Compulsory treatment across a 2-year follow-up within an "Early Intervention in Psychosis" program in Italy: Incidence rates and baseline predictors

Introduction: Individuals with First Episode Psychosis (FEP) have a higher risk of compulsory admission, but evidence on its prognostic role on outcomes and its baseline predictors is poor. The aims of this investigation were to calculate incidence rate of compulsory admission in FEP individuals treated within an Italian "Early Intervention in Psychosis" (EIP) service across 2 years of follow-up, and to compare clinical and sociodemographic characteristics between FEP patients with and without compulsory admission during the follow-up. Methods: 500 FEP patients were recruited within the "Parma-Early Psychosis" program and completed a sociodemographic chart, the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale. For inter-group comparisons, Mann-Whitney and Chi-square tests, Kaplan-Meier survival analysis, Cox and binary logistic regression, and mixed-design ANOVA were performed. Results: 30 (6 %) FEP participants were compulsory admitted. At baseline, they were likely to be males and to have a diagnosis of schizophrenia and lower GAF scores. Longitudinally, they had higher risk of service disengagement, new attempted suicide, and functioning impairment, and showed significant group effects in terms of more severe positive symptoms, negative symptoms, uncooperativeness, and GAF scores (0.023 < eta(2) < 0.100). At baseline, the most robust predictor for compulsory treatment was uncooperativeness (HR = 1.460), while the strongest protective factor was family history of psychosis in first-degree relatives (HR = 5.790). Conclusions: A not negligible part of FEP participants were compulsory admitted across the follow-up. This was longitudinally associated with poor outcomes and worse treatment response. Implementing initiatives to improve the skills of professionals to increase treatment motivation from presentation is crucial to promote positive outcomes.