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Fusar-Poli P, Estradé A, Esposito CM, Rosfort R, Basadonne I, Mancini M, Stanghellini G, Otaiku J, Olanrele O, Allen L, Lamba M, Alaso C, Ieri J, Atieno M, Oluoch Y, Ireri P, Tembo E, Phiri IZ, Nkhoma D, Sichone N, Siadibbi C, Sundi PRIO, Ntokozo N, Fusar-Poli L, Floris V, Mensi MM, Borgatti R, Damiani S, Provenzani U, Brondino N, Bonoldi I, Radua J, Cooper K, Shin JI, Cortese S, Danese A, Bendall S, Arango C, Correll CU, Maj M. The lived experience of mental disorders in adolescents: a bottom-up review co-designed, co-conducted and co-written by experts by experience and academics. World Psychiatry 2024; 23:191-208. [PMID: 38727047 PMCID: PMC11083893 DOI: 10.1002/wps.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
We provide here the first bottom-up review of the lived experience of mental disorders in adolescents co-designed, co-conducted and co-written by experts by experience and academics. We screened first-person accounts within and outside the medical field, and discussed them in collaborative workshops involving numerous experts by experience - representing different genders, ethnic and cultural backgrounds, and continents - and their family members and carers. Subsequently, the material was enriched by phenomenologically informed perspectives and shared with all collaborators. The inner subjective experience of adolescents is described for mood disorders, psychotic disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, anxiety disorders, eating disorders, externalizing disorders, and self-harm behaviors. The recollection of individuals' past histories also indexes the prodromal (often transdiagnostic) features predating the psychiatric diagnosis. The experience of adolescents with mental disorders in the wider society is described with respect to their family, their school and peers, and the social and cultural context. Furthermore, their lived experience of mental health care is described with respect to receiving a diagnosis of mental disorder, accessing mental health support, receiving psychopharmacological treatment, receiving psychotherapy, experiencing peer support and mental health activism, and achieving recovery. These findings can impact clinical practice, research, and the whole society. We hope that this co-designed, co-conducted and co-written journey can help us maintain our commitment to protecting adolescents' fragile mental health, and can help them develop into a healthy, fulfilling and contributing adult life.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
| | - Cecilia M Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - René Rosfort
- S. Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Ilaria Basadonne
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health and Territory, G. D'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group, King's College London, London, UK
| | | | - Lucas Allen
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Judy Ieri
- Global Mental Health Peer Network, Nairobi, Kenya
| | | | | | - Phides Ireri
- Global Mental Health Peer Network, Nairobi, Kenya
| | - Ephraim Tembo
- Global Mental Health Peer Network, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | | | | | - Noah Sichone
- Global Mental Health Peer Network, Lusaka, Zambia
| | - Candy Siadibbi
- Global Mental Health Peer Network, Lusaka, Zambia
- Psychology Association of Zambia, Lusaka, Zambia
| | | | - Nyathi Ntokozo
- Global Mental Health Peer Network, Bulawayo, Zimbabwe
- Youth Support Network Trust, Bulawayo, Zimbabwe
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Valentina Floris
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina M Mensi
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Bonoldi
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Kate Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Solent NHS Trust, Southampton, UK
- Department of Precision and Regenerative Medicine and Jonic Area, University of Bari, Bari, Italy
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Bendall
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario G. Marañón, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Berlin, Germany
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Schultze-Lutter F, Banaschewski T, Barth GM, Bechdolf A, Bender S, Flechtner HH, Hackler S, Heuer F, Hohmann S, Holzner L, Huss M, Koutsouleris N, Lipp M, Mandl S, Meisenzahl E, Munz M, Osman N, Peschl J, Reissner V, Renner T, Riedel A, Romanos M, Romer G, Schomerus G, Thiemann U, Uhlhaas PJ, Woopen C, Correll CU, Care-Konsortium D. [Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024. [PMID: 38809160 DOI: 10.1024/1422-4917/a000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesien
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Schweiz
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Gottfried M Barth
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Andreas Bechdolf
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, CCM, Charité - Universitätsmedizin Berlin, Deutschland
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
| | - Stephan Bender
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Hans-Henning Flechtner
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Sandra Hackler
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Fabiola Heuer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
| | - Sarah Hohmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikums Hamburg-Eppendorf, Hamburg, Deutschland
| | - Laura Holzner
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - Michael Huss
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz; Mainz, Deutschland
| | - Nikolaos Koutsouleris
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
- Max Planck Institute of Psychiatry, Max Planck Fellow Group Precision Psychiatry, München, Deutschland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Lipp
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Selina Mandl
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Universität München, Klinikum der Universität München, Deutschland
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Manuel Munz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters des Zentrums für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Deutschland
| | - Naweed Osman
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Jens Peschl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Volker Reissner
- Abteilung für Kinder- und Jugendpsychiatrie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Deutschland
| | - Tobias Renner
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Anett Riedel
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Marcel Romanos
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Deutschland
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster, Deutschland
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Leipzig, Deutschland
| | - Ulf Thiemann
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Peter J Uhlhaas
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- Institute of Neuroscience and Psychology, University of Glasgow, UK
| | | | - Christoph U Correll
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - das Care-Konsortium
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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3
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Ho G, Pratt DN, Bridgwater MA, Schiffman J, Ellman LM, Mittal VA. Factors impacting intent to seek treatment within youth at clinical high risk for psychosis. Schizophr Res 2024; 267:273-281. [PMID: 38581831 PMCID: PMC11102833 DOI: 10.1016/j.schres.2024.03.047] [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: 05/22/2023] [Revised: 01/25/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
Existing work indicates that there is unmet need for care in those at clinical high risk (CHR) for psychosis. However, research on the factors that drive treatment seeking behaviors in this population is limited. Further, it is unknown how help-seeking behavior in CHR individuals compares to those seen in mood disorders, who have a higher rate of treatment seeking behavior. Participants (n = 559) completed an assessment of their intent to seek mental health treatment, attenuated psychosis-risk symptoms, and psychiatric symptoms and diagnoses. Participants were divided into CHR (n = 91), Mood Disorders (MD) (n = 72), or Community Controls (CC) groups (n = 396), whose intent to seek treatment was compared. Associations between intent to seek treatment with past treatment, depression, anxiety, positive and negative symptoms, distress from symptoms, intelligence quotient (IQ) estimates, and insight were assessed in CHR individuals. Further, it was assessed how this differs for the MD group. The MD group reported higher intent to seek treatment than CHR individuals, which reported higher intent to seek treatment than the CC group. In those at CHR, previous treatment, greater depression and anxiety severity, and higher distress all independently predicted higher intent to seek treatment. Depression predicted intent to seek treatment in both MD and CHR individuals. Previous treatment predicted intent to seek treatment in those at CHR. Our findings suggest that depression and past treatment utilization are critical factors in increasing intent to seek treatment in those at CHR, potentially serving as important targets for engaging this population in treatment.
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Affiliation(s)
- Gillian Ho
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA.
| | - Miranda A Bridgwater
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Vijay A Mittal
- Institutes for Policy Research and Innovations in Developmental Sciences, Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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4
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Jordan G, Bassetto S, DeLuca J, Dobbs MF, Florence A, Allemang B, O'Keeffe D, Basile M, Funaro MC, Davidson L, Ben-David S, Shah J. Personal Recovery Among People at Risk for Developing Serious Mental Health Problems: A Qualitative Systematic Review. Psychiatr Serv 2024:appips20230133. [PMID: 38410038 DOI: 10.1176/appi.ps.20230133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. METHODS A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. RESULTS The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. CONCLUSIONS These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness.
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Affiliation(s)
- Gerald Jordan
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Stella Bassetto
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Joseph DeLuca
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Matthew F Dobbs
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Ana Florence
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Brooke Allemang
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Donal O'Keeffe
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Mikaela Basile
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Melissa C Funaro
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Larry Davidson
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Shelly Ben-David
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Jai Shah
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
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5
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Herrera SN, Sarac C, Phili A, Gorman J, Martin L, Lyallpuri R, Dobbs MF, DeLuca JS, Mueser KT, Wyka KE, Yang LH, Landa Y, Corcoran CM. Psychoeducation for individuals at clinical high risk for psychosis: A scoping review. Schizophr Res 2023; 252:148-158. [PMID: 36652831 PMCID: PMC9974813 DOI: 10.1016/j.schres.2023.01.008] [Citation(s) in RCA: 2] [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] [Received: 07/24/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
Psychoeducation is recommended in the treatment of patients with schizophrenia and has been shown to improve satisfaction with mental health service and treatment adherence, reduce relapse and hospital readmission rates, and enhance functioning and quality of life. Youth at clinical high risk for psychosis (CHR) may also benefit from receiving psychoeducation as part of their treatment. The goal of this study was to conduct a scoping review to map out the existing literature on psychoeducation for CHR individuals, including content, utilization, and benefits, in order to identify areas for future research and clinical care. Following PRISMA guidelines, we conducted a systematic search of electronic databases (MEDLINE, Embase, PsycINFO, Scopus, and Web of Science Core Collection) to identify literature through 02/25/2022 that provided data or significant commentary about the provision of psychoeducation to CHR individuals. After screening titles and abstracts, four co-authors assessed full-text articles for eligibility. Thirty-three studies were included in the review. Psychoeducation is recommended in the treatment of CHR individuals, is a preferred treatment option among CHR individuals, and many CHR programs report offering psychoeducation. However, details about the psychoeducational content and method of delivery are notably absent from recommendations and reports on the provision of CHR psychoeducation in real-world settings. We identified two brief and structured CHR psychoeducation interventions and one longer-term psychoeducational multifamily group model for CHR that show feasibility and promise, though they have not yet undergone randomized trials to evaluate effectiveness of the psychoeducation. We also identified several comprehensive CHR interventions that included an explicit psychoeducation module, though the unique role of the psychoeducational component is unknown. Despite being recommended as a critical component of treatment for CHR individuals and preferred by CHR individuals, the ways in which psychoeducation are being delivered to CHR individuals in real-world practice is still largely ambiguous. Rigorous evaluations of psychoeducation treatment models are needed, as well as investment from clinical programs to facilitate the implementation and dissemination of standardized psychoeducation for CHR individuals.
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Affiliation(s)
- Shaynna N Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Cansu Sarac
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antigone Phili
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane Gorman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lily Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Romi Lyallpuri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; School of Nursing, Columbia University, New York, NY, USA
| | - Matthew F Dobbs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph S DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Katarzyna E Wyka
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA; Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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6
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Brown K, Parry S. How do people with first episode psychosis experience therapeutic relationships with mental health practitioners? A narrative review. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2160487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Katrina Brown
- Faculty of Health and Medicine, Lancaster University, Lancaster
| | - Sarah Parry
- Faculty of Health and Medicine, Lancaster University, Lancaster
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7
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Herrera SN, Lyallpuri R, Sarac C, Dobbs MF, Nnaji O, Jespersen R, DeLuca JS, Wyka KE, Yang LH, Corcoran CM, Landa Y. Development of the Brief Educational Guide for Individuals in Need (BEGIN): A psychoeducation intervention for individuals at risk for psychosis. Early Interv Psychiatry 2022; 16:1002-1010. [PMID: 34811878 DOI: 10.1111/eip.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/30/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
AIM Identification of individuals with psychosis risk (PR) through screening and specialized assessment is becoming more widespread in an effort to promote early intervention and improve recovery outcomes. PR individuals report interest in psychoeducation, though such interventions are currently lacking. Our goal was to develop a structured PR psychoeducation intervention grounded in theory and stakeholder feedback. METHODS By following a step-by-step intervention development model, we identified relevant conceptual frameworks, developed the content and format, and obtained stakeholder feedback. This process resulted in a 5-session PR psychoeducation intervention, Brief Educational Guide for Individuals in Need (BEGIN), with content conveyed visually via a slideshow presentation. PR individuals (n = 5) and parents of PR individuals (n = 5) reviewed BEGIN's content and format, and provided feedback through semi-structured qualitative interviews. Major themes were identified through iterative thematic analysis. RESULTS PR individuals and parents had a positive impression of BEGIN's materials and step-by-step format and psychoeducation about the PR condition. They indicated that the intervention was likely to encourage agency. PR participants emphasized the importance of a patient's decision regarding whether their family member(s) should participate in BEGIN. Parents reported that BEGIN is an important first step in treatment and offers a safe therapeutic environment. Feedback was then utilized to modify the intervention. CONCLUSIONS BEGIN is desired by consumers and may lay the foundation for future engagement with treatment by facilitating agency. A feasibility trial is underway and future studies are needed to measure outcomes (e.g., treatment engagement) and evaluate BEGIN as an evidence-based PR psychoeducation model.
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Affiliation(s)
- Shaynna N Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Romi Lyallpuri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cansu Sarac
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew F Dobbs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Obiora Nnaji
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Jespersen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph S DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katarzyna E Wyka
- Department of Psychiatry, Weill Medical College of Cornell University, New York, New York, USA.,Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, New York, USA.,Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
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8
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Schiffman J, Horton LE, Landa Y, Woods SW. Considerations for providing feedback to patients and families regarding clinical high-risk for psychosis status. Schizophr Res 2022; 244:55-57. [PMID: 35597133 DOI: 10.1016/j.schres.2022.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Leslie E Horton
- University of Pittsburgh Department of Psychiatry, United States of America
| | - Yulia Landa
- Icahn School of Medicine at Mount Sinai, United States of America
| | - Scott W Woods
- Department of Psychiatry, Yale University, United States of America
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9
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Tham M, Bendall S, Carlyon-Stewart T, Polari A, Hartmann J, Kerr M, Amminger P, McGorry P, Nelson B, Ratheesh A. My child's future mental health: Carer's engagement with risk identification in an intervention study for youth with at-risk mental states. Early Interv Psychiatry 2022; 16:626-631. [PMID: 34414674 DOI: 10.1111/eip.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
AIM Prevention and early intervention efforts of serious mental illnesses has yielded promising results. However, alongside benefits, several ethical concerns have been raised, including the effects of being identified as being at-risk. In these debates, the voice of parents or carers is conspicuously absent. This is especially concerning as several at-risk interventions are trialled in under-age youth where parents consent on behalf of young people. Therefore, this study aimed to understand carer's experiences of their teenager being identified as at risk for psychosis. METHODS Semi-structured interviews were conducted with seven carers who had provided consent for their teenager to participate in a stepped intervention study for youth at-risk for psychosis. Questions explored their experiences regarding having their teenager being identified as at-risk. Transcripts were analysed using thematic analysis. RESULTS We identified five main themes from seven female carers' experiences of risk identification including: (a) recall of risk information was limited, or variable, (b) goal of risk disclosure was perceived to be positive, (c) negative emotions were associated with knowledge of risk, (d) relief from uncertainty and helplessness and (e) effects of risk disclosure were mediated by individual circumstance. CONCLUSION Overall, the results demonstrate that carers' experience of risk disclosure varied with factors surrounding their individual circumstances, and the process of disclosure. Whilst participants acknowledged potential adverse effects associated with risk disclosure, many still adopted a positive outlook. Tailoring safe and effective disclosure of risk to suit the needs of youth and carers could outweigh the potential risks.
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Affiliation(s)
- Michael Tham
- Orygen Research Centre, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Bendall
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Carlyon-Stewart
- Orygen Research Centre, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Polari
- Orygen Research Centre, Parkville, Victoria, Australia.,Orygen Specialist Programs, Orygen Youth Health, Parkville, Victoria, Australia
| | - Jessica Hartmann
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kerr
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Amminger
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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10
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Woodberry KA, Powers KS, Bryant C, Downing D, Verdi MB, Elacqua KM, Reuman ARL, Kennedy L, Shapiro DI, West ML, Huang D, Crump FM, Grivel MM, Blasco DA, Herrera SN, Corcoran CM, Seidman LJ, Link BG, McFarlane WR, Yang LH. Emotional and stigma-related experiences relative to being told one is at risk for psychosis. Schizophr Res 2021; 238:44-51. [PMID: 34598105 PMCID: PMC8633064 DOI: 10.1016/j.schres.2021.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/03/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving this information. METHODS Participants (n = 54) identified as at PR via structured interview rated their emotions about PR before and after being told they were at PR. Qualitative analyses explored the valence of participant reflections on being given this information. RESULTS Participants reported significantly less negative emotion after being told of their PR status (p < .001), regardless of whether they were hearing this for the first time (p = .72). There was no change in positive emotions or the predominant belief that they should keep their PR status private. Most participants commented positively about the process of feedback but negatively about its impact on their self-perceptions and/or expectations of others' perceptions of them. CONCLUSION This is the first study to collect pre-post data related to being told one is at PR and to examine quantitative and qualitative responses across and within individuals. For a majority of participants, clinical feedback stimulated negative stereotypes even as it relieved some distress. To actively address internalized stigma, clinicians providing feedback to PR youth must attend to the positive and negative impacts on how youth think about themselves as well as how they feel.
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Affiliation(s)
- Kristen A. Woodberry
- Center for Psychiatric Research, Maine Medical Center,Department of Psychiatry, Tufts School of Medicine,Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School
| | | | - Caitlin Bryant
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychology, University of Massachusetts Boston
| | - Donna Downing
- Center for Psychiatric Research, Maine Medical Center
| | - Mary B. Verdi
- Center for Psychiatric Research, Maine Medical Center
| | | | | | - Leda Kennedy
- Department of Psychiatry, Beth Israel Deaconess Medical Center,New York Psychiatric Institute, Columbia University
| | - Daniel I. Shapiro
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School,Department of Psychiatry and Behavioral Sciences, University of California Davis
| | - Michelle L. West
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School,Anschutz Medical Campus, University of Colorado,Department of Psychiatry, University of Colorado School of Medicine
| | - Debbie Huang
- Mailman School of Public Health, Columbia University
| | | | | | - Drew A. Blasco
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | | | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai,James J Peter Veterans Affairs Medical Center
| | - Larry J. Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School
| | - Bruce G. Link
- Department of Sociology, University of California, Riverside
| | - William R. McFarlane
- Center for Psychiatric Research, Maine Medical Center,Department of Psychiatry, Tufts School of Medicine
| | - Lawrence H. Yang
- Mailman School of Public Health, Columbia University,School of Global Public Health, New York University
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11
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Polari A, Street R, Conus P, Finkelstein A, Hartmann JA, Kim SW, McGorry P, Schley C, Simmons M, Stratford J, Thompson A, Yung A, Nelson B, Lavoie S. Patients', carers' and clinicians' attitudes towards alternative terms to describe the at-risk for psychosis state. Schizophr Res 2021; 237:69-75. [PMID: 34507056 DOI: 10.1016/j.schres.2021.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 07/16/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Language used in psychiatry is important because it provides an understandable and accurate way of describing clinical and theoretical concepts. The use of labels in psychiatry has often been associated with stigma and reduced engagement with clinical services. This studys aims were to generate new terms for the 'at-risk mental state' (ARMS) concept and to investigate what young people, their caregivers and clinicians thought about them as well as terms commonly used in early intervention clinics. Another aim was to understand participants preference related to the best timing to introduce the at-risk concept and the extent and context of the information presented. METHODS New terms illustrating the at-risk concept have been generated by a youth reference group with lived experience of mental illness: 'pre-diagnosis stage' (PDS), potential of developing a mental illness (PDMI) and disposition for developing a mental illness (DDMI). A specifically designed questionnaire was administered to 46 patients with ARMS, 24 caregivers and 52 clinicians to obtain their feedback on newly proposed terms and on the terms already used in clinical practice and research. RESULTS The preferred terms were PDS, PDMI and ARMS. The least favoured terms were Ultra High Risk and Attenuated Psychosis Syndrome, which were thought to be associated with the most stigma. Most participants agreed that disclosure about diagnosis should be delivered early by the key clinician. CONCLUSIONS Patients generated terms such as PDS, PDMI, alongside ARMS should be considered to be used in clinical practice. They present with low stigma and are illustrative of young peoples difficulties.
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Affiliation(s)
- Andrea Polari
- Orygen Specialist Programs, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Rebekah Street
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Lausanne, Switzerland
| | | | - Jessica A Hartmann
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Magenta Simmons
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Andrew Thompson
- Orygen Specialist Programs, Melbourne, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison Yung
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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12
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A qualitative systematic review of Early Intervention in Psychosis service user perspectives regarding valued aspects of treatment with a focus on cognitive behavioural therapy. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x2100026x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Despite the increasing evidence base and focus given to Early Intervention in Psychosis (EIP) services, qualitative literature remains sparse, particularly in relation to the ‘At Risk Mental State’ (ARMS) group. Although research has looked to service user experience within EIP, data have not been collated to understand valued aspects of treatment across both EIP groups: first episode psychosis (FEP) and ARMS, particularly regarding cognitive behavioural therapy (CBT).
Aims:
To conduct a systematic review of qualitative literature to examine service user perspectives on support provided in EIP treatment with a focus on CBT.
Method:
This was a thematic synthesis of qualitative studies. Nine studies were included in the analysis identified through a systematic database search and citation tracking. Studies were critically appraised using the critical appraisal skills programme tool.
Results:
Nine studies were identified for inclusion. Six analytical themes and 20 descriptive categories were identified.
Conclusions:
User perspectives confirm previous findings highlighting importance of therapeutic relationships for treatment success. Normalisation, learning and understanding were valued across both groups, which increased coping, and can be facilitated throughout the EIP journey. Harnessing the support of those involved in users’ care and understanding these relationships further enhances interventions utilised. Understanding the stage the individual is at regarding their experiences is essential in relation to targeting support. Transdiagnostic aspects of CBT were valued across both groups. ARMS referred to more specific strategies and there were some differences regarding coping styles and flexibility preferences; however, this may be due to group differences in problem trajectory and care provision.
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13
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DeLuca JS, Akouri-Shan L, Jay SY, Redman SL, Petti E, Lucksted A, Rouhakhtar PR, Klaunig MJ, Edwards SM, Reeves GM, Schiffman J. Predictors of internalized mental health stigma in a help-seeking sample of youth: The roles of psychosis-spectrum symptoms and family functioning. JOURNAL OF ABNORMAL PSYCHOLOGY 2021; 130:587-593. [PMID: 34553954 DOI: 10.1037/abn0000679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Experiencing psychosis-spectrum symptoms is challenging to youth. Among many difficulties, internalized mental health stigma-the internalization of negative stereotypes-can lead to shame and withdrawal. The objective of this study was to better understand the correlates of internalized stigma among a clinical sample of youth with psychosis-spectrum symptoms. Participants (n = 66; 12-25 years old) were referred by community providers in Maryland, United States. Psychosis-spectrum symptoms were measured via the Structured Interview for Psychosis-Risk Syndromes (SIPS); family-functioning was measured via the Family Assessment Device. Interviewers rated participants' social/role functioning via the Global Functioning: Social and Role Scales. Internalized stigma was measured using the Internalized Stigma of Mental Illness (ISMI) total scale and subscales. The sample included 34 individuals at clinical high risk for psychosis, 16 experiencing early psychosis, and 16 help-seeking controls. Regression analyses indicated that unusual beliefs, avolition, role functioning, and lower family-functioning (caregiver-reported) were significantly associated with higher aspects of internalized stigma, controlling for other symptoms and sociodemographics. These models explained 27% of the variance (adjusted R2) in the total ISMI scale and between 15% to 49% of the variance in ISMI-subscales. Among this help-seeking sample, unusual beliefs, avolition, higher role functioning, and lower family-functioning (caregiver-reported) were associated with more internalized stigma. Pending future research with larger samples, therapeutic interventions focused on these factors and their correlates may benefit youth. Future research is needed to determine temporal precedence of these associations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Alicia Lucksted
- Division of Psychiatric Services Research, Department of Psychiatry
| | | | | | - Sarah M Edwards
- Division of Child and Adolescent Psychiatry, Department of Psychiatry
| | - Gloria M Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry
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14
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Woods SW, Bearden CE, Sabb FW, Stone WS, Torous J, Cornblatt BA, Perkins DO, Cadenhead KS, Addington J, Powers AR, Mathalon DH, Calkins ME, Wolf DH, Corcoran CM, Horton LE, Mittal VA, Schiffman J, Ellman LM, Strauss GP, Mamah D, Choi J, Pearlson GD, Shah JL, Fusar-Poli P, Arango C, Perez J, Koutsouleris N, Wang J, Kwon JS, Walsh BC, McGlashan TH, Hyman SE, Gur RE, Cannon TD, Kane JM, Anticevic A. Counterpoint. Early intervention for psychosis risk syndromes: Minimizing risk and maximizing benefit. Schizophr Res 2021; 227:10-17. [PMID: 32402605 PMCID: PMC8218020 DOI: 10.1016/j.schres.2020.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis. METHOD Response to points of critique. RESULTS We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma. DISCUSSION Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.
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Affiliation(s)
- Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA.
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA; Department Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Fred W Sabb
- Lewis Center for Neuroimaging, University of Oregon, Eugene, USA
| | - William S Stone
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | - John Torous
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | | | - Daniel Mamah
- Department of Psychiatry, Washington University in Saint Louis, MO, USA
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA; Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, King's College London, UK; Department of Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Celso Arango
- Dept. of Child and Adolescent Psychiatry, Universidad Complutense de Madrid, Spain
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, UK
| | | | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, South Korea
| | - Barbara C Walsh
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | | | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
| | - John M Kane
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Alan Anticevic
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
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15
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Colizzi M, Ruggeri M, Lasalvia A. Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review. Psychol Med 2020; 50:705-726. [PMID: 32063250 DOI: 10.1017/s0033291720000148] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies have provided initial evidence that people at risk for psychosis (PR) suffer from stigma and discrimination related to their condition. However, no study has systematically reviewed stigma and discrimination associated with being at PR and the potential underlying mechanisms. METHODS This work aimed to systematically review all studies addressing stigma and discrimination in PR people in order to assess: (1) the occurrence of this phenomenon and its different components (public, internalized, perceived, and labeling-related), (2) whether stigma affects outcomes of the PR state, and (3) whether other factors modulate stigma among PR individuals. RESULTS The reviewed studies (n = 38) widely differ in their design, methodological quality, and populations under investigation, thus limiting direct comparison of findings. However, converging evidence suggests that the general public endorses stigmatizing attitudes towards PR individuals, and that this is more frequent in people with a low educational level or with no direct experience of the PR state. PR individuals experience more internalized stigma and perceive more discrimination than healthy subjects or patients with non-psychotic disorders. Further, PR labeling is equally associated with both positive (e.g. validation and relief) and negative effects (e.g. status loss and discrimination). Moreover, stigma increases the likelihood of poor outcome, transition to full-psychosis, disengagement from services, and family stigma among PR individuals. Finally, very limited evidence awaiting replication supports the efficacy of cognitive therapies in mitigating the negative effects of stigma. CONCLUSIONS Evidence confirms previous concerns about stigma and its negative consequences for PR individuals, thus having important public health implications.
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Affiliation(s)
- Marco Colizzi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134Verona, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonSE5 8AF, UK
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134Verona, Italy
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16
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Baer LH, Shah JL, Lepage M. Anxiety in youth at clinical high risk for psychosis: A case study and conceptual model. Schizophr Res 2019; 208:441-446. [PMID: 30651203 DOI: 10.1016/j.schres.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 11/16/2022]
Abstract
Some individuals identified as being at clinical high risk (CHR) for developing psychosis may suffer substantial anxiety due to a fear of transitioning to psychosis. This can be associated with catastrophic misinterpretation of normal mental experiences, such as a momentary lapse in attention, as markers for psychosis, fueled by hypervigilance for mental experiences that may be perceived as signs of impending psychosis. This anxiety may only worsen due to the self-stigma triggered by admission to a psychiatric CHR clinic, independent of whether or not the individual transitions to psychosis. Based on a clinical case study, we propose a cognitive model for this anxiety, an extension of Clark's model of panic. Our model accounts for causal factors of this distress, such as self-stigma and maladaptive core beliefs. It also includes maintaining factors such as hypervigilance for mental experiences and catastrophic misinterpretation of normal mental experiences as anomalous and portending eventual psychosis. We outline assessment and treatment guidelines and offer suggestions for how this model could be empirically validated. We suggest that treatment with this model, under the neural diathesis-stress framework, may have the potential to lower the risk of transition to psychosis and that assessment for such anxiety should be part of standard CHR care.
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Affiliation(s)
- L H Baer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
| | - J L Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - M Lepage
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
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17
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Yang LH, Woodberry KA, Link BG, Corcoran CM, Bryant C, Shapiro DI, Downing D, Girgis RR, Brucato G, Huang D, Crump FM, Verdi M, McFarlane WR, Seidman LJ. Impact of "psychosis risk" identification: Examining predictors of how youth view themselves. Schizophr Res 2019; 208:300-307. [PMID: 30792136 PMCID: PMC7079577 DOI: 10.1016/j.schres.2019.01.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/07/2019] [Accepted: 01/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Identifying young people as at clinical high-risk (CHR) for psychosis affords opportunities for intervention to possibly prevent psychosis onset. Yet such CHR identification could plausibly increase stigma. We do not know whether these youth already perceive themselves to be at psychosis-risk (PR) or how their being told they are at PR might impact how they think about themselves. METHODS 148 CHR youth were asked about labels they had been given by others (labeling by others) or with which they personally identified (self-labeling). They were then asked which had the greatest impact on how they thought about themselves. We evaluated whether being told vs. thinking they were at PR had stronger effects. FINDINGS The majority identified nonpsychotic disorders rather than PR labels as having the greatest impact on sense of self (67.6% vs. 27.7%). However, participants who identified themselves as at PR had an 8.8 (95% CI = 2.0-39.1) increase in the odds of the PR label having the greatest impact (p < 0.01). Additionally, having been told by others that they were at PR was associated with a 4.0 increase in odds (95% CI = 1.1-15.0) that the PR label had the most impact (p < 0.05). INTERPRETATION Nonpsychotic disorder labels appear to have a greater impact on CHR youth than psychosis-risk labels. However, thinking they are at PR, and, secondarily, being told they are at PR, appears to increase the relative impact of the PR label. Understanding self- and other-labeling may be important to how young people think of themselves, and may inform early intervention strategies.
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Affiliation(s)
- Lawrence H. Yang
- New York University College of Global Public Health, 715 Broadway, New York, NY 10003.,Mailman School of Public Health, Columbia University. 722 W 168th St, New York, NY 10032
| | - Kristen A. Woodberry
- Maine Medical Center Research Institute, Portland Maine 04102,Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bruce G. Link
- University of California at Riverside, 900 University Ave, Riverside, CA 92521
| | - Cheryl M. Corcoran
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 1 Gustave L. Levy Pl., New York, NY 10029,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peter Veterans Affairs Medical Center, 130 West Kingsbridge Rd, Bronx, NY, 10468, USA
| | - Caitlin Bryant
- Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,University of Massachusetts, Boston, 100 Morrissey Boulevard, Boston, MA 02125
| | - Daniel I. Shapiro
- Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Donna Downing
- Maine Medical Center Research Institute, Portland Maine 04102
| | - Ragy R. Girgis
- New York State Psychiatric Institute, Columbia University Department of Psychiatry, 1051 Riverside Dr. New York, NY 10032,The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032
| | - Gary Brucato
- New York State Psychiatric Institute, Columbia University Department of Psychiatry, 1051 Riverside Dr. New York, NY 10032,The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032
| | - Debbie Huang
- Mailman School of Public Health, Columbia University. 722 W 168th St, New York, NY 10032
| | - Francesca M. Crump
- The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032
| | - Mary Verdi
- Maine Medical Center Research Institute, Portland Maine 04102
| | - William R. McFarlane
- Maine Medical Center Research Institute, Portland Maine 04102,Department of Psychiatry, School of Medicine, Tufts University, 0 Park Plaza #1101, Boston, MA 02116
| | - Larry J. Seidman
- Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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18
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Conrad AM, Lewin TJ, Sly KA, Schall U, Halpin SA, Hunter M, Carr VJ. Utility of risk-status for predicting psychosis and related outcomes: evaluation of a 10-year cohort of presenters to a specialised early psychosis community mental health service. Psychiatry Res 2017; 247:336-344. [PMID: 27984822 DOI: 10.1016/j.psychres.2016.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/21/2016] [Accepted: 12/03/2016] [Indexed: 01/13/2023]
Abstract
Psychosis transition rates by those at clinical high risk have been highly variable and few studies have compared service presenters across the full psychosis risk spectrum with respect to medium-term outcomes. A 10-year service cohort was examined (N=1997), comprising all presentations to an early psychosis service for young people experiencing a recent psychotic episode or at increased risk ('Psychological Assistance Service', Newcastle, Australia). Baseline and longitudinal service data (median follow-up =7.3 years) were used in a series of logistic regressions to examine relationships between psychosis risk-status and subsequent illness episodes, hospital admissions, and community contacts. Six baseline groups were identified: existing (14.5%) and recent psychosis (19.8%); ultra-high risk (UHR, 9.6%); non-psychotic disorders without (35.4%, the reference group) and with psychiatric admissions (8.3%); and incomplete assessments (12.5%). High comorbidity levels were reported by the cohort (psychosocial problems, 61.1%; depression, 54.1%; substance misuse, 40.7%). UHR clients experienced similar psychosis transition rates to the reference group (17.3% vs. 14.6%; 8.9% vs. 9.1% within 2-years) and comparable rates of subsequent non-psychosis outcomes. A 25.9% conversion rate from early psychosis to schizophrenia was detected. However, among transitioning individuals, UHR clients faired relatively better, particularly with respect to changes in comorbidity and mental health contacts. Interventions tailored to current problems, recovery and psychological strengthening may be more appropriate than those based on estimated psychosis risk, which currently lacks clinical utility.
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Affiliation(s)
- Agatha M Conrad
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia.
| | - Terry J Lewin
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; Schizophrenia Research Institute, Neuroscience Research Australia, Randwick, NSW, Australia.
| | - Ketrina A Sly
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Ulrich Schall
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; Schizophrenia Research Institute, Neuroscience Research Australia, Randwick, NSW, Australia; Child and Adolescent Mental Health Services, Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Sean A Halpin
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; Child and Adolescent Mental Health Services, Hunter New England Mental Health, Newcastle, NSW, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Mick Hunter
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Vaughan J Carr
- Schizophrenia Research Institute, Neuroscience Research Australia, Randwick, NSW, Australia; School of Psychiatry, University of New South Wales, Kensington, NSW, Australia; Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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