Kelly Anderson: Looking at early treatment for first episode of psychosis

In brief

Kelly Anderson

Early psychosis intervention (EPI) programs in Ontario are intended to serve people who have symptoms of a psychotic disorder and have received either no previous treatment or minimal treatment. The province’s EPI standards, released in 2011, say that these individuals should be referred for a full assessment, be contacted by telephone within 72 hours of being referred, and be offered a face-to-face meeting with a crisis response team within two weeks.

Kelly Anderson, a post-doctoral fellow in the Department of Social and Epidemiological Research at the Centre for Addiction and Mental Health (CAMH), wants to find out how many people who have a first episode of psychosis receive follow-up from a psychiatrist, general practitioner, or some form of shared care. She also wants to assess the impact that this follow-up has on a person’s likelihood of being rehospitalized and using emergency services.

EENet has developed a Student Spotlight on Kelly’s work. Student Spotlights are brief profiles of up-and-coming student researchers.

Read it below or download the PDF.

About Kelly

Kelly is a post-doctoral fellow in the Department of Social and Epidemiological Research at the Centre for Addiction and Mental Health (CAMH) and received a Fellowship Award from the Canadian Institutes of Health Research. She has a Bachelor of Health Sciences degree and a Master's degree in Health Research Methodology from McMaster University, in Hamilton, and a PhD from the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University, in Montreal.

Project Title: Health service use and outcomes following the first episode of psychosis

Project Supervisors: Dr. Paul Kurdyak, CAMH; Dr. Kwame McKenzie, CAMH; Dr. Ezra Susser, Columbia University

What Is Kelly’s research about?

Kelly wants to find out how many people who have a first episode of psychosis receive follow-up from a psychiatrist, general practitioner, or some form of shared care. She also wants to assess the impact that this follow-up has on a person’s likelihood of being rehospitalized and using emergency services.

“We’re trying to see how many service providers are meeting the standards of early psychosis intervention (EPI), which is rapid follow-up in the early stages of illness,” she explained.

EPI programs are designed to serve people with psychosis related to serious mental illness, such as schizophrenia, schizoaffective disorder, mood disorder, delusional disorder, and bipolar disorder. EPI programs in Ontario are intended to serve people who are experiencing symptoms of a psychotic disorder and have received either no treatment for psychosis or minimal prior treatment for psychosis.

The Ontario EPI standards released in 2011 say that individuals who meet these criteria should be referred for a comprehensive assessment, be contacted by telephone within 72 hours of being referred, and be offered a face-to-face meeting with a crisis response team within two weeks.

Intervening in a comprehensive way as quickly as possible after the onset of psychosis is important because there’s evidence that the longer the delay to treatment, the poorer the clinical outcomes. Also, delayed treatment can affect a person’s psychological and social development, as well as their relationships with others, their ability to go to school or work, their use of substances, and the cost to the system.

“In the last ten years or so, the government has devoted a lot of resources to early intervention for people with a first episode of psychosis,” Kelly explained.

There are currently more than 50 programs across the province, “and, so far, there’s been very limited evidence as to how well these resources are being rolled out and how well these standards are being implemented.”

With her project, she hopes to find out if service providers are meeting the province’s standards and the extent to which this impacts on the outcomes of people with schizophrenia.

Kelly will look at health services data for all people who had a first diagnosis of schizophrenia between 1999 and 2009 in Ontario. She’ll use data from the Institute for Clinical Evaluative Sciences (ICES) on Ontario Health Insurance Plan (OHIP) billings and hospitalizations.

She has always been interested in mental health and psychiatry, Kelly said, and in recent years, her interest has focused on adolescent and young adult mental health, “Mainly because of everything that we see in the media about teen suicides and mental illness among teenagers and young adults.”

“There’s a statistic that more than 75% of cases of mental illness are diagnosed before the age of 25, which I found shocking,” she said. “And the high burden of illness in that age group led me along this path.”

She’s currently linking the data for her study cohort. Based on the reported age- and sex-specific rates of schizophrenia and the size of the Ontario population, she expects there will be close to 10,000 individuals with first-episode schizophrenia.

Once the cohort is constructed, the next step will be to analyze the data and disseminate the results. She’s also trying to obtain data from the early intervention programs in Toronto which will be linked to her cohort, to get more information on which patients are using early intervention services.

Kelly’s project is funded through a Canadian Institutes of Health Research postdoctoral fellowship and received ethics approval from the CAMH Research Ethics Board and the privacy officer at ICES. She expects to finish the project in March 2015. 

She’s also involved in other projects on ethnicity and pathways to care for first-episode psychosis and is leading a systematic review on the neurotoxic effects of untreated psychosis on brain morphology.

What’s next for Kelly?

Her ultimate goal is to get a university faculty position and continue with her research on health services for adolescents and young adults, as well as the social determinants of the course and outcome of mental illness. Eventually, she’d like to expand her research to other disorders that have a high prevalence among adolescents and young adults, like suicide and eating disorders.

For more information about Kelly’s study, please contact her at Kelly [dot] Anderson [at] camh [dot] ca.

Author: Rossana Coriandoli

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