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A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis. Community Ment Health J 2022; 59:728-755. [PMID: 36463531 DOI: 10.1007/s10597-022-01056-z] [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: 02/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types "Early Intervention" and "Individual Placement and Support" were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.
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Tarride JE, Blackhouse G, Abdel-Baki A, Latimer E, Mulvale G, Cooper B, Langill G, Milinkovic D, Stennett R, Hurley J. Economic Evaluation of Early Psychosis Interventions From A Canadian Perspective. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:768-777. [PMID: 35306862 PMCID: PMC9510998 DOI: 10.1177/07067437221087044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Compared to treatment as usual (TAU), early psychosis intervention programs (EPI) have been shown to reduce mortality, hospitalizations and days of assisted living while improving employment status. AIMS The study aim was to conduct a cost-benefit analysis (CBA) and a cost-effectiveness analysis (CEA) to compare EPI and TAU in Canada. METHODS A decision-analytic model was used to estimate the 5-year costs and benefits of treating patients with a first episode of psychosis with EPI or TAU. EPI benefits were derived from randomized controlled trials (RCTs) and Canadian administrative data. The cost of EPI was based on a published survey of 52 EPI centers in Canada while hospitalizations, employment and days of assisted living were valued using Canadian unit costs. The outcomes of the CBA and CEA were expressed in terms of net benefit (NB) and incremental cost per life year gained (LYG), respectively. Scenario analyses were conducted to examine the impact of key assumptions. Costs are reported in 2019 Canadian dollars. RESULTS Base case results indicated that EPI had a NB of $85,441 (95% CI: $41,140; $126,386) compared to TAU while the incremental cost per LYG was $26,366 (95% CI: EPI dominates TAU (less costs, more life years); $102,269). In all sensitivity analyses the NB of EPI remained positive and the incremental cost per LYG was less than $50,000. CONCLUSIONS In addition to EPI demonstrated clinical benefits, our results suggest that large-scale implementation of EPI in Canada would be desirable from an economic point of view .
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Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, 5622Université de Montréal, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Eric Latimer
- Mental Health and Society Division, Douglas Research Centre, Montreal, Quebec, Canada.,Department of Psychiatry, 248191McGill University, Montreal, Quebec, Canada
| | - Gillian Mulvale
- Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada.,DeGroote School of Business, 3710McMaster University, Hamilton, Ontario, Canada
| | - Brian Cooper
- Cleghorn Early Intervention Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gord Langill
- Canadian Mental Health Association Haliburton Kawartha Pine Ridge Branch, Peterborough, Ontario, Canada
| | - Deborah Milinkovic
- Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada.,Department of Economics, 3710McMaster University, Hamilton, Ontario, Canada
| | - Rosain Stennett
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
| | - Jeremiah Hurley
- Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada.,Department of Economics, 3710McMaster University, Hamilton, Ontario, Canada
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Ramain J, Conus P, Golay P. A narrative review of intervention in first-episode affective psychoses. J Psychiatr Res 2021; 143:123-137. [PMID: 34487989 DOI: 10.1016/j.jpsychires.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/18/2021] [Accepted: 09/01/2021] [Indexed: 01/18/2023]
Abstract
While first-episode schizophrenia has received extensive attention in the literature, few studies have focused on the first episode of affective psychoses. Considering the lack of structured data regarding this diagnostic grouping commonly used in clinical settings, our aim was to scope the literature on first-episode affective psychoses to consolidate current knowledge and to identify areas to be targeted in future studies. We also planned to investigate the relevance of the "affective psychosis" concept regarding diagnostic categories and specific needs of intervention. We conducted a search on the Embase, Medline, PubMed, PsycINFO and Web Of Science databases until October 2020. We selected studies and synthesized the key findings into a narrative review regarding major topics of early intervention research: diagnostic categorization, premorbid factors, intervention, duration of untreated illness, neurobiology and neurocognition. After screening 961 titles and abstracts and 193 full-text papers, we selected 77 studies for inclusion. Our results showed heterogeneity in diagnosis-related grouping under the concept of affective psychoses, especially variability regarding the inclusion of schizoaffective disorder. Nonetheless, this concept still encompasses patients with different psychopathological and neurocognitive profiles from the non-affective patients requiring specialized intervention. This study thus provided support for the relevance of this concept as well as a need for further investigation.
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Affiliation(s)
- Julie Ramain
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Philippe Golay
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland; Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Switzerland
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Pothier W, Lecomte T, Cellard C, Delfosse C, Fortier S, Corbière M. La réinsertion professionnelle et le retour aux études chez les personnes en début d’évolution d’un trouble psychotique. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088182ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bertulies-Esposito B, Sicotte R, Iyer SN, Delfosse C, Girard N, Nolin M, Villeneuve M, Conus P, Abdel-Baki A. Détection et intervention précoce pour la psychose : pourquoi et comment ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088178ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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First-episode psychosis and vocational outcomes: A predictive model. Schizophr Res 2019; 211:63-68. [PMID: 31327504 DOI: 10.1016/j.schres.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/15/2019] [Accepted: 07/07/2019] [Indexed: 11/21/2022]
Abstract
Most studies on predictors of vocational outcomes are cross-sectional and results are varied. This study aimed to examine the vocational rates of patients with first-episode psychosis (FEP), identify factors predicting a lack of engagement in age-appropriate roles, and evaluate the predictive ability of a model with baseline sociodemographic information and 2-year symptom and functioning trajectories on vocational outcomes. The Singapore Early Psychosis Intervention Program (EPIP) has maintained a standing database on patient clinico-demographic information. The primary outcome, vocational status, was operationalized as "meaningfully employed", that is, being gainfully employed or engaged in an age-appropriate role, and "unemployed". Using logistic regression, the predictive ability of the proposed model was evaluated. Vocational data was available for 1177 patients accepted into EPIP between 2001 and 2012. At the end of two years in the service, 829 (70.4%) patients were meaningfully employed and 348 (29.6%) patients were unemployed. The binary logistic regression model on the prediction of 2-year vocational outcomes yielded an AUC of 0.759 (SE = 0.016, p-value < 0.001). Clinico-demographic risk factors for being unemployed at the end of two years included being Malay, single, and unemployed at baseline; having a longer duration of untreated psychosis (DUP); a diagnosis of schizophrenia, schizophreniform, or delusional disorder at baseline; and belonging to the 'delayed response' or 'slower response and no response' general psychopathology trajectories. We have proposed a model that allows vocational outcomes to be predicted with high specificity. The results of this study will be relevant in developing future intervention models to improve outcomes among FEP patients with different illness trajectories.
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Cognitive and metacognitive factors predict engagement in employment in individuals with first episode psychosis. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100141. [PMID: 31828018 PMCID: PMC6889423 DOI: 10.1016/j.scog.2019.100141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 11/23/2022]
Abstract
Background Research has demonstrated that cognitive abilities predict work outcomes in people with psychosis. Cognitive Remediation Programs go some way in improving work outcomes, but individuals still experience difficulty maintaining employment. Metacognition has been demonstrated to predict work performance in individuals with schizophrenia, but this has not yet been applied to First Episode Psychosis (FEP). This study assessed whether metacognition, intellectual aptitude and functional capacity can predict engagement in work and number of hours of work within FEP. Methods Fifty-two individuals with psychosis, from an Early Intervention in Psychosis service, completed measures of IQ, metacognition (Metacognitive Assessment Interview), functional capacity (UPSA), and functional outcome (hours spent in structured activity per week, including employment). Results Twenty-six participants (22 males, 4 females) were employed and twenty-six (22 males, 4 females) were not employed. IQ and metacognition were significantly associated with whether the individual was engaged in employment [IQ (p = .02) and metacognition (p = 006)]. When controlling for IQ, metacognition (differentiation subscale) remained significant (p = .04). Next, including only those employed, no cognitive nor metacognitive factors predicted number of hours in employment. Discussion This is the first study to directly assess metacognition as a predictor of work hours for individuals with FEP. This study highlights the importance of enhancing metacognitive ability in order to improve likelihood of, and engagement in, employment for those with FEP.
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Abdel-Baki A, Ouellet-Plamondon C, Medrano S, Nicole L, Rousseau C. Immigrants' outcome after a first-episode psychosis. Early Interv Psychiatry 2018; 12:193-201. [PMID: 26616492 DOI: 10.1111/eip.12302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/22/2015] [Indexed: 12/11/2022]
Abstract
AIM Immigration is a risk factor for psychosis emergence, and previous studies show that immigrants are less likely to engage in treatment for psychosis. However, the literature on outcome is scant and heterogeneous. This study was designed to compare first-generation (FGI) and second-generation immigrants (SGI) to non-immigrants' symptomatic and functional outcomes 2 years after a first-episode psychosis (FEP). METHODS A 2-year prospective longitudinal study of 223 FEP patients between 18 and 30 years took place in two early intervention services (EIS) in Montreal, Canada. RESULTS Forty-two per cent of the sample were immigrants (FGI (n = 56), SGI (n = 38)). Compared with non-immigrants, immigrants had similar symptomatic and functioning profiles at baseline, 1 and 2 years, except that fewer SGI had a history of homelessness and more were living with their families. FGI were less likely to have a substance use disorder but more likely to pursue their studies and to present depressive symptoms. CONCLUSIONS Even if immigrants are known to be at greater risk of developing psychosis, probably secondary to stress related to immigration, their symptomatic and functional outcomes, once engaged in EIS treatment, are similar to or sometimes better than non-immigrants' outcomes. Because immigrants tend to be less engaged in their follow-up, understanding why they disengage from treatment is crucial to develop better therapeutic approaches to better engage them as EIS treatment can improve their outcomes effectively.
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Affiliation(s)
- Amal Abdel-Baki
- Department of Psychiatry, Clinique JAP, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry, Clinique JAP, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | | | - Luc Nicole
- Institut en Santé Mentale de l'Université de Montréal, Montreal, Quebec, Canada
| | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Abdel-Baki A, Lal S, D-Charron O, Stip E, Kara N. Understanding access and use of technology among youth with first-episode psychosis to inform the development of technology-enabled therapeutic interventions. Early Interv Psychiatry 2017; 11:72-76. [PMID: 26011657 DOI: 10.1111/eip.12250] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 04/12/2015] [Indexed: 11/30/2022]
Abstract
AIM Computers, video games and technological devices are part of young people's everyday lives. However, their use in first-episode psychosis (FEP) treatment is rare. The purpose of this study was to better understand the access and use of technology among individuals with FEP, including gaming activities, to inform future development of technology-enabled therapeutic applications. METHODS Self-administered survey on use of technological tools in 71 FEP individuals. RESULTS PCs/laptops were used by all participants; cellphones/smartphones by 92%, consoles by 83% (mainly male and younger participants). Women texted and used social networks more frequently; men played games (mainly action) more often. The younger individuals reported playing games frequently (32% daily) with less use of the Web and social networks (favourite: Facebook). CONCLUSIONS These data will be useful for developing Web-based psychoeducation tools and cognitive remediation video games for youth with FEP.
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Affiliation(s)
- Amal Abdel-Baki
- Départment of Psychiatrie, Centre Hospitalier Université de Montréal (CHUM), Montréal, Quebec, Canada.,Department of psychiatry, Université de Montréal, Montréal, Quebec, Canada.,Centre de Recherche du CHUM, Montréal, Quebec, Canada
| | - Shalini Lal
- Centre de Recherche du CHUM, Montréal, Quebec, Canada.,École de réadaptation, Université de Montréal, Montréal, Quebec, Canada.,Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Olivier D-Charron
- Department of psychiatry, Université de Montréal, Montréal, Quebec, Canada
| | - Emmanuel Stip
- Départment of Psychiatrie, Centre Hospitalier Université de Montréal (CHUM), Montréal, Quebec, Canada.,Department of psychiatry, Université de Montréal, Montréal, Quebec, Canada.,Centre de Recherche du CHUM, Montréal, Quebec, Canada
| | - Nadjia Kara
- Département de Génie Logiciel et TI, Ecole de Technologie Supérieure, Montréal, Quebec, Canada
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Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiol Psychiatr Sci 2015; 24:446-57. [PMID: 25016950 PMCID: PMC8367356 DOI: 10.1017/s2045796014000419] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS Young adults with early psychosis want to pursue normal roles - education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes. METHODS We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies. RESULTS Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio = 3.66 [1.93-6.93], p < 0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services. CONCLUSIONS In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services.
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Citrome L, Eramo A, Francois C, Duffy R, Legacy SN, Offord SJ, Krasa HB, Johnston SS, Guiraud-Diawara A, Kamat SA, Rohman P. Lack of tolerable treatment options for patients with schizophrenia. Neuropsychiatr Dis Treat 2015; 11:3095-104. [PMID: 26719694 PMCID: PMC4689285 DOI: 10.2147/ndt.s91917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Atypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. PATIENTS AND METHODS AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. RESULTS A high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE risk factors were combined. CONCLUSION When combining patient risk profile with antipsychotic AE profile, physicians may quickly run out of tolerable treatment options for individual patients, despite the availability of many AAs, suggesting a need for additional treatment options with better tolerability and without compromising efficacy.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | | | | | - Ruth Duffy
- Otsuka America Pharmaceuticals, Princeton, NJ, USA
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