PMID- 30079763
OWN - NLM
STAT- MEDLINE
DCOM- 20190911
LR  - 20200309
IS  - 1497-0015 (Electronic)
IS  - 0706-7437 (Print)
IS  - 0706-7437 (Linking)
VI  - 63
IP  - 11
DP  - 2018 Nov
TI  - Effectiveness of Community Treatment Order in Patients with a First Episode of 
      Psychosis: A Mirror-Image Study.
PG  - 766-773
LID - 10.1177/0706743718777389 [doi]
AB  - OBJECTIVE: Poor adherence to antipsychotic medications is strongly associated 
      with psychotic relapses and hospitalizations. This may hinder patients' ability 
      to function, particularly in a first episode of psychosis (FEP). Poor adherence 
      to treatment may be due to poor insight that can alter the capacity to consent to 
      care, including pharmacotherapy. When patients are judged legally lacking the 
      capacity to consent to care, treatment can be mandated through community 
      treatment orders (CTOs). This naturalistic study examines the effects of CTOs in 
      FEP patients. METHOD: This study examines 38 FEP patients legally deemed unable 
      to consent to care during their follow-up. Using a naturalistic mirror-image 
      approach, we compare clinical (Scale for the Assessment of Positive Symptoms 
      [SAPS], Scale for the Assessment of Negative Symptoms [SANS]), functional (Global 
      Assessment of Functioning Scale [GAF], Social and Occupational Functioning 
      Assessment Scale [SOFAS]), and service use (number of emergency room visits, 
      length of hospitalizations) indicators before and after CTO. RESULTS: After the 
      CTO, 37 of 38 patients complied with treatment. Statistically significant 
      improvements in clinical (triangle upSAPS = -6.3; 95% CI, 4.5 to 8.1 and triangle upSANS = -2.2; 95% 
      CI, 0.9 to 3.4, P < 0.01) and functional (triangle upGAF = +15.0; 95% CI, 8.4 to 21.6, 
      triangle upSOFAS = +18.6; 95% CI, 12.8 to 24.4, P < 0.01) outcomes were observed. 
      Significant reduction in emergency room visits ( P = 0.016) and days of 
      hospitalization per month in acute care units ( P < 0.05) were identified with no 
      difference in hospital days per month in short-stay units. Moreover, encounters 
      with case managers ( P = 0.008) and attendance of cognitive therapy sessions ( P 
      = 0.031) were significantly higher. However, patients' weight significantly 
      increased after CTO (triangle upweight = +8.0 kg, P < 0.01). CONCLUSIONS: In FEP patients, 
      CTOs improve compliance to treatment, which contributes to reducing positive and 
      negative symptoms, shortening hospital stays, and improving functioning.
FAU - Levy, Emmanuelle
AU  - Levy E
AD  - 1 Department of Psychiatry, McGill University, Montreal, Quebec.
AD  - 2 Douglas Mental Health University Institute, Verdun, Quebec.
FAU - Mustafa, Sally
AU  - Mustafa S
AD  - 2 Douglas Mental Health University Institute, Verdun, Quebec.
FAU - Naveed, Kanza
AU  - Naveed K
AD  - 2 Douglas Mental Health University Institute, Verdun, Quebec.
FAU - Joober, Ridha
AU  - Joober R
AD  - 1 Department of Psychiatry, McGill University, Montreal, Quebec.
AD  - 2 Douglas Mental Health University Institute, Verdun, Quebec.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20180805
PL  - United States
TA  - Can J Psychiatry
JT  - Canadian journal of psychiatry. Revue canadienne de psychiatrie
JID - 7904187
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cognitive Behavioral Therapy/*statistics & numerical data
MH  - Early Medical Intervention/statistics & numerical data
MH  - Female
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Involuntary Treatment/*statistics & numerical data
MH  - Male
MH  - Mandatory Programs/*statistics & numerical data
MH  - Mental Health Services/*statistics & numerical data
MH  - Outcome and Process Assessment, Health Care/*statistics & numerical data
MH  - Patient Acceptance of Health Care/statistics & numerical data
MH  - Patient Compliance/*statistics & numerical data
MH  - Psychotic Disorders/*physiopathology/*therapy
MH  - Quebec
MH  - Young Adult
PMC - PMC6299184
OTO - NOTNLM
OT  - capacity to consent
OT  - community treatment order
OT  - first-episode psychosis
OT  - hospitalization
OT  - involuntary treatment
COIS- Declaration of Conflicting Interests: The author(s) declared the following 
      potential conflicts of interest with respect to the research, authorship, and/or 
      publication of this article: Dr. Levy reports to have received a grant from 
      Janssen for the conduct of this study and to be a speaker for Janssen, Lundbeck, 
      and Otsuka outside the submitted work. Dr. Joober reports to be a speaker and/or 
      consulting committee member for Pfizer, Janssen, BMS, Sunovian, Myelin, Otsuka, 
      Lundbeck, shire, and Perdue; to have received grants from Janssen, BMS, Otsuka, 
      Lundbeck, Astra Zeneca, and HLS; and to have royalties from Henry Stewart talks, 
      all outside the submitted work except for the abovementioned grant.
EDAT- 2018/08/07 06:00
MHDA- 2019/09/12 06:00
PMCR- 2019/05/01
CRDT- 2018/08/07 06:00
PHST- 2018/08/07 06:00 [pubmed]
PHST- 2019/09/12 06:00 [medline]
PHST- 2018/08/07 06:00 [entrez]
PHST- 2019/05/01 00:00 [pmc-release]
AID - 10.1177_0706743718777389 [pii]
AID - 10.1177/0706743718777389 [doi]
PST - ppublish
SO  - Can J Psychiatry. 2018 Nov;63(11):766-773. doi: 10.1177/0706743718777389. Epub 
      2018 Aug 5.