Acute psychotic disorders are mental disorders, which, although the prevalence is recorded only in the range of 0.05-1%, significantly impact various aspects of life. Many studies state that comprehensive interventions during the initial critical period of psychotic disorders are significantly proportional to better prognosis. Various methods are used to improve the prognosis of psychotic disorders, one of which has been developed in many countries is the Early Intervention in Psychosis (EIP) program. 

Reportedly, patients with acute psychotic disorders who are not treated immediately will tend to show negative symptoms. The negative symptoms are: superficial/apathetic emotions, social isolation, decreased desire, neglect. So that, later in life, they would difficult to continue their healthy life after recovery. It can also increase comorbidity with other diseases (due to lack of self-care), financial losses, increased violence rates, drug abuse, and high suicide rates. These problems underlie why the EIP program needs to be implemented.

Early Intervention Program In Psychosis



What is Early Intervention in Psychosis?

Early Intervention in Psychosis (EIP) is a multidisciplinary mental health community service that provides care and support for sufferers of early episodes of acute psychotic disorders. The main goal is to provide intervention services as soon as possible to reduce the Duration of Untreated Psychosis (DUP), which can worsen the disease's prognosis with all its consequences.

EIP has several aspects, including early detection, early intervention, and ongoing services provided for 2 to 3 years. EIP is often aimed at populations aged 14-35 years because theoretically and clinically mentioned that acute psychotic disorders are more commonly at a young age. However, this program can be used for various ages.

This service has been implemented and adapted in various countries such as the United Kingdom, Australia, United States, Canada, Denmark, Norway, and the Netherlands. While in Asia, there are Singapore, Hong Kong, Korea, and Japan that have adapted this service and adapted to the backgrounds and needs of each country.

In general, based on the National Institute for Health and Care Excellence (NICE) guidelines, here are some vital components of the EIP program:

  • Rapid and precise assessment of early episodes of psychotic disorders.
  • Providing information for the patient, or the patient's family, to better understand psychotic disorders and their administration (psychoeducation).
  • Support patients with psychotic disorders and their families during the service period, including social support in economic and household problems and relapse prevention.
  • Pharmacological and psychotherapy interventions (including supportive and behavioral therapy).
  • Crisis intervention services by Assertive Community Treatment (ACT).
  • Regular physical health checks.
  • Monitoring conditions or other accompanying complaints in patients such as depression, anxiety disorders, or drug abuse.
  • Services in hospital and outpatient care.


Clinical Targets for Early Intervention in Psychosis

The Early Intervention in Psychosis (EIP) program, as the name suggests, is intended to treat patients with acute episodes of early psychotic disorders. However, in its implementation, this service also detects individuals who are currently in several conditions, namely:
  1. The prodromal phase is a period of change in behavior, function, social participation that appears before the symptoms of acute psychotic disorders.
  2. At-risk mental state, a period of acute psychotic disorders lasting less than 7 days, usually not too severe but shows poor performance of social and cognitive functions.
  3. The first episode of acute psychotic disorder is a mental disorder characterized by severe hardship in evaluating reality. Symptoms include delusions, hallucinations, or disruption of thought processes within 2 weeks or less and can interfere with at least some aspects of daily life and work. The term first episode describes the first time a person experiences these symptoms.


Early Intervention Model in Psychosis

There are three main early intervention models in Psychosis (EIP) services: stand-alone, hub and spoke, and integrated. This program has advantages and disadvantages and can be adjusted to the population's resources and needs.

Stand Alone
Stand-alone services work independently, not included in the Mental Health Team established by the government or certain agencies. Research has found this model to be quite clinically and economically effective and more efficient in applying interventions recommended by NICE. Suitable to be applied in urban areas that have access to complete health services.

Hub and Spoke
The stand-alone model may be rather difficult to apply in rural areas sparsely populated and have limited health facilities. Complicating factors such as delayed referral due to the long distance to access services, lower service capacity, and staff recruitment problems. Whereas in the hub and spoke model, specialized team workers remain connected and access additional assistance and supervision from the Mental Health Team. Therefore, the referral process can be faster.

Integrated
With an integrated model, EIP services are fully integrated with the Community Health Team. There is a consensus states that the integrated model is actually less effective. Why? Because it reduces the focus of work on early intervention of acute psychotic disorders, patients lack personal service. This model can minimize medication adherence, increase the number of patients not receiving treatment, and extend DUP.

Early Intervention in Psychosis Framework

According to their respective conditions, each country tries to adapt Early Intervention in Psychosis (EIP) with details that may differ slightly from other countries. The following is an example of the EIP framework flow conducted in the United Kingdom, that often implements and develops this service.

Early Intervention in Psychosis Framework


EIP's Success in Various Aspects

A randomized control trial (RCT) study in the United Kingdom showed that Early Intervention in Psychosis (EIP) can reduce psychopathology and improve patient quality of life, satisfaction with care, return to work, and medication adherence. In this program, family psychoeducation shows a significant prognosis improvement, so the relapse rate decreases to 40%. This service also succeeded in reducing the risk of suicide in patients aged 14-35 years, from 15% to 1%.

A retrospective cohort study in Ontario (n = 1522) for almost two decades reported that users of EIP services tended to control psychiatrists more often (78% versus 13%), visited the Emergency Unit less frequently because of relapses or other medical comorbidities, and had rates suicidal mortality was much lower than the group that did not use EIP services.

A retrospective longitudinal study at Oxford in 2010-2013 (n = 3674) also stated that patients with acute psychotic disorders who applied EIP were proven to be 116% more likely to find work, 17% better being well. When calculated from an economic standpoint, the EIP program can save expenses up to £ 63.3 million per year, so this service is very cost-effective compared to standard maintenance.



Summary
Early Intervention in Psychosis (EIP) is a multidisciplinary mental health program that provides care and support for patients with early episodes of acute psychotic disorders. This service broadly covers early detection & intervention to sustainable holistic services provided for 2-3 years. Not only for patients, but EIP also provides psychoeducation and support for families of patients with acute psychotic disorders. This program has been universally proven effective in preventing the adverse effects of acute psychotic disorders such as medical comorbidities, financial losses, and high suicide rates.


Source: Alomedika
Writer: Dr. Damba Bestari. 

References
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