Going back to work or to study after a first-episode psychosis :

the impact of an early intervention program over 5 years Amal Abdel-Baki (1,2), Geneviève Létourneau (1,2), Albert Ng (1,2), Caroline Morin (1)

(1)Centre Hospitalier de l’Université de Montréal, Montreal, Canada ; (2) Psychiatry Department, University of Montreal, Montreal, Canada.

Correspondence: amal.abdel-baki@umontreal.ca

IntroductionResults

Methods

Psychosis usually emerges between 15 and 35 years of age, a period during which vocational choices are made, and often compromises the patients educational and professional projects.With regular treatments offered in psychiatry, unemployment rates for people suffering from “severe mental illness” are 75-85 %[1]. Marwaha’s review showed that employment rates for people suffering from schizophrenia ranged between: 4-27 %[2] and even if a significant number number would like to have a job, few are offered specific services[2].

•All subjects admitted to Clinique JAP (10/2002 – 07/2006)

•Aged 18- 30 years old at admission•Main diagnosis of affective or non-affective psychosis (DSM-IV criteria)•Untreated or treated for psychosis ≤ 1 year

136 subjects admitted to JAP

114 met inclusion criteria

97 subjects were considered for the analyses

(17 subjects were excluded since followed for less than one year,

median 2.2 months)

Diagnostic group (n=97)

Discussion and Conclusion

References[1] Marshall M, Bond GR, Huxley P. Vocational rehabilitation for people with severe mental illness. Cochrane Database of Systematic Reviews 2008, issue 3.[2] Marwaha S. et Johnson S. Schizophrenia and employment – a review. Social Psychiatry and Psychiatric Epidemiology. 2004 May;39(5):337-49. Review [3] Bond GR. Supported employement: Evidence for an evidence-based practice. Psychiatric Rehabilitation Journal. 2004 Spring; Volume 27, Number 4

AcknowledgmentsAll patients and workers at the Clinique JAP who made this research project possible

The Clinique JAP (Centre Hospitalier de l’Université de Montréal) is an early intervention program for psychosis where occupational rehabilitation is not only one of the major therapeutic goals but is also used as a ‘treatment modality’. ‘Vocational case management’ (VCM) as well as therapeutic groups aim toward going back to a productive activity. The interdisciplinary team offers an integrated treatment for psychosis and vocational functioning. On top of regular intensive case management services VCM offers help to get and maintain a job including outreach in that purpose and the ‘active’ elements of supported employment which are: aiming for competitive jobs, continuous and individualized support, integration of vocational and treatment teams and fast job research based on patients preferences[3].

Diagnosis for first-episode psychosis (n=97)

45%

10%

32%

8%4%

Schizophrenia

Schizoaffective

Bipolar I withpsychosis

Psychoticdepression

Other psychosis

File Review

Follow-up : min: 12 months and max: 60 months

Schizophrenia spectrum psychoses

Affective non-schizophrenic psychoses

44%

56%

Early detection and treatment High occupational rates at admission75.3 % of the subjects gained or maintained their occupational status throughout the studyMost subjects held competitive employment / attend regular schoolsHaving had an occupation prior to the admission is associated with early returnDiagnosis influences later but not early evolution of occupational statusOccupation rates for our subjects were similar to those of the general population, although our subjects had clearly lower educational levelsSpecific interdisciplinary focus on obtaining/maintaining professional or academic activities seem to improve occupational levels for patients suffering from first-episode psychosis

Factors associated to return to occupation

•Having an occupation throughout the yearpreceding admission, and at admission is significantly associated with return to a productive occupation during the 2 first years of follow-up but not to later occupational outcome.•Affective psychosis vs Schizophrenia spectrum psychosis are associated with higher rates of occupation in later follow-up only (≥ 24 months)

Mean Age: 23.5 yo Sex 78.3% male