Aucun titre de diapositive

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Aucun titre de diapositive
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: [email protected]
Results
Introduction
Diagnosis for firstepisode psychosis (n=97)
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].
Diagnostic group (n=97)
4%
Schizophrenia spectrum psychoses
8%
Schizophrenia
Affective non-schizophrenic psychoses
Schizoaffective
44%
Bipolar I with
psychosis
45%
Psychotic
depression
32%
56%
Other psychosis
10%
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].
Productive occupation in early psychosis subjects
100%
No
90%
32.0%
34.2%
80%
42.1%
52.1%
70%
60%
52.6%
42.9%
18.6%
14.5%
7.4%
40%
30%
20%
7.3%
7.2%
6.2%
15.6%
13.4%
10.3%
35.1%
13.2%
25.0%
26.8%
Last month
before
admission
(n=97)
Admission
(n=97)
3 months
(n=97)
10%
8.3%
Studies
8.7%
12.0%
66.0%
36.8%
33.0%
30.1%
6 months
(n=95)
12 months
(n=91)
18 months
(n=83)
Work
43.4%
40.6%
Last year
before
admission
(n=97)
24 months
(n=76)
36 months
(n=69)
48 months
(n=50)
•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
No
Part time
67.0%
55.8%
63.9%
66.0%
56.0%
13.2%
18.9%
11.3%
12.4%
21.6%
21.6%
20.6%
25.3%
15.5%
Admission
(n=97)
3 months
(n=97)
6 months
(n=95)
30.8%
12 months
(n=91)
27.8%
12.0%
11.1%
11.6%
64.0%
13.3%
44.7%
37.1%
Last month
before
admission
(n=97)
13.2%
24.0%
44.9%
61.4%
16.5%
Last year
before
admission
(n=97)
No
Full time
42.1%
46.4%
61.1%
43.5%
25.3%
18 months
(n=83)
60 months
(n=36)
Studies in first episode psychosis
Employment in first episode psychosis
•All subjects admitted to Clinique JAP
(10/2002 – 07/2006)
63.9%
0%
Methods
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Work and studies
5.6%
14.5%
7.9%
8.4%
13.7%
29.9%
10.0%
2.0%
11.0%
50%
14.4%
22.2%
36.2%
49.4%
53.6%
22.0%
24 months
(n=76)
36 months
(n=69)
48 months
(n=50)
60 months
(n=36)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
67.0%
77.1%
79.4%
6.3%
6.2%
83.5%
Part time
78.9%
75.8%
Full time
79.5%
77.6%
76.8%
88.0%
86.1%
8.2%
24.7%
Last year
before
admission
(n=97)
16.7%
14.4%
7.2%
9.3%
Last month
before
admission
(n=96)
Admission
(n=97)
3 months
(n=97)
9.5%
13.2%
8.4%
7.9%
4.3%
11.6%
11.0%
12.0%
14.5%
18.8%
4.0%
8.0%
5.6%
8.3%
6 months
(n=95)
12 months
(n=91)
18 months
(n=83)
24 months
(n=76)
36 months
(n=69)
48 months
(n=50)
60 months
(n=36)
File Review
Type of work subjects treated in early intervention service
Motherhood
Follow-up : min: 12 months and max: 60 months
3.8%
136 subjects admitted to JAP
Mental health rehabilitation program
6.3%
6.1%
6.3%
6.1%
5.7%
5.7%
2.4%
2.4%
16.7%
Adapted work
2.5%
2.5%
10.0%
96.2%
87.5%
88.6%
87.9%
78.6%
85.0%
Non mental health rehabilitation program
3.1%
3.1%
3.1%
90.6%
4.5%
2.3%
2.3%
4.5%
5.3%
2.6%
2.6%
86.4%
89.5%
24 months
(n=44)
36 months
(n=38)
Regular Work
Factors associated to return to occupation
5.3%
5.3%
2.6%
5.3%
3.8%
3.8%
3.8%
3.8%
81.6%
84.6%
48 months
(n=38)
60 months
(n= 26)
114 met inclusion criteria
Last year
before
admission
(n=52)
Last month
before
admission
(n=32)
Admission
(n=33)
3 months
(n=35)
97 subjects were considered for the
analyses
(17 subjects were excluded since
followed for less than one year,
median 2.2 months)
Mean Age: 23.5 yo
Sex 78.3% male
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
Acknowledgments
All patients and workers at the Clinique JAP who made this research project possible
6 months
(n=42)
12 months
(n=40)
18 months
(n=32)
•Having an occupation throughout the year
preceding 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)
Discussion and Conclusion
 Early detection and treatment  High occupational rates at admission
75.3 % of the subjects gained or maintained their occupational status throughout
the study
Most subjects held competitive employment / attend regular schools
Having had an occupation prior to the admission is associated with early return
Diagnosis influences later but not early evolution of occupational status
Occupation rates for our subjects were similar to those of the general population,
although our subjects had clearly lower educational levels
Specific interdisciplinary focus on obtaining/maintaining professional or
academic activities seem to improve occupational levels for patients suffering
from first-episode psychosis

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