Early Intervention n Psychosis; the TIPSstudy
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- Hector Roberts
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From this document you will learn the answers to the following questions:
What is the risk of suicide in schizophrenia?
How long did the median DUP last?
What type of DUP was long in our region?
Transcription
1 Early Intervention n Psychosis; the TIPSstudy TK Larsen MD, PhD P r o f e s s o r o f P s y c h i a t r y UiB & SUS H e a d o f t h e R e g i o n a l C e n t r e f o r C l i n i c a l R e s e a r c h i n P s y c h o s i s, S t a v a n g e r U n i v e r s i t y H o s p i t a l, N o r w a y
2 TIPS PI s; Thomas H McGlashan (Yale) & Per Vaglum (Oslo) Collaboration between Stavanger University Hospital and University of Olso and Roskilde in Denmark Prof Svein Friis (N), dr Ulrik Haahr (DK), dr Jan Olav Johannessen (N), prof TK Larsen (N), prof Ingrid Melle (N), prof Stein Opjordsmoen (N), prof Bjørn Rishovd-Rund (N), dr Erik Simonsen (N)
3 TIPS = Early Treatment and Intervention in First Episode Psychosis Norway; Rogaland + Ullevåll sector Oslo/ Roskilde Danmark Population age FE non-affective psychosis
4 map ED UD
5 TIPS; background DUP was long in our region; mean 2.1 years, median 26 weeks schizophrenia patients had a median DUP og 54 weeks
6 ED = early detection low threshold ED-teams information campaigns
7 ED-teams anyone can call... PANSS within 24 hours if psychosis; start of treatment within 1 week
8 ED-teams two teams in Rogaland staff; 1 psychiatrist; 1 psychologist and 3 psych nurses/social workers on call Monday - Friday
9 ED-teams 100 contacts per month
10 Information Campaigns separate programs for teachers, GP s, school psychology-services etc general populations appr 1 mill kroner per year
11 detection teams (DT) 1997 total non-anonymous PANSS first episode included
12 detection teams (DT) referred from % family (mother) 25 patient 14 school 11 GP 9 outpat clinic 26 other 15
13 detection teams (DT) / PANSS psychosis yes/no TOPP SCID therapists TIPS 24 hours 1 week full assessment
14 Same area after stop of campaigns. Post-ED TIPS early detection program Rogaland county, Norway ED sample TIPS historical control, same area Pre-ED TIPS parallell control Separate cathcment areas, same time period Identical treatment and assesment, no early detection No-ED sample 504
15 TIPS; results noed ED age gender (female) single substance abuse VUP ,44 0,38 0,63 0,75 0,27 0,38 16 (0-966) 5 (0-1196)
16 DUP HC ED no ED 50,0 37,5 25,0 12,5 0 < >104
17 FEP and suicidality schizophrenia; life time risk of suicide - 5% previous attempts predicts later attempts and completed suicide other risk factors; current depression - hoplessness and drug abuse 15-25% have made a suicide attempt before first treatment
18 FEP and suicidality 2-11 % suicide attempt during 1 year of treatment suicide attempts cen be the factor that brings people into treatment undetected cases might have a higher rate TIPS; could a system with low threshold for detection influence rates of suicidal behaviour?
19 TIPS; results no-ed ED
20 symptoms at baseline noed ED
21 summary baseline DUP is significantly shorter ED patients are less symptomatic & have less suicidality
22 TIPS; 1 year follow-up noed ED remission 0,68 0,64 cont. psychotic total duration of psychosis 0,21 0,
23 main finding duration of first episode is reduced with 50%! this equals the popular understanding of early treatment
24 symptoms at 1 year noed ED
25 TIPS; 1 year follow-up noed ED QoL daily acitivity 4.2 (1.0) 4.6 (1.1) QoL social activity 3.2 (1.0) 3.5 (1.0)
26 positive PANSS-component ed no-ed baseline 3 months 1 year 2 year 5 year
27 negative PANSS-component 22 ed no-ed 11 0 baseline 3 months 1 year 2 year 5 year
28 depression PANSS-component ed no-ed 15,0 7,5 0 baseline 3 months 1 year 2 year 5 year
29 excitement PANSS-component ed no-ed baseline 3 months 1 year 2 year 5 year
30 cognitive PANSS-component 8 ed no-ed 4 0 baseline 3 months 1 year 2 year 5 year
31 negative PANSS-component (3 factors) 17,0 ed no-ed 8,5 0 baseline 3 months 1 year 2 year 5 year
32 suicidality at 5 years ed no-ed 50% 25% 0% thoughts plans attemts
33 social outcome at 5 years ed no-ed 80% 40% 0% friends working
34 course of illness at 5 years ed no-ed 80% 40% 0% remission relapse continous
35 summary 5 year follow-up ED-patients have better scores on PANSS cognitive component, more friends and less suicidal thoughts a 10 year follow-up study will be carried out during
36 TIPS-II; what is the effect of stopping the informations work? IC noic DUP
37 baseline symptoms with no-ic noic IC
38 more about TIPS
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