Welcome to the EPA 2022 Interactive Programme 

Abstract Body

First Episode Psychosis (FEP) treatment is a critical element of mental health-care systems, which has been shown to improve outcomes in this patient group. Due to divergent historical and political trajectories, countries of Central and Eastern Europe have taken a different course in the development of mental health-care. Among these differences is the less advanced level of present FEP treatment networks. Traditionally mental health-care is more inpatient based in these countries, with a lesser emphasis on specialized outpatient services, and early intervention programmes have been only launched during the last 15 years.

Despite the lag of the development of FEP services, a variety of models has been already started in our countries. In my lecture I will review the literature about the Central and Esteran European region. I will also present good practices of how the existing early intervention programmes can be integrated into the traditional mental health-care systems.

Abstract Body

Introduction

First episode psychosis (FEP) programs target the first 3-5 years after the first manifestation of a psychotic episode. Although follow-up results after 10-15 years are mixed, reported results of the first 5-10 years are promising in improving relapse prevention, functional outcomes and reducing mental health care costs, compared to treatment as usual.

Objectives

Our objective was to develop the first complex FEP program in Hungary.

Methods

Male and female inpatients, (age:17-40years), hospitalized due to a first psychotic episode and consenting to participate, were included, since 2019 October. Drug induced psychosis and organic background in the etiology of the psychotic episode were excluded. Duration of the program is 2-3 years, based on the individual needs of the patients. The program provides detailed clinical and neuropsychological examinations, MRI, pharmacotherapy, various psychosocial interventions, and support group for relatives.

Results

Twenty-eight patients [15 male,13 female, mean age=22,4 (18-40)years] were included. The program has been repeatedly limited by COVID-19 pandemic. Psychiatric control, pharmacotherapy, psychoeducation and supportive therapy, however could be continously provided via telepsychiatry, even during the lockdown. During the first 2 years, 90% of the patients remained in treatment, showed good compliance with pharmacotherapy; 10% of the patients were rehospitalized due to relapse. In the presentation, besides clinical experiences, preliminary clinical outcome data will also be presented.

Conclusions

The first complex FEP program in Hungary, although limited repeatedly by the pandemic, show promising clinical results with low relapse rates and high level of adherence to therapy in the first 2 years after a first psychotic episode.

Abstract Body

We have witnessed a significant push towards staging in medicine. That trend has not bypassed psychiatry, with realization that early phases of various disorders present the window for early intervention that is most likely to result in preserving every-day functionality and achieving favourable outcomes. First-episode psychosis programs have been developed in order to ensure adequate early interaction with psychiatric services, help achieve faster and quality remission, prevent relapses and ensure better long-term outcomes. There is still, however, no consensus on the format or the most appropriate intervention in the early-course psychosis.

Patients in Zagreb, Croatia, are offered a number of first-episode psychosis programs, one of which is housed in the largest Croatian psychiatric institution, University Psychiatric Hospital Vrapce. Specialized early-course treatment model in Vrapce stemmed from first-episode inpatient unit established in 2004, and grew to present in its core integration of care across different organizational units, acuity levels, and specific patient needs. Recognizing that a significant number of first-episode patients first interact with psychiatric services through emergency units, Vrapce's model fostered early interaction with specialized services staff starting with intensive and emergency care units, allowing for continuity of care and early recruitment into specialized services. Vertical integration meant inpatient acute and subacute units seamlessly linked with day hospital and outpatient services, creating the setting for earlier formation of therapeutic alliance and treatment plans, but also allowing for flexible entry points for users. COVID-19 pandemic, in addition to challenging the initial integrations of services, facilitated transfer of certain services into virtual space.