Specialized inpatient treatment for young people with early psychosis: acute-treatment and 12-month results

Intervention Programmes for First-Episode Psychosis: A Scoping Review

The aim of this scoping review was to map intervention programmes for first-episode psychosis by identifying their characteristics, participants, and specific contexts of implementation. It seems reasonable to suggest that early intervention may be beneficial in improving recovery outcomes and reducing the duration of untreated psychosis (DUP). Despite the expansion of these programmes, there are still some significant variations and barriers to access that need to be addressed. In line with the Joanna Briggs Institute (JBI) methodology and the Participants, Concept, and Context (PCC) framework, this review encompasses studies focusing on individuals grappling with early-stage psychosis and their caregivers across a range of settings, including hospital and community environments. The review identified 47 studies from 2002 to 2023, which revealed a great deal of diversity in programme characteristics and implementation contexts. This reflects a global perspective. The results showed that there is a great deal of variety in the characteristics of the programmes, with interventions ranging from single-component strategies, such as cognitive-behavioural therapy (CBT) and cognitive remediation therapy (CRT), to multicomponent programmes that integrate a number of different approaches, including psychosocial, pharmacological, and family-focused strategies. The objectives included attempts to improve cognitive functioning; enhance coping skills; reduce caregiver burden; and address symptoms such as anxiety, depression, and hallucinations. It is notable that there was considerable variation in the frequency, duration, and follow-up periods of the interventions, with some lasting just three sessions over one month and others spanning five years and 48 sessions. The majority of the programmes were delivered in community or outpatient settings, although there were also examples of hospital- and home-based interventions. These findings highlight the value of early interventions and provide a useful resource for adapting programmes to different social and cultural contexts. It would be beneficial for future research to explore how these interventions can be tailored to diverse settings.

[Utilization of healthcare services by young adults with first psychotic episodes at the FRITZ am Urban in Berlin considering the migration background]

BACKGROUND

In Germany, there are hardly any studies that investigated the care pathways in the early course of psychosis and the duration of untreated psychosis (DUP) and took the migration background into account.

OBJECTIVE

The study examined whether young adults with (PwM) and without a migration background (PoM) who had a first psychotic episode or first contact with the psychiatric care system within the last 5 years differ in their utilization of care services and DUP.

MATERIAL AND METHODS

The data collection and post hoc analyses were carried out as a part of a cohort study (84 inpatients) at the Early Intervention and Therapy Center (FRITZ) in Berlin.

RESULTS

The number of PwM (n = 38) who experienced a first psychotic episode did not significantly differ from the comparison group (PoM, n = 46) in the utilization of healthcare services (p = 0.22). Neither the time until seeking help from the first service nor the number of contacts with healthcare services and DUP significantly differed between PwM and Pom. The PwM were predominantly young adults with a good education background who grew up in Germany.

DISCUSSION

Users sought help at FRITZ relatively quickly, independent of their migration background, which supports further implementation of specialized early detection and intervention services in Germany. The results could be attributed to the selection of the study population.

CONCLUSION

Further studies are needed that address people with lower education and low language skills. The early detection programs and awareness campaigns should be adapted to this target group.

Subjective experiences of an acceptance and mindfulness-based group intervention (Feel-Good-Group) in young people with early psychosis

Background

Mindfulness-based interventions are promising psychological treatment approaches that may have more substantial long-lasting intervention effects than cognitive behavioral therapy when treating individuals with early psychosis. A pilot study analyzed mindfulness-based inpatient group therapy's feasibility and potential efficacy (Feel-Good).

Objective

This paper explores the subjective experiences of participants in the Feel-Good inpatient therapy group to gain insight into the possible changes brought about by the mindfulness-based intervention.

Methods

A semi-structured change interview was used to examine the experience of ten participants who participated in the Feel-Good intervention and the additional qualitative assessment. The interviews were conducted 16 weeks after the Feel-Good group ended (16-week Follow-Up). Interviews were transcribed verbatim and analyzed using thematic analysis.

Results

The analysis generated five themes-one about personal changes brought about by the Feel-Good group, three about the group therapy experience, and one about wishes/modification suggestions to change and improve the Feel-Good group. The findings suggested that the Feel-Good group was perceived as very helpful, leading to numerous changes in one's overall well-being and relation to emotions. However, patients recommended a more directive therapeutic style and reduced time required for study assessments.

Conclusion

Gathering qualitative insight from participants on the Feel-Good intervention revealed meaningful insight into patients' experience of change processes. In addition, participant suggestions help to improve the intervention and study design to increase therapy attendance rates and treatment satisfaction, potentially increasing treatment effectiveness in the future.

Clinical trial registration

ClinicalTrials.gov, identifier NCT04592042.

soulspace: Integrated youth mental health care in Berlin, Germany-An introduction to the program and a description of its users

AIM

A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe soulspace as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany.

METHODS

We introduce soulspace as easily accessible mental health care for young people, and we characterize soulspace along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). Soulspace is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community-based counselling service. It provides initial contact, counselling, diagnostics, and treatment.

RESULTS

Our analyses of the pathways to soulspace and the characteristics of the soulspace users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth-facing counselling service as was done in soulspace seems to have reduced the threshold to seek help for families and for young people in need for support.

CONCLUSIONS

In summary, with soulspace, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed.

[Current evidence for various inpatient psychotherapy programs in the treatment of psychoses-A narrative review article]

BACKGROUND

The analysis of the efficacy of evidence-based psychotherapy for patients with psychotic disorders has mostly been carried out in the outpatient field. In the inpatient field the efficacy is sometimes difficult to assess due to different healthcare systems.

OBJECTIVE

The aim of this narrative review is to summarize international guidelines and meta-analyses on the efficacy of inpatient psychotherapeutic treatment strategies for patients with psychotic disorders. Based on this, recommendations for disorder-specific ward concepts for acute and postacute fields are formulated.

METHODS

The German S3 guidelines, international guidelines, current meta-analyses and primary studies on psychological interventions in the treatment of psychotic disorders were included. Based on the results, recommendations for the inpatient psychotherapeutic treatment in various phases of treatment were formulated (acute phase and postacute phase).

RESULTS

In the acute phase a combination of cognitive behavioral therapy (CBTp) in the individual setting and family interventions in the group setting as well as metacognitive training (MCT acute) is effective and recommended. In the postacute phase, in addition to individual and group CBTp and family interventions, psychoeducation, social skills training and cognitive remediation have been shown to be effective and are recommended.

DISCUSSION

The suggested recommendations for concrete interventions in various treatment phases and the evidence base are critically discussed and recommendations for the structure of wards are presented.

Feasibility and efficacy of an acceptance and mindfulness-based group intervention for young people with early psychosis (Feel-Good group)

BACKGROUND

Over the last decade, researchers have sought for alternative interventions that have better treatment effects than Cognitive Behavioral Therapy (CBT) when treating psychotic symptoms. Mindfulness-based interventions have been a proposed alternative to CBT, yet research regarding its feasibility, acceptance and effectiveness is lacking when treating individuals with early psychosis in inpatient settings.

OBJECTIVE

Before conducting a large-scale randomized-controlled trial (RCT), this pilot study evaluated the feasibility and the potential efficacy of a mindfulness-based inpatient group intervention that targets emotion regulation in patients with early psychosis, and thus indirectly improving psychotic symptoms.

METHODS

A pre-post study was performed. Thirty-six patients with early psychosis treated at the specialized inpatient treatment "Frühinterventions- und Therapiezentrum; FRITZ" (early intervention and therapy center) received eight group therapy sessions. Assessments were performed at baseline, after 8 weeks post treatment and at follow-up after 16 weeks.

RESULTS

Rates of patients who participated in the study suggests that a mindfulness-based group therapy is highly accepted and feasible for patients with early psychosis being treated in an inpatient ward. Friedman analyses revealed significant changes in the primary outcomes of emotional goal attainment (Goal 1: W = 0.79; Goal 2: W = 0.71) and psychotic symptoms (PANSS-T: W = 0.74). Significant, albeit small, effect sizes were found in patients' self-perception of emotion regulation skills (ERSQ: W = 0.23).

DISCUSSION

We found favorable findings regarding the feasibility and acceptance of the Feel-Good mindfulness-based intervention. Results of the study provide a basis for an estimation of an adequate sample size for a fully powered RCT that needs to be conducted to test whether Feel-Good is effective in the inpatient treatment of psychotic symptoms for individuals with early psychosis.

CLINICAL TRIAL REGISTRATION

[https://clinicaltrials.gov/ct2/show/NCT04592042], identifier [NCT04592042].