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Project Description

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Randall JR, Vokey S, Loewen H, et al. A Systematic Review of the Effects of Early Interventions for Psychosis on the Usage of Inpatient Services. Schizophrenic Bulletin. 2015. [Full-text]

EPPIS provides psychiatric service and support to individuals between 13-35 years of age who are experiencing or recovering from a first episode of psychosis.  Psychosis does not refer to a specific disease but rather a group of symptoms in which some loss of contact with reality has occurred (e.g., hallucinations, delusions, disorganized thinking or unusual behaviour). Early psychosis may be indicated by prodromal symptoms (i.e., symptoms that present a change from previous status), such as depression or anxiety, sleep disruption, declining functioning at school or work, or social withdrawal. Previous research indicates that individuals receiving optimal treatment within 6 months of onset of symptoms have a better recovery than those who delay treatment (1-3).
 
The EPPIS program was initiated in Winnipeg RHA in January 2003.  Referral to EPPIS can be through the Child & Adolescent Mental Health Program for children under 18, or directly to EPPIS for individuals aged 18-35.  Contingent upon a diagnosis of a primary psychotic disorder, patients are screened for other symptoms, previous treatments, and assessed for their ability to participate in a multidisciplinary/multimodal treatment plan. The program stresses the importance of early integration with family and community, restoring the individual’s prior personal roles and responsibilities, and the development of suitable life goals. Success in the program should reduce demand for intensive health services, and improve social functioning and education outcomes.
 
The EPPIS program has not previously been evaluated, and this study would be the first to examine this front line intervention in child mental health. The impact of mental health conditions on use of health services in Manitoba is well established, with mental health conditions such as schizophrenia resulting in physician visit rates that are at least two to three times greater than rates for individuals without a mental health disorder (4). This project will provide a look at the effectiveness of a very targeted intervention and its ability to alter the life course of a potentially debilitating disease, especially for individuals with less resources at their disposal (i.e., low SES).


Research Question

Does the EPPIS program improve health and educational outcomes for those participating?


Hypotheses

1. The EPPIS program will result in fewer post treatment hospitalizations, emergency room visits and suicide attempts/completions for treated patients, compared to individuals with psychotic disorders not referred to the program; the program will be equally effective for all patients referred to the program.

2. School-aged participants in EPPIS will have better educational outcomes (marks, on-time status, high school graduations) than non-participants with psychotic disorders.

3. Patients referred and admitted to the EPPIS program will have the same SES gradient, age and sex distribution as those with psychotic disorders not referred to the program.


References

(1) Loebel AD, Lieberman JA, Alvir JM, Mayerhoff DI, Geisler SH, Szymanski SR. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 1992 September;149(9):1183-8.
 
(2) Wyatt RJ, Green MF, Tuma AH. Long-term morbidity associated with delayed treatment of first admission schizophrenic patients: a re-analysis of the Camarillo State Hospital data. Psychol Med 1997 March;27(2):261-8.
 
(3) Birchwood M, Todd P, Jackson C. Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 1998;172(33):53-9.
 
(4) Martens PJ, Fransoo R, McKeen N et al. Patterns of Regional Mental Illness Disorder Diagnoses and ervice Use in Manitoba: A Population-Based Study. Winnipeg, MB: Manitoba Centre for Health Policy; 2004.