First episode psychoses in people over-35 years old: uncovering potential actionable targets for early intervention services.

The traditional youth-oriented design of Early Intervention Services (EIS) may lead to the exclusion of patients who have their psychotic onset later in life. A retrospective study was conducted to compare first-episode psychosis (FEP) patients who accessed treatment when aged ≤ 35 years with those ≥36+. A total of 854 patients were identified among 46,222 individuals who had access to community psychiatric services from 1991 to 2021. FEP were aged 18-65, received care between 2012 and 2021 and had a diagnosis of affective or non-affective FEP. Two groups were identified (FEP diagnosed at age ≤ 35 vs ≥ 36) and compared for sociodemographic and clinical characteristics. Most patients were diagnosed when aged ≥ 36+ (61.8%). Compared to the ≤ 35 group, older patients were more likely to be women, married and diagnosed with affective psychosis, and they were less frequently hospitalized. Long-acting injectables antipsychotics (LAI) were less frequently prescribed in the ≥ 36+ group, whereas antidepressants were more frequently prescribed compared to those aged ≤ 35. In both age groups, women were less frequently prescribed LAIs compared to men. These findings highlight the need to reorient EIS to accommodate the needs of older FEP, especially women.

Dimensions and predictors of clinical and personal recovery in first-episode psychoses: Results from a cross-sectional study.

INTRODUCTION: First episode psychosis (FEP) services ensure higher recovery rates compared to usual care. The aim of this study was to investigate the different dimensions of recovery and its predictors. METHODS: This cross-sectional study recruited within those admitted to the Ferrara FEP service since 2012 that at the time of analysis were still receiving psychiatric care. At admission, demographic, social and clinical information were collected. In September 2022, patients were assessed with the Health of the Nation Outcome Scale to evaluate clinical/functional recovery, the Recovery Assessment Scale to evaluate personal recovery, and the G12 item of the Positive and Negative Syndrome Scale to evaluate insight. Patients in recovery were compared to those not in recovery by bivariate analyses. Adjusted logistic regressions were performed to investigate predictors of recovery. RESULTS: Within 141 admitted, and 105 still receiving care, 54 patients completed the assessment. Most (51.9%) were in clinical/functional, 61.1% in personal recovery, and 38.8% both. Psychiatric hospitalization positively predicted clinical/functional recovery, whereas being prescribed oral antipsychotics was a negative predictor. Personal recovery was predicted by male sex and showed a negative association with overall severity of symptomatology. Those in personal recovery were more likely to have been prescribed long-acting antipsychotics, but this was not significant in the multivariable analysis. Poor insight negatively predicted clinical/functional recovery but had no impact on personal recovery. CONCLUSION: Our findings confirm that clinical/functional and personal recovery are semi-independent dimensions and not always overlap. Further research is needed to promote interventions targeted at all recovery dimensions.