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Allan SM, Hodgekins J, Beazley P, Oduola S. Pathways to care in at-risk mental states: A systematic review. Early Interv Psychiatry 2021; 15:1092-1103. [PMID: 33047505 DOI: 10.1111/eip.13053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/23/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
AIM Pathways to care are well studied in the First Episode Psychosis field, but less attention has been given to At-Risk Mental States or prodromal psychosis. This is important because accessing appropriate help at the earliest opportunity is likely to improve outcomes, particularly for those who make transition to psychosis. The present systematic review aimed to synthesize the available literature on pathways to care in ARMS or prodromal psychosis, and investigate the barriers and facilitators to receiving care for ARMS. METHODS The CINAHL Complete, EMBASE, Medline Complete, PsycINFO and PubMED databases were searched. Studies were included if they were published in English between 1985 and 2019, where reported data came exclusively from an At-Risk Mental State population, and the study described or related to pathways to care. RESULTS Ten studies met the inclusion criteria, of which 8 were quantitative. Screening tools and pathways to care instruments varied. Mental health professionals, and general practitioners played a key role in help seeking. Family involvement was also found to be an important factor. CONCLUSIONS Pathways to care research in At-Risk Mental States are more scarce than in the field of First Episode Psychosis. More research is warranted, especially concerning the role of patient-level characteristics on pathways to care. A validated measure of pathways to care may also be of benefit.
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Affiliation(s)
- Sophie M Allan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Cambridgeshire, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Peter Beazley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
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2
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McIlwaine SV, Shah J. Mental Health Services Research Targeting the Clinical High-Risk State for Psychosis: Lessons, Future Directions and Integration with Patient Perspectives. Curr Psychiatry Rep 2021; 23:11. [PMID: 33533984 DOI: 10.1007/s11920-021-01224-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW We summarize the history of the clinical high-risk stage of psychosis (CHR), current research on this stage and recent critiques of the field, and evaluate current CHR guidelines and frameworks. RECENT FINDINGS Following its identification and characterization, CHR services have successfully been developed in North America, Europe, Australia and elsewhere. As reflected in guidelines, these services and their orientation largely emerged as an outgrowth of the framework pioneered by early intervention services for first-episode psychosis. We critically discuss what is known so far about the subjective experience of the CHR syndrome, the meaning of this "unofficial" diagnosis as well as what is known and unknown about the service-related needs. While a range of outstanding questions remain in the field, there is a particular need for patient-oriented work and to investigate the service-related needs of young people at CHR.
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Affiliation(s)
- Sarah V McIlwaine
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Programme for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 7070 boul. Champlain, Verdun, Montreal, QC, H4H 1A8, Canada
| | - Jai Shah
- Prevention and Early Intervention Programme for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 7070 boul. Champlain, Verdun, Montreal, QC, H4H 1A8, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
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3
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Haidl TK, Seves M, Eggers S, Rostamzadeh A, Genske A, Jünger S, Woopen C, Jessen F, Ruhrmann S, Vogeley K. Health literacy in clinical-high-risk individuals for psychosis: A systematic mixed-methods review. Early Interv Psychiatry 2019; 13:1293-1309. [PMID: 30688012 DOI: 10.1111/eip.12776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/30/2018] [Accepted: 12/26/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Numerous studies suggest that health literacy (HL) plays a crucial role in maintaining and improving individual health. Empirical findings highlight the relation between levels of a person's HL and her/his clinical outcome. To date, the role of HL in persons at-risk for psychosis has not been systematically reviewed. METHODS We conducted a systematic review using a mixed-methods approach to analyse a variety of study types. Peer-reviewed publications were systematically searched in PUBMED, Cochrane Library, PsycINFO and Web of Science. RESULTS The search string returned 10587 publications. After screening, 15 quantitative, four qualitative studies and two reviews were included. Only one study assessed HL as primary outcome, assessing knowledge and beliefs about psychosis among the general population. In the other studies, sub-dimensions of HL were investigated. None of the publications operationalized HL or it's sub-dimensions with a validated measure. CONCLUSIONS A lack of understanding of their condition, and fear of stigmatization, were associated with a delay in help-seeking among people with clinical-high-risk state for psychosis. Family members, school personnel, general practitioners and the internet play a crucial role in the HL process. Considerable barriers in obtaining adequate specialist support emphasize the urgent need of a "HL environment" for persons at risk for psychosis.
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Affiliation(s)
- Theresa K Haidl
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Mauro Seves
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Susanne Eggers
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Anna Genske
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
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4
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MacDonald K, Fainman-Adelman N, Anderson KK, Iyer SN. Pathways to mental health services for young people: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1005-1038. [PMID: 30136192 PMCID: PMC6182505 DOI: 10.1007/s00127-018-1578-y] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE While early access to appropriate care can minimise the sequelae of mental illnesses, little is known about how youths come to access mental healthcare. We therefore conducted a systematic review to synthesise literature on the pathways to care of youths across a range of mental health problems. METHODS Studies were identified through searches of electronic databases (MEDLINE, PsycINFO, Embase, HealthSTAR and CINAHL), supplemented by backward and forward mapping and hand searching. We included studies on the pathways to mental healthcare of individuals aged 11-30 years. Two reviewers independently screened articles and extracted data. RESULTS Forty-five studies from 26 countries met eligibility criteria. The majority of these studies were from settings that offered services for the early stages of psychosis, and others included inpatient and outpatient settings targeting wide-ranging mental health problems. Generally, youths' pathways to mental healthcare were complex, involved diverse contacts, and, sometimes, undue treatment delays. Across contexts, family/carers, general practitioners and emergency rooms featured prominently in care pathways. There was little standardization in the measurement of pathways. CONCLUSIONS Except in psychosis, youths' pathways to mental healthcare remain understudied. Pathways to care research may need to be reconceptualised to account for the often transient and overlapping nature of youth mental health presentations, and the possibility that what constitutes optimal care may vary. Despite these complexities, additional research, using standardized methodology, can yield a greater understanding of the help-seeking behaviours of youths and those acting on their behalf; service responses to help-seeking; and the determinants of pathways. This understanding is critical to inform ongoing initatives to transform youth mental healthcare.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada.
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5
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Kim JS, Park CM, Choi JA, Park E, Tchoe HJ, Choi M, Suh JK, Kim YH, Won SH, Chung YC, Bae KY, Lee SK, Park SC, Lee SH. The association between season of birth, age at onset, and clozapine use in schizophrenia. Acta Psychiatr Scand 2017; 136:445-454. [PMID: 28741647 DOI: 10.1111/acps.12776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to determine whether the rate of clozapine use, an indicator of refractoriness in schizophrenia, is associated with the season of birth and age at onset in patients with schizophrenia based on nationwide data. METHODS Patients with schizophrenia (n = 114 749) who received prescriptions for antipsychotic medication between 2008 and 2014 were retrospectively identified from the Korean National Health Insurance Service database. The study population was divided into three groups based on their age at the onset of schizophrenia (early, middle, and late onset). We assessed differences in the month of birth between patients and the general population. In addition, the cumulative clozapine use was calculated. RESULTS Compared to the late-onset schizophrenia group, the early- and middle-onset groups showed a higher probability of birth during the winter season. In addition, the early-onset group showed the highest cumulative clozapine use rate. In the middle-onset group, the initiation of clozapine use was significantly earlier for patients born in winter compared to those born in summer. CONCLUSION Our results indicate that the age at onset is an important factor in predicting the prognosis of schizophrenia patients. The season of birth also affects the prognosis, but with less robustness. Specifically, it appears that early disease onset and winter birth might be associated with poor outcomes in Korean patients with schizophrenia.
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Affiliation(s)
- J S Kim
- Clinical Emotion and Cognition Research Laboratory, Goyang, Korea.,Department of Psychiatry, Soonchunhyang University of College of Medicine, Cheonan, Korea
| | - C M Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - J A Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - E Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - H J Tchoe
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.,Pharmaceutical Policy & Outcomes Research, School of Pharmacy, Sungkyunkwan University, Sowon, Korea
| | - M Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - J K Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Y H Kim
- Gong-ju National Hospital, Gongju, Korea
| | - S H Won
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Korea
| | - Y C Chung
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - K Y Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - S K Lee
- Department of Psychiatry, Hallym University Chuncheon Sacred Hospital, College of Medicine, Hallym University, Chuncheon, Korea
| | - S C Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Korea
| | - S H Lee
- Clinical Emotion and Cognition Research Laboratory, Goyang, Korea.,Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
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6
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Schultze-Lutter F, Rahman J, Ruhrmann S, Michel C, Schimmelmann BG, Maier W, Klosterkötter J. Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1831-41. [PMID: 26155901 DOI: 10.1007/s00127-015-1093-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Prevention of psychosis requires both presence of clinical high risk (CHR) criteria and early help-seeking. Previous retrospective studies of the duration of untreated illness (i.e. prodrome plus psychosis) did not distinguish between prodromal states with and without CHR symptoms. Therefore, we examined the occurrence of CHR symptoms and first help-seeking, thereby considering effects of age at illness-onset. METHODS Adult patients first admitted for psychosis (n = 126) were retrospectively assessed for early course of illness and characteristics of first help-seeking. RESULTS One-hundred and nine patients reported a prodrome, 58 with CHR symptoms. In patients with an early illness-onset before age 18 (n = 45), duration of both illness and psychosis were elongated, and CHR symptoms more frequent (68.9 vs. 33.3 %) compared to those with adult illness-onset. Only 29 patients reported help-seeking in the prodrome; this was mainly self-initiated, especially in patients with an early illness-onset. After the onset of first psychotic symptoms, help-seeking was mainly initiated by others. State- and age-independently, mental health professionals were the main first point-of-call (54.0 %). CONCLUSIONS Adult first-admission psychosis patients with an early, insidious onset of symptoms before age 18 were more likely to recall CHR symptoms as part of their prodrome. According to current psychosis-risk criteria, these CHR symptoms, in principle, would have allowed the early detection of psychosis. Furthermore, compared to patients with an adult illness-onset, patients with an early illness-onset were also more likely to seek help on their own account. Thus, future awareness strategies to improve CHR detection might be primarily related to young persons and self-perceived subtle symptoms.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland.
| | - Jonas Rahman
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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7
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Falkenberg I, Valmaggia L, Byrnes M, Frascarelli M, Jones C, Rocchetti M, Straube B, Badger S, McGuire P, Fusar-Poli P. Why are help-seeking subjects at ultra-high risk for psychosis help-seeking? Psychiatry Res 2015; 228:808-15. [PMID: 26071897 DOI: 10.1016/j.psychres.2015.05.018] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
Abstract
In addition to attenuated psychotic symptoms, individuals at high clinical risk of developing psychosis display a wide range of psychopathological features. Some of these may be subjectively perceived as more troubling than others and may therefore be more likely to trigger help-seeking behavior. We aimed at investigating the nature and prevalence of symptoms subjectively considered most distressing by high-risk individuals at the time of their presentation to early recognition services and to determine their impact on baseline and longitudinal functional and clinical outcomes. The clinical records of 221 clients meeting ultra-high risk (UHR) criteria and receiving care at a specialized early intervention service ("Outreach and Support in South London") between 2001 and 2011 were reviewed. Main outcome measures were reason to seek help as subjectively reported by the clients, comorbid DSM-IV SCID diagnoses, transition to psychosis, psychosocial functioning at baseline and after a median follow-up period of 4.5 years. Affective symptoms, i.e., depression and/or anxiety, were the most commonly reported subjective reasons to seek help (47.1%). Sub-threshold psychotic symptoms were reported by 39.8%. There was no significant association between subjective complaints at presentation and transition to psychosis. However, the group reporting affective symptoms as their main subjective reason to seek help at baseline had a significantly poorer longitudinal outcome in psychosocial functioning relative to the group reporting sub-threshold psychotic symptoms. Assessment of subjective complaints in UHR individuals at initial presentation may help to identify predictors of future functional outcome and tailor treatments accordingly.
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Affiliation(s)
- Irina Falkenberg
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
| | - Lucia Valmaggia
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Majella Byrnes
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Marianna Frascarelli
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ceri Jones
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
| | - Steven Badger
- OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
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8
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von Reventlow HG, Krüger-Özgürdal S, Ruhrmann S, Schultze-Lutter F, Heinz A, Patterson P, Heinimaa M, Dingemans P, French P, Birchwood M, Salokangas RKR, Linszen D, Morrison A, Klosterkötter J, Juckel G. Pathways to care in subjects at high risk for psychotic disorders - a European perspective. Schizophr Res 2014; 152:400-7. [PMID: 24377700 DOI: 10.1016/j.schres.2013.11.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 11/07/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
Evidence-based decisions on indicated prevention in early psychosis require large-scale studies on the pathways to care in high-risk subjects. EPOS (The European Prediction of Psychosis Study), a prospective multi-center, naturalistic field study in four European countries (Finland, Germany, The Netherlands and England), was designed to acquire accurate knowledge about pathways to care and delay in obtaining specialized high risk care. Our high risk sample (n=233) reported on average 2.9 help-seeking contacts, with an average delay between onset of relevant problems to initial help-seeking contact of 72.6 weeks, and between initial help-seeking contact and reaching specialized high risk care of 110.9 weeks. This resulted in a total estimated duration of an unrecognized risk for psychosis of 3 ½ years. Across EPOS EU regions, about 90% of care pathway contacts were within professional health care sectors. Between EPOS regions, differences in the pathways parameters including early detection and health-care systems were often very pronounced. High-risk participants who later made transition to a full psychotic disorder had significantly longer delays between initial help-seeking and receiving appropriate interventions. Our study underlines the need for regionally adapted implementation of early detection and intervention programs within respective mental health and health care networks, including enhancing public awareness of early psychosis.
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Affiliation(s)
- Heinrich Graf von Reventlow
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital Bochum, Alexandrinenstr. 1, 44801 Bochum, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital Bochum, Alexandrinenstr. 1, 44801 Bochum, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, 50924 Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, University of Cologne, 50924 Cologne, Germany; University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Patterson
- Early Intervention Service, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Youthspace, Birmingham & Solihull Mental Health Foundation Trust, 66-68 Hagley Road, B16 8PF Birmingham, United Kingdom
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Psychiatric Clinic, 20520 Turku, Finland
| | - Peter Dingemans
- Academic Medical Centre, University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam Zuidoost, The Netherlands; Mediant, Broekheurne-Ring 1050, 7546 TA Enschedé, The Netherlands
| | - Paul French
- School of Psychology, University of Manchester, Oxford Road, M13 9PL, United Kingdom
| | - Max Birchwood
- Early Intervention Service, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Raimo K R Salokangas
- Department of Psychiatry, University of Turku, Psychiatric Clinic, 20520 Turku, Finland
| | - Don Linszen
- Academic Medical Centre, University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam Zuidoost, The Netherlands; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, PO Box 16, University of Maastricht, 6200 MD Maastricht, The Netherlands
| | - Anthony Morrison
- School of Psychology, University of Manchester, Oxford Road, M13 9PL, United Kingdom
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, 50924 Cologne, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital Bochum, Alexandrinenstr. 1, 44801 Bochum, Germany.
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9
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Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1905-16. [PMID: 23832100 DOI: 10.1007/s00127-013-0736-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study set out to investigate the patterns of referral in a sample (n = 206) of patients having first-time access to an Italian comprehensive program that targets the early detection of and early intervention on subjects at the onset of psychosis. The primary goal of the study was to investigate the duration of untreated illness (DUI) and/or the duration of untreated psychosis (DUP) in the sample since the implementation of the program. METHOD Data on pathways of referrals prospectively collected over a 11-year period, from 1999 to 2010; data referred to patients from a defined catchment area, and who met ICD-10 criteria for a first episode of a psychotic disorder (FEP) or were classified to be at ultra-high risk of psychosis (UHR) according to the criteria developed by the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne. Changes over time in the DUI and DUP were investigated in the sample. RESULTS Referrals increased over time, with 20 subjects enrolled per year in the latter years of the study. A large majority of patients contacted a public or private mental health care professional along their pathway to treatment, occurring more often in FEP than in UHR patients. FEP patients who had contact with a non-psychiatric health care professional had a longer DUP. Over time, DUP and DUI did not change in FEP patients, but DUI increased, on average, in UHR patients. CONCLUSIONS The establishment of an EIP in a large metropolitan area led to an increase of referrals from people and agencies that are not directly involved in the mental health care system; over time, there was an increase in the number of patients with longer DUI and DUP than those who normally apply for psychiatric services.
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10
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Anderson KK, Fuhrer R, Wynant W, Abrahamowicz M, Buckeridge DL, Malla A. Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1389-98. [PMID: 23429939 DOI: 10.1007/s00127-013-0665-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/04/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The observed association between treatment delay and poor outcomes in first-episode psychosis has led to an interest in the topography of symptom development preceding the onset of psychosis and associated help-seeking behaviors. We estimated the extent to which socio-demographic, clinical, and health service indicators are associated with patterns of service use for mental health reasons preceding a first diagnosis of psychosis. METHODS Population-based administrative data from physician billings, hospitalizations, and public health clinics were used to identify incident cases of schizophrenia-spectrum psychosis among individuals aged 14-25 years in Montréal. Mental health contacts in the 4 years preceding the index diagnosis were analyzed. RESULTS Thirty-two percent of cases had no contact with services for a mental health reason preceding the index diagnosis, and nearly 50% received the index diagnosis of psychosis in the emergency department. Individuals in contact with primary care had a reduced likelihood of contact with the emergency department and inpatient services (OR = 0.15, 0.06-0.39) and of receiving the index diagnosis in the emergency department (OR = 0.36, 0.24-0.54), but also had a longer time to contact with a psychiatrist (HR = 0.32, 0.23-0.45). CONCLUSIONS Improving access to primary care may reduce the burden on emergency departments and inpatient units; however, primary care providers may need additional training in the symptoms of early psychosis and referral protocols. Given the limitations associated with using clinical samples from specialized services, population-based administrative data are an important source of information for understanding patterns of health services use preceding a first diagnosis of psychosis.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada
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11
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Stowkowy J, Colijn MA, Addington J. Pathways to care for those at clinical high risk of developing psychosis. Early Interv Psychiatry 2013; 7:80-3. [PMID: 22741608 DOI: 10.1111/j.1751-7893.2012.00368.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Understanding the pathways to care is a prerequisite for early detection in first-episode patients with psychosis. Less in known about the pathways to care for individuals at clinical high risk for psychosis. METHODS A sample of 35 clinical high risks for psychosis individuals were administered a semistructured questionnaire inquiring about pathways to care. RESULTS The majority of contacts were made to general practitioners (32.8%). Various symptoms of concern were reported among the sample, the most common being depression (15.9%) followed by anxiety (11.0%). Delusions/paranoia were the most frequent symptoms associated with successful referral to contacts (14.3%). CONCLUSION Education on the pathway to successful access to care and treatment in a putatively prodromal for psychosis group of individuals is valuable information that can potentially aid in a faster discovery of these individuals and their access to treatment and care.
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Affiliation(s)
- Jacqueline Stowkowy
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2013; 48:125-36. [PMID: 22976337 DOI: 10.1007/s00127-012-0571-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Although there have been numerous studies on pathways to care in first-episode psychosis (FEP), few have examined the determinants of the pathway to care and its impact on subsequent engagement with mental health services. METHODS Using a sample of 324 FEP patients from a catchment area-based early intervention (EI) program in Montréal, we estimated the association of several socio-demographic, clinical, and service-level factors with negative pathways to care and treatment delay. We also assessed the impact of the pathway to care on time to disengagement from EI services. RESULTS Few socio-demographic or clinical factors were predictive of negative pathways to care. Rather, service-level factors, such as contact with primary care providers, have a stronger impact on patterns of health service use across multiple indicators. Patients who were in contact with primary care had a reduced likelihood of negative pathways to care, but also had longer referral delays to EI services. Socio-demographic and clinical factors were more relevant for predicting subsequent engagement with EI services, and indicators of negative pathways to care were not associated with service disengagement. CONCLUSIONS Primary care providers may be an efficacious target for interventions aimed at reducing overall treatment delay. Increasing the uptake of primary care services may also reduce the likelihood of negative pathways to care. Our findings draw attention to the need for further investigations of the role that the primary care system plays in early intervention for FEP, and strategies for supporting service providers in this role.
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Chandra PS, Kommu JVS, Rudhran V. Schizophrenia in women and children: a selective review of literature from developing countries. Int Rev Psychiatry 2012; 24:467-82. [PMID: 23057983 DOI: 10.3109/09540261.2012.707118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Women and children with psychotic disorders in developing countries may be vulnerable and have considerable social disadvantages. Gender disadvantage has implications for all health outcomes including mental illnesses. In the more relevant gender-related context we discuss several important issues which affect women with schizophrenia, namely stigma, caregiver burden, functional outcome, marriage, victimization and help-seeking. The findings indicate that there are variations in clinical and functional outcomes and age of onset of illness between different regions. Drug side effects, such as metabolic syndrome appear to be quite common, adding to disease burden in women from developing countries. Victimization and coercion may contribute to poor quality of life and health concerns such as STIs and HIV. Stigma among women with schizophrenia appears to play a major role in help-seeking, caregiver burden and issues such as marriage and parenting. Gender-sensitive care and practices are few and not well documented. Research in the area of psychoses in children and adolescents from LAMI countries is sparse and is mainly restricted to a few clinic-based studies. More research is needed on organic and medical factors contributing to childhood psychoses, pathways to care, help-seeking, and impact of early detection and community care.
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Affiliation(s)
- Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Bhang SY, Yoo HIK, Kim JH, Kim BS, Bahn GH, Ahn DH, Suh DS, Cho SC, Hwang JW, Lee YS. Revision of Adolescent Mental Health and Problem Behavior Screening Questionnaire : Development of Adolescent Mental Health and Problem Behavior Screening Questionnaire-II. Soa Chongsonyon Chongsin Uihak 2011. [DOI: 10.5765/jkacap.2011.22.4.271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bola JR, Park EH, Kim SY. Reassessing the high proportion of involuntary psychiatric hospital admissions in South Korea. Community Ment Health J 2011; 47:603-6. [PMID: 21416122 DOI: 10.1007/s10597-011-9396-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 02/28/2011] [Indexed: 11/25/2022]
Abstract
The 2007 WHO-AIMS report on the mental health system of South Korea documented progress towards a national mental health plan, protection of human rights, and growth of community based services. Yet concern was expressed that the high proportion of involuntary to total psychiatric hospitalizations (92%) may indicate an excessively coercive system. Involuntary hospitalization in Korea rose from 117 to 132 (per 100,000) between 2000 and 2006. In 2000, the median rate in the European Union (EU) was 74 per 100,000 (Range: 6-218). While Korea's involuntary hospitalization rate is within the EU range, its proportion of involuntary hospitalizations is three times that of the highest EU country (30%, Sweden). Underdevelopment of voluntary psychiatric services and culturally mandated family referrals resulting in involuntary hospitalization are apparent reasons for the high proportion of involuntary hospitalizations. Population-based rates per 100,000 more accurately describe involuntary hospitalization than the proportion (ratio) measure used in the WHO-AIMS reports.
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Affiliation(s)
- John R Bola
- Department of Applied Social Studies, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong.
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