Stigma of Treatment Stages for First-Episode Psychosis: A Conceptual Framework for Early Intervention Services

Most influential symptoms in the early detection of clinical high risk for psychosis in Indonesia: A basic symptom network

Basic symptoms (BS) are subtle, self-experienced disturbances in mental processes. Cognitive, visual and acoustic BS were included in clinical-high risk criteria for psychosis (CHR-P). So far, their interplay has been studied only in Western samples and always in concert with other symptoms, such as (attenuated) psychotic symptoms. Thus, we studies the interrelation of the 56 BS assessed with the 'Schizophrenia Proneness Instrument, Adult version', in an Indonesian sample of CHR-P patients (N = 108) 16-30 years-of-age, 18.95 % male) according to BS criteria using network analysis. The used estimator partially correlates with the Gaussian graphical model (GGM) and graph module. Model selection uses regularization techniques by setting λ = 0.05. The most central and traversed nodes in the robust, stable network were visual disturbances-'near- and tele-vision', 'disturbances of the perception of straight lines/contours' and 'micropsia, macropsia'. Visual disturbances were also predominately involved in the 16 strongest edges, thereby linking strongly with alienation experiences. Contrary to networks in Western samples in that cognitive BS played a central and important role, subjective visual disturbances seem to play an important role in the possible emergence and maintenance of BS, in particular of alienation experiences, in Indonesian patients with CHR-P. Future studies should therefore study this potential role longitudinally along with their neurobio/cognitive underpinnings. Furthermore, it should be studies, if cognitive-behavioral therapy as suggested for alienation experiences may prevent progression and reduce symptom load.

Stigma of ultra-high risk for psychosis: an updated systematic review

OBJECTIVE

To determine whether the stigma associated with schizophrenia has also been directed towards people at ultra-high risk of psychosis (UHR), the present review aimed to synthetize the literature to update and extend our understanding of this topic.

METHODS

A systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in the PubMed, EMBASE, Cochrane, and Web of Science databases for articles published until April 30, 2023, using a combination of search terms describing at-risk mental states for psychosis, stigma, and related terms.

RESULTS

Thirty-eight studies were included. Twenty-nine addressed individuals with UHR directly, and nine conducted interviews with non-patients regarding UHR. A total of 2,560 individuals with UHR were assessed, with a mean sample size of 88.3 participants. Most were quantitative non-randomized/observational studies with young adults, 71.4% used the Structured Interview for Psychosis-Risk Syndromes, and 25% used the Comprehensive Assessment of At-Risk Mental States. Overall, the studies mainly involved patients of UHR clinics from high-income Western countries. The described stigma can be grouped into five forms, the most frequently explored of which was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress, and associative stigma. Quantitative nonrandomized studies predominated: only one was an interventional study. Most of the results confirmed the presence of stigma toward individuals with UHR.

CONCLUSION

Despite the knowledge gaps and scarcity of research on UHR-related stigma, the results suggest that stigma toward people with UHR exists and that it is already present at early stages of psychosis.

Rate and correlates of self-stigma in adult patients with early psychosis

Introduction

Self-stigma impedes recovery process and is associated with poorer clinical and functional outcomes in people with psychotic disorders. However, there is limited research specifically examining self-stigma in the early stage of illness, and mixed findings were observed regarding factors associated with increased self-stigma. We aimed to investigate the rate and correlates of self-stigma in a cohort of adult patients with early psychosis using a comprehensive array of clinical, treatment and other illness-related variables.

Methods

A total of 101 Chinese adult early psychosis patients aged 26-55 years who had received three-year psychiatric treatment for first psychotic episode in Hong Kong and completed self-stigma assessment were included for the current investigation. A broad range of assessments encompassing socio-demographics, premorbid adjustment, onset and illness profiles, symptom severity, psychosocial functioning, treatment characteristics and medication side-effects were conducted.

Results

Twenty-eight (27.7%) patients had moderate-to-high levels of self-stigma. Univariate linear regression analyses showed that age at study entry, sex, educational level, age at psychosis onset, duration of untreated psychosis (DUP), insight level, global psychosocial functioning, and the use of second-generation antipsychotic were related to self-stigma levels. Final multivariable regression model revealed that female sex, younger age at entry, longer DUP and better insight were independently associated with higher levels of self-stigma.

Conclusion

More than one-fourth of early psychosis patients experienced significant self-stigma, highlighting an unmet need for early detection and intervention of self-stigma in the initial years of illness. Further investigation is warranted to clarify trajectories and predictors of self-stigma in the early illness course.

Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process

Background

In 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile.

Methods

A qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews (n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions (n = 6) with individuals with FEP and caregivers (n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recommendations for the key principles, multidisciplinary team, psychosocial components, and the training and supervision model of OnTrack.

Results

Participants expressed enthusiasm and support for OnTrack's recovery-oriented and person-centered principles of care. While many participants lauded the emphasis on shared decision-making and family involvement, some reported reticence, citing that it is culturally normative for patients and families to adopt a passive role in treatment. Peer specialists, and the family psychoeducation and support and supported education and employment components were perceived as aspects that could encourage the promotion of personhood and autonomy development. However, implementation challenges, including the prevailing biomedical approach, professional hierarchy, and the lack of infrastructure, human, and financial resources necessitate some modifications to these aspects. Some mental health professionals further conveyed reservations regarding the perceived hierarchical structure of the supervision model.

Conclusion

OnTrack represents a shift from a biomedical model to a valued, aspirational, person-centered and culturally responsive model that focuses on recovery, shared decision-making and psychosocial care. With the appropriate governmental and agency-level provision of resources and modifications to some of the program components, particularly regarding the shared decision-making framework, peer specialist, family engagement, and the training supervision model, OTCH could be a transformative program for a more comprehensive, evidence-based care for individuals with FEP in Chile.