S242. BEFORE AND AFTER: PATHWAYS TO CARE AND AFTER DISCHARGE AT A NEWLY ESTABLISHED EARLY PSYCHOSIS INPATIENT UNIT
Authors: Trimmel Melanie , Koch Marlene , Baumgartner Josef , Hinterbuchinger Barbara , Litvan Zsuzsa , Mossaheb Nilufar , Friedrich Fabian 
Published: May 2020

Abstract

Background
The duration from onset of psychotic symptoms to appropriate treatment also includes pathways to adequate care centers. Treatment delays within health care services might influence overall outcome of patients experiencing a first episode psychosis (FEP) negatively. In addition, subsequent postdischarge care is an essential part of maintaining treatment and therefore crucial for relapse prevention. This study aimed to examine pathways to specialized early intervention inpatient care and recommendations relating postdischarge care among patients with FEP at a newly established early psychosis inpatient unit within a general psychiatric service in a general hospital.

Methods
Data of all patients admitted to the early psychosis inpatient unit of the Clinical Division of Social Psychiatry of the Medical University of Vienna from 01.01.2016 to 31.03. 2017 were analysed. The unit was established in 2014. Diagnoses of FEP include first episode of schizophreniform, acute polymorphic, affective, organic or substance-related psychosis according to ICD-10.

Results
In the given period a total of 127 patients were admitted, whereof 91 (= 71,7%) were diagnosed with a psychotic disorder at time of discharge. Among them 36 (= 39,6%) patients had a first episode psychosis, including 21 (58,3%) with schizophrenia spectrum psychosis, 10 (27,8%) with affective psychosis, 4 (11,1%) with substance-related psychosis and 1 (2,8%) with organic psychosis as main diagnosis at time of discharge. The mean age of FEP patients was 26.7 years (SD 10,4), with no significant differences concerning sex distribution (52,8% male, 47,2% female). For the majority of FEP patients, namely 23 (63,9%) referral was done through the acute psychiatric outpatient clinic. 4 (11,1%) patients were assigned by the specialized early psychosis outpatient clinic of the same department and 3 (8,3%) by mental health professionals in private practice. The other 5 (13,9%) FEP patients were transferred from either non-psychiatric or psychiatric inpatient units. The largest proportion of FEP patients (91,7%, n = 36) were discharged to secondary care, of those 16 (44,4%) to psychosocial outpatient services. 3 (8,3%) patients were assigned to day-care hospital.

Discussion
Our results show that shortly after the establishment of an early psychosis inpatient unit within a general psychiatric service most referrals involved the acute psychiatric outpatient clinic. Hence, information on the availability and specialization was communicated adequately within the rest of the psychiatric staff. The comparatively low proportion of referrals from the early psychosis outpatient clinic might be related to the fact that it focusses on clinical high risk states, who might not be in need of inpatient treatment as much as FEP patients. To ensure pathways to specialized early psychosis care without delay raising awareness of early recognition within the psychiatric staff is required. Reported results concerning discharge recommendations imply that in most cases sufficient psychopathological stability for subsequent outpatient care was achieved. Furthermore, the high rate of referrals to secondary care might reflect the mental health service structure with specialized low threshold services in Vienna, Austria.