Early Intervention n Psychosis; the TIPSstudy
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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 TIPS; background DUP was long in our region; mean 2.1 years, median 26 weeks schizophrenia patients had a median DUP og 54 weeks
5 ED = early detection low threshold ED-teams information campaigns
6 ED-teams anyone can call... PANSS within 24 hours if psychosis; start of treatment within 1 week
7 ED-teams two teams in Rogaland staff; 1 psychiatrist; 1 psychologist and 3 psych nurses/social workers on call Monday - Friday
8 ED-teams 100 contacts per month
9 Information Campaigns separate programs for teachers, GP s, school psychology-services etc general populations appr 1 mill kroner per year
10 detection teams (DT) 1997 total non-anonymous PANSS first episode included
11 detection teams (DT) referred from % family (mother) 25 patient 14 school 11 GP 9 outpat clinic 26 other 15
12 detection teams (DT) / PANSS psychosis yes/no TOPP SCID therapists TIPS 24 hours 1 week full assessment
13 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
14 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)
15 DUP HC ED no ED 50,0 37,5 25,0 12,5 0 < >104
16 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
17 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?
18 TIPS; results no-ed ED
19 symptoms at baseline noed ED * * * * * positive negative general GAFs GAFf 15 0
20 summary baseline DUP is significantly shorter ED patients are less symptomatic & have less suicidality
21 TIPS; 1 year follow-up noed ED remission 0,68 0,64 cont. psychotic total duration of psychosis 0,21 0,
22 main finding duration of first episode is reduced with 50%! this equals the popular understanding of early treatment
23 symptoms at 1 year noed ED * 30 positive negative allmene GAFs GAFf 15 0
24 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)
25 5 year outcome unpublished data...
26 LME negative symptoms!
27 LME cognitive symptoms!
28 LME depressive symptoms
29 LME GAF social functioning
30 suicidality at 5 years ed no-ed 50% * 25% 0% thoughts plans attemts
31 social outcome at 5 years ed no-ed 80% * 40% 0% friends working
32 course of illness at 5 years ed no-ed 80% 40% 0% remission relapse continous
33 summary 5 year follow-up ED-patients have better outcome during 5 years (LME) for negative, cognitive and depressive PANSS factors + better GAFf scores a 10 year follow-up study will be carried out during
34 TIPS-II; what is the effect of stopping the informations work? IC noic 50,0 37,5 25,0 12,5 <1 DUP >24mndr 0
35 baseline symptoms with no-ic noic IC * 40 * positive negative allmene GAFs 10 0
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