美国研究：近半数首次精神病发作患者在CSC项目三年内退出，多数原因不明

Nearly half of patients enrolled in coordinated specialty care (CSC) for first-episode psychosis (FEP) were discharged from the program within three years, most often under ambiguous circumstances, according to a report in Psychiatric Services.

Why It’s Relevant

Sustained engagement in a CSC program is critical because outcomes of FEP are shaped largely within the first five years after onset. However, disengagement remains a persistent challenge. Discharge from CSC may happen for “positive” reasons (return to school or work, transfer to a community provider) or adverse reasons (suicide, legal trouble, refusal of care). In many cases the reason is ambiguous, such as when contact is lost with the patient or the patient relocates outside the catchment area.

This study examined rates of and reasons for disengagement in the Academic-Community Early Psychosis Intervention Network, a network of CSC programs in six states.

By the Numbers

• Among 701 clients receiving CSC, 44% were discharged within three years and 25% within 10 months.
• Ambiguous discharges were most common (55% of discharges), followed by adverse discharges (28%); just 17% of discharges occurred under positive circumstances.
• Longer duration of untreated psychosis, prior hospitalization, and cannabis use were associated with ambiguous discharge. Legal involvement increased the risk for adverse discharge, while commercial insurance and weekly family contact were associated with positive discharge.

The Other Side

The large proportion of ambiguous discharges makes interpretation difficult, as many of these cases may have masked more adverse outcomes. In addition, missing data limited the ability to examine other key clinical predictors, such as patient functioning or strength of the therapeutic alliance.

Takeaway Message

These findings highlight the need for early identification of individuals in CSC programs at risk for adverse and ambiguous discharges, targeted support for youth-specific engagement challenges, and improved strategies for ensuring continuity of care when clients relocate. Future research should incorporate CSC program–level factors to better understand why some individuals stay engaged while others are discharged.

Related Information

Source

Sümeyra N. Tayfur, et. al. Discharge from coordinated specialty care: timing, reasons, and predictors in a national early psychosis network. Psychiatric Services. Published August 27, 2026. doi:10.1176/appi.ps.20260106

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