RESEARCH WEEKLY: Individuals with Early Episode Psychosis May Have Unique Treatment Needs 

By Kelli South

There are differences in symptoms and treatment outcomes for those experiencing their first episode of psychosis early in life compared to those experiencing an episode of psychosis later in life.  

Individuals who experience early episode psychosis (EEP) were more likely to visit the emergency department for mental health related issues and to have an inpatient psychiatric hospital stay than those with late episode psychosis (LEP), according to research published in Psychiatric Services this month.  

Study details 

The researchers, conducting an analysis for the Veterans Health Administration (VHA), used data from patients in the VHA to compare treatment outcomes for the EEP and LEP groups. They defined early episode psychosis as people with a diagnosed psychotic disorder under the age of 30, but who were diagnosed with the disorder in the last four years. There were 4,595 individuals in the VHA data that met these requirements. Those with late episode psychosis were any other individuals with a psychotic disorder above the age of 30 and with a longer history of the illness; the data set included 108,713 individuals who met these criteria.

The study compared both the characteristics and demographics of individuals with EEP versus LEP and compared type and quantity of treatments both groups received. 


Patients with EEP differed from those with LEP in several ways: those with EEP were more likely to have been flagged as high risk for suicide, more likely to be homeless, more likely to have PTSD, and more likely to have a co-occurring substance use disorder than the LEP group. 

On the treatment side, both groups were equal in their number of outpatient mental health visits, but the EEP group had fewer primary care visits. Importantly, after controlling for other potential contributing factors, the EEP group was significantly more likely to have visited the emergency department for mental health reasons and significantly more likely to have had an inpatient psychiatric admission than the LEP group. 


The increased likelihood of visiting the emergency department and having an inpatient psychiatric stay for individuals with EEP implies that this group of individuals may have different treatment needs compared to others experiencing psychosis. The authors posit that EEP may have unique needs relative to LEP that may not be met by the standard treatment practices for psychotic disorders.  

The authors also hypothesize that individuals with EEP may be an overlooked contributor to heavy utilization of high intensity mental health treatment services. They suggest that future researchers examine possible treatments tailored specifically to the EEP group, to reduce their use of emergency and inpatient psychiatric services. This could be a cost-effective way to decrease the overall costs of mental health in the health care system. 

Kelli South is the research associate at the Treatment Advocacy Center.

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