Early Intervention Centre Research Articles

Implementation Research: Embracing Practitioners' Views.

This research explores practitioners' perspectives during the implementation of triadic gaze intervention (TGI), an evidence-based protocol for assessing and planning treatment targeting gaze as an early signal of intentional communication for young children with physical disabilities. Using qualitative methods, 7 practitioners from 1 early intervention center reported their perceptions about (a) early intervention for young children with physical disabilities, (b) acceptability and feasibility in the use of the TGI protocol in routine practice, and (c) feasibility of the TGI training. Qualitative data were gathered from 2 semistructured group interviews, once before and once after TGI training and implementation. Qualitative results documented the practitioners' reflections on recent changes to early intervention service delivery, the impact of such change on TGI adoption, and an overall strong enthusiasm for the TGI protocol, despite some need for adaptation. These results are discussed relative to adapting the TGI protocol and training, when considering how to best bring about change in practice. More broadly, results highlighted the critical role of researcher-practitioner collaboration in implementation research and the value of qualitative data for gaining a richer understanding of practitioners' perspectives about the implementation process.

Psychometric properties of the Spanish version of the family-centred practices scale for use with families of young children receiving early childhood intervention.

Early childhood intervention (ECI) centres in Spain recently initiated a process of change towards the adoption of family-centred practices (FCPs). Knowledge about the extent to which practitioners' use FCPs is needed. The psychometric properties of the Spanish version of the FCPs scale were examined. A convenience sample of 105 families of children with developmental delays attending three different ECI centres in Spain completed the FCPs scale and provided information about the ECI centre characteristics and practices, caregiver self-efficacy beliefs, and family and child demographic information. The Spanish version of the FCP scale was found to be both reliable and valid. FCPs were correlated with self-efficacy beliefs, parents' involvement in their child's ECI program and family decision making. The FCP scale provides practitioners with useful information about their practices, but also has capacity-building consequences for families. The study is a first step for examining the use of FCPs in Spain.

Clozapine use in early psychosis

BackgroundThe superior efficacy of clozapine in treatment resistant schizophrenia has been clearly demonstrated, yet there are often delays in the commencement of clozapine. In this study, we aimed to determine; the proportion of young people with a first episode of psychosis (FEP) who would be considered eligible for clozapine treatment, the theoretical delay in commencing clozapine and to compare the outcomes of those treated with clozapine to those who were eligible but not treated with clozapine. MethodsThis study was conducted at Orygen Youth Health (OYH), a youth mental health service for young people aged 15–24. All clients who were treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) clinic between 01.01.2011 and 31.12.2013 were included. Results544 young people presented with a FEP in the study period and 9.4% (N = 51) subsequently fulfilled criteria for treatment-resistant schizophrenia. Of these individuals, thirty (58.8%) were commenced on clozapine, in addition to a further eleven. The median delay to the commencement of clozapine was 42 weeks (I.Q.R. = 7.5–64). Of those commenced on clozapine, 76.6% achieved remission of positive psychotic symptoms and 50% were in employment or education by the time of discharge or transfer to the adult mental health services. The rate of discontinuation of clozapine was 24.4% and 60.0% of discontinuations were due to cardiac complications and the remainder were due to non-compliance. ConclusionsThese findings suggest that early intervention for psychosis services have a crucial role in ensuring timely initiation of clozapine in individuals with a diagnosis of treatment-resistant schizophrenia.

Service Use of an Early Intervention Centre, Clinical and Sociodemographic Characteristics of Young Adults with Early Psychosis with and without Migration Background

The present study evaluated service use of our newly established Early Intervention and Treatment Centre (FRITZ) in Berlin for young adults with first or early psychosis with and without migration background. We conducted a retrospective chart review of in-patients with early psychosis who were admitted to FRITZ between May 2014 and May 2015. We investigated the proportion of patients with migration background, sociodemographic and clinical characteristics of patients. Corresponding to the proportion of migrants in the catchment area, 35 % of our service users from the catchment area (n = 60) had a migration background. Migrants had a better social adaption, but showed lower insight into illness, less substance induced psychoses and less inpatient admissions. The majority of all patients were admitted to FRITZ via the emergency department. The findings indicate that FRITZ was almost equally well received by patients with and without migration background. Patients with migration background showed distinct sociodemographic and clinical characteristics that could be relevant for treatment. Implications for future clinical practice are discussed.

Rates and predictors of relapse following discontinuation of antipsychotic medication after a first episode of psychosis

BackgroundThere is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis. Robust predictors of relapse after discontinuation are yet to be identified. The present study aimed to determine the proportion of young people who discontinue their antipsychotic medication after a first episode of psychosis, the proportion who experience relapse, and predictors of relapse. MethodsA retrospective study of all individuals presenting to the Early Psychosis Prevention and Intervention Centre between 01/01/11 and 31/12/13 was conducted. A Cox regression analysis was conducted to identify predictors of relapse. ResultsA total of 544 young people with a FEP were included. A trial of discontinuation was undertaken by 61% of the cohort. Median duration of antipsychotic medication prior to first trial of discontinuation was 174.50days. Amongst those trialing discontinuation, 149 (45.8%) experienced relapse in a median follow-up time post discontinuation of 372days. On multivariate analysis, predictors of relapse were a diagnosis of cannabis abuse disorder (HR: 1.40), and longer duration of antipsychotic medication (HR: 1.05). ConclusionAntipsychotic discontinuation frequently occurs earlier than guidelines recommend. Individuals with a diagnosis of cannabis abuse are more likely to experience relapse and addressing this substance abuse prior to discontinuation could possibly reduce relapse rates.

Parent Empowerment in Early Intervention Programmes of Children with Hearing Loss in Mumbai, India

Purpose: Since families are perceived to be active agents in the early intervention programmes of young children with disabilities, professionals ought to treat parents as equal partners and keep them informed and involved in various aspects of the intervention. This study aimed to explore the areas in which parent empowerment is currently being facilitated in the early intervention centres for children with hearing loss. Method: A qualitative research with conversational analysis was the approach used. Focus group discussions with the two primary stakeholders, namely parents and special educators, were held separately at five sites in Mumbai, to gather their views on the existing areas of empowerment. It was also decided to explore the felt needs of parents in this regard. Person triangulation was used to ascertain the credibility of the data. Results: Conversational analysis yielded 4 themes with respect to parents: Parental knowledge, involvement, support and needs. Conclusion and Implications: The study highlighted the gaps in parent empowerment in the programmes undertaken by early intervention centres. A recommendation is made to develop a common framework for empowering parents. It is envisaged that such a framework will bridge the gap between what currently exists for parents, their felt needs, and current global practices. This framework could also assist in measuring family empowerment outcomes.

Evaluation of a professional development training programme for mental health clinicians specializing in early psychosis

The Early Psychosis Prevention and Intervention Centre Statewide Services (ESW) team provides training for multidisciplinary clinicians that specialise in early psychosis across the State of Victoria, Australia. The aim of this paper is to describe the 4-phase approach utilised by ESW to prepare for and deliver workshops, to report on participants' ratings of the ESW workshops, and to make recommendations for other trainers of early psychosis clinicians. Between March 2009 and September 2014, ESW provided 85 training workshops that had a strong focus on evidence-based approaches and international guidelines, and utilized clinical examples of early psychosis interventions. At the conclusion of each workshop, participants were asked to complete a questionnaire that comprised qualitative and quantitative elements. These assessed perceived trainer knowledge, learning, interactivity and specific topic feedback. The focus of this paper will be on describing the quantitative data resulting from these questionnaires. A total of 1708 clinicians provided feedback on the 85 workshops. There was a high level of compliance, with 83.0% of workshop participants completing the questionnaires. Feedback was positive across all areas, with the 2 areas that were most highly endorsed being that presenters "appeared to know their subject matter well" (endorsed by 98.4% of participants) and that "topics were explained well" (endorsed by 96.8% of participants). Training for early psychosis clinicians that focusses on core clinical topics, is well planned, incorporates feedback from previous training, and is based on adult learning principles, is likely to be effective and well received by early psychosis clinicians.

Cómo implementar el modelo centrado en la familia en atención temprana.

<p style="margin: 0cm 0cm 0pt; text-align: justify; line-height: 150%; -ms-text-justify: inter-ideograph;"><span style="color: black; line-height: 150%; font-family: 'Times New Roman',serif; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US">From the results of a research aimed at improving the quality of life of families with a child with intellectual disability, the purpose of this paper is to provide a methodology for the implementation of the family-centered model in early childhood intervention centers in our country. Quantitative and qualitative analyses of the collected data allow us to systematize the steps or stages that would be necessary to provide professionals and families in early intervention centers with useful tools to empower the families and to enhance the children’s development. This article represents another step further from the proposals made by other researchers in other countries with different traditions and culture in the field of early intervention, and intends to reflect the characteristics of our country in terms of the history and the path of early intervention in recent decades.</span></p>

Parenting Stress and Coping Strategies in Mothers of Children Receiving Early Intervention Services

The relationship between coping strategies of mothers of children receiving early intervention services and parenting stress was studied. A total of 144 mothers from 17 early intervention centers located in the Valencian Community, Spain, participated of the study. Mother’s mean age was 35.6 years (SD = 4.10) and children’s mean age was 2.71 years (SD = 1.21). Mothers’ parenting stress level was measured using the Parenting Stress Index-SF (PSI-SF) and their coping strategies were evaluated using the Adult Coping Response Inventory (CRI-A). We proposed two structural equation models to predict total parenting stress and its factors in relationship to child’s and mother’s sociodemografic variables, and mediated by mother’s coping strategies. Mothers’ education level and child diagnosis had a direct impact on the three PSI-SF factors. Type of disorder and Cognitive Avoidance were positively and significantly (p < .05) related to the Emotional Discharge coping strategy, explaining a 20.9% of the variance. On the other hand, mothers’ educational level and child’s type of disorder, directly, and coping strategies, in the form of mediator or directly, have a relationship with the dimensions of maternal stress. Both models show similar results although the second model supports the existence of a latent stress factor that is explained by the three stress factors. The authors concluded that mothers of children with especial needs could potencially benefit from early intervention programs that provide supports to help them to incorporate aproach coping styles to their coping strategies.

Increased Striatal and Reduced Prefrontal Cerebral Blood Flow in Clinical High Risk for Psychosis.

Increased striatal dopaminergic activity and decreased prefrontal functioning have been reported in individuals at clinical high risk (CHR) for psychosis. Abnormal metabolic rate might affect resting-state cerebral blood flow (rCBF) in the respective regions. Here, we examined if striatal and prefrontal rCBF differ between patients with CHR, first-episode psychosis (FEP), chronic schizophrenia-spectrum disorder (SZ) and controls. Two cohorts with a total of 122 participants were included and analyzed separately: 32 patients with SZ and 31 healthy controls (HC) from the University Hospital of Psychiatry, and 59 patients from the Bern Early Recognition and Intervention Center (29 with CHR, 12 with FEP, and 18 clinical controls [CC]). Ultra-high risk criteria were assessed with the Structured Interview for Psychosis-Risk Syndromes, basic symptom criteria with the Schizophrenia Proneness Instrument. rCBF was measured with pseudo-continuous arterial spin labeling 3T-Magnetic Resonance Imaging. Striatal rCBF was significantly increased and prefrontal rCBF significantly decreased in the SZ group compared to HC group and in the CHR and FEP groups compared to CC group. Striatal rCBF correlated significantly with positive symptom scores in SZ and CHR. An inverse correlation between striatal and frontal rCBF was found in controls (HC, CC), but not in patient groups (SZ, FEP, CHR). This is the first study to demonstrate increased neuronal activity within the striatum, but reduced prefrontal activity in patients with CHR, FEP, and SZ compared to the respective controls. Our results indicate that alterations in striatal and prefrontal rCBF are reflecting metabolic abnormalities preceding the onset of frank psychosis.

Rates and predictors of 18-months remission in an epidemiological cohort of 661 patients with first-episode psychosis.

Most first episode psychosis (FEP) outcome studies are based on patient samples enrolled through an informed consent procedure, which may induce important biases. Our aim was to study the 18-month outcome of FEP in an epidemiological sample of patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC). The files of 661 FEP patients treated for up to 18months between 1998 and 2000 were assessed. Symptomatic remission was defined as receiving a score≤3 on the Clinical Global Impressions (CGI) scales, and functional remission as concurrent fulfillment of occupation/employment and independent living. Predictors were analyzed using stepwise logistic regression models. At endpoint, 63% of FEP patients had reached symptomatic remission and 44% functional remission. Duration of untreated psychosis, baseline symptom intensity, time in service and decrease or remission of substance use, predicted both symptomatic and functional outcome. A history of suicide attempt or non-adherence to medication was linked to lower likelihood to reach symptomatic remission while pre-morbid GAF and employment at baseline were linked to functional outcome. The development of early intervention strategies should be pursued, in order both to provide treatment before symptoms reach a high intensity and to maintain social integration. Specific strategies need to promote engagement, facilitate adherence to medication and to create a framework where key issues such as substance abuse co-morbidity can be addressed.

Predictors of parents' adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design.

Many families have problems adhering to home exercise programs (HEP) for children with developmental disabilities. However, parental participation in HEP is known to have a positive effect on child-related outcome variables, as well as on parental functioning. This study examined whether the different behaviours of health professionals, and the behaviour and social characteristics of parents determine rates of parental adherence to both the frequency per week, and duration per session, of HEP for children with developmental disabilities attending paediatric services in early intervention centres. In this study, developmental disabilities include those caused by developmental delay or specific health conditions such as cerebral palsy, congenital illness, or others. Survey. Eighteen early intervention centers. Parents of children with developmental disabilities receiving HEP. A self-reported questionnaire was used to examine: whether frequency and duration of weekly exercise sessions was prescribed by physiotherapists; whether the child had received the HEP according to what was prescribed; and items related to the individual, social support, illnesses and the involvement of the health professional. Multiple logistic regression analyses examined their relative relevance. In this study 219 parents participated. The rate of adherence to the prescribed frequency and duration of the HEP was similar (61.4-57.2%). The probability of adherence to both components increased for parents who had a low perception of the existence of barriers for integrating the exercises into their daily routine (OR=2.62 and 4.83). Furthermore, other cognitive factors of parents had a variable influence. The involvement of the professional had a significant impact regarding the frequency of the HEP. Professional involvement increased the probability of exercises being followed accurately by adopting strategies such as: providing information about the progress and evolution of the exercises (OR=3.75); justifying their usefulness (OR=2.17); giving advice on how to include them into the daily routine (OR=2.54); checking skills during follow-up (OR=2.21) and asking about home adherence (OR=2.20). Providing information during clinical encounters, advising how to include exercises into the daily routine, and checking skills and adherence during follow-up represent practical targets for clinicians aiming to improve the frequency of HEP for children with developmental disabilities. This study contributes to the knowledge of physicians and therapists regarding how their interventions (in particular, information, instructions for HEP and follow-up) influence parents regarding their adherence to HEP.

SA58. The First-Episode Psychosis Outcome Study: Preliminary Data on the Long-Term Follow-Up of First-Episode Psychosis Patients Who Were Treated at the Early Psychosis Prevention and Intervention Centre Between 1998 and 2000

Abstract Background: Specialist early intervention (SEI) service models are designed to treat symptoms, promote social and vocational recovery, prevent relapse, and resource and up skill patients and their families. While the immediate benefits of SEI are clear, and have been demonstrated, the long-term impact of SEI on illness course is less clear. The First Episode Outcome Study involves the long-term follow-up of a representative sample of first-episode psychosis patients who were treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000. The aim of this presentation is 3-fold: (1) to describe the methodology of FEPOS long-term follow-up; (2) to present preliminary mortality data; and (3) examine the preliminary characteristics of those who have been contacted and interviewed. Methods: Between January 1998 and December 2000, 661 patients between the ages of 15 and 29 years were treated at the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The 18-month treatment characteristics of this cohort have been extensively examined in the FEPOS. The long-term outcomes of this cohort are now being examined in a new study (known as FEPOS15). Results: Characteristics of 46 individuals who are deceased will be described. The clinical, functional, physical health, and quality-of-life characteristics of the first 100 individuals who have been contacted will also be discussed. Conclusion: This follow-up study is one of the longest, largest, and most comprehensive studies of the multidimensional outcomes of an SEI service for psychosis.

Recognising the “forgotten man”: Fathers’ experiences in caring for a young child with autism spectrum disorder

ABSTRACTBackground Despite decades of research on family adaptation in relation to caring for a child with an autism spectrum disorder (ASD), the wellbeing of fathers remains poorly understood.Method The present study sought to investigate experiences of fathers of young children with ASD aged between 2½ and 6 years attending an ASD-specific early intervention centre. Eighteen fathers initially completed a mailed questionnaire and 8 of these fathers were then interviewed by telephone. The questionnaire included standardised measures assessing constructs of the double ABCX model of family adaptation. The interview used open-ended questions to understand the experiences of fathers’ involvement in caring, sources of support, and coping strategies.Results Fathers experienced elevated levels of parental stress and elevated depressive symptoms. Interviews deepened understanding of fathers’ personal experiences of each component of the double ABCX model.Conclusions Findings from this study provide further insight into the fathering role and demonstrate the utility of the double ABCX model as a framework for exploring their experiences. The need for further research to explore practical implications to better support fathers is discussed.

Predictors of functional status at service entry and discharge among young people with first episode psychosis.

Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients with poor functioning and the features influencing functional status over time may pave the way to better treatment. A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status). 52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functioning and education, and were more likely to have self-reported histories of learning disability, forensic issues, traumatic experiences and substance use. At service entry, they had more severe symptoms and poorer global functioning. 37% of these patients maintained a poor functional status at discharge, and 18% of those with a good functional status at service entry experienced a decline. Although psychosocial interventions might assist a young person with FEP with working towards functional goals, for some, the impact of factors such as ongoing substance use and forensic issues on functional status needs to be addressed.

Development of an implementation guide to facilitate the roll-out of early intervention services for psychosis.

Our aim was to develop an implementation guide that was informed by an analysis of context-specific barriers and enablers, behaviour change theory, as well as evidence about the effects of implementation interventions, for the establishment and scaling up of an early intervention model for psychosis (called Early Psychosis Prevention and Intervention Centre (EPPIC)). We used a systematic approach involving four steps. First, the target behaviours of the EPPIC model for implementation were specified. Second, a consultation was undertaken to explore the barriers and enablers to undertaking these priority minimum standard clinical behaviours. Third, an implementation strategy that included a range of behaviour change techniques tailored to address the identified barriers was developed. Finally, a tool to assess whether those implementing the EPPIC model maintained fidelity to the implementation strategy was designed. We identified a range of barriers that could act to dilute the core components of the EPPIC model and compromise its implementation. An implementation strategy using theory and evidence-based strategies for behaviour change was designed to address these barriers. The process we used in the development of the implementation strategy provided a unique opportunity to consider the essential areas to cover, how to make information easily understandable and accessible while noting the complexity of issues involved in not only implementation, but also the scaling up of the EPPIC model for services.

Young men’s access to community-based mental health care: qualitative analysis of barriers and facilitators

Background: Young men experiencing mental ill health report the lowest rates of professional help-seeking of any demographic group across the lifespan. This phase of life (i.e. adolescence and emerging adulthood) also corresponds to a period of disconnection from healthcare services for young men.Aims: The present exploratory qualitative study aimed to identify barriers and facilitators to mental health care, as identified by a sample of young help-seeking men and staff involved in mental health service provision.Method: Interviews and focus groups were undertaken with 25 young males (mean = 18.80 years, SD = 3.56) and four service providers. Participants were recruited from headspace enhanced primary care early intervention centres in Australia.Results: Thematic analysis indicated four overarching barriers and facilitators. The identified barriers were male role expectations, talk therapy as unknown territory, difficulties navigating the system and intake processes. The identified facilitators were positive initial contact, effective cross-sector partnerships, availability of male practitioners and use of targeted messaging.Conclusions: Given the ongoing low rates of help-seeking, high rates of suicide and other adverse outcomes for young men, priority research and clinical attention is needed for this group. Recommendations are offered for future research, including suggestions for implementation of targeted strategies addressing gender-based health needs.

Assessment and Diagnosis of Autism Spectrum Disorder in Hanoi, Vietnam

For individuals with autism spectrum disorder (ASD), early and accurate diagnosis enables early intervention, which leads to improved quality of life. The diagnostic label of ASD has only been recognized in Vietnam since 2000 and the number of children who have been diagnosed has increased dramatically. However, there is limited understanding about the condition. This article aims to describe the current assessment and diagnostic practices in Hanoi, Vietnam, a low resource setting. Data for this article came from in-depth interviews with parents of children with ASD and service providers, and observation at health clinics and early intervention centers that provide ASD assessment during field work from July 2011 to May 2012. This study reveals that although there is some improvement in assessment services, parents still face a number of challenges in accessing quality assessment and diagnosis of ASD in Vietnam. These include rushed and perfunctory assessment; a lack of clinical guidelines for assessment; limited communication among health professionals in assessment teams, and between professionals and parents of children with ASD. Public awareness-raising of the signs of autism, capacity building for professionals, development of practical and contextual appropriate assessment protocols are needed to enhance the accessibility and quality of assessment services.

Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial

BackgroundFirst-episode psychosis most often has its onset during late adolescence. In caring for the young person, families endure high levels of stress and depression. Meanwhile, the social networks of families often erode. Our group has previously shown that family cognitive behaviour therapy (CBT) leads to significantly improved perceived stress compared with specialist first-episode treatment as usual; however, there are well-known barriers to the dissemination of effective family interventions. To address this, we have developed a novel online intervention entitled ‘Altitudes’ that fully integrates purpose-built online social networking, expert and peer moderation, and evidence-based psychoeducation within a single application. The primary aim of this trial is to evaluate the effectiveness of Altitudes in reducing stress in carers over a 6-month period.Methods/designWe describe here a single-blinded cluster randomised controlled trial (cRCT) with permutated blocks. The clusters comprise individual families. The two treatment conditions include Altitudes plus Specialist Treatment as Usual (STAU) and STAU alone. Altitudes involves participation in our novel online programme whereas STAU comprises specialist family work at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. We aim to recruit 160 family members of young, 15–27 year-old, patients registered for treatment for first-episode psychosis (FEP) at EPPIC. The design includes two assessment time points, namely, baseline and 6-month follow-up. The study is due for completion within 2 years including an 18-month recruitment period and a 6-month treatment phase. The primary outcome is carers’ perceived stress at 6 months. Secondary outcome measures include a biomarker of stress, depressive symptoms, worry, substance use, loneliness, social support, satisfaction with life, and a range of measures that tap into coping resources. We seek to gain a dynamic picture of carer stress through our Smartphone Ecological Momentary Assessment (SEMA) tool.DiscussionThis is the first randomised controlled trial designed to evaluate an online intervention for carers of young people recovering from FEP. It has the potential to produce evidence in support of a highly novel, accessible, and cost-effective intervention to reduce stress in carers who are providing support to young people at a critical phase in their recovery from psychosis.Trial registrationAustralian New Zealand Clinical Trial Registry, identifier: ACTRN12616000968471. Retrospectively registered on 22 July 2016.

Predictors of favourable outcome in young people with a first episode psychosis without antipsychotic medication

IntroductionData from the literature suggests that some first episode psychosis (FEP) patients may recover without antipsychotic medication. There is however no reliable way to identify them. In a previous paper we found, in a cohort of 584 FEP patients, that those consistently refusing medication had poorer pre-morbid functioning, less insight, higher rate of substance use and poorer outcome. However, some medication refusers, had a favourable outcome. The study aim was to identify predictors of good short term outcome despite non-exposure to medication. MethodsThe Early Psychosis Prevention and Intervention Centre (EPPIC) admitted 786 FEP patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. Data on medication adherence was available in 584 patients. Among the 17.9% of patients who consistently refused medication over the entire treatment phase we compared patients who had a favourable symptomatic and functional outcome with those who did not. ResultsAmong patients who consistently refused medication, 41% achieved symptomatic remission and 33% reached functional recovery. Predictors of symptomatic remission were a better premorbid functioning level, higher education and employment status at baseline. Predictors of functional recovery were a shorter duration of the prodrome phase, less severe psychopathology at baseline and lower cannabis use. ConclusionsDespite limitations mainly linked to the fact that non-exposure to antipsychotic medication was based on patient's treatment refusal, this study identified some characteristics which may contribute to the identification of a sub-group of FEP patients who may have good short term outcome without antipsychotic treatment.