Services for people at high risk improve outcomes in patients with first episode psychosis

OBJECTIVE: About one‐third of patients referred to services for people at high risk for psychosis may have already developed a first episode of psychosis (FEP). We compared clinical outcomes in FEP patients who presented to either high risk or conventional mental health services. METHOD: Retrospective study comparing duration of hospital admission, referral‐to‐diagnosis time, need for compulsory hospital admission and frequency of admission in patients with FEP who initially presented to a high‐risk service (n = 164) to patients with FEP who initially presented to conventional mental health services (n = 2779). Regression models were performed, controlling for several confounders. RESULTS: FEP patients who had presented to a high‐risk service spent 17 fewer days in hospital [95% CI: −33.7 to (−0.3)], had a shorter referral‐to‐diagnosis time [B coefficient −74.5 days, 95% CI: −101.9 to −(47.1)], a lower frequency of admission [IRR: 0.49 (95% CI: 0.39–0.61)] and a lower likelihood of compulsory admission [OR: 0.52 (95% CI: 0.34–0.81)] in the 24 months following referral, as compared to FEP patients who were first diagnosed at conventional services. CONCLUSION: Services for people at high risk for psychosis are associated with better clinical outcomes in patients who are already psychotic

The relationship between exposure to adverse life events in childhood and adolescent years and subsequent adult psychopathology in 49,163 adult prisoners:a systematic review

There is empirical support for an association between childhood adverse life events and psychopathology in adult offenders. This systematic review aims to summarise the literature that measures the predictive value of childhood adverse life events on mental illness and personality disorders in prisoners in custody. Forty-seven studies were identified. The studies examined a total of 49,163 participants (36,055 males, 13,108 females). The number of offenders in each study ranged from 43 to 16,043. Childhood abuse and neglect were primarily examined. There was support that these subtypes of childhood adverse life events are associated with several psychiatric disorders, in particular substance abuse and psychopathy. Additionally, there were differences across male and female prisoners both in terms of the numbers of studies that looked at specific psychopathologies, and the associations between specific childhood adverse life event subtypes and future psychiatric difficulties. Methodological considerations, future research, and clinical implications are discussed