SA53. Is It Useful to Force First-Episode Psychosis Patients to Comply With Medications? Another Look at Community Treatment Orders
Bibliographic record
Abstract
Background: Patients suffering from a first episode of psychosis who do not adhere to antipsychotic treatment often have important difficulties functioning socially, academically, and professionally. Nonadherence to antipsychotic medication in psychosis has been strongly associated with multiple relapses and hospitalizations. When patients are unable to consent to care, legal procedures enable psychiatrists to treat or hospitalize patients against their will. This may result in faster remission, more productive lives, and less time in the hospital. The purpose of this study is to determine the effect of community treatment orders (CTO) on first-episode psychosis (FEP) patients’ clinical outcomes. Methods: We studied FEP patients from the PEPP-Montreal clinic who were hospitalized, unable to consent to care, and for whom a community treatment order was requested. All patients at PEPP-Montreal are evaluated prospectively for several relevant clinical dimensions (measured by SAPS, SANS, CDS and HAS, GAF, and SOFAS). To determine the effect of the treatment order on patients’ outcome, we designed a mirror study comparing the severity of illness before and after the treatment order. Results: Of the 41 patients examined, we find a sizable and significant change in clinical outcomes after CTO. Indeed, the average decrease in SAPS (6.3) and in SANS (2.1) were highly significant (P < .01). In terms of functioning, we find a significant (P < .01) increase in function on the GAF (15.5-point increase) and the SOFAS (18.0-point increase). However, we also find that patients significantly increase in weight after the CTO (average 7.2 kg, P < .01). Last, we find that the change in SAPS was negatively correlated with the time taken to obtain a CTO (greatest changes in SAPS occurring with CTOs obtained within the first 3 months of treatment). Conclusion: Our results suggest that CTOs can be highly effective in reducing positive and negative symptoms in FEP patients and in increasing their functioning. Furthermore, earlier CTOs should be sought as CTOs issued later in the illness may be less effective.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.099 | 0.013 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".