

14). Jung MH, Jang JH, Kang DH, Choi JS, Shin NY, Kim HS, et al. The reliability and validity of the korean version of the structured interview for prodromal syndrome. Psychiatry Investig. 2010; 7:257–263.

15). Yung AR, Phillips LJ, Drew LT. Promoting access to care in early psychosis. McGorry PD, Fackson HJ, editors. Recognition and management of Early Psychosis: A Preventive Approach. New York: Cambridge University Press;1999. p. 80–114.

16). Upthegrove R, Birchwood M, Ross K, Brunett K, McCollum R, Jones L. The evolution of depression and suicidality in first episode psychosis. Acta Psychiatr Scand. 2010; 122:211–218.

17). Andriopoulos I, Ellul J, Skokou M, Beratis S. Suicidality in the “prodromal” phase of schizophrenia. Compr Psychiatry. 2011; 52:479–85.

18). McFarlane WR, Cook WL, Downing D, Verdi MB, Woodberry KA, Ruff A. Portland identification and early referral: a community-based system for identifying and treating youths at high risk of psychosis. Psychiatric Services. 2010; 61:512–515.