Community treatment order: identifying the need for more evidence based justification of its use in first episode psychosis patients
Abstract
Objectives Community Treatment Order (CTO) is a legal regime that obliges patients suffering mental disorder to adhere to treatment in the community and allows for a swift admission to hospital if necessary. Study aims were to: (i) determine CTO frequency in a large representative sample of first episode psychosis (FEP) patients; (ii) compare the characteristics of patients with or without CTO before entry, during treatment and at discharge from an early psychosis program.Methods Information on 660 patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000 was collected from medical files.Results 19.2% of patients were under CTO at least once during treatment and they differed on most pre-treatment, baseline, treatment and service discharge variables. They were less educated, more likely to have a history of offending behavior, had lower pre-morbid functioning, longer duration of untreated psychosis, increased prevalence and more persistent substance use disorders, greater severity of symptoms, lower functioning, poorer insight at any time during treatment and were more likely to be admitted to hospital.Conclusions CTO frequency was high, likely related to the representativeness of the cohort. Characteristics of patients on CTO are comparable to those with serious and persistent mental illness. Considering the absence of solid evidence regarding the effectiveness of this form of compulsion, it is crucial to study the use of CTO in FEP patients in order to explore its impact and identify patients for whom it may be beneficial.
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Poor insight predicts greater likelihood of involuntary legal commitment to treatment and hospital readmission in first-episode psychosis.
“Poor insight has also been found to predict a greater likelihood of involuntary legal commitment to treatment 69 and hospital readmission in first-episode psychosis 70 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [69]
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- Authors
- Morandi, S., Golay, P., Lambert, M., Schimmelmann, B. G., McGorry, P. D., Cotton, S. M., & Conus, P.
- Affiliations
- Centre Hospitalier Universitaire Vaudois (CH)
- University Medical Center Hamburg-Eppendorf (DE)
- University of Bern (CH)
- The University of Melbourne (AU)
- Corresponding author
- Morandi, Stéphane
- ORCID
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 185
- Pages
- 67-72
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2561681737
- Cited by
- 16
- References
- 39
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 1 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 1
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- National Health and Medical Research Council Career Development Fellowship (APP1061998)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- community treatment orders, first-episode psychosis
- MeSH terms
- Adolescent, Adult, Community Mental Health Services, Female, Humans, Male, Psychiatric Status Rating Scales, Psychotic Disorders, Cohort Studies, Treatment Outcome, Evidence-Based Practice, Young Adult
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