Continuity of care and therapeutic adherence in young people at psychosis onset: the integrated intervention model of the Psychiatric Service of Bolzano

Abstract

To report on: 1) the modification process occurred within the Psychiatric Service of Bolzano toward an early, intensive, specific and multimodal system of care for patients experiencing their first psychotic episode and their family members; 2) the 12-month clinical and social course of a sample of patients referred to the "Early Intervention Project". Longitudinal naturalist study evaluating the 12-month clinical and outcome of a cohort of first-episode psychosis patients consecutively referred to the "Early Intervention Project" implemented within the Psychiatric Service of Bolzano. Socio-demographic characteristics, housing situation and occupational status, interventions offered (medical intervention, psychotherapy, psychoeducation to family members, social intervention) and hospital admissions were drawn from electronic medical records. Levels of psychopathology and global functioning were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Global assessment of Functioning (GAF), respectively. During the first five years of activity (2012-2017) 116 patients had been referred to the Project. At 12 months 83.6%were still in charge, 7.76% moved to another area, 8.5% have abandoned the intervention. No significant difference in terms of age and gender was found between patients who remained in the project and those who lost contact. All patients had received specific integrated treatment; moreover, 16% had received intensive residential care. Notably, only 13.5% have had a hospital readmission over the 12 months of intervention. The PANSS total, positive and negative scores displayed significant reduction from baseline (BL) to follow-up (FU); in parallel, increase in GAF score from BL to FU was observed. All patients employed at BL were able to keep their job at FU; 17% of all patients unemployed at baseline were employed at FU. The "Early Intervention Project" implemented in Bolzano was found to ensure integrated, multidisciplinary and early treatment, as defined by the most recent international guidelines, which produced significant improvement in both clinical and social outcomes in a cohort of first-episode psychosis patients.