SA53. Is It Useful to Force First-Episode Psychosis Patients to Comply With Medications? Another Look at Community Treatment Orders

摘要

>Background: Patients suffering from a first episode of psychosis who do not adhere to antipsychotic treatment often have important difficulties functioning socially, academically, and professionally. Nonadherence to antipsychotic medication in psychosis has been strongly associated with multiple relapses and hospitalizations. When patients are unable to consent to care, legal procedures enable psychiatrists to treat or hospitalize patients against their will. This may result in faster remission, more productive lives, and less time in the hospital. The purpose of this study is to determine the effect of community treatment orders (CTO) on first-episode psychosis (FEP) patients’ clinical outcomes. >Methods: We studied FEP patients from the PEPP-Montreal clinic who were hospitalized, unable to consent to care, and for whom a community treatment order was requested. All patients at PEPP-Montreal are evaluated prospectively for several relevant clinical dimensions (measured by SAPS, SANS, CDS and HAS, GAF, and SOFAS). To determine the effect of the treatment order on patients’ outcome, we designed a mirror study comparing the severity of illness before and after the treatment order. >Results: Of the 41 patients examined, we find a sizable and significant change in clinical outcomes after CTO. Indeed, the average decrease in SAPS (6.3) and in SANS (2.1) were highly significant (P < .01). In terms of functioning, we find a significant (P < .01) increase in function on the GAF (15.5-point increase) and the SOFAS (18.0-point increase). However, we also find that patients significantly increase in weight after the CTO (average 7.2 kg, P < .01). Last, we find that the change in SAPS was negatively correlated with the time taken to obtain a CTO (greatest changes in SAPS occurring with CTOs obtained within the first 3 months of treatment). >Conclusion: Our results suggest that CTOs can be highly effective in reducing positive and negative symptoms in FEP patients and in increasing their functioning. Furthermore, earlier CTOs should be sought as CTOs issued later in the illness may be less effective.