Care of Youth in Their First Emergency Presentation for Psychotic Disorder
Bibliographic record
Abstract
OBJECTIVE: Emergency departments (EDs) are often the first point of care for youth with psychotic disorders; however, the care and aftercare they receive have not been well described. The aim of this study was to examine care and aftercare following first ED visit for psychotic disorder among youth. METHODS: We conducted a population-based retrospective cohort study of first ED presentations for psychotic disorder among youth 16 to 24 years old (N = 2,875) in Ontario, Canada. The youth were diagnosed with a psychotic disorder according to ICD-10 coding. We captured all first visits for psychotic disorder between April 2010 and March 2013. Our primary outcome was rate of outpatient mental health care within 30 days. We also examined factors associated with timely psychiatric aftercare, rates of outpatient mental health follow-up by provider type, ED revisit, and psychiatric admission within 30 days and 1 year. RESULTS: Forty percent of youth discharged to the community from their first ED presentation for psychotic disorder received no outpatient mental health care within 30 days. Factors associated with psychiatric aftercare included higher neighborhood income (income quintile 5 vs 1, hazard ratio [HR] = 1.48; 95% CI, 1.05-2.09; P = .026), rural residence (HR = 0.46; 95% CI, 0.31-0.70; P < .001), and mental health care in the 1 year before presentation (outpatient psychiatrist visit: HR = 1.89; 95% CI, 1.50-2.37; P < .001; psychiatric admission: HR = 0.71; 95% CI, 0.52-0.98; P = .038). CONCLUSIONS: Many youth do not receive timely follow-up after their first ED visit for psychotic disorder. There is an urgent need to improve service access for this vulnerable population.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".