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Preventing the First Episode of Psychosis William R. McFarlane, M.D., Director, National Program Office Early Detection, Intervention and Prevention of.

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Presentation on theme: "Preventing the First Episode of Psychosis William R. McFarlane, M.D., Director, National Program Office Early Detection, Intervention and Prevention of."— Presentation transcript:

1 Preventing the First Episode of Psychosis William R. McFarlane, M.D., Director, National Program Office Early Detection, Intervention and Prevention of Psychosis Program Robert Wood Johnson Foundation Maine Medical Center Research Institute Portland, Maine Tufts University School of Medicine

2 Early detection and prevention in another illness “If you catch cancer at Stage 1 or 2, almost everybody lives. If you catch it at Stage 3 or 4, almost everybody dies. We know from cervical cancer that by screening you can reduce cancer up to 70 percent.” ---Lee Hartwell, MD Nobel Laureate, Medicine President and Director, Hutchinson Center New York Times Magazine December 4, 2005, p. 56

3 2-3% Proportion of youth who develop schizophrenia or a severe, psychotic mood disorder

4 75% Proportion of people who have one psychotic episode and schizophrenia and then develop disability

5 12-15% Proportion of people with schizophrenia or a psychotic mood disorder who commit suicide

6 $61 billion Annual U.S. costs for schizophrenia

7 Functioning as an effect of number of psychotic episodes

8 Portland Identification and Early Referral (PIER) Reducing the incidence of major psychotic disorders in a defined population, by early detection and treatment

9 Professional and public education Reducing stigma Increasing understanding of early stages of mental illness and prodromal symptoms How to get consultation, specialized assessments and treatment quickly

10 Family practitioners Pediatricians General Public Mental health clinicians Military bases and recruiters Clergy Emergency and crisis services College health services EDIPPP Team Advertising School teachers, guidance counselors, nurses, social workers Employers

11 Family-aided Assertive Community Treatment (FACT) In-depth assessment of symptoms of risk Rapid initiation of treatment Psychoeducational multifamily groups Supported employment and education Key intensive case management methods

12 Early Detection and Intervention for the Prevention of Psychosis (EDIPPP) A national multisite effectiveness trial Reducing the incidence of major psychotic disorders in a defined population, by early detection and treatment

13 Early Detection and Intervention for the Prevention of Psychosis Effectiveness Test at six sites: –Portland, Maine –Glen Oaks and Queens, New York –Ann Arbor, Michigan –Salem, Oregon –Sacramento, California –Albuquerque, New Mexico Large, nationally representative sample PIER community outreach and identification systems Sponsored by RWJF: $17 million

14 Outcomes

15 Early identification across cities SITE Population Age-corrected rate**, at 25/100,000* Years of community outreach Maine 323,105 63%8 Michigan 344,791 37% Oregon 631,853 29%2.5 California 466,488 26% New York 557,725 17% 1.5 New Mexico 662,564 12% Total 2,986,526 27% ** Proportion (69.2%) of ages population represented by ages population *Rate for Nottingham, U.K., in Kirkbride, et al., Arch Gen Psychiatry. 2006;63:

16 Rates of psychosis and negative events Over 24 months Low-riskHigh-risk Severe Psychosis 2.3%6.3% Negative Events* 22%25% *Hospitalizations, incarcerations, suicide attempts, assaults, rape

17 In school or working: Baseline and 24 months

18 First hospitalizations for psychosis Maine Urban controls areas vs. Greater Portland *p<0.0001

19 Savings for First Hospital Admissions for Psychosis Greater Portland vs. Urban Maine vs Difference in incidence vs Portland population Average Cases prevented Mean LOS, days Bed Day Rate Annual savings, Greater Portland Annual per capita savings, per 100,000 population 330, $900$519,453 $1.57

20 Early intervention is prevention One year rates for conversion to psychosis % 23.0% Fusar-Poli, et al, JAMA Psychiatry, 2013 Risk reduction = 66%

21 Outcomes in First Four California PIER Programs N = 125Baseline12 Month Working15% 49% In school57% 56% Onset of Psychosis:21% 3% Hospitalizations:13% 7% Suicide attempts:8% 2%

22 Conclusions Community-wide education is feasible. Referral of 30% up to 60% of the at-risk population. Global outcome in FACT was better than regular treatment. The rate psychosis onset is less than 1/4 of expected. Average functioning was in the normal range by 24 months. Five cities show a declining incidence. Programs in California are showing same results. ¾ were in school or working up to 10 years later.

23 Conclusion As in successes for prevention in cancer and cardiovascular disease, early identification and intervention for psychosis give us enormous opportunities to reduce the total burden of disease in the United States.

24 For further information:


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