1
|
Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions. BMC Psychiatry 2024; 24:96. [PMID: 38317157 PMCID: PMC10840293 DOI: 10.1186/s12888-024-05577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. METHODS A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. RESULTS There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. CONCLUSIONS This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.
Collapse
Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
| |
Collapse
|
2
|
Oduola S, Craig TKJ, Iacoponi E, Macdonald A, Morgan C. Sociodemographic and clinical predictors of delay to and length of stay with early intervention for psychosis service: findings from the CRIS-FEP study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:25-36. [PMID: 37353580 PMCID: PMC10799823 DOI: 10.1007/s00127-023-02522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE We investigated the influence of sociodemographic and clinical characteristics on delay to early intervention service (EIS) and the length of stay (LOS) with EIS. METHODS We used incidence data linked to the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study. We followed the patients from May 2010 to March 2016. We performed multivariable Cox regression to estimate hazard ratios of delay to EIS. Negative binomial regression was used to determine LOS with EIS by sociodemographic and clinical characteristics, controlling for confounders. RESULTS 343 patients were eligible for an EIS, 34.1% of whom did not receive the service. Overall, the median delay to EIS was 120 days (IQR; 15-1668); and the median LOS was 130.5 days (IQR 0-663). We found that women (adj.HR 0.58; 95%C I 0.42-0.78), living alone (adj.HR: 0.63; 95% CI 0.43-0.92) and ethnicity ('Other': adj.HR 0.47; 95% CI 0.23-0.98) were associated with prolonged delay to EIS. However, family involvement in help-seeking for psychosis (adj.HR 1.37; 95% CI 1.01-1.85) was strongly associated with a shorter delay to EIS. Patients who have used mental health services previously also experienced long delays to EIS. CONCLUSIONS Our analyses highlight the link between sociodemographic status, help-seeking behaviours, and delay to EIS. Our findings also show the vulnerability faced by those with a previous mental health problem who later develop psychosis in receiving specialist treatment for psychosis. Initiatives that ameliorate indicators of social disadvantage are urgently needed to reduce health inequalities and improve clinical outcomes.
Collapse
Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Eduardo Iacoponi
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Alastair Macdonald
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| |
Collapse
|
3
|
Grindey A, Bradshaw T. Do different adverse childhood experiences lead to specific symptoms of psychosis in adulthood? A systematic review of the current literature. Int J Ment Health Nurs 2022; 31:868-887. [PMID: 35306711 DOI: 10.1111/inm.12992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
Previous research has demonstrated significant associations between adverse childhood experiences (ACEs) and risks of psychosis. Further research has examined underlying mechanisms to understand the relationship between these variables. This review aimed to explore the associations between various ACEs and the development of different psychotic symptoms in adulthood. The Cochrane Library, Cinahl, PsychINFO, Medline, Embase, and Web of Science were searched from January 1980 to November 2021 to ensure a systematic review of relevant literature. Poverty, fostering, adoption, childhood emotional and physical neglect, and childhood physical (CPA), sexual (CSA), and emotional abuse (CEA) significantly correlated with delusions. Significant relationships were found between hallucinations and CSA and CPA. Paranoia correlated with violent adversities including CPA, assault, and witnessing killing. Limited associations were identified for thought disorder and negative symptoms. The findings of this review indicate that there may be a degree of specificity between various ACEs and psychotic symptoms, but these findings are subject to some limitations. The findings also demonstrate the importance of inquiring about and addressing ACE in clinical practice to develop formulations and treatment plans for individuals with psychosis.
Collapse
Affiliation(s)
- Ashleigh Grindey
- Home Based Treatment Team, Salford, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Tim Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Nieto L, Domínguez-Martínez T, Rosel-Vales M, Saracco-Alvarez R, Celada-Borja C, Rascón-Gasca ML. Clinical and Functional Differences Between Mexican Youth at Clinical High Risk for Psychosis and With Familial High Risk. Front Psychol 2022; 13:911030. [PMID: 35859823 PMCID: PMC9289544 DOI: 10.3389/fpsyg.2022.911030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Few studies have explored the differences in clinical psychopathology between youth at high risk for psychosis and those at familial high risk for psychosis. This study seeks to describe and compare the sociodemographic, clinical, and functional characteristics of At-Risk Mental State (ARMS) for psychosis youth and those with a first- or second-degree relative with psychosis (Familial High-Risk: FHR) in a Mexican sample. Twenty-one ARMS individuals and 21 with FHR were evaluated for sociodemographic characteristics, psychopathological symptoms, and functional impairment. ARMS individuals were significantly younger, had fewer years of schooling, and were more likely to be male than those in the FHR group. Groups did not differ as regards marital status or occupation. The ARMS group showed greater severity of prodromal symptoms, schizotypal personality traits, and general psychopathology than the FHR group. In addition, they reported more premorbid adjustment deficit from early adolescence than the FHR group. Current overall social and role functioning was significantly lower in the ARMS group. Findings are consistent with ARMS studies from other countries. First- or second-degree relatives of patients with psychosis should be considered a vulnerable group as they display several symptoms of general psychopathology and may experience social adjustment problems in their adult lives. The lack of early detection and intervention psychosis programs in Mexico underlines the need to prioritize the development of preventive strategies to help close the care gap.
Collapse
Affiliation(s)
- Lourdes Nieto
- Division of Epidemiological and Psychosocial Research, Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- *Correspondence: Lourdes Nieto,
| | - Tecelli Domínguez-Martínez
- Division of Epidemiological and Psychosocial Research, Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Mauricio Rosel-Vales
- Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ricardo Saracco-Alvarez
- Department of Clinical Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Cesar Celada-Borja
- Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - María Luisa Rascón-Gasca
- Division of Epidemiological and Psychosocial Research, Department of Social Sciences in Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| |
Collapse
|
5
|
Léger M, Wolff V, Kabuth B, Albuisson E, Ligier F. The mood disorder spectrum vs. schizophrenia decision tree: EDIPHAS research into the childhood and adolescence of 205 patients. BMC Psychiatry 2022; 22:194. [PMID: 35300648 PMCID: PMC8932125 DOI: 10.1186/s12888-022-03835-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The early detection of patients at risk of developing schizophrenia and bipolar disorder, and more broadly mood spectrum disorder, is a public health concern. The phenotypical overlap between the prodromes in these disorders calls for a simultaneous investigation into both illness trajectories. METHOD This is an epidemiological, retrospective, multicentre, descriptive study conducted in the Grand-Est region of France in order to describe and compare early symptoms in 205 patients: 123 of which were diagnosed with schizophrenia and 82 with bipolar disorder or mood spectrum disorder. Data corresponding to the pre-morbid and prodromal phases, including a timeline of their onset, were studied in child and adolescent psychiatric records via a data grid based on the literature review conducted from birth to 17 years of age. RESULTS Two distinct trajectories were highlighted. Patients with schizophrenia tended to present more difficulties at each developmental stage, with the emergence of negative and positive behavioural symptoms during adolescence. Patients with mood spectrum disorder, however, were more likely to exhibit anxiety and then mood-related symptoms. Overall, our results corroborate current literature findings and are consistent with the neurodevelopmental process. We succeeded in extracting a decision tree with good predictability based on variables relating to one diagnosis: 77.6% of patients received a well-indexed diagnosis. An atypical profile was observed in future mood spectrum disorder patients as some exhibited numerous positive symptoms alongside more conventional mood-related symptoms. CONCLUSION The combination of all these data could help promote the early identification of high-risk patients thereby facilitating early prevention and appropriate intervention in order to improve outcomes.
Collapse
Affiliation(s)
- Mathilde Léger
- Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent [University Department of Childhood and Adolescent Psychiatry], Centre Psychothérapique de Nancy [Nancy Psychotherapy Centre], F-54520 Laxou, France
| | - Vanessa Wolff
- Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent [University Department of Childhood and Adolescent Psychiatry], Centre Psychothérapique de Nancy [Nancy Psychotherapy Centre], F-54520 Laxou, France
| | - Bernard Kabuth
- Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent [University Department of Childhood and Adolescent Psychiatry], Centre Psychothérapique de Nancy [Nancy Psychotherapy Centre], F-54520 Laxou, France ,grid.29172.3f0000 0001 2194 6418EA 4432, PRISME, Université de Lorraine [Lorraine University], Laxou, France
| | - Eliane Albuisson
- grid.410527.50000 0004 1765 1301DRCI UMDS, Centre Hospitalier Universitaire de Nancy, Nancy University Hospital, Laxou, France
| | - Fabienne Ligier
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent [University Department of Childhood and Adolescent Psychiatry], Centre Psychothérapique de Nancy [Nancy Psychotherapy Centre], F-54520, Laxou, France. .,EA 4360 APEMAC, Université de Lorraine, Laxou, France.
| |
Collapse
|
6
|
Zhao T, Xu XL, Lu YQ, Liu M, Yuan J, Nie JM, Yu JH, Liu SQ, Yang TT, Zhou GQ, Liu J, Qin YM, Chen H, Harypursat V, Chen YK. The Effect of Early vs. Deferred Antiretroviral Therapy Initiation in HIV-Infected Patients With Cryptococcal Meningitis: A Multicenter Prospective Randomized Controlled Analysis in China. Front Med (Lausanne) 2021; 8:779181. [PMID: 34869498 PMCID: PMC8639871 DOI: 10.3389/fmed.2021.779181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The optimal timing for initiation of antiretroviral therapy (ART) in HIV-positive patients with cryptococcal meningitis (CM) has not, as yet, been compellingly elucidated, as research data concerning mortality risk and the occurrence of immune reconstitution inflammatory syndrome (IRIS) in this population remains inconsistent and controversial. Method: The present multicenter randomized clinical trial was conducted in China in patients who presented with confirmed HIV/CM, and who were ART-naïve. Subjects were randomized and stratified into either an early-ART group (ART initiated 2-5 weeks after initiation of antifungal therapy), or a deferred-ART group (ART initiated 5 weeks after initiation of antifungal therapy). Intention-to-treat, and per-protocol analyses of data for these groups were conducted for this study. Result: The probability of survival was found to not be statistically different between patients who started ART between 2-5 weeks of CM therapy initiation (14/47, 29.8%) vs. those initiating ART until 5 weeks after CM therapy initiation (10/55, 18.2%) (p = 0.144). However, initiating ART within 4 weeks after the diagnosis and antifungal treatment of CM resulted in a higher mortality compared with deferring ART initiation until 6 weeks (p = 0.042). The incidence of IRIS did not differ significantly between the early-ART group and the deferred-ART group (6.4 and 7.3%, respectively; p = 0.872). The percentage of patients with severe (grade 3 or 4) adverse events was high in both treatment arms (55.3% in the early-ART group and 41.8% in the deferred-ART group; p=0.183), and there were significantly more grade 4 adverse events in the early-ART group (20 vs. 13; p = 0.042). Conclusion: Although ART initiation from 2 to 5 weeks after initiation of antifungal therapy was not significantly associated with high cumulative mortality or IRIS event rates in HIV/CM patients compared with ART initiation 5 weeks after initiation of antifungal therapy, we found that initiating ART within 4 weeks after CM antifungal treatment resulted in a higher mortality compared with deferring ART initiation until 6 weeks. In addition, we observed that there were significantly more grade 4 adverse events in the early-ART group. Our results support the deferred initiation of ART in HIV-associated CM. Clinical Trials Registration: www.ClinicalTrials.gov, identifier: ChiCTR1900021195.
Collapse
Affiliation(s)
- Ting Zhao
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Xiao-Lei Xu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yan-Qiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Min Liu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Yuan
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing-Min Nie
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Jian-Hua Yu
- Division of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang, China
| | - Shui-Qing Liu
- Division of Infectious Diseases, Guiyang Public Health Clinical Center, Guizhou, China
| | - Tong-Tong Yang
- Division of Infectious Diseases, Public Health Clinical Center of Chengdu, Sichuan, China
| | - Guo-Qiang Zhou
- Division of Infectious Diseases, The First Hospital of Changsha, Hunan, China
| | - Jun Liu
- Division of Infectious Diseases, Kunming Third People's Hospital, Yunnan, China
| | - Ying-Mei Qin
- Division of Infectious Diseases, The Fourth's Hospital of Nanning, Guangxi, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yao-Kai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| |
Collapse
|
7
|
Oduola S, Craig TKJ, Morgan C. Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:931-941. [PMID: 32681277 PMCID: PMC8192380 DOI: 10.1007/s00127-020-01922-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is inconsistent evidence on the influence of ethnicity on duration of untreated psychosis (DUP). We investigated ethnic differences in DUP in a large epidemiological dataset of first episode psychosis patients in an inner city area of south London, UK. METHODS We analysed data on 558 first episode psychosis patients at the South London and Maudsley NHS Trust, between 2010 and 2012. We performed multivariable logistic regression to estimate the odds of a short DUP (≤ 6 months) by ethnic group, controlling for confounders. RESULTS There was no evidence that ethnicity is associated with duration of untreated psychosis. However, we found evidence that a short DUP was strongly associated with age, living circumstances, and pathways to care variables (involuntary admission, out of office hour contact, accident and emergency referral, criminal justice agency referral and family involvement in help-seeking). Conversely, a long DUP was associated with report of social isolation, living alone, being single and General Practitioner referral. CONCLUSION Our findings suggest that indicators of social isolation were associated with long DUP. Our data also show that pathways into care characteristics play significant role in DUP. Thus, the challenge of tackling the issue of timely access to EI under the new Access and Waiting Time standard for psychosis requires a multilevel approach, including joint working with communities, public awareness of psychosis, less restrictive referral pathways and adequate resourcing of early intervention for psychosis services. These will go a long way in addressing patients' needs rather than be determined by service structures.
Collapse
Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| |
Collapse
|
8
|
Worthington MA, Miklowitz DJ, O'Brien M, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cannon TD. Selection for psychosocial treatment for youth at clinical high risk for psychosis based on the North American Prodrome Longitudinal Study individualized risk calculator. Early Interv Psychiatry 2021; 15:96-103. [PMID: 31943807 PMCID: PMC7358123 DOI: 10.1111/eip.12914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/22/2019] [Accepted: 12/14/2019] [Indexed: 01/19/2023]
Abstract
AIM Recent findings suggest that family-focused therapy (FFT) is effective for individuals at clinical high-risk for psychosis (CHR-P). As outcomes of CHR-P individuals are quite varied, certain psychosocial interventions may be differentially effective in subgroups. The present study examined change in positive symptoms for CHR-P individuals at different levels of predicted risk for conversion to psychosis who received either FFT, a brief form of family education termed enhanced care (EC) or treatment as usual. METHODS Participants were drawn from the North American Prodromal Longitudinal Study (NAPLS2). A subset of NAPLS2 participants completed a randomized study involving FFT or EC. The present study includes participants from the FFT-CHR sub-study and non-randomized NAPLS2 participants. Predicted risk of conversion was calculated using the Individualized Risk Calculator for Psychosis. Robust linear regressions evaluated whether the association between predicted risk of conversion and positive symptom change differed across intervention groups. RESULTS A total of 94 participants from the FFT-CHR sub-study (FFT-CHR n = 50, EC n = 44) and 401 non-randomized NAPLS2 participants were included in this study. There was a treatment group by predicted risk of conversion interaction that predicted positive symptom improvement: higher risk individuals improved more with FFT-CHR than EC or the non-randomized NAPLS group, whereas lower-risk individuals did not differ in positive symptom improvement across treatment groups (FFT-CHR vs EC: P = .03, β = 20.27; FFT-CHR vs NAPLS2: P < .001, β = 28.40). CONCLUSIONS Intensive treatments such as FFT-CHR may be most appropriate for individuals at the highest levels of clinical risk for psychosis.
Collapse
Affiliation(s)
| | - David J Miklowitz
- Department of Psychiatry, UCLA Semel Institute, University of California, Los Angeles, California
| | - Mary O'Brien
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, California
| | | | | | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, California
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, California
| | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
| |
Collapse
|
9
|
Development and Feasibility Exploration of a Combined Compensatory and Restorative Approach to Addressing Cognitive Challenges in Early Intervention Psychosis. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
10
|
Schmidt S, Schultze-Lutter F, Schimmelmann B, Maric N, Salokangas R, Riecher-Rössler A, van der Gaag M, Meneghelli A, Nordentoft M, Marshall M, Morrison A, Raballo A, Klosterkötter J, Ruhrmann S. EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry 2020; 30:388-404. [DOI: 10.1016/j.eurpsy.2015.01.013] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/28/2022] Open
Abstract
AbstractThis guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.
Collapse
|
11
|
Machado DM, Murta SG, da Costa II. Applying intervention mapping approach to a program for early intervention in first-episode mental crisis of a psychotic type. ACTA ACUST UNITED AC 2020; 33:3. [PMID: 32170555 PMCID: PMC7070112 DOI: 10.1186/s41155-020-00141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
The holotropic mind perspective, an integral part of the framework of transpersonal psychology, has been considered a revolutionary approach to a certain spectrum of experiences in Non-ordinary states of consciousness (NOSC) which conventional approaches tend to treat indiscriminately as pathological processes, because PHM recognizes in these experiences their healing and evolutionary potential. This article describes the needs assessment, implementation, and evaluation of an experiential and educational program on the holotropic mind perspective and its praxis, Holotropic Breathwork® (HB), with students and professionals from the Group for Early Intervention in First-Episode Mental Crisis of a Psychotic Type of the University of Brasilia. The intervention aimed to establish change goals and objectives that would promote the adoption of the holotropic mind perspective's elements, such as a framework to broaden and strengthen mental health programs that assist people experiencing NOSC. The stages developed, inspired by the Intervention Mapping protocol, included a needs assessment; elaboration of change objective matrices; selection and description of methods based on theory and their applications; conception, planning, and implementation of the intervention; and results evaluation. Participants reported that the intervention allowed the expansion of their theoretical-conceptual and technical frameworks, giving them a less pathologizing understanding of and approach to NOSC and allowing them to perceive and manage such states, not as indiscriminately pathological expressions, but as phenomena inherent to the human condition that can be accepted and cared for without the exclusionary and exhaustive bias of mental disorders. Limitations and practical implications are discussed.
Collapse
Affiliation(s)
- Daniela Martins Machado
- Department of Clinical Psychology, University of Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil. .,Health Sciences School, Foundation for Teaching and Research in Health Sciences of the State Health Department of the Federal District, Brasilia, Brazil.
| | - Sheila Giardini Murta
- Department of Clinical Psychology, University of Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Ileno Izídio da Costa
- Department of Clinical Psychology, University of Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| |
Collapse
|
12
|
Carden LJ, Saini P, Seddon C, Watkins M, Taylor PJ. Shame and the psychosis continuum: A systematic review of the literature. Psychol Psychother 2020; 93:160-186. [PMID: 30426672 DOI: 10.1111/papt.12204] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/07/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Shame is increasingly implicated in the development and maintenance of several psychological problems including psychosis. The aim of the current paper was to review the research literature concerning the relationship between shame and the psychosis continuum, examining the nature and direction of this relationship. METHOD Systematic searches of databases PsycINFO, Medline, Scopus, and Web of Science (from the earliest available database date until November 2016) were undertaken to identify papers that examined the relationship between shame and psychosis or psychotic experiences. RESULTS A total of 20 eligible papers were identified. Risk of bias assessment identified methodological shortcomings across the research in relation to small, unrepresentative samples and failure to control for confounding variables. Narrative synthesis suggested positive associations between shame and paranoia (n = 10, r = .29-.62), shame and psychosis (n = 1, r = .40), and shame and affiliation with voices (n = 1, β = .26), and suggested that shame was greater in those with psychosis compared to controls (n = 4, d = 0.76-1.16). CONCLUSIONS Overall, several studies provide partial support for the theory that shame is an important factor in relation to psychotic experiences in both clinical and non-clinical populations, particularly paranoia. However, the predominance of cross-sectional designs prevents any conclusions being drawn concerning the temporal nature of associations. Additional research is necessary to further delineate the role of shame in relation to specific psychotic experiences such as voice-hearing. Longitudinal research is particularly needed to help establish the directionality and temporal aspects of effects. PRACTITIONER POINTS Research indicates moderate-to-strong positive associations between shame and psychotic experiences in the existing literature. The results provide preliminary evidence that shame may play a role in relation to psychosis and, more specifically, paranoia. Findings should be interpreted with caution due to many disparities across the studies reviewed and methodological shortcomings (e.g., small sample sizes). It is not currently possible to determine causality or direction of effect due to the cross-sectional design of all existing studies.
Collapse
Affiliation(s)
- Louise J Carden
- Single Point of Access, Mersey Care NHS Trust, Liverpool, UK
| | - Pooja Saini
- NIHR CLAHRC NWC, Institute of Psychology, Health & Society, University of Liverpool, UK.,School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - Claire Seddon
- Liverpool Early Intervention Service, Mersey Care NHS Trust, Liverpool, UK
| | - Megan Watkins
- NIHR CLAHRC NWC, Institute of Psychology, Health & Society, University of Liverpool, UK
| | - Peter James Taylor
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, UK
| |
Collapse
|
13
|
Loughlin M, Bucci S, Brooks J, Berry K. Service users' and carers' experiences of engaging with early intervention services: A meta-synthesis review. Early Interv Psychiatry 2020; 14:26-36. [PMID: 30912274 DOI: 10.1111/eip.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 01/14/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS. METHODS Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool. RESULTS Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed. CONCLUSIONS The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings.
Collapse
Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
14
|
Wright A, Browne J, Mueser KT, Cather C. Evidence-Based Psychosocial Treatment for Individuals with Early Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:211-223. [PMID: 31708048 DOI: 10.1016/j.chc.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coordinated specialty care (CSC) first-episode models are an evidence-based practice in the treatment of first-episode psychosis. Group, individual, and family therapies in CSC aim to help the client and family understand and cope with the experience of psychosis, promote symptomatic and functional recovery and improve quality of life, and support the pursuit of personally meaningful goals of the client. Common elements to these interventions include building a therapeutic alliance, recovery orientation, education, and skills training, which can be directed to a range of targets, including problem-solving, communication, social skills, and social cognition.
Collapse
Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Wenneberg C, Glenthøj BY, Hjorthøj C, Buchardt Zingenberg FJ, Glenthøj LB, Rostrup E, Broberg BV, Nordentoft M. Cerebral glutamate and GABA levels in high-risk of psychosis states: A focused review and meta-analysis of 1H-MRS studies. Schizophr Res 2020; 215:38-48. [PMID: 31784336 DOI: 10.1016/j.schres.2019.10.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/24/2022]
Abstract
Disturbances in the brain glutamate and GABA (γ-aminobutyric acid) homeostasis may be markers of transition to psychosis in individuals at high-risk (HR). Knowledge of GABA and glutamate levels in HR stages could give an insight into changes in the neurochemistry underlying psychosis. Studies on glutamate in HR have provided conflicting data, and GABA studies have only recently been initialized. In this meta-analysis, we compared cerebral levels of glutamate and GABA in HR individuals with healthy controls (HC). We searched Medline and Embase for articles published on 1H-MRS studies on glutamate and GABA in HR states until April 9th, 2019. We identified a total of 28 eligible studies, of which eight reported GABA (243 HR, 356 HC) and 26 reported glutamate (299 HR, 279 HC) or Glx (glutamate + glutamine) (584 HR, 632 HC) levels. Sample sizes varied from 6 to 75 for HR and 10 to 184 for HC. Our meta-analysis of 1H-MRS studies on glutamate and GABA in HR states displayed significantly lower (P = 0.0003) levels of thalamic glutamate in HR individuals than in HC and significantly higher (P = 0.001) Glx in the frontal lobe of genetic HR individuals (1st-degree relatives) than in HC. No other significant differences in glutamate and GABA levels were found. Subject numbers in the studies on glutamate as well as GABA levels were generally small and the data conflicting. Our meta-analytical findings highlight the need for larger and more homogeneous studies of glutamate and GABA in high-risk states.
Collapse
Affiliation(s)
- Christina Wenneberg
- Copenhagen Research Center for Mental Health, CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark; Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Ndr. Ringvej 29-67, 2600, Glostrup, Denmark.
| | - Birte Yding Glenthøj
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Ndr. Ringvej 29-67, 2600, Glostrup, Denmark.
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen K, Denmark.
| | - Frederik Johan Buchardt Zingenberg
- Copenhagen Research Center for Mental Health, CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark.
| | - Louise Birkedal Glenthøj
- Copenhagen Research Center for Mental Health, CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark; Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Ndr. Ringvej 29-67, 2600, Glostrup, Denmark.
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Ndr. Ringvej 29-67, 2600, Glostrup, Denmark.
| | - Brian Villumsen Broberg
- Center for Neuropsychiatric Schizophrenia Research, CNSR, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, Ndr. Ringvej 29-67, 2600, Glostrup, Denmark.
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark.
| |
Collapse
|
16
|
Kim SW, Nelson B, Yang YK, Chung YC. Editorial: Early Intervention in Psychotic Disorders. Front Psychiatry 2020; 11:574532. [PMID: 33192707 PMCID: PMC7531034 DOI: 10.3389/fpsyt.2020.574532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/04/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, South Korea
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,College of Medicine, Institute of Behavioral Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, South Korea
| |
Collapse
|
17
|
Van Meter A, Guinart D, Bashir A, Sareen A, Cornblatt BA, Auther A, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, Saba R, Cascio NL, Correll CU. Bipolar Prodrome Symptom Scale - Abbreviated Screen for Patients: Description and validation. J Affect Disord 2019; 249:357-365. [PMID: 30807937 DOI: 10.1016/j.jad.2019.02.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There is no standard method for assessing symptoms of the prodrome to bipolar disorder (BD), which has limited progress toward early identification and intervention. We aimed to validate the Bipolar Prodrome Symptom Scale-Abbreviated Screen for Patients (BPSS-AS-P), a brief self-report derived from the validated, clinician-rated Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP), as a means to screen and identify people for whom further evaluation is indicated. METHOD Altogether, 134 participants (aged 12-18 years) were drawn from a study of the pre-syndromal stage of mood and psychotic disorders. All participants had chart diagnoses of a mood- or psychosis-spectrum disorder. Participants were interviewed with the BPSS-FP and completed measures of mania and non-mood psychopathology. Prior to being interviewed, patients completed the BPSS-AS-P. Scores on the BPSS-AS-P were determined by summing the severity and frequency ratings for each item. RESULTS BPSS-AS-P scores were highly reliable (Cronbach's alpha = 0.94) and correlated with the interview-based BPSS-FP Mania Symptom Index (r = 0.55, p < .0001). BPSS-AS-P scores had good convergent validity, correlating with the General Behavior Inventory-10M (r = 0.65, p < .0001) and Young Mania Rating Scale; r = 0.48, p < .0001). The BPSS-AS-P had good discriminant validity, not being correlated with scales measuring positive and negative symptoms of psychotic disorders (p-values = 0.072-0.667). LIMITATIONS Findings are limited by the cross-sectional nature of the study by the fact that the participants were all treatment-seeking. Future studies need to evaluate the predictive validity of the BPSS-AS-P for identifying those who develop BD in a community sample. CONCLUSION BPSS-AS-P has promise as a screening tool for people at risk for BD. Adopting the BPSS-AS-P would support the goal of characterizing the prodrome systematically in order to facilitate research and clinical care.
Collapse
Affiliation(s)
- Anna Van Meter
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Daniel Guinart
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Asjad Bashir
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Aditya Sareen
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Andrea Auther
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Ricardo E Carrión
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Maren Carbon
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén Medical Center, Jaén, Spain; Department of Psychiatry, University of Granada, Granada, Spain
| | - Ditte L Vernal
- Research Unit for Child- and Adolescent Psychiatry, Aalborg University Hospital, North Denmark Region, Denmark
| | - Susanne Walitza
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Miriam Gerstenberg
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Nella Lo Cascio
- Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
| |
Collapse
|
18
|
Bone JK, McCloud T, Scott HR, Machin K, Markham S, Persaud K, Johnson S, Lloyd-Evans B. Psychosocial Interventions to Reduce Compulsory Psychiatric Admissions: A Rapid Evidence Synthesis. EClinicalMedicine 2019; 10:58-67. [PMID: 31193820 PMCID: PMC6543173 DOI: 10.1016/j.eclinm.2019.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Compulsory mental health hospital admissions are increasing in several European countries but are coercive and potentially distressing. It is important to identify which mental health service models and interventions are effective in reducing compulsory admissions. METHODS We conducted a rapid evidence synthesis to explore whether there is any evidence for an effect on compulsory admissions for 15 types of psychosocial intervention, identified by an expert group as potentially relevant to reducing compulsory admission. A search for randomised controlled trials (RCTs) reporting compulsory admission as a primary or secondary outcome or adverse event was carried out using clinical guidelines, recent systematic reviews, and database searches postdating these reviews. FINDINGS We found 949 RCTs reporting on the interventions of interest, of which 19 reported on compulsory admission. Our narrative synthesis found some evidence for the effectiveness of crisis planning and self-management, while evidence for early intervention services was mixed. We did not find evidence to support adherence therapy, care from crisis resolution teams and assertive community treatment, but numbers of relevant studies were very small. We found no trials which tested effects on compulsory admission of the nine other intervention types. INTERPRETATION Crisis planning and self-management interventions with a relapse prevention element are most promising for preventing compulsory admissions. Given our broad search strategy, the lack of evidence demonstrates that there is an urgent need for more research on interventions which may reduce compulsory admissions. FUNDING Independent research commissioned and funded by the National Institute for Health Research Policy Research Programme.
Collapse
Affiliation(s)
- Jessica K. Bone
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Tayla McCloud
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Hannah R. Scott
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Karen Machin
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Sarah Markham
- NIHR Mental Health Policy Research Unit, University College London, London, UK
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| |
Collapse
|
19
|
Wright AC, Davies G, Fowler D, Greenwood K. Three-Year Follow-Up Study Exploring Metacognition and Function in Individuals With First Episode Psychosis. Front Psychiatry 2019; 10:182. [PMID: 31031648 PMCID: PMC6473558 DOI: 10.3389/fpsyt.2019.00182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/13/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction: Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition. Metacognitive ability has been demonstrated to mediate between neurocognition and functional outcome in First Episode Psychosis (FEP). Whether metacognition also predicts longer-term recovery in first episode psychosis is unknown. This study assessed whether neurocognition, functional capacity and metacognitive ability in FEP predicted functional outcome three years later. Methods: Eighty individuals with First Episode Psychosis were re-contacted after an average 3 years (range: 26-45 month follow-up) from baseline. Twenty-six participants (33%) completed completed measures of neurocognition, metacognition, functional capacity, functional outcome (hours spent in structured activity per week) and psychopathology at baseline and at follow-up. Results: Individual regression analyses demonstrated neurocognition, functional capacity, and metacognitive ability at baseline significantly predicted functional outcome at three years. However, when baseline functional outcome was controlled, only metacognitive ability was a significant predictor of change in functional outcome from baseline to follow-up, p < 0.001. This model explained 72% (adjusted r 2 = 0.69) of the variance in functional outcome at follow-up. Negative symptoms did not change the model. Discussion: This study demonstrated that better metacognitive ability significantly predicted improvement in functioning in FEP across a 3-year period. This highlights the potential value of clinical interventions that focus on improving metacognitive ability at first point of illness to maximize recovery.
Collapse
Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom.,Center of Excellence for Psychosocial and Systemic Research, Massachusetts General Hospital, Boston, MA, United States
| | - Geoff Davies
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| |
Collapse
|
20
|
Griffiths R, Mansell W, Edge D, Tai S. Sources of Distress in First-Episode Psychosis: A Systematic Review and Qualitative Metasynthesis. QUALITATIVE HEALTH RESEARCH 2019; 29:107-123. [PMID: 30066602 DOI: 10.1177/1049732318790544] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this study, we aim to increase our understanding of the self-reported sources of distress among people who have experienced first-episode psychosis. Following a systematic literature search, 33 relevant studies containing first-person accounts of first-episode psychosis were identified, which were synthesized using thematic analysis. Two interrelated superordinate themes were identified: intrapersonal distress and interpersonal distress. Participants reported multiple, diverse, and multifaceted sources of distress across both themes. These were substantially different from those routinely recognized and targeted in clinical practice. This review suggests that practitioners who maintain a stance of genuine curiosity about the potential sources of distress for this population will be perceived as more helpful. The findings also highlight the importance of being service user-led when planning and delivering mental health care. Additional clinical and research implications are discussed.
Collapse
Affiliation(s)
- Robert Griffiths
- 1 Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Warren Mansell
- 2 The University of Manchester, Manchester, United Kingdom
| | - Dawn Edge
- 2 The University of Manchester, Manchester, United Kingdom
| | - Sara Tai
- 2 The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
21
|
Lutgens D, Joober R, Iyer S, Lepage M, Norman R, Schmitz N, Mustafa S, Abadi S, Malla A. Progress of negative symptoms over the initial 5 years of a first episode of psychosis. Psychol Med 2019; 49:66-74. [PMID: 29534765 DOI: 10.1017/s003329171800048x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Specialized early intervention (EI) following a first episode of psychosis (FEP) are effective at reducing negative symptoms, although its trajectory warrants systematic assessment. However, findings are equivocal as to whether extended gains are made post 2 years of EI and whether there is additional benefit of extending EI for an additional 3 years. METHODS Data on 178 FEP patients, from a randomized controlled trial of a 3-year extension of EI service v. transfer to regular care following 2 years of EI service, were used for this report. Repeated measures analysis of variance were conducted separately for the initial 2 years of treatment in an EI service, and for the 3-year post-randomization to examine trajectories of negative symptoms over the two periods in the two arms of the study. RESULTS There were significant improvements in total negative symptoms over the first 2 years of EI F(4.612, 797.905) = 25.263, p < 0.001 and in domains of 'expressivity' and 'motivation'. In the following 3 years, there were further significant improvements in negative symptoms F(4.318, 759.908) = 4.182, p = 0.002 with no difference between groups F(4.318, 759.908) = 1.073, p = 0.371. Changes in negative symptoms over the extension period were driven by expressivity F(4.01, 674.73) = 7.19, p < 0.01, but not motivation F(6.58, 1112.18) = 0.95, p = 0.46. CONCLUSION Negative symptoms improve significantly over the first 2 years of EI. Subsequent amelioration was largely the result of expressivity. Motivation deficits remained stable. Extended EI offered no advantage over regular care post-randomization.
Collapse
Affiliation(s)
- Danyael Lutgens
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Ridha Joober
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Srividya Iyer
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Martin Lepage
- McGill University,Douglas Hospital Research Centre,Montreal,QC,Canada
| | - Ross Norman
- Department of Psychiatry,Western University; Prevention and Early Intervention Program for Psychosis (PEPP-London) London,Ontario,Canada
| | - Norbert Schmitz
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Sally Mustafa
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Sherezad Abadi
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Ashok Malla
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| |
Collapse
|
22
|
Singh K, Ghazi F, White R, Sarfo-Adu B, Carter P. Improving access to Early Intervention in Psychosis (EIP): the 2-week wait for cancer comes to psychosis. BMJ Open Qual 2018; 7:e000190. [PMID: 30167471 PMCID: PMC6109946 DOI: 10.1136/bmjoq-2017-000190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 06/19/2018] [Accepted: 07/19/2018] [Indexed: 11/21/2022] Open
Abstract
Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a ‘parity of esteem’ between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence. A baseline assessment in late 2014 found that just 21% of all referrals received and accepted met this target within the EIP Team for the North-East London NHS Foundation Trust. This project sought to improve the team’s performance, seeking input from all team members and using an iterative process with the primary aim of meeting the target ahead of its roll-out. It was determined that the relatively high number of inappropriate referrals (34% at baseline) is a key causative agent in delaying staff from processing eligible cases in a timely fashion. These are defined as referrals which do not meet basic eligibility criteria such as no previous treatment for psychosis. Interventions were therefore designed targeting three domains of improving staff awareness of the new target, improving efficiency by changing the case allocation process and improving the referral pathway for external sources. The impact of these changes was re-evaluated over two cycles beyond baseline. By the final cycle, 62% of new referrals were seen within 2 weeks, while inappropriate referrals declined to just 3%. The multi-interventional nature of this project limits its generalisability and further work should be carried out to identify those changes that were most impactful. Nevertheless, focused targeting of the referral pathway may prove to be of benefit to other EIP services struggling with lengthy wait times.
Collapse
Affiliation(s)
| | - Fatima Ghazi
- General Practice, Freezywater Primary Care Centre, London, UK
| | - Rebecca White
- General Practice, Early Intervention in Psychosis Service, North-East London NHS Foundation Trust, London, UK
| | | | - Peter Carter
- Early Intervention in Psychosis Service, North-East London NHS Foundation Trust, London, UK
| |
Collapse
|
23
|
Chau HS, Chong WS, Wong JGWS, Hung GBK, Lui SSY, Chan SKW, Chang WC, Hui CLM, Lee EHM, McGorry PD, Jones PB, Chen EYH. Early intervention for incipient insanity: early notions from the 19 th century English literature. Early Interv Psychiatry 2018; 12:708-714. [PMID: 27273703 DOI: 10.1111/eip.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/23/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
AIM Early intervention programmes in mental illnesses started to bloom in the 1990s, and many programmes have been established worldwide during the past twenty years. However, the concept of early intervention has emerged during the 19th century but it did not make much impact on practice. The aim of this review is to identify the difficulties appeared during that period of time which could provide insight into the modern development of early intervention initiatives. METHODS A narrative review which focused on English literature about early intervention for insanity during the 19th century was undertaken. RESULTS Clinicians during the 19th century recognized that treatment would be the most effective at the early stage of the mental illness and they had emphasized the importance of early intervention. However, because of a number of factors, such as the limited roles of asylums, lack of knowledge about mental disorder and the lack of effective treatment, the idea of early intervention did not make impact in clinical service during that period of time. CONCLUSION During the past two hundred years, understanding towards mental illness has advanced and more effective treatments, such as the use of anti-psychotic medications, have been developed. Reflecting on the past experience and difficulties might shed light on the development of today early intervention in mental disorder.
Collapse
Affiliation(s)
- Hang Sze Chau
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Wai Sun Chong
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | | | | | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | - Patrick D McGorry
- Department of Psychiatry, ORYGEN Research Centre, University of Melbourne, Melbourne, Australia
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| |
Collapse
|
24
|
Malla A, de Bonneville M, Shah J, Jordan G, Pruessner M, Faridi K, Rabinovitch M, Iyer SN, Joober R. Outcome in patients converting to psychosis following a treated clinical high risk state. Early Interv Psychiatry 2018; 12:715-719. [PMID: 28613411 DOI: 10.1111/eip.12431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/21/2016] [Accepted: 12/24/2016] [Indexed: 11/28/2022]
Abstract
AIM We explored 2-year outcomes in a sample of clinical high risk (CHR) patients who converted to psychosis despite receiving interventions. METHODS Of 167 CHR patients, 18 had converted to psychosis and received treatment for their first episode of psychosis in an early intervention service over 2 years. RESULTS Compared to patients admitted directly to the same early intervention service without having been identified as CHR prior to onset of psychosis, CHR converters were in remission for fewer months (M = 5 vs M = 10); were more likely to be prescribed more than 1 antipsychotic medication (90% vs 68%) and to receive clozapine treatment (38% vs 2%) over 2 years. CONCLUSIONS CHR patients who convert to psychosis may be inherently more resistant to comprehensive treatment and may have poorer outcomes. Conversion to psychosis from a state of CHR can be reduced to a rate of 10%-12% following interventions, yet outcomes for patients who convert despite such interventions remain unexplored.
Collapse
Affiliation(s)
- Ashok Malla
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open minds/Esprits ouverts, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marianne de Bonneville
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jai Shah
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open minds/Esprits ouverts, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Gerald Jordan
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open minds/Esprits ouverts, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marita Pruessner
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Kia Faridi
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Mark Rabinovitch
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open minds/Esprits ouverts, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open minds/Esprits ouverts, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
25
|
Allard J, Lancaster S, Clayton S, Amos T, Birchwood M. Carers' and service users' experiences of early intervention in psychosis services: implications for care partnerships. Early Interv Psychiatry 2018; 12:410-416. [PMID: 26758476 DOI: 10.1111/eip.12309] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/15/2015] [Indexed: 11/29/2022]
Abstract
AIM To explore carers' and service users' experiences of UK Early Intervention Services following referral for first-episode psychosis. METHODS Thirty-two semi-structured interviews (16 interviews with service users and 16 corresponding interviews with their carers) were completed and analysed. RESULTS Carers spoke retrospectively and prospectively by framing their accounts into the periods before and since their engagement with Early Intervention Services. Desperation was evident as emotive experiences were recalled prior to referral. Relief then emerged as carers described support and engagement with key workers. Hope and optimism for the service user's prognosis and life trajectory were also expressed.Service users described similar positive experiences of Early Intervention Services and the support and insight they had gained through their relationships with key workers. They were however less focused on accounts of desperation and relief and more immersed in their current understanding and attempts to normalize their experiences of first-episode psychosis. Prognosis and future trajectories were only discussed tentatively. CONCLUSION Communication and 'partnerships' with service users and carers are essential for effective service engagement, delivery of care and the reduction in relapse following first-episode psychosis. This study highlights how key workers from Early Intervention Services are appropriately valued and situated to develop such relationships. Findings also reveal that service users' and carers' focus and expectations of recovery vary during the early stages of engagement with services. How key workers manage awareness and communication around such differing expectations is a crucial consideration for maintaining the 'partnerships' necessary for effective service provision.
Collapse
Affiliation(s)
- Jon Allard
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Susan Lancaster
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sara Clayton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tim Amos
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Max Birchwood
- School of Psychology, University of Birmingham, Birmingham, UK
| |
Collapse
|
26
|
Untreated illness and recovery in clients of an early psychosis intervention program: a 10-year prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:171-182. [PMID: 29188310 DOI: 10.1007/s00127-017-1464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether duration of untreated psychosis (DUP) and duration of untreated illness (DUI) are associated with measures of both subjective and objective recovery 10 years after a first episode of psychosis. METHODS A cohort of 65 clients from an early psychosis intervention program completed a battery of outcome measures 10 years following initial treatment for first-episode psychosis (FEP). The outcomes of interest were self-perceived recovery scores (Maryland Assessment of Recovery in People with Serious Mental Illness Scale) and occupational activity, defined as engagement in work and/or school on a full/part-time basis. Multiple linear and logistic regression analyses were used to estimate the associations between DUP and DUI with each measure of recovery, adjusting for potential confounding factors. RESULTS We did not find a statistically significant association between DUP and either occupational activity (OR = 1.26, 95% CI 0.81-1.95) or self-perceived recovery score (β = - 0.73, 95% CI - 2.42 to 0.97). However, we found a significant negative association between DUI and self-perceived recovery score (β = - 0.52, 95% CI - 0.87 to - 0.16). CONCLUSIONS Our findings suggest that DUI may have a stronger influence than DUP on recovery from FEP at 10-year follow-up. This suggests the potential value in targeted interventions for people with a long DUI to increase the likelihood of achieving recovery after the first episode of psychosis.
Collapse
|
27
|
Renwick L, Irmansyah, Keliat BA, Lovell K, Yung A. Implementing an innovative intervention to increase research capacity for enhancing early psychosis care in Indonesia. J Psychiatr Ment Health Nurs 2017; 24:671-680. [PMID: 28786548 DOI: 10.1111/jpm.12417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE TOPIC?: In low- and middle-income settings (LMICs) such as Indonesia, the burden from psychotic illness is significant due to large gaps in treatment provision Mental health workers and community nurses are a growing workforce requiring new evidence to support practice and enhanced roles and advanced competencies among UK mental health nurses also requires greater research capacity Research capacity building projects can strengthen research institutions, enhance trial capacity, improve quality standards and improve attitudes towards the importance of health research. WHAT THIS PAPER ADDS?: Delivering innovative, cross-cultural workshops to enhance research capacity to multidisciplinary, early career researchers in Indonesia and the UK are rated highly by attendees Supporting people in this way helps them to gain competitive grant funding to complete their own research which can improve the health of the population To our knowledge, there are no other studies reporting the attainment of grant income as a successful outcome of international research partnerships for mental health nursing so our finding is novel. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This method could be implemented to improve networking and collaboration between UK academics and early career researchers in other lower- and middle-income settings This strategy can also strengthen existing partnerships among early career researchers in the UK to meet the demands for greater research mentorship and leadership among mental health nurses and enhance nurses capabilities to contribute to evidence for practice. ABSTRACT Aim To strengthen research capacity for nurses and early career researchers in Indonesia and the UK to develop a local evidence base in Indonesia to inform policy and improve the nation's health. These strategies can strengthen research institutions, enhance trial capacity, improve quality standards and improve attitudes towards the importance of health research. Methods Four days of workshops were held in Jakarta, Indonesia developing collaborative groups of academic nurses and early career researchers from the UK and Indonesia (30 people including mentors) to produce competitive grant bids to evaluate aspects of early psychosis care. Qualitative and quantitative evaluations were conducted. Results Participants evaluated the workshops positively finding benefit in the structure, content and delivery. Research impact was shown by attaining several successful small and large grants and developing offshoot collaborative relationships. Discussion These novel findings demonstrate that collaborative workshops can strengthen research capacity by developing partnerships and instigating new collaborations and networks. No other studies of international research partnerships among mental health nurses have reported this outcome to our knowledge. Implications for Practice This method could be implemented to improve networking and collaboration between UK academics and early career researchers and also with external colleagues in other LMICs.
Collapse
Affiliation(s)
- L Renwick
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Irmansyah
- Marzoeki Mahdi Hospital, Bogor, Indonesia
| | - B A Keliat
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - K Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - A Yung
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
28
|
Addington D, Anderson E, Kelly M, Lesage A, Summerville C. Canadian Practice Guidelines for Comprehensive Community Treatment for Schizophrenia and Schizophrenia Spectrum Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:662-672. [PMID: 28886669 PMCID: PMC5593248 DOI: 10.1177/0706743717719900] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this review is to identify the features and components of a comprehensive system of services for people living with schizophrenia. A comprehensive system was conceived as one that served the full range of people with schizophrenia and was designed with consideration of the incidence and prevalence of schizophrenia. The system should provide access to the full range of evidence-based services, should be recovery oriented, and should provide patient-centred care. METHOD A systematic search was conducted for published guidelines for schizophrenia and schizophrenia spectrum disorders. The guidelines were rated by at least 2 raters, and recommendations adopted were primarily drawn from the National Institute for Clinical Excellence (2014) Guideline on Psychosis and Schizophrenia in adults and the Scottish Intercollegiate Guidelines Network guidelines on management of schizophrenia. RESULTS The recommendations adapted for Canada cover the range of services required to provide comprehensive services. CONCLUSIONS Comprehensive services for people with schizophrenia can be organized and delivered to improve the quality of life of people with schizophrenia and their carers. The services need to be organized in a system that provides access to those who need them.
Collapse
Affiliation(s)
- Donald Addington
- 1 Department of Psychiatry, Hotchkiss Brain Institute, Foothills Hospital, University of Calgary, Calgary, Alberta
| | | | - Martina Kelly
- 3 Department of Family Medicine, University of Calgary, Calgary, Alberta
| | - Alain Lesage
- 4 Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Québec
| | | |
Collapse
|
29
|
Crespo-Facorro B, Pelayo-Teran JM, Mayoral-van Son J. Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review. Neurol Ther 2016; 5:105-130. [PMID: 27553839 PMCID: PMC5130917 DOI: 10.1007/s40120-016-0050-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes. In addition, some of the SGAs (risperidone, amisulpride, and paliperidone) have been associated with a significant increase of plasma prolactin levels. Overall, in cases of FEP, there should be a clear recommendation of using lower doses of the antipsychotic medication. If no or minimal clinical improvement is found after 2 weeks of treatment, such patients may benefit from a change or augmentation of treatment. Clinicians should provide accurate information to patients and relatives about the high risk of relapse if antipsychotics are discontinued, even if patients have been symptom free and functionally recovered on antipsychotic treatment for a lengthy period of time.
Collapse
Affiliation(s)
- Benedicto Crespo-Facorro
- Department of Psychiatry, IDIVAL, School of Medicine, University Hospital Marqués de Valdecilla. CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Edificio IDIVAL, planta 2 | Avda. Cardenal Herrera Oria, s/n. |, 39011, Santander, Spain.
| | - Jose Maria Pelayo-Teran
- Department of Psychiatry, IDIVAL, School of Medicine, University Hospital Marqués de Valdecilla. CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Edificio IDIVAL, planta 2 | Avda. Cardenal Herrera Oria, s/n. |, 39011, Santander, Spain
| | - Jacqueline Mayoral-van Son
- Department of Psychiatry, IDIVAL, School of Medicine, University Hospital Marqués de Valdecilla. CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Edificio IDIVAL, planta 2 | Avda. Cardenal Herrera Oria, s/n. |, 39011, Santander, Spain
| |
Collapse
|
30
|
Durbin J, Selick A, Hierlihy D, Moss S, Cheng C. A first step in system improvement: a survey of Early Psychosis Intervention Programmes in Ontario. Early Interv Psychiatry 2016; 10:485-493. [PMID: 25366518 DOI: 10.1111/eip.12201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 09/24/2014] [Indexed: 11/30/2022]
Abstract
AIM Ontario, Canada is a large province with a geographically dispersed population. Early psychosis intervention (EPI) programmes are available province-wide, with delivery approaches adapted to context. This study examined EPI programme delivery in relation to recently released provincial EPI Program Standards, and variations based on geographic context. METHODS The data source was a province-wide key informant survey of early psychosis programmes conducted after release of the Standards. Chi-squared tests compared large- and small-area programmes on selected programme structural features and perceived adherence to 19 service components. RESULTS Responses were obtained from 52 programme sites, including 21 small-area programmes with 1 to 2 staff. In general, frequency of EPI delivery was highest for individual assessment and treatment components, and moderate for social supports and family support. Implementation was lowest for public education, early detection and recovery planning. Small-area programmes reported lower implementation for over half of the components, with differences statistically significant for psychiatric assessment and physical health monitoring. CONCLUSION Since the release of the Standards, the Ontario Ministry of Health has partnered with a provincial network of EPI stakeholders to support practice improvement. This survey identified components where more implementation support is needed, overall and for rural area delivery. Ultimately, systematic monitoring of programme fidelity and measuring client outcomes are key to advancing the quality of EPI programme delivery.
Collapse
Affiliation(s)
- Janet Durbin
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Avra Selick
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Sarah Moss
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Chiachen Cheng
- First Place, Canadian Mental Health Association - Thunder Bay Branch, Thunder Bay, Ontario, Canada
| |
Collapse
|
31
|
Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review. Int J Bipolar Disord 2016; 4:19. [PMID: 27613276 PMCID: PMC5017982 DOI: 10.1186/s40345-016-0060-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/30/2016] [Indexed: 12/15/2022] Open
Abstract
Background We aimed to investigate a key element of the early intervention approach; whether treatment at an earlier stage of bipolar disorder is more effective than later in its course. Methods A comprehensive literature review using Medline, Embase, Psychinfo, PsycArticle and Web of Science as data sources, with a subsequent narrative synthesis. Study quality was assessed using the Cochrane risk of bias method. Results Our search strategy yielded eight primary papers and two meta-analyses (of psychological therapies and Olanzapine) in total representing 8942 patients. Five studies focused on comparisons between first and multiple episode; the others on fewer vs more episode categories. There was a consistent finding suggesting treatment in earlier illness stage resulted in better outcomes in terms of response, relapse rate, time to recurrence, symptomatic recovery, remission, psychosocial functioning and employment. This effect was found for pharmacological (Lithium, Olanzapine, Divalproex) and psychological treatment. Limitations There was high risk of selection, performance and attrition bias in most studies. First admission or presentation is unlikely to equate to first episode because of duration of untreated illness. Some patients having experienced multiple episodes could be “treatment resistant”. Study heterogeneity precluded meta-analysis. Conclusions Psychological and pharmacological treatment in the early stages of illness is more effective than in later stages of bipolar disorder across multiple domains. There is a first episode and early phase effect. Consistent with the staging model of illness findings provide evidence for the clinical utility of an early intervention approach in bipolar disorder to improve patient outcomes.
Collapse
|
32
|
Marwaha S, Thompson A, Upthegrove R, Broome MR. Fifteen years on - early intervention for a new generation. Br J Psychiatry 2016; 209:186-8. [PMID: 27587758 DOI: 10.1192/bjp.bp.115.170035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/07/2016] [Indexed: 11/23/2022]
Abstract
Early intervention for psychosis (EIP) is a model of service delivery that aims to support young people with first-episode psychosis by providing the best available treatments, supporting recovery and preventing relapse. In this editorial, we review the evidence for EIP, how the model has developed since its inclusion in the NHS policy implementation guideline for mental health in 2001, challenges and areas of ongoing debate, and future development.
Collapse
Affiliation(s)
- Steven Marwaha
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Andrew Thompson
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rachel Upthegrove
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Matthew R Broome
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
33
|
Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry 2016; 16:293. [PMID: 27538886 PMCID: PMC4990880 DOI: 10.1186/s12888-016-1002-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosis can be associated with acute recreational drug and novel psychoactive substance (NPS) toxicity. However, there is limited data available on how common this is and which drugs are most frequently implicated. We describe a European case series of psychosis associated with acute recreational drug toxicity, and estimate the frequency of psychosis for different recreational drugs. METHODS The European Drug Emergencies Network (Euro-DEN) collects data on presentations to Emergency Departments (EDs) with acute recreational drug and NPS toxicity at 16 centres in ten countries. Euro-DEN data from October 2013 through September 2014 was retrospectively searched, and cases with psychosis were included. The proportion of cases with psychosis per drug was calculated in the searched Euro-DEN dataset. RESULTS Psychosis was present in 348 (6.3 %) of 5529 cases. The median (interquartile range) age was 29 (24-38) years, 276 (79.3 %) were male and 114 (32.8 %) were admitted to psychiatric ward. The drugs most commonly reported were cannabis in 90 (25.9 %) cases, amphetamine in 87 (25.0 %) and cocaine in 56 (16.1 %). More than one drug was taken in 189 (54.3 %) cases. Psychosis was frequent in those ED presentations involving tryptamines (4/7; 57.1 %), methylenedioxypyrovalerone (MDPV) (6/22; 27.3 %), methylphenidate (6/26; 23.1 %), lysergic acid diethylamide (LSD) (18/86; 20.9 %), psilocybe mushrooms (3/16; 18.8 %), synthetic cannabinoid receptor agonists (4/26; 15.4 %) and amphetamine (87/593; 14.7 %), but less common in those involving mephedrone (14/245; 5.7 %), methylenedioxymethamphetamine (MDMA) (20/461; 4.3 %) and methedrone (3/92; 3.3 %). Amphetamine was the most frequent drug associated with psychosis when only one agent was reported, with psychosis occurring in 32.4 % of these presentations. CONCLUSION The frequency of psychosis in acute recreational drug toxicity varies considerably between drugs, but is a major problem in amphetamine poisoning. In rapidly changing drug markets and patterns of use, the Euro-DEN sentinel network contributes to measuring the scale of drug-related harms in Europe beyond other more established indicators.
Collapse
Affiliation(s)
- Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Alison M. Dines
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
| | - David M. Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - Fridtjof Heyerdahl
- The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Erik Hovda
- The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Paul I. Dargan
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| |
Collapse
|
34
|
Chen F, Wang L, Wang J, Heeramun-Aubeeluck A, Yuan J, Zhao X. Applicability of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome in a college population. Early Interv Psychiatry 2016; 10:308-15. [PMID: 25113068 DOI: 10.1111/eip.12173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to examine the reliability, validity, sensitivity and specificity of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome (APS) in a college population. METHODS The participants were recruited from a university. Five hundred seventy-nine students completed the CPQ-16 and the Symptom Checklist-90. One class (n = 79) was randomly selected to be retested with the CPQ-16 after 2 weeks. A randomly selected group of 49 individuals who tested positive and 50 individuals who tested negative were interviewed using the Structured Interview for Prodromal Syndromes (SIPS). RESULTS The internal consistency reliability was good (Cronbach's α = 0.72). The test-retest reliability was 0.88. The total score on the CPQ-16 was moderately to highly correlated with the total score on the Symptom Checklist-90 and all of the subscales (r = 0.39-0.67, P < 0.001). A cut-off CPQ-16 score of 9 was used to differentiate between those with a APS diagnosis on the SIPS versus those with no SIPS diagnoses; this cut-off value yielded 85% sensitivity, 87% specificity, a positive predictive value of 63% and a positive likelihood ratio of 6.69. The area under the ROC curve (AUC) was significant for the CPQ-16 total score (AUC = 0.93, SE = 0.026, 95% CI = 0.87-0.98, P < 0.001). Based on the proposed cut-off score, the CPQ-16 yielded a positive rate of 5.0% (29/579). CONCLUSIONS The CPQ-16, administered in a face-to-face interview, demonstrated high reliability and the ability to identify college students at risk for psychosis.
Collapse
Affiliation(s)
- Fazhan Chen
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Wang
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jikun Wang
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Jiabei Yuan
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xudong Zhao
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.,Faculty of Humanities and Behavioral Medicine, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
35
|
Romero-Ferreiro MV, Aguado L, Rodriguez-Torresano J, Palomo T, Rodriguez-Jimenez R, Pedreira-Massa JL. Facial affect recognition in early and late-stage schizophrenia patients. Schizophr Res 2016; 172:177-83. [PMID: 26874869 DOI: 10.1016/j.schres.2016.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 01/14/2023]
Abstract
Prior studies have shown deficits in social cognition and emotion perception in first-episode psychosis (FEP) and multi-episode schizophrenia (MES) patients. These studies compared patients at different stages of the illness with only a single control group which differed in age from at least one clinical group. The present study provides new evidence of a differential pattern of deficit in facial affect recognition in FEP and MES patients using a double age-matched control design. Compared to their controls, FEP patients only showed impaired recognition of fearful faces (p=.007). In contrast to this, the MES patients showed a more generalized deficit compared to their age-matched controls, with impaired recognition of angry, sad and fearful faces (ps<.01) and an increased misattribution of emotional meaning to neutral faces. PANSS scores of FEP patients on Depressed factor correlated positively with the accuracy to recognize fearful expressions (r=.473). For the MES group fear recognition correlated positively with negative PANSS factor (r=.498) and recognition of sad and neutral expressions was inversely correlated with disorganized PANSS factor (r=-.461 and r=-.541, respectively). These results provide evidence that a generalized impairment of affect recognition is observed in advanced-stage patients and is not characteristic of the early stages of schizophrenia. Moreover, the finding that anomalous attribution of emotional meaning to neutral faces is observed only in MES patients suggests that an increased attribution of salience to social stimuli is a characteristic of social cognition in advanced stages of the disorder.
Collapse
Affiliation(s)
| | | | - Javier Rodriguez-Torresano
- Department of Psychiatry, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Tomás Palomo
- Complutense University of Madrid, Spain; Department of Psychiatry, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Avda. de Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Roberto Rodriguez-Jimenez
- Complutense University of Madrid, Spain; Department of Psychiatry, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Avda. de Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - José Luis Pedreira-Massa
- Department of Psychiatry, Hospital Infantil Universitario Niño Jesús, Avda. Menéndez Pelayo, N° 65, 28009 Madrid, Spain; The National University of Distance Education, Spain
| |
Collapse
|
36
|
Shrivastava A, Berlemont C, Campbell R, Johnston M, De Sousa A, Shah N. Suicide in hospitalized early psychosis patients at the time of discharge from hospital: An exploratory study of attempters and nonattempters. Indian J Psychiatry 2016; 58:142-6. [PMID: 27385845 PMCID: PMC4919956 DOI: 10.4103/0019-5545.183773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Early intervention programs for psychosis are gateways for suicide prevention. These programs offer an excellent opportunity for prevention due to easy access, early identification, and provisions for continuity of care. These programs have been found effective in reducing rates of suicide after discharge to communities. The objective of this study was to examine suicide risk level among early psychosis patients admitted with and without previous suicide attempts. We hypothesized that all patients admitted with early psychosis would be at high risk of suicide, regardless of a previous suicide attempt. METHODOLOGY Suicide risk was compared between patients admitted with a suicide attempt (n = 30) and patients admitted without a suicide attempt (n = 30). The primary outcome measure of interest was suicide risk which was measured with the Scale for Impact of Suicidality-Management, Assessment and Planning of Care clinical interview. All patients met DSM-IV TR criteria for schizophrenia. Psychopathology was assessed using the Brief Psychiatric Rating Scale and level of depression was assessed using the Hamilton Depression Rating Scale. The data were statistically analyzed. RESULTS Patients admitted with a previous attempt (mean = 29.5, standard deviation [SD] =12.0) did not differ significantly in suicide risk from those admitted without a previous attempt (mean = 27.5, SD = 12.5), (t[58] =0.63, P = 0.53). Patients admitted without a suicide attempt scored higher in depressive symptoms (t[58] =10.62, P < 0.001) than that of admitted with a suicide attempt. There were no significant differences between patients admitted with and without suicide attempts on any comorbidity, other than a trend toward a higher prevalence of personality disorder in patients with no suicide attempt. Attempters and nonattempters did not differ on any demographic variables either. CONCLUSIONS Of those admitted without a previous suicide attempt, our findings suggest that it is critical that all patients discharged from an acute psychiatric unit must receive comprehensive community care. The identification of risk, and subsequent intervention for suicidal and self-harm behaviors, should be a central part of treatment for all mental disorders.
Collapse
Affiliation(s)
- Amresh Shrivastava
- Consultant Psychiatrist, Lawson Health Research Institute, London, Ontario, Canada
| | - Coralee Berlemont
- Medical Social Worker, Forensic Program, Regional Mental Health Care, St. Thomas, London, Ontario, Canada
| | - Robbie Campbell
- Department of Psychiatry, The Western University and Chief, Assessment and Mood and Anxiety Program, Regional Mental Health Care, London, Ontario, Canada
| | - Megan Johnston
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharastra, India
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharastra, India
| |
Collapse
|
37
|
Abstract
Despite a lack of recent progress in the treatment of schizophrenia, our understanding of its genetic and environmental causes has considerably improved, and their relationship to aberrant patterns of neurodevelopment has become clearer. This raises the possibility that 'disease-modifying' strategies could alter the course to - and of - this debilitating disorder, rather than simply alleviating symptoms. A promising window for course-altering intervention is around the time of the first episode of psychosis, especially in young people at risk of transition to schizophrenia. Indeed, studies performed in both individuals at risk of developing schizophrenia and rodent models for schizophrenia suggest that pre-diagnostic pharmacotherapy and psychosocial or cognitive-behavioural interventions can delay or moderate the emergence of psychosis. Of particular interest are 'hybrid' strategies that both relieve presenting symptoms and reduce the risk of transition to schizophrenia or another psychiatric disorder. This Review aims to provide a broad-based consideration of the challenges and opportunities inherent in efforts to alter the course of schizophrenia.
Collapse
|
38
|
Woodberry KA, Shapiro DI, Bryant C, Seidman LJ. Progress and Future Directions in Research on the Psychosis Prodrome: A Review for Clinicians. Harv Rev Psychiatry 2016; 24:87-103. [PMID: 26954594 PMCID: PMC4870599 DOI: 10.1097/hrp.0000000000000109] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to: ABSTRACT The psychosis prodrome, or period of clinical and functional decline leading up to acute psychosis, offers a unique opportunity for identifying mechanisms of psychosis onset and for testing early-intervention strategies. We summarize major findings and emerging directions in prodromal research and provide recommendations for clinicians working with individuals suspected to be at high risk for psychosis. The past two decades of research have led to three major advances. First, tools and criteria have been developed that can reliably identify imminent risk for a psychotic disorder. Second, longitudinal clinical and psychobiological data from large multisite studies are strengthening individual risk assessment and offering insights into potential mechanisms of illness onset. Third, psychosocial and pharmacological interventions are demonstrating promise for delaying or preventing the onset of psychosis in help-seeking, high-risk individuals. The dynamic psychobiological processes implicated in both risk and onset of psychosis, including altered gene expression, cognitive dysfunction, inflammation, gray and white matter brain changes, and vulnerability-stress interactions suggest a wide range of potential treatment targets and strategies. The expansion of resources devoted to early intervention and prodromal research worldwide raises hope for investigating them. Future directions include identifying psychosis-specific risk and resilience factors in children, adolescents, and non-help-seeking community samples, improving study designs to test hypothesized mechanisms of change, and intervening with strategies that, in order to improve functional outcomes, better engage youth, address their environmental contexts, and focus on evidence-based neurodevelopmental targets. Prospective research on putatively prodromal samples has the potential to substantially reshape our understanding of mental illness and our efforts to combat it.
Collapse
Affiliation(s)
- Kristen A Woodberry
- From Harvard Medical School (Drs. Woodberry, Shapiro, and Seidman) and Beth Israel Deaconess Medical Center (Drs. Woodberry, Shapiro, and Seidman, and Ms. Bryant)
| | | | | | | |
Collapse
|
39
|
Postan E. Defining Ourselves: Personal Bioinformation as a Tool of Narrative Self-Conception. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:133-151. [PMID: 26797683 PMCID: PMC4823336 DOI: 10.1007/s11673-015-9690-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 06/02/2015] [Indexed: 06/05/2023]
Abstract
Where ethical or regulatory questions arise about an individual's interests in accessing bioinformation about herself (such as findings from screening or health research), the value of this information has traditionally been construed in terms of its clinical utility. It is increasingly argued, however, that the "personal utility" of findings should also be taken into account. This article characterizes one particular aspect of personal utility: that derived from the role of personal bioinformation in identity construction. The suggestion that some kinds of information are relevant to identity is not in itself new. However, the account outlined here seeks to advance the debate by proposing a conception of the relationship between bioinformation and identity that does not depend on essentialist assumptions and applies beyond the narrow genetic contexts in which identity is customarily invoked. The proposal is that the identity-value of personal bioinformation may be understood in terms of its instrumental role in the construction of our narrative identities, specifically that its value lies in helping us to develop self-narratives that support us in navigating our embodied existences. I argue that this narrative conception provides useful insights that are pertinent to the ethical governance of personal bioinformation. It illuminates a wider range of ethical considerations in relation to information access; it accounts for variations in the utility of different kinds of information; and it highlights that the context in which information is conveyed can be as important as whether it is disclosed at all. These arguments are illustrated using an example drawn from psychiatric neuroimaging research.
Collapse
Affiliation(s)
- Emily Postan
- Edinburgh Law School, The University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL, UK.
| |
Collapse
|
40
|
|
41
|
Hartmann JA, Yuen HP, McGorry PD, Yung AR, Lin A, Wood SJ, Lavoie S, Nelson B. Declining transition rates to psychotic disorder in "ultra-high risk" clients: Investigation of a dilution effect. Schizophr Res 2016; 170:130-6. [PMID: 26673973 DOI: 10.1016/j.schres.2015.11.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/19/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
During recent years, a decrease has been noted in the rate of transition of ultra-high risk (UHR) clients to a psychotic disorder. Although important to the concept of the at-risk mental state, the reasons for this decline remain largely unknown. We investigated the possibility of a 'dilution effect' in contributing to the decline, i.e. if later UHR cohorts present with less severe clinical intake characteristics than earlier cohorts. Firstly, clinical intake characteristics of a large UHR sample (n=397) were compared across baseline year epochs (1995-2006). Characteristics showing significant differences were included in a Cox-regression to examine if they could explain the decline in transition rates. Secondly, because later cohorts show lower transition rates, 'more stringent' UHR-criteria were retrospectively applied to these cohorts (post-2000, n=219), investigating if this resulted in a higher transition rate. Results indicated that earlier cohorts presented with (1) a larger array of attenuated psychotic symptoms, (2) higher ratings on conceptual disorganization (formal thought disorder) and (3) a higher proportion of individuals with trait risk factor (all P<.001). However, these factors could not fully account for the decline in transition rates. Applying more stringent UHR-criteria to the post-2000-subsample did not substantially change the rate of transition. Our study suggests that later UHR cohorts presented with different clinical intake characteristics than earlier cohorts. While this may have contributed to the observed decrease in transition rates to psychosis, it does not appear to fully account for this decline, suggesting other factors have also impacted on transition rates over time.
Collapse
Affiliation(s)
- Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, VIC, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, VIC, Australia
| | - Alison R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, VIC, Australia; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Birmingham, UK; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, VIC, Australia
| | - Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, VIC, Australia
| |
Collapse
|
42
|
Essential components of early intervention programs for psychosis: Available intervention services in the United States. Schizophr Res 2015; 168:79-83. [PMID: 26307427 DOI: 10.1016/j.schres.2015.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022]
Abstract
Programs providing interventions for early psychosis are becoming commonplace in the United States (U.S.); however, the characteristics of existing services remain undocumented. We examined program characteristics, clinical services, and program eligibility criteria for outpatient early intervention programs across the U.S. using a semi-structured telephone interview. Content analysis was used to identify the presence or absence of program components, based in part on a recent list of essential evidence-based components recommended for early intervention programs (Addington, MacKenzie, Norman, Wang and Bond, 2013) as well as program characteristics, including eligibility criteria. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the examined components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The populations served by US programs were most frequently defined by restrictions on the duration of psychosis and age. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for future improvement.
Collapse
|
43
|
Kirkbride JB. Epidemiology on demand: population-based approaches to mental health service commissioning. BJPsych Bull 2015; 39:242-7. [PMID: 26755969 PMCID: PMC4706199 DOI: 10.1192/pb.bp.114.047746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/31/2014] [Accepted: 09/03/2014] [Indexed: 11/23/2022] Open
Abstract
One in three people will experience a mental health problem in their lifetime, but the causes and consequences of psychiatric morbidity are socially patterned. Epidemiological studies can provide aetiological clues about the causes of disorder, and when they can provide robust estimates about risk in different strata of the population these can also be used translationally, to provide commissioners and service planners with detailed information about local service need. This approach is illustrated using a newly developed population-level prediction tool for first-episode psychosis, PsyMaptic. Such public mental health prediction tools could be used to improve allocation of finite resources, by integrating evidence-based healthcare, public health and epidemiology together.
Collapse
|
44
|
Chien WT, Bressington D. A randomized controlled clinical trial of a nurse-led structured psychosocial intervention program for people with first-onset mental illness in psychiatric outpatient clinics. Psychiatry Res 2015; 229:277-86. [PMID: 26193827 DOI: 10.1016/j.psychres.2015.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/19/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
Abstract
This study aimed to test the effectiveness of a nurse-led structured psychosocial intervention program in Chinese patients with first-onset mental illness. A single-blind, parallel group, randomized controlled trial design was used. The study involved 180 participants with mild to moderate-severe symptoms of psychotic or mood disorders who were newly referred to two psychiatric outpatient clinics in Hong Kong. Patients were randomly assigned to either an eight-session nurse-led psychosocial intervention program (plus usual care) or usual psychiatric outpatient care (both n=90). The primary outcome was psychiatric symptoms. Outcomes were measured at recruitment, one week and 12 months post-intervention. Patients in the psychosocial intervention group reported statistically significant improvements in symptoms compared to treatment as usual. There were also significant improvements in illness insight and perceived quality of life and reduction in length of re-hospitalizations over the 12-month follow-up. The findings provide evidence that the nurse-led psychosocial intervention program resulted in improved health outcomes in Chinese patients with first-onset mental illness.
Collapse
Affiliation(s)
- Wai-Tong Chien
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong S.A.R, China.
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong S.A.R, China
| |
Collapse
|
45
|
Ruggeri M, Bonetto C, Lasalvia A, Fioritti A, de Girolamo G, Santonastaso P, Pileggi F, Neri G, Ghigi D, Giubilini F, Miceli M, Scarone S, Cocchi A, Torresani S, Faravelli C, Cremonese C, Scocco P, Leuci E, Mazzi F, Pratelli M, Bellini F, Tosato S, De Santi K, Bissoli S, Poli S, Ira E, Zoppei S, Rucci P, Bislenghi L, Patelli G, Cristofalo D, Meneghelli A. Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants. Schizophr Bull 2015; 41:1192-203. [PMID: 25995057 PMCID: PMC4535643 DOI: 10.1093/schbul/sbv058] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.
Collapse
Affiliation(s)
- Mirella Ruggeri
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy;
| | - Chiara Bonetto
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Antonio Lasalvia
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Angelo Fioritti
- Department of Mental Health, Azienda ULSS Bologna, Bologna, Italy
| | - Giovanni de Girolamo
- Scientific Direction, St John of God Clinical Research Centre of Brescia, Brescia, Lombardia, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova, Padova, Italy and Azienda Ospedaliera Padova, Italy
| | | | - Giovanni Neri
- Department of Mental Health, Azienda ULSS Modena, Modena, Italy; Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Italy
| | | | | | | | - Silvio Scarone
- Department of Psychiatry, University of Milano, Milano, Italy
| | - Angelo Cocchi
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | | | - Carlo Faravelli
- Department of Psychiatry, University of Firenze, Firenze, Italy
| | - Carla Cremonese
- Department of Mental Health, Azienda Ospedaliera Padova, Padova, Italy
| | - Paolo Scocco
- Department of Mental Health, Azienda ULSS 16, Padova, Italy
| | | | | | | | | | - Sarah Tosato
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Katia De Santi
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sarah Bissoli
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Sara Poli
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Elisa Ira
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Silvia Zoppei
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Paola Rucci
- Department of Mental Health, Azienda ULSS Bologna, Bologna, Italy; Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Italy
| | - Laura Bislenghi
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | - Giovanni Patelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | - Doriana Cristofalo
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Anna Meneghelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| |
Collapse
|
46
|
Abstract
BACKGROUND An increasing number of studies identifies the duration of illness (DI) as an important predictor of outcome in patients affected by major psychoses (MP). The aim of the present paper was to revise medical literature about DI and its effects on MP, focusing in particular on the relationship between DI and outcome with particular reference to treatment response, suicidal risk, cognitive impairment and social functioning. METHODS A search in the main database sources has been performed to obtain a comprehensive overview. Studies with different methodologies (open and double-blinded) have been included, while papers considering other variables such as duration of untreated episode/illness were excluded. MP included the diagnoses of schizophrenia, bipolar disorder and major depressive disorder. RESULTS Available data show that DI influences treatment response, suicidal risk and loss of social functioning in schizophrenic patients, while results are more controversial with regard to cognitive impairment. In bipolar disorder, a long DI has been associated with less treatment response, more suicidal risk and cognitive impairment, but more data are needed to draw definitive conclusions. Finally, studies, regarding DI of illness and its predictive value of outcome in major depressive disorder show contradictory results. CONCLUSIONS DI appears a negative outcome factor particularly for schizophrenia, while with regard to mood disorders, more data are needed to draw definitive sound conclusions.
Collapse
Affiliation(s)
- Alfredo Carlo Altamura
- Alfredo C Altamura, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Via F. Sforza 35, 20122, Milan , Italy
| | | | | |
Collapse
|
47
|
Srihari VH, Tek C, Kucukgoncu S, Phutane VH, Breitborde NJK, Pollard J, Ozkan B, Saksa J, Walsh BC, Woods SW. First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial. Psychiatr Serv 2015; 66:705-12. [PMID: 25639994 PMCID: PMC4490067 DOI: 10.1176/appi.ps.201400236] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine the effectiveness of a comprehensive first-episode service, the clinic for Specialized Treatment Early in Psychosis (STEP), in an urban U.S. community mental health center by comparing it with usual treatment. METHODS This pragmatic randomized controlled trial enrolled 120 patients with first-episode psychosis within five years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from inpatient psychiatric units, and enrollees were randomly allocated to STEP or usual treatment. Main outcomes included hospital utilization (primary); the ability to work or attend age-appropriate schooling-or to actively seek these opportunities (vocational engagement); and general functioning. Analysis was by modified intent to treat (excluding only three who withdrew consent) for hospitalization; for other outcomes, only data for completers were analyzed. RESULTS After one year, STEP participants had less inpatient utilization compared with those in usual treatment: no psychiatric hospitalizations, 77% versus 56% (risk ratio [RR]=1.38, 95% confidence interval [CI]=1.08-1.58); mean hospitalizations, .33±.70 versus .68±.92 (p=.02); and mean bed-days, 5.34±13.53 versus 11.51±15.04 (p=.05). For every five patients allocated to STEP versus usual treatment, one additional patient avoided hospitalization over the first year (number needed to treat=5; CI=2.7-26.5). STEP participants also demonstrated better vocational engagement (91.7% versus 66.7%; RR=1.40, CI=1.18-1.48) and showed salutary trends in global functioning measures. CONCLUSIONS This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses.
Collapse
Affiliation(s)
- Vinod H Srihari
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Cenk Tek
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Suat Kucukgoncu
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Vivek H Phutane
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Nicholas J K Breitborde
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jessica Pollard
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Banu Ozkan
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - John Saksa
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Barbara C Walsh
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Scott W Woods
- Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| |
Collapse
|
48
|
Kline E, Thompson E, Demro C, Bussell K, Reeves G, Schiffman J. Longitudinal validation of psychosis risk screening tools. Schizophr Res 2015; 165:116-22. [PMID: 25975827 DOI: 10.1016/j.schres.2015.04.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
The development of widely used interview tools has helped to standardize the criteria for a "clinical high risk" syndrome, thus enabling advances in efforts to develop interventions for this phase of illness. These assessments, however, are burdensome to administer and not likely to be adopted for widespread use. Scalable early intervention depends on the availability of brief, low-cost assessment tools that can serve to screen populations of interest or triage treatment-seekers toward specialized care. The current study examines the sensitivity, specificity, and predictive strength of three self-report measures (Prime Screen-Revised, Prodromal Questionnaire-Brief, and Youth Psychosis at Risk Questionnaire-Brief) with regard to psychosis onset and symptom persistence over six months of follow-up within an indicated sample of 54 adolescents and young adults ages 12-22. Within this sample, all three measures demonstrated excellent sensitivity to emerging psychosis and strong agreement with clinician evaluations of attenuated psychosis symptoms. Additionally, all screeners obtained negative predictive values of 1.00 with regard to psychosis onset, indicating that an individual scoring below the recommended threshold score would be extremely unlikely to develop psychosis over the following six months. The longitudinal validation of psychosis risk screening tools constitutes an important step toward establishing a standard of care for early identification and monitoring in this vulnerable population.
Collapse
Affiliation(s)
- Emily Kline
- Massachusetts Mental Health Center, Public Psychiatry Division of Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA 02115, USA
| | - Elizabeth Thompson
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Caroline Demro
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Kristin Bussell
- University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore, MD 21201, USA
| | - Gloria Reeves
- University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore, MD 21201, USA
| | - Jason Schiffman
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
| |
Collapse
|
49
|
Preventing brain disorders: a framework for action. Soc Psychiatry Psychiatr Epidemiol 2015; 50:833-41. [PMID: 25595136 DOI: 10.1007/s00127-015-1007-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/08/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Prevention efforts have greatly reduced the prevalence of many communicable and non-communicable diseases worldwide. In contrast, prevention strategies for mental disorders remain in their infancy. This paper provides a summary of the key issues surrounding mental disorder prevention and proposes a framework for how to catalyze action in the area. MATERIALS AND METHODS Three core assumptions guide this work (1) the onset of mental disorders is often preventable, (2) among those individuals with a mental disorder, the trajectory of health and functioning can be shaped by external resources, and (3) many specific and generic risk and protective factors for mental disorders are associated with specific stages of the life course. CONCLUSION We propose that the adoption of a life course approach to prevention can be clarifying and motivating for both research and practice.
Collapse
|
50
|
Abstract
Cognitive therapy for psychosis has developed over the past 30 years from initial case studies, treatment manuals, pilot randomized controlled studies to fully powered and methodologically rigorous efficacy and, subsequently, effectiveness trials. Reviews and meta-analyses have confirmed the benefits of the interventions. Considered appraisal by government and professional organizations has now led to its inclusion in international treatment guidelines for schizophrenia. Patients consistently ask for access to psychotherapeutic interventions, and it is slowly becoming available in many European countries and other parts of the world, eg, US and the People’s Republic of China. However, it remains unacceptably difficult to access for the vast majority of people with psychosis who could benefit from it. Psychosis affects people in the prime of their lives and leads to major effects on their levels of distress, well-being, and functioning, and also results in major costs to society. Providing effective interventions at an early stage has the potential to reduce the high relapse rates that occur after recovery from first episode and the ensuing morbidity and premature mortality associated with psychosis.
Collapse
Affiliation(s)
- Helen Mander
- Mental Health Group, University of Southampton, Southampton, Hampshire, England, UK
| | - David Kingdon
- Mental Health Group, University of Southampton, Southampton, Hampshire, England, UK
| |
Collapse
|