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Murden R, Allan SM, Hodgekins J, Oduola S. The effectiveness of public health interventions, initiatives, and campaigns designed to improve pathways to care for individuals with psychotic disorders: A systematic review. Schizophr Res 2024; 266:165-179. [PMID: 38412687 DOI: 10.1016/j.schres.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/19/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Lengthy duration of untreated psychosis (DUP) and duration of untreated illness (DUI) in people at clinical high-risk for psychosis (CHR-P) and first episode psychosis (FEP) is associated with poorer outcomes. However, individuals with FEP often experience negative pathways to care involving contacts with police, crisis services and requiring compulsory admissions, and evidence suggests individuals with both FEP and CHR-P often experience lengthy delays to treatment. Early detection interventions, such as public health interventions, may be one way to reduce delays. This systematic review aimed to synthesise the available evidence on such interventions. METHODS The EMBASE, PsychINFO, CINAHL, and MEDLINE databases were searched. Studies were included if they compared an intervention designed to improve timely access to treatment for individuals with FEP or CHR-P to standard treatment provision. Interventions may be targeted at potential patients, their families, the general public, or non-healthcare professionals. Outcomes of interest were DUP or DUI, and/or characteristics of pathways to care. RESULTS Nineteen studies met the inclusion criteria. All consisted of FEP populations, none of CHR-P populations. Employing narrative synthesis, we found mixed results about the effectiveness of interventions at reducing DUP and interventions appeared to differentially impact groups. Pathways to care information was limited and mixed. CONCLUSION Findings on the effectiveness of interventions designed to improve timely access to treatment were inconclusive. More research is warranted to better understand where delays occur and factors which may influence this for both FEP and CHR-P populations which may help to develop targeted interventions to address delays.
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Affiliation(s)
- Rhiannon Murden
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; Birmingham and Solihull Mental Health NHS Foundation Trust, Uffculme Centre, 52 Queensbridge Road, Moseley, Birmingham B13 8QY, UK.
| | - Sophie M Allan
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Sheri Oduola
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
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Bertulies-Esposito B, Iyer S, Abdel-Baki A. The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:585-597. [PMID: 35014891 PMCID: PMC9301149 DOI: 10.1177/07067437211065726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Early intervention services for psychosis (EIS) are associated with improved clinical and economic outcomes. In Quebec, clinicians led the development of EIS from the late 1980s until 2017 when the provincial government announced EIS-specific funding, implementation support and provincial standards. This provides an interesting context to understand the impacts of policy commitments on EIS. Our primary objective was to describe the implementation of EIS three years after this increased political involvement. METHODS This cross-sectional descriptive study was conducted in 2020 through a 161-question online survey, modeled after our team's earlier surveys, on the following themes: program characteristics, accessibility, program operations, clinical services, training/supervision, and quality assurance. Descriptive statistics were performed. When relevant, we compared data on programs founded before and after 2017. RESULTS Twenty-eight of 33 existing EIS completed the survey. Between 2016 and 2020, the proportion of Quebec's population having access to EIS rose from 46% to 88%; >1,300 yearly admissions were reported by surveyed EIS, surpassing governments' epidemiological estimates. Most programs set accessibility targets; adopted inclusive intake criteria and an open referral policy; engaged in education of referral sources. A wide range of biopsychosocial interventions and assertive outreach were offered by interdisciplinary teams. Administrative/organisational components were less widely implemented, such as clinical/administrative data collection, respecting recommended patient-to-case manager ratios and quality assurance. CONCLUSION Increased governmental implementation support including dedicated funding led to widespread implementation of good-quality, accessible EIS. Though some differences were found between programs founded before and after 2017, there was no overall discernible impact of year of implementation. Persisting challenges to collecting data may impede monitoring, data-informed decision-making, and quality improvement. Maintaining fidelity and meeting provincial standards may prove challenging as programs mature and adapt to their catchment area's specificities and as caseloads increase. Governmental incidence estimates may need recalculation considering recent epidemiological data.
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Affiliation(s)
- Bastian Bertulies-Esposito
- Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, Canada.,Quebec Integrated University Centre for Health and Social Services of Centre-Sud-de-l'Ile-de-Montreal, Montreal, Canada.,177460Centre de recherche du CHUM, Montreal, Canada
| | - Srividya Iyer
- Department of Psychiatry, 5620McGill University, Montreal, Canada.,Montréal West Island Integrated University Health and Social Services Centre, Douglas Hospital Research Centre & Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, Canada.,177460Centre de recherche du CHUM, Montreal, Canada.,Clinique JAP (Early Intervention for Psychosis Clinic) and the Youth Mental Health Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
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Follow-up of subjects labelled with putative pre-psychotic states: Viewed from a transdiagnostic clinical high-at-risk mental state (CHARMS) paradigm. J Formos Med Assoc 2021; 121:1159-1166. [PMID: 34732303 DOI: 10.1016/j.jfma.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 09/16/2021] [Accepted: 10/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Follow-up of subjects with putative pre-psychotic states is essential to clarify the transition process to psychosis, while "non-converters" also deserve clinical attention as many may evolve into other psychiatric disorders with diverse outcomes. This study aimed to examine help-seeking individuals who have been labelled at clinical high-risk state but not converting to full-blown psychosis during first two years of follow-up. METHODS A retrospective observational cohort study of help-seeking subjects was conducted by reviewing medical records of participants in a previous early psychosis study at the study hospital between 2006 and 2020. We portrayed those who developed first episode psychosis after first 2-year follow-up in detail, and provided sketches of clinical macrophenotypes other than psychosis emerging from subjects among different risk groups. RESULTS Among 132 eligible subjects, data of 98 (74.2%) were available for detailed evaluation. Of these, 15 transitioned to first-episode psychosis (11.4%) with time to psychosis from 2 to 11 years, 11 had anxiety spectrum (8.3%), 11 had depressive spectrum (8.3%), 10 had obsessive compulsive (7.6%), 5 had bipolar spectrum disorders (3.8%), 13 had predominantly schizotypal (9.8%) and 4 had other personality traits (3%), and 13 had problems attributable to adjustment or developmental issues (9.8%). CONCLUSIONS Various diagnoses, either full- or sub-threshold, appropriately describe the diverse clinical phenomenology of a cohort presenting with non-specific and/or subthreshold psychotic symptoms. The clinical high-at-risk mental state (CHARMS) paradigm provides a reasonable transdiagnostic approach for orienting clinicians' attention toward young subjects seeking mental health help at an early stage of illness to potentially pluripotent trajectories.
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Suen YN, Chan KWS, Siu LTT, Lo LHL, Cheung C, Hui LMC, Lee HME, Chang WC, Wong PS, Chen YHE. Relationship between stressful life events, stigma and life satisfaction with the willingness of disclosure of psychotic illness: A community study in Hong Kong. Early Interv Psychiatry 2021; 15:686-696. [PMID: 32583621 DOI: 10.1111/eip.13008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/01/2020] [Accepted: 05/24/2020] [Indexed: 11/27/2022]
Abstract
AIM The preference of and potential barriers to disclosure of psychotic illness vary across cultures. Studying its patterns and correlates can guide the design of future culture-specific intervention and public education approaches to improve willingness to disclose and thereby reducing the duration of untreated psychosis (DUP). METHODS A population-based, random telephone survey was conducted with a total of 1514 respondents in Hong Kong in January 2018. Cross-sectional data on willingness to disclose psychotic illness, life satisfaction, stigmatizing attitude and recent experience of stressful life events (SLEs) were analysed against age and gender using structural equation modelling (SEM). RESULTS Unwillingness to disclose to anyone was reported by 12% of the participants. Family was reported as the preferred disclosure candidate by most respondents. Our model, which showed a good fit to the data demonstrated that stigmatizing attitude and life satisfaction were directly associated with willingness to disclose illness. Younger age was correlated with more recent experience of SLEs, lower life satisfaction and less willingness to disclose illness. Women's disclosure willingness was positively associated with their life satisfaction, which was sensitive to recent exposure to single SLE. In contrast, men's was negatively associated with their stigmatizing attitude, which increased significantly upon exposure to two or more recent SLEs. CONCLUSION Encouraging the public to help their family to seek treatment should be a focal point of a successful mental health public education campaign. Cultural-specific and integrated interventions should be developed targeting the vulnerable groups including people with high recent life stress, particularly woman and those with younger age.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China
| | - Kit Wa Sherry Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, SAR, China
| | | | | | - Charlton Cheung
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China
| | | | - Ho Ming Edwin Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, SAR, China
| | - Pui Sze Wong
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China
| | - Yu Hai Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, SAR, China
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Bertulies-Esposito B, Sicotte R, Iyer SN, Delfosse C, Girard N, Nolin M, Villeneuve M, Conus P, Abdel-Baki A. Détection et intervention précoce pour la psychose : pourquoi et comment ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088178ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Joa I, Bjornestad J, Johannessen JO, Langeveld J, Stain HJ, Weibell M, Hegelstad WTV. Early Detection of Ultra High Risk for Psychosis in a Norwegian Catchment Area: The Two Year Follow-Up of the Prevention of Psychosis Study. Front Psychiatry 2021; 12:573905. [PMID: 33716805 PMCID: PMC7943837 DOI: 10.3389/fpsyt.2021.573905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/03/2021] [Indexed: 02/02/2023] Open
Abstract
Objectives: Most individuals experience a relatively long period of sub-clinical psychotic like symptoms, known as the ultra high risk (UHR) or at risk mental states (ARMS), prior to a first episode of psychosis. Approximately 95% of individuals who will later develop psychosis are not referred to specialized clinical services and assessed during the UHR phase. The study aimed to investigate whether a systematic early detection program, modeled after the successful early detection of psychosis program TIPS, would improve the detection of help-seeking UHR individuals. The secondary aim was to examine the rates and predictors of conversion to psychosis after 2 years. Method: The overall study design was a prospective (2012-2018), follow- up study of individuals fulfilling UHR inclusion criteria as assessed by the structural interview for prodromal syndromes (SIPS). Help-seeking UHR individuals were recruited through systematic early detection strategies in a Norwegian catchment area and treated in the public mental health services. Results: In the study period 141 UHR help-seeking individuals were identified. This averages an incidence of 7 per 100,000 people per year. The baseline assessment was completed by 99 of these and the 2 year psychosis conversion rate was 20%. A linear mixed-model regression analysis found that the significant predictors of conversion were the course of positive (0.038) and negative symptoms (0.017). Age was also a significant predictor and showed an interaction with female gender (<0.000). Conclusion: We managed to detect a proportion of UHR individuals in the upper range of the expected prediction by the population statistics and further case enrichment would improve this rate. Negative symptoms were significant predictors. As a risk factor for adverse functional outcomes and social marginalization, this could offer opportunities for earlier psychosocial intervention.
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Affiliation(s)
- Inge Joa
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Jone Bjornestad
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jan Olav Johannessen
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Johannes Langeveld
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Helen J Stain
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Melissa Weibell
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS-Network for Clinical Research in Psychosis, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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7
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Liu CC, Liu CM, Chien YL, Lin YT, Hsieh MH, Hwang TJ, Hwu HG. Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis. Front Psychiatry 2021; 12:714878. [PMID: 34557119 PMCID: PMC8453020 DOI: 10.3389/fpsyt.2021.714878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Contradictory messages regarding the necessity of long-term antipsychotic treatment after first episode psychosis arouse deliberations in clinical practice. We explored if there is an alternative beyond the dichotomy of maintenance treatment and discontinuation of medications. Methods: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special interests in patients able to maintain good functioning under treatment with a low antipsychotic dose. Results: Of the 81 patients with first-episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n = 46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit; among them, 15 patients received dosage of antipsychotics no more than the minimum effective dose [chlorpromazine equivalent (CPZE) dose, 200 mg/day]. Besides, 10 of 55 patients (18.2%) only received very low dose antipsychotics (CPZE < 50 mg/day) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization, and being on clozapine therapy were correlated to poorer functioning. Antipsychotic-free status was achieved only in two non-psychotic patients. Conclusions: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first-episode psychosis, even if they could not completely withdraw antipsychotics in the long term. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.
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Affiliation(s)
- Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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8
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Valle R. Review of Early Intervention Programmes in Psychosis: Implementation Proposal for Peru. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:178-186. [PMID: 32888661 DOI: 10.1016/j.rcp.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/14/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
A delay in receiving an antipsychotic treatment is associated with unfavourable clinical and functional outcomes in patients with a first episode of psychosis. In recent years, early psychosis intervention programmes have been implemented that seek the early detection and treatment of patients who begin to describe psychotic symptoms. These programmes have shown to be more effective than standard care in improving the symptoms of the disorder and recovering the patient's functionality, in turn proving to be more cost-effective. The benefits of these programmes have led to their implementation in high-income countries. However, implementation in medium- and low-income countries has been slower. Peru, a Latin American country with an upper middle income, is undergoing a mental health reform that prioritises health care based on the prevention, treatment and psychosocial recovery of patients from a comprehensive and community approach. The present manuscript describes the characteristics and structure of the pioneering and more developed programmes for early psychosis intervention, and discusses the benefits and challenges of implementing an early psychosis intervention programme in Peru in the current context of mental health reform.
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Affiliation(s)
- Rubén Valle
- Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú; Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; DEIDAE de Adultos y Adultos Mayores, Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú.
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Fresan A, Apiquian R, Robles-García R, Zarate CAT, Balducci PM, Broussard B, Wan CR, Compton MT. Similarities and Differences in Associations Between Duration of Untreated Psychosis (DUP) and Demographic, Premorbid, and Symptom Severity Measures in Two Samples of First-Episode Psychosis Patients from Mexico and the United States. Psychiatr Q 2020; 91:769-781. [PMID: 32221766 PMCID: PMC7780290 DOI: 10.1007/s11126-020-09736-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Early-psychosis researchers have documented that duration of untreated psychosis (DUP) is an important predictor of outcomes in first-episode psychosis. Very few cross-national studies have been conducted, and none have been carried out involving patients from both Mexico and the U.S. We collaborated to answer three questions: (1) Are DUP estimates similar in two very different settings and samples? (2) Are demographic variables, premorbid adjustment, and symptom severity similarly related to DUP in the two different settings? (3) Does the same set of variables account for a similar proportion of variance in DUP in the two settings? Data on sociodemographic characteristics, premorbid adjustment, symptom severity, and DUP were available for 145 Mexican and 247 U.S. first-episode psychosis patients. DUP was compared, and bivariate analyses and multiple linear regressions were carried out in each sample. DUP estimates were similar (medians of 35 weeks in Mexico and 38 weeks in the U.S.). In the Mexican sample, DUP was associated with gender, employment status, premorbid social adjustment, and positive symptom severity (explaining 18% of variance). In the U.S. sample, DUP was associated with age, employment status, premorbid social adjustment, and positive symptom severity (but in the opposite direction of that observed in the Mexican sample), accounting for 25% of variance. Additional cross-national collaborations examining key facets of early-course psychotic disorders, including DUP, will clarify the extent of generalizability of findings, strengthen partnerships for more internationally relevant studies, and support the global movement to help young people struggling with first-episode psychosis and their families.
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Affiliation(s)
- Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, DF, Mexico
| | - Rogelio Apiquian
- División de Ciencias del Comportamiento y del Desarrollo, Universidad de las Américas A.C, Mexico City, DF, Mexico
| | - Rebeca Robles-García
- Dirección de Investigaciones Epidemiológicas y Sociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, DF, Mexico
| | | | - Pierfrancesco Maria Balducci
- Scuola di Specializzazione in Psichiatria, Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy
| | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Michael T Compton
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians & Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA.
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10
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Ferrara M, Guloksuz S, Li F, Burke S, Tek C, Friis S, Ten Velden Hegelstad W, Joa I, Johannessen JO, Melle I, Simonsen E, Srihari VH. Parsing the impact of early detection on duration of untreated psychosis (DUP): Applying quantile regression to data from the Scandinavian TIPS study. Schizophr Res 2019; 210:128-134. [PMID: 31204063 DOI: 10.1016/j.schres.2019.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/14/2019] [Accepted: 05/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prolonged duration of untreated psychosis (DUP) is associated with poor outcomes. The TIPS study halved DUP with an early detection (ED) campaign; however, conventional statistical analyses, focused on mean estimates, failed to reveal the effects of ED across the full DUP distribution, restricting inferences about ED's effectiveness. Utilizing a novel quantile regression based analysis, we examined the differential impact of ED across DUP. Secondary analysis explored possible predictors of DUP, and moderators of the effect of the campaign. METHODS The TIPS ED campaign was conducted in two health care sectors in Norway, with two equivalent health care sectors serving as controls. Quantile regression analysis was performed to analyze ED campaign's effect. RESULTS 281 patients with first episode psychosis were recruited, including 141 from the ED area. ED had no effect on the first quartile (Q1) of DUP, whereas a significant reduction in Q2 (11weeks), and Q3 (41weeks) of DUP was observed. The effect of ED was significantly stronger on reducing Q3 than Q1 or Q2, suggesting that the campaign was more effective in longer DUP samples. Male gender and single status predicted longer DUP in Q3: by 38 and 27weeks, respectively. Single status, but not gender, emerged as a significant moderator of ED campaign effect. CONCLUSIONS Quantile regression provided in depth information about the non-uniformity, and moderators, of TIPS's ED effort across the full distribution of DUP, demonstrating the value of this analytic approach to re-examine prior, and plan analyses for future, early detection efforts.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, viale Muratori 201, 41121 Modena, Italy.
| | - Sinan Guloksuz
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Fangyong Li
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Yale University Center for Science and Social Science Information, PO Box 208111, 06520 New Haven, CT, USA.
| | - Shadie Burke
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
| | - Cenk Tek
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Postbox 1039, Blindern, 0315 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway.
| | - Wenche Ten Velden Hegelstad
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway.
| | - Inge Joa
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway.
| | - Jan Olav Johannessen
- Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway.
| | - Ingrid Melle
- NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, Building 49, P.O. Box 4956, Nydalen, N-0424, University of Oslo, Oslo, Norway.
| | - Erik Simonsen
- Psychiatric Research Unit, Faelledvej 8, 4200 Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Vinod H Srihari
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA.
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11
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Liu CC, Lin YT, Liu CM, Hsieh MH, Chien YL, Hwang TJ, Hwu HG. Trajectories after first-episode psychosis: Complement to ambiguous outcomes of long-term antipsychotic treatment by exploring a few hidden cases. Early Interv Psychiatry 2019; 13:895-901. [PMID: 29927087 DOI: 10.1111/eip.12696] [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: 12/22/2017] [Revised: 03/08/2018] [Accepted: 05/16/2018] [Indexed: 12/29/2022]
Abstract
AIM Patient's long-term phenomenology after first-episode psychosis could be blurred due to early intervention. The contradictory messages regarding necessity of long-term antipsychotic treatment derived from different methodologies warrants careful reappraisal. METHODS We approached a group of patients lost to follow-up in a previous study. Targeting these 44 missing patients, we sent 2 carefully worded letters to invite them for interviews to see if their life trajectories were different from those who stayed in a university-based hospital system. RESULTS A total of 21 patients replied, but only 8 agreed to in-depth interviews. Of these, 2 warranted revision of their diagnoses as there had been no recurrence of psychotic symptoms and they had remained antipsychotic-free for several years despite displaying a dysthymic state; 1 fulfilled remission criteria on intermittent low-dose antipsychotics but kept a distance from any potential stressor; 1 achieved full remission with good functioning and discontinued medications for a year, but resumed taking antipsychotics after feeling an impending relapse; the other 4 showed common courses of chronic schizophrenia with repeated admission and/or rehabilitation programs in other service systems. CONCLUSIONS The trajectories after first-episode psychosis should not be over-simplified by calculating the probability of relapse or the odds of achieving adequate functioning determined by medication adherence or not. Examining from a dynamic perspective employing a qualitative approach to take into account diagnostic stability, treatment preferences, psychosocial factors, individual coping strategies and personalized formulation of illness, we can gain more insight into the ambiguous information revealed by the recent literature.
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Affiliation(s)
- Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
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12
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Abstract
The last 20 years have seen an increased focus on early intervention in psychotic disorders in research and clinical practice. Interventions have typically aimed at either reducing the duration of untreated psychosis (DUP), or developing specialized treatment facilities for patients with first episode psychosis (FEP). This review presents an overview of the most important trials and meta-analytic evidence within this field. The possibilities for reducing DUP and elements included in specialized early intervention treatment are discussed. Further, it examines long-term outcomes of early interventions and results from prolonged early intervention trials. Lastly, it analyses possible interactions between DUP and specialized early intervention treatment. In conclusion, both elements appear necessary in order to develop an integrated service that can provide the optimal treatment for patients with FEP. The aim of this article is to provide an overview over the most important trials and evidence regarding the outcome of early intervention in first episode psychosis.
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Affiliation(s)
- Nikolai Albert
- Copenhagen Research Center for Mental Health - CORE, Copenhagen Mental Health Centre , Copenhagen , Denmark
| | - Melissa Authen Weibell
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital , Stavanger , Norway
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13
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Hansen H, Stige SH, Moltu C, Johannessen JO, Joa I, Dybvig S, Veseth M. "We all have a responsibility": a narrative discourse analysis of an information campaign targeting help-seeking in first episode psychosis. Int J Ment Health Syst 2019; 13:32. [PMID: 31086563 PMCID: PMC6507175 DOI: 10.1186/s13033-019-0289-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns. METHODS A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info's website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data. RESULTS Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along). CONCLUSION Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients' recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking.
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Affiliation(s)
- Hege Hansen
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Postbox 7030, 5020 Bergen, Norway
| | | | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jan Olav Johannessen
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Sveinung Dybvig
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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14
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Hastrup LH, Haahr UH, Nordgaard J, Simonsen E. The effect of implementation of an early detection team: A nationwide register-based study of characteristics and help-seeking behavior in first-episode schizophrenia in Denmark. Schizophr Res 2018; 201:337-342. [PMID: 29706446 DOI: 10.1016/j.schres.2018.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/12/2018] [Accepted: 04/19/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND In an effort to make people with signs of psychosis seek help as early as possible, Region Zealand launched in 2012 an early detection team project as the first and only in Denmark. The project consisted of a combination of easy access and an information campaign targeting the public. This nation-wide study examined characteristics and help-seeking behavior of patients with first-episode schizophrenia (FES) in the early detection region in comparison with other Danish regions. METHOD Data from the Danish National Schizophrenia register on all Danish patients diagnosed with first-episode schizophrenia during 2012 to 2015 were linked to demographic and health care data drawn from official national registers. Binary logistic regression analyses examined the difference between the early detection region and other regions controlling for demographic characteristics and utilization of mental health care services and contacts to general practitioner (GP). RESULTS Patients in the early detection region were younger (OR = 0.51; CI: 0.42-0.62; p < 0.000) than in regions without early detection teams. Furthermore, they were more likely to be of Danish origin, and less likely to have contact with mental health services and GPs prior to FES. CONCLUSION The study suggests that implementing an early detection team in combination with an information campaign contributed to detecting patients with first-episode schizophrenia earlier than in regions without the early detection team. The study gives an indication of different pathways among patients in the early detection region.
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Affiliation(s)
| | - Ulrik Helt Haahr
- Psychiatric Research Unit, Region Zealand, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Julie Nordgaard
- Early Psychosis Intervention Center, Psychiatry East Region Zealand, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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15
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Chau HS, Chong WS, Wong JGWS, Hung GBK, Lui SSY, Chan SKW, Chang WC, Hui CLM, Lee EHM, McGorry PD, Jones PB, Chen EYH. Early intervention for incipient insanity: early notions from the 19 th century English literature. Early Interv Psychiatry 2018; 12:708-714. [PMID: 27273703 DOI: 10.1111/eip.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/23/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
AIM Early intervention programmes in mental illnesses started to bloom in the 1990s, and many programmes have been established worldwide during the past twenty years. However, the concept of early intervention has emerged during the 19th century but it did not make much impact on practice. The aim of this review is to identify the difficulties appeared during that period of time which could provide insight into the modern development of early intervention initiatives. METHODS A narrative review which focused on English literature about early intervention for insanity during the 19th century was undertaken. RESULTS Clinicians during the 19th century recognized that treatment would be the most effective at the early stage of the mental illness and they had emphasized the importance of early intervention. However, because of a number of factors, such as the limited roles of asylums, lack of knowledge about mental disorder and the lack of effective treatment, the idea of early intervention did not make impact in clinical service during that period of time. CONCLUSION During the past two hundred years, understanding towards mental illness has advanced and more effective treatments, such as the use of anti-psychotic medications, have been developed. Reflecting on the past experience and difficulties might shed light on the development of today early intervention in mental disorder.
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Affiliation(s)
- Hang Sze Chau
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Wai Sun Chong
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | | | | | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | - Patrick D McGorry
- Department of Psychiatry, ORYGEN Research Centre, University of Melbourne, Melbourne, Australia
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong
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16
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Chan SKW, Chau EHS, Hui CLM, Chang WC, Lee EHM, Chen EYH. Long term effect of early intervention service on duration of untreated psychosis in youth and adult population in Hong Kong. Early Interv Psychiatry 2018; 12:331-338. [PMID: 26801970 DOI: 10.1111/eip.12313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/15/2005] [Indexed: 11/30/2022]
Abstract
AIM The current study explored the effect of an early intervention (EI) service for psychosis in Hong Kong (EASY) on the reduction of the duration of untreated psychosis (DUP) at 10 years, in adolescent and adult patients. METHOD Data from three first-episode psychosis (FEP) studies conducted over 10 years using the same DUP assessment was analysed. FEP study 1 year before the EI service (2000) was used as a control, with those aged <25 comprising the youth psychosis control group and those aged over 25 comprising the adult psychosis control group. Data from the EASY service collected in 2010 constituted the youth psychosis EI group and data from an adult EI service collected from 2009 to 2011 constituted the adult psychosis EI group. DUP of EI and control groups was compared. The effect of the mode of onset and family history of psychosis on DUP was studied. RESULTS DUP in the adult group was significantly reduced from median of 180 days to 93 days after 10 years (U = 12 906.50, P = 0.01), particularly in those with gradual onset and without family history. However, no significant change of DUP was found in the youth psychosis group. CONCLUSIONS Results of the current study provide evidence that EI programmes with public awareness campaign can significantly reduce DUP of adult patients but not in youth group. The effect is more specific in those with long DUP. Further research should explore the specific factors contributed to the long DUP of patients of different age groups so as to establish targeted intervention strategies.
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Affiliation(s)
- Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Esther H S Chau
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Wing C Chang
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hongkong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hongkong
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17
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Duration of untreated illness as a key to early intervention in schizophrenia: A review. Neurosci Lett 2018; 669:59-67. [DOI: 10.1016/j.neulet.2016.10.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 09/05/2016] [Accepted: 10/02/2016] [Indexed: 12/25/2022]
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18
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Is it possible to implement community care based on mental health in Japan? A comparison between decade ago and present on Duration of Untreated Psychosis (DUP). Asian J Psychiatr 2018; 33:88-92. [PMID: 29547755 DOI: 10.1016/j.ajp.2018.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/15/2018] [Accepted: 03/01/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In recent years, the early detection and treatment of the first episode of schizophrenia (FES) has attracted worldwide attention. In Japan, psychiatric care has changed to an open and accessible framework over the past decade. Therefore, the duration of untreated psychosis (DUP) is thought to have been shortened. The purposes of this study were to investigate whether recent DUP periods are shorter than they were 10 years ago and whether the DUP at present differs among psychiatric facilities. We investigated the recent DUP at a psychiatric hospital and its satellite clinic. MATERIAL AND METHODS We examined the differences in DUP, age, sex, referral pathway, living companions, social participation, and schooling history among 3 groups of FES patients: (i) a psychiatric hospital during 1999-2001 and (ii) during 2009-2011, and (iii) a psychiatric clinic during 2009-2011. RESULTS The average DUP was 14.3 (SD = 17.5) months for the psychiatric hospital during 1999-2001, 16.0 (SD = 18.7) months for the psychiatric hospital during 2009-2011, and 24.4 (SD = 30.0) months for the psychiatric clinic during 2009-2011. No significant differences were found in the DUP for each facility and during this decade. Also, the differences in the DUP could not be attributed to factors such as living companions or social participation. DISCUSSION Increases in the numbers of patients and psychiatric clinics have not led to the early detection of FES. To shorten the DUP in the future, closer cooperation among the medical field, the educational field, and the health and welfare will be needed.
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19
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Friis S, Sundet K, Rund BR, Vaglum P, McGlashan TH. Neurocognitive dimensions characterising patients with first-episode psychosis. Br J Psychiatry 2018; 43:s85-90. [PMID: 12271806 DOI: 10.1192/bjp.181.43.s85] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundAssessment of neurocognitive dysfunction in schizophrenia is hampered by the multitude of tests used in the literature.AimsWe aimed to identify the main dimensions of an assessment battery for patients with first-episode psychosis and to estimate the relationship between dimension scores and gender, age, education, diagnosis and symptoms.MethodEight frequently used neuropsychological tests were used. We tested 219 patients 3 months after start of therapy or at remission, whichever occurred first.ResultsWe identified five dimensions: working memory (WM); verbal learning (VL); executive function (EF); impulsivity (Im); and motor speed (MS). Significant findings were that the MS score was higher for men, and the WM and VL scores were correlated with years of education.ConclusionsNeurocognitive function in first-episode psychosis is described by at least five independent dimensions.
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20
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El-Adl M, Burke J, Little K. First-episode psychosis: primary care experience and implications for service development. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.108.019646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim and MethodsTo capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service. A survey of Northamptonshire general practitioners (GPs) using a confidential questionnaire was carried out.ResultsOut of 284 GPs, 123 (43%) responded. General practitioners are unlikely to start treatment before referring to a specialist service: 63 GPs (51% of responders) start treatment in 10% or less of individuals with first-episode psychosis and 19 (15.5%) GPs start treatment in 75% or more before referring them to psychiatric service; 42 GPs (34%) refer those who request/accept a referral and 66 GPs (53%) refer all even if they refuse. Overall, 92 GPs (74%) agreed that an early intervention in psychosis service is needed and 77 (63%) GPs welcome having a mental health clinic in their surgery.Clinical ImplicationsIndividuals are more likely to accept referral to a psychiatric service if offered than to ask for it. People disengaging, stigma, the service being difficult to access/inappropriate and carers' lack of knowledge about mental illness are the likely causes for delayed referral.
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21
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Davies EJ. Developmental aspects of schizophrenia and related disorders: possible implications for treatment strategies. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.106.002600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Schizophrenia and other schizophrenia-spectrum disorders are neurodevelopmental disorders which may share genetic susceptibility factors and represent differential expressions of an underlying vulnerability. Schizophrenia may have its onset in childhood and can be reliably diagnosed. However, developmental factors modulate disease expression in children. Although the prevalence of schizophrenia in childhood is low, children who develop schizophrenia in adult life may show subtle and non-specific developmental abnormalities, consistent with the neurodevelopmental hypothesis. Studies of the schizophrenia prodrome also demonstrate that abnormalities may be apparent years before the onset of positive symptoms. Such evidence raises the possibility of using preventive approaches in the treatment of schizophrenia. Further advances in our knowledge of the aetiopathology of schizophrenia (and the identification of endophenotypes within the group of schizophrenia and related disorders) may further improve our ability to predict disease development, making implementation of preventive interventions more achievable.
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22
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Friis S, Vaglum P, Haahr U, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, McGlashan TH. Effect of an early detection programme on duration of untreated psychosis. Br J Psychiatry 2018; 48:s29-32. [PMID: 16055804 DOI: 10.1192/bjp.187.48.s29] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundIt is unclear whether an early detection programme increases or decreases the number of patients with a long duration of untreated psychosis (DUP), and whether these differ from other patients with a long DUP.AimsTo investigate whether the number and characteristics of patients with a long DUP in the early detection programme differ from those with along DUP in the non-earlydetection programme.MethodWe compared the number and characteristics of patients with a DUP $2 years in an early detection area and a non-early detection area.ResultsThe early detection programme recruited slightly fewer patients with a long DUP than the non-early detection programme. The patients in the early detection programme had lower PANSS scores, but more frequently had a deteriorating course of premorbid social functioning.ConclusionsAn early detection programme does not seem to drain a pool of previously undetected patients with a long DUP. The patients in the early detection programme seem to have a lower symptom level at baseline and to have had a deteriorating premorbid social course.
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Affiliation(s)
- Svein Friis
- Department of Research and Education, Division of Psychiatry, Ullevål University Hospital, Oslo N-0407, Norway.
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23
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Berg JE. Psychometric testing of immigrants and natives in an acute psychiatry facility. Ment Illn 2017; 9:6987. [PMID: 29383216 PMCID: PMC5768086 DOI: 10.4081/mi.2017.6987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- John E Berg
- Faculty of Health Sciences, Oslo and Akershus University Hospital, Oslo, Norway
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24
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Mauri MC, Di Pace C, Reggiori A, Paletta S, Colasanti A. Primary psychosis with comorbid drug abuse and drug-induced psychosis: Diagnostic and clinical evolution at follow up. Asian J Psychiatr 2017; 29:117-122. [PMID: 29061407 DOI: 10.1016/j.ajp.2017.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 04/12/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022]
Abstract
The study reports a follow-up assessment of 48 patients with concomitant drug abuse at the first admission for psychosis. We focused on the diagnostic distinction between primary psychosis with concomitant drug abuse and drug induced psychosis, to observe whether the diagnoses are stable over time and whether the clinical course significantly differs. The study examined 25 primary psychotic disorder with comorbid drug abuse and 23 drug-induced psychotic disorder patients. Diagnostic and psychopathological assessments were made at baseline and at follow-up. Mean follow-up period was 4.96 years. Patients with comorbid Drug Abuse exhibited higher scores in the item Unusual Content of Thought at baseline than drug-induced psychotic disorder patients: 5.48 vs 4.39 while the two patients groups did not differ in any of the BPRS items evaluated at follow-up. The primary psychosis with comorbid drug abuse and the substance induced psychosis groups were similar regarding diagnostic stability, and a diagnosis of schizophrenia at follow-up occurred similarly. There was no evidence that Drug Induced psychotic patients' symptoms tend to improve more after cessation of drug abuse. An earlier age of onset was found in primary psychotic patients, particularly for patients diagnosed as affected by schizophrenia at follow up. These results might reflect the uncertainty of the distinction between Primary and Drug Induced Psychosis and the difficulties in applying the DSM IV-TR criteria for diagnosing comorbid drug use disorders and psychotic disorders.
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Affiliation(s)
- M C Mauri
- Psychopharmacology Unit, Clinical Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Di Pace
- Psychopharmacology Unit, Clinical Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Reggiori
- Psychopharmacology Unit, Clinical Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - S Paletta
- Psychopharmacology Unit, Clinical Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Colasanti
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Imanova Centre for Imaging Sciences, London, United Kingdom
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25
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"With a little help from my friends" social predictors of clinical recovery in first-episode psychosis. Psychiatry Res 2017; 255:209-214. [PMID: 28578180 DOI: 10.1016/j.psychres.2017.05.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/24/2017] [Accepted: 05/28/2017] [Indexed: 11/23/2022]
Abstract
Social functioning is a conglomerate of factors central to clinical recovery after a first-episode psychosis. There is a lack of studies investigating the relative impact of factors related to social interaction. Disentangling these could facilitate improvement of psychosocial interventions. This study aims to investigate the impact of social interactions on two-year clinical recovery in first-episode psychosis, by examining frequency and satisfaction of relationships with family and friends. A baseline sample of 178 first-episode psychosis individuals were followed up over two years regarding social functioning and clinical status. We longitudinally compared those who were to those who were not recovered using generalized estimating equations analyses. Our results showed that frequency of social interactions with friends was a significant positive predictor of clinical recovery over a two-year period. Perceived satisfaction with relationships, and frequency of family interaction did not show significant effects. We conclude that interaction with friends is a malleable factor that could be targeted for early intervention. This would facilitate protective factors through the preservation of existing social networks and thus reduce the risk of disability associated with long-term psychosis. Findings indicate that even individuals with an inclination towards social withdrawal and isolation could benefit from this type of intervention.
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26
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Weibell MA, Hegelstad WTV, Auestad B, Bramness J, Evensen J, Haahr U, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, McGorry P, Friis S. The Effect of Substance Use on 10-Year Outcome in First-Episode Psychosis. Schizophr Bull 2017; 43:843-851. [PMID: 28199703 PMCID: PMC5472130 DOI: 10.1093/schbul/sbw179] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Substance use is common in first-episode psychosis (FEP) and has been linked to poorer outcomes with more severe psychopathology and higher relapse rates. Early substance discontinuation appears to improve symptoms and function. However, studies vary widely in their methodology, and few have examined patients longitudinally, making it difficult to draw conclusions for practice and treatment. We aimed to investigate the relationship between substance use and early abstinence and the long-term course of illness in a representative sample of FEP patients. Out of 301 included patients, 266 could be divided into 4 groups based on substance use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users and nonusers. Differences in clinical and functional measures during the follow-up period were assessed using linear mixed effects models for the analysis of repeated measures data. Patients who stopped using substances within the first 2 years after diagnosis had outcomes similar to those who had never used with fewer symptoms than episodic or persistent users. Both episodic and persistent users had lower rates of symptom remission than nonusers, and persistent users also had more negative symptoms than those who stopped using. Our findings emerge from one of very few long-term longitudinal studies examining substance use cessation in FEP with 10-year follow-up. The results convey hope that the detrimental effects of substance abuse on mental health may be significantly reversed if one stops the abuse in time. This can help patients who struggle with addiction with their motivation to embrace abstinence.
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Affiliation(s)
- Melissa A. Weibell
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway;,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- SERAF, Norwegian Centre for Addiction Research, Oslo, Norway;,Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway;,Vestre Viken Hospital Trust, Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark;,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Per Vaglum
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia;,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Svein Friis
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Bjornestad J, Joa I, Larsen TK, Langeveld J, Davidson L, Ten Velden Hegelstad W, Anda LG, Veseth M, Melle I, Johannessen JO, Bronnick K. "Everyone Needs a Friend Sometimes" - Social Predictors of Long-Term Remission In First Episode Psychosis. Front Psychol 2016; 7:1491. [PMID: 27757090 PMCID: PMC5047905 DOI: 10.3389/fpsyg.2016.01491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background: Predictors of long-term symptomatic remission are crucial to the successful tailoring of treatment in first episode psychosis. There is lack of studies distinguishing the predictive effects of different social factors. This prevents a valid evaluating of their independent effects. Objectives: To test specific social baseline predictors of long-term remission. We hypothesized that first, satisfaction with social relations predicts remission; second, that frequency of social interaction predicts remission; and third, that the effect of friend relationship satisfaction and frequency will be greater than that of family relations satisfaction and frequency. Material and Methods: A sample of first episode psychosis (n = 186) completed baseline measures of social functioning, as well as clinical assessments. We compared groups of remitted and non-remitted individuals using generalized estimating equations analyses. Results: Frequency of social interaction with friends was a significant positive predictor of remission over a two-year period. Neither global perceived social satisfaction nor frequency of family interaction showed significant effects. Conclusions: The study findings are of particular clinical importance since frequency of friendship interaction is a possibly malleable factor. Frequency of interaction could be affected through behavioral modification and therapy already from an early stage in the course, and thus increase remission rates.
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Affiliation(s)
- Jone Bjornestad
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Network for Medical Sciences, University of StavangerStavanger, Norway
| | - Inge Joa
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Network for Medical Sciences, University of StavangerStavanger, Norway
| | - Tor K Larsen
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Section of Psychiatry, Department of Clinical Medicine, University of BergenBergen, Norway
| | - Johannes Langeveld
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University Hospital Stavanger, Norway
| | - Larry Davidson
- School of Medicine and Institution for Social and Policy Studies, Yale University, New Haven CT, USA
| | - Wenche Ten Velden Hegelstad
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University Hospital Stavanger, Norway
| | - Liss G Anda
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University Hospital Stavanger, Norway
| | - Marius Veseth
- Faculty of Health and Social Sciences, Bergen University College Bergen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, University of Oslo Oslo, Norway
| | - Jan O Johannessen
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Section of Psychiatry, Department of Clinical Medicine, University of BergenBergen, Norway
| | - Kolbjorn Bronnick
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Section of Psychiatry, Department of Clinical Medicine, University of BergenBergen, Norway
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28
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Kühl JOG, Laursen TM, Thorup A, Nordentoft M. The incidence of schizophrenia and schizophrenia spectrum disorders in Denmark in the period 2000-2012. A register-based study. Schizophr Res 2016; 176:533-539. [PMID: 27341953 DOI: 10.1016/j.schres.2016.06.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION We aimed to examine changes over time in the incidence of broad and narrow schizophrenia spectrum disorders in Denmark from 2000 to 2012. METHODS Patients were classified as incident schizophrenia if registered with a first time in- or outpatient contact with relevant diagnostic codes in the Danish Psychiatric Central Register between 2000 and 2012. Their history of contacts was traced back to 1969. Broad schizophrenia included schizophrenia, schizotypal disorder, persistent delusional disorder, acute and transient psychotic disorders, schizoaffective disorders, and other nonorganic and unspecified psychotic disorders, (ICD 10 codes F20-F29). Narrow schizophrenia was defined with the ICD 10 codes F20.0-F20.9. Incidence rates (IR) and incidence rate ratios (IRR) were calculated using Poisson regression. RESULTS The IRR for broad schizophrenia increased by 1.43 (CI 95% 1.34-1.52) for females and 1.26 (CI 95% 1.20-1.33) for males. IRR for narrow schizophrenia increased by 1.36 (CI 95% 1.24-1.48) for females and 1.20 (CI 95% 1.11-1.29) for males. There was a significantly increased incidence in patients up to 32years of age. This was mainly explained by a significant 2-3 fold increase in outpatient incidence. We found a significant decrease in IRR for patients with broad and narrow schizophrenia aged 33 or older for both in- and outpatients. CONCLUSION The increased incidence of schizophrenia could partly be explained by better implementation of the diagnostic criteria for schizophrenia in child and adolescent psychiatry and improved access to early intervention services, but a true increase in incidence of schizophrenia cannot be excluded. The decrease of incidence in the older age group could indicate that the national Danish early intervention strategy was successful.
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Affiliation(s)
- Johanne Olivia Grønne Kühl
- Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Aarhus University, Denmark; iPSYCH The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Denmark
| | - Anne Thorup
- Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Child and Adolescent Mental Health Services, Capital Region of Denmark, Denmark; iPSYCH The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; iPSYCH The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Denmark.
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29
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Lutgens D, Malla A, Joober R, Iyer S. The impact of caregiver familiarity with mental disorders on timing of intervention in first-episode psychosis. Early Interv Psychiatry 2015; 9:388-96. [PMID: 24472653 DOI: 10.1111/eip.12121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 12/07/2013] [Indexed: 11/28/2022]
Abstract
AIM Based on prior research, we hypothesized that personal or family familiarity with psychosis would have a different effect on pathways to care as compared to personal or family familiarity with mental disorders. METHODS Caregivers of 32 patients receiving treatment for a first episode of psychosis at a specialized early intervention centre provided information regarding their familiarity with psychosis and mental disorders. Information on the duration of untreated psychosis (DUP) and on the duration of untreated illness (DUI) was collected from patients and their caregivers. RESULTS Although we found a trend in the direction of lowered DUP and longer DUI for those with personal or family familiarity with psychosis, these effects were not statistically significant. A trend was found for a higher DUI for those with personal or family familiarity with mental disorders in general, but this effect was not significant. CONCLUSION We did not find that differential familiarity with mental disorders and by extension, personal or family familiarity, affected measures of delay in treatment of a first episode of psychosis. Trends in our findings in the hypothesized directions suggest that a larger sample size may reveal significant differential effects of previous experience with mental disorders in general and psychosis in particular on delay in help seeking during different phases of the illness.
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Affiliation(s)
- Danyael Lutgens
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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30
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Schürhoff F, Fond G, Berna F, Bulzacka E, Vilain J, Capdevielle D, Misdrahi D, Leboyer M, Llorca PM. A National network of schizophrenia expert centres: An innovative tool to bridge the research-practice gap. Eur Psychiatry 2015; 30:728-35. [PMID: 26072427 DOI: 10.1016/j.eurpsy.2015.05.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 12/20/2022] Open
Abstract
Schizophrenia is probably the most severe psychiatric disorder with much suffering for the patients and huge costs for the society. Efforts to provide optimal care by general practitioners and psychiatrists are undermined by the complexity of the disorder and difficulties in applying clinical practice guidelines and new research findings to the spectrum of cases seen in day-to-day practice. An innovative model of assessment aimed at improving global care of people with schizophrenia provided by the French national network of schizophrenia expert centres is being described. Each centre has established strong links to local health services and provides support to clinicians in delivering personalized care plans. A common set of assessment tools has been adopted by the ten centres spread over the whole French territory. A web application, e-schizo(©) has been created to record data in a common computerized medical file. This network offers systematic, comprehensive, longitudinal, and multi-dimensional assessments of cases including a medical workup and an exhaustive neuropsychological evaluation. This strategy offers an effective way to transfer knowledge and share expertise. This network is a great opportunity to improve the global patient care and is conceived as being an infrastructure for research from observational cohort to translational research.
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Affiliation(s)
- F Schürhoff
- Inserm, U955, psychopathologie et génétique des maladies psychiatriques, 94000 Créteil, France; Faculté de médecine, université Paris-Est, 94000 Créteil, France; DHU PePSY, pôle de psychiatrie, hôpitaux universitaires Henri-Mondor, AP-HP, 94000 Créteil, France; Fondation FondaMental, 94000 Créteil, France.
| | - G Fond
- Inserm, U955, psychopathologie et génétique des maladies psychiatriques, 94000 Créteil, France; Faculté de médecine, université Paris-Est, 94000 Créteil, France; DHU PePSY, pôle de psychiatrie, hôpitaux universitaires Henri-Mondor, AP-HP, 94000 Créteil, France; Fondation FondaMental, 94000 Créteil, France
| | - F Berna
- Fondation FondaMental, 94000 Créteil, France; Clinique psychiatrique, hôpital Civil, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France
| | - E Bulzacka
- Inserm, U955, psychopathologie et génétique des maladies psychiatriques, 94000 Créteil, France; Faculté de médecine, université Paris-Est, 94000 Créteil, France; DHU PePSY, pôle de psychiatrie, hôpitaux universitaires Henri-Mondor, AP-HP, 94000 Créteil, France; Fondation FondaMental, 94000 Créteil, France
| | - J Vilain
- Inserm, U955, psychopathologie et génétique des maladies psychiatriques, 94000 Créteil, France; Faculté de médecine, université Paris-Est, 94000 Créteil, France; DHU PePSY, pôle de psychiatrie, hôpitaux universitaires Henri-Mondor, AP-HP, 94000 Créteil, France; Fondation FondaMental, 94000 Créteil, France
| | - D Capdevielle
- Fondation FondaMental, 94000 Créteil, France; Service universitaire de psychiatrie adulte, université Montpellier 1, hôpital de la Colombière, CHU de Montpellier, 34090 Montpellier, France; Inserm U-888, 34093 Montpellier, France
| | - D Misdrahi
- Fondation FondaMental, 94000 Créteil, France; Pôle de psychiatrie 347, centre hospitalier Charles-Perrens, 33076 Bordeaux cedex, France; CNRS UMR 5287-INCIA, université de Bordeaux 2, 33076 Bordeaux, France
| | - M Leboyer
- Inserm, U955, psychopathologie et génétique des maladies psychiatriques, 94000 Créteil, France; Faculté de médecine, université Paris-Est, 94000 Créteil, France; DHU PePSY, pôle de psychiatrie, hôpitaux universitaires Henri-Mondor, AP-HP, 94000 Créteil, France; Fondation FondaMental, 94000 Créteil, France
| | - P-M Llorca
- Fondation FondaMental, 94000 Créteil, France; Service psychiatrie et addictologie de l'adulte CMP B, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; EA 7280 UFR médecine, université Clermont 1, 63000 Clermont-Ferrand, France
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McFarlane WR, Levin B, Travis L, Lucas FL, Lynch S, Verdi M, Williams D, Adelsheim S, Calkins R, Carter CS, Cornblatt B, Taylor SF, Auther AM, McFarland B, Melton R, Migliorati M, Niendam T, Ragland JD, Sale T, Salvador M, Spring E. Clinical and functional outcomes after 2 years in the early detection and intervention for the prevention of psychosis multisite effectiveness trial. Schizophr Bull 2015; 41:30-43. [PMID: 25065017 PMCID: PMC4266296 DOI: 10.1093/schbul/sbu108] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth. METHODS In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures. RESULTS A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025). CONCLUSION FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis.
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Affiliation(s)
- William R. McFarlane
- Tufts University School of Medicine, Boston, MA;,Maine Medical Center Research Institute, Portland, ME;,*To whom correspondence should be addressed; Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, US; tel: 207-662-4348, e-mail:
| | - Bruce Levin
- Mailman School of Public Health, Columbia University, New York, NY
| | - Lori Travis
- Maine Medical Center Research Institute, Portland, ME
| | - F. Lee Lucas
- Maine Medical Center Research Institute, Portland, ME
| | - Sarah Lynch
- Maine Medical Center Research Institute, Portland, ME
| | - Mary Verdi
- Maine Medical Center Research Institute, Portland, ME
| | | | - Steven Adelsheim
- Department of Psychiatry, Stanford University School Of Medicine, Palo, Alto, CA
| | | | - Cameron S. Carter
- Department of Psychiatry, University of California at Davis, Sacramento, CA
| | | | - Stephan F. Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, MI;,Washtenaw Community Health Organization, Ypsilanti, MI
| | | | - Bentson McFarland
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR
| | | | | | - Tara Niendam
- Department of Psychiatry, University of California at Davis, Sacramento, CA
| | - J. Daniel Ragland
- Department of Psychiatry, University of California at Davis, Sacramento, CA
| | - Tamara Sale
- Portland State University, Portland, OR;,Mid-Valley Behavioral Care Network, Salem, OR
| | - Melina Salvador
- Department of Psychiatry, Stanford University School Of Medicine, Palo, Alto, CA
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Lin J, Lee EHM, Tong CY, Lee JTM, Chen EYH. Therapeutic potentials of mind–body interventions for psychosis. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/cpr.14.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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A controlled evaluation of a targeted early case detection intervention for reducing delay in treatment of first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1711-8. [PMID: 24902532 DOI: 10.1007/s00127-014-0893-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Interventions aimed at influencing specific pathways to care may reduce the duration of untreated psychosis (DUP). The purpose of this study was to reduce delay in referral to an early intervention service following first contact for help seeking for psychosis in a defined urban catchment area. METHODS Using a historical control design, we conducted a targeted intervention comprised of intensive training and education regarding first onset of psychosis and benefits of early intervention with all potential points of contact in pathways to care in a defined catchment area of a specialized early intervention (EI) service. Data collected on different components of DUP [help seeking (H-DUP) and referral (R-DUP)] and demographic and clinical characteristics on patients seeking treatment of first episode of a psychotic (FEP) disorder accepted in the EI service for 3 years before and 3 years after the intervention were contrasted. No other systemic changes occurred in this catchment area during this period. RESULTS There was a significant increase in the number of cases of FEP referred to the EI service post-intervention from hospitals other than the parent institute, in the proportion with a diagnosis of affective psychosis and proportion of patients from a lower socioeconomic status (SES). Although largest proportion of patients continued to make their first contact with community services, the latter failed to refer cases of psychosis to the EI service despite making a large number of mostly non-cases (for psychosis). The intervention had no direct effect on total DUP, R-DUP or H-DUP. After controlling for diagnosis and SES, post-intervention, R-DUP remained significantly lower for patients making first contact with the emergency service of the parent institute. CONCLUSIONS The intervention failed to reduce R-DUP for patients making contact with or referred from community services and most patients still used hospital resources to enter treatment at the EI service.
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ten Velden Hegelstad W, Joa I, Barder H, Evensen J, Haahr U, Johannessen JO, Langeveld J, Melle I, Opjordsmoen S, Røssberg JI, Rund BR, Simonsen E, Vaglum P, McGlashan T, Friis S, Larsen TK. Variation in duration of untreated psychosis in an 18-year perspective. Early Interv Psychiatry 2014; 8:323-31. [PMID: 23773272 PMCID: PMC3870041 DOI: 10.1111/eip.12057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 05/04/2013] [Indexed: 12/01/2022]
Abstract
AIM The Scandinavian TIPS project engineered an early detection of psychosis programme that sought to reduce the duration of untreated psychosis (DUP) through early detection teams and extensive information campaigns since 1997. In 1997-2000, DUP was reduced from 26 to 4.5 weeks median. The programme was continued beyond the initial project in modified forms for over 13 years. The aim of this study was to track the vicissitudes of DUP over an 18-year period (1993-2010) with differing early detection efforts in a defined catchment area. METHOD The DUP of all patients meeting criteria for first episode psychosis was measured 1993-1994 and from 1997 to 2010 in a naturalistic long-term study. DUP values of all patients were included, irrespective of patients' participation in a clinical follow-up study, yielding a highly representative sample. RESULTS DUP varied across studies with differing information campaign intensity and content. These variations will be described and explored. CONCLUSIONS Early detection campaigns should have a stable focus and high intensity level. Future research should further elucidate pathways to care in order to establish principal targets for information campaigns.
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Affiliation(s)
- Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Norway; Faculty of Psychology, University of Bergen, Bergen
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Fraguas D, Del Rey-Mejías A, Moreno C, Castro-Fornieles J, Graell M, Otero S, Gonzalez-Pinto A, Moreno D, Baeza I, Martínez-Cengotitabengoa M, Arango C, Parellada M. Duration of untreated psychosis predicts functional and clinical outcome in children and adolescents with first-episode psychosis: a 2-year longitudinal study. Schizophr Res 2014; 152:130-8. [PMID: 24332406 DOI: 10.1016/j.schres.2013.11.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/01/2013] [Accepted: 11/12/2013] [Indexed: 11/30/2022]
Abstract
Longer duration of untreated psychosis (DUP) in adult patients with first-episode psychosis (FEP) has been associated with poor clinical and social outcomes. We aimed to estimate the influence of DUP on outcome at 2-year follow-up in subjects with an early-onset (less than 18 years of age) FEP of less than 6 months' duration. A total of 80 subjects (31.3% females, mean age 16.0±1.8 years) were enrolled in the study. The influence of DUP on outcome was estimated using multiple regression models (two linear models for influence of DUP on the C-GAF at 2 years and C-GAF change through the follow-up period, and a logistic model for influence of DUP on 41 PANSS remission at 2 years in schizophrenia patients (n=47)). Mean DUP was 65.3±54.7 days. Median DUP was 49.5 days. For the whole sample (n=80), DUP was the only variable significantly related to C-GAF score at 2-year follow-up (Beta=-0.13, p<0.01), while DUP and premorbid adjustment (Beta=-0.01, p<0.01; and Beta=-0.09, p=0.04, respectively) were the only variables significantly related to C-GAF change. In schizophrenia patients, DUP predicted both C-GAF score at 2 years and C-GAF change, while in patients with affective psychosis (n=22), DUP was unrelated to outcome. Lower baseline C-GAF score (OR=0.91, p<0.01) and shorter DUP (OR=0.98, p=<0.01) were the only variables that significantly predicted clinical remission in schizophrenia patients. In conclusion, longer DUP was associated with lower C-GAF at 2 years, less increase in C-GAF, and lower rates of clinical remission in early-onset FEP. Our findings support the importance of early detection programs, which help shorten DUP.
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Affiliation(s)
- David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - Angel Del Rey-Mejías
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR-111, CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clínic of Barcelona, Spain; Department of Psychiatry and Psychobiology, University of Barcelona, Spain
| | - Montserrat Graell
- Section of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Soraya Otero
- Child Psychiatry Unit, Hospital Universitario Marqués de Valdecilla, CIBERSAM, Santander, Spain
| | - Ana Gonzalez-Pinto
- Mood Disorders Research Center, 03-RC-003, Hospital Santiago Apóstol, Vitoria, CIBERSAM, Spain
| | - Dolores Moreno
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, SGR-111, CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clínic of Barcelona, Spain; Department of Psychiatry and Psychobiology, University of Barcelona, Spain
| | | | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
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Weibell MA, Joa I, Bramness J, Johannessen JO, McGorry PD, ten Velden Hegelstad W, Larsen TK. Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area. BMC Psychiatry 2013; 13:319. [PMID: 24279887 PMCID: PMC4222718 DOI: 10.1186/1471-244x-13-319] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/18/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Substance misuse is a well-recognized co-morbidity to psychosis and has been linked to poor prognostic outcomes in patients. Researchers have yet to investigate the difference in rates and characteristics between first-episode Substance Induced Psychosis (SIP) and primary psychosis. We aimed at comparing patients with SIP to primary psychosis patients with or without substance misuse at baseline. METHODS Thirty SIP patients, 45 primary psychosis patients with substance misuse (PS) and 66 primary psychosis patients without substance misuse (PNS) in a well-defined Norwegian catchment area were included from 2007-2011. Assessments included symptom levels (PANSS), diagnostic interviews (SCID), premorbid function scale (PAS) and global functioning (GAF f/s). RESULTS Treated incidence for SIP was found to be 6.5/100 000 persons per year, 9.7/100 000 persons per year for PS and 24.1/100 000 persons per year for PNS (15-65 yrs). Patients who had substance misuse (PS and SIP) were more likely to be male. Duration of Untreated Psychosis (DUP) was significantly shorter in the SIP group (5.0 wks., p = 0.003) and these had more positive symptoms on the PANSS (p = 0.049). SIP patients also did poorer on early youth academic levels on the PAS. CONCLUSIONS Yearly treated incidence of SIP is 6.5/100 000 persons per year in a Norwegian catchment area. SIP patients have short DUPs, are more likely to be male, have more positive symptoms at baseline and poorer premorbid academic scores in early adolescence. Follow-up will evaluate stability of diagnosis and characteristics.
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Affiliation(s)
- Melissa A Weibell
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway.
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway,Faculty of Social Sciences, Institute of Health, University of Stavanger, Kjell Arholmsgt 41, 4021 Stavanger, Norway
| | - Jørgen Bramness
- Norwegian Centre for Addiction Research, University of Oslo, P.O box 1039, 0315 Oslo, Norway,Norwegian Institute of Public Health, P.O. box 4404, 0403 Oslo, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway,Faculty of Social Sciences, Institute of Health, University of Stavanger, Kjell Arholmsgt 41, 4021 Stavanger, Norway
| | - Patrick D McGorry
- ORYGEN Research Centre, University of Melbourne, Locked bag 10, Parkville, Melbourne, VIC 3052, Australia
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway
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Chien WT, Leung SF, Yeung FK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatr Dis Treat 2013; 9:1463-81. [PMID: 24109184 PMCID: PMC3792827 DOI: 10.2147/ndt.s49263] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients' long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.
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Affiliation(s)
- Wai Tong Chien
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Hayes SL, Mann MK, Morgan FM, Kelly MJ, Weightman AL. Collaboration between local health and local government agencies for health improvement. Cochrane Database Syst Rev 2012; 10:CD007825. [PMID: 23076937 PMCID: PMC9936257 DOI: 10.1002/14651858.cd007825.pub6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In many countries, national, regional and local inter- and intra-agency collaborations have been introduced to improve health outcomes. Evidence is needed on the effectiveness of locally developed partnerships which target changes in health outcomes and behaviours. OBJECTIVES To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes in any population or age group. SEARCH METHODS We searched the Cochrane Public Health Group Specialised Register, AMED, ASSIA, CENTRAL, CINAHL, DoPHER, EMBASE, ERIC, HMIC, IBSS, MEDLINE, MEDLINE In-Process, OpenGrey, PsycINFO, Rehabdata, Social Care Online, Social Services Abstracts, Sociological Abstracts, TRoPHI and Web of Science from 1966 through to January 2012. 'Snowballing' methods were used, including expert contact, citation tracking, website searching and reference list follow-up. SELECTION CRITERIA Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) where the study reported individual health outcomes arising from interagency collaboration between health and local government agencies compared to standard care. Studies were selected independently in duplicate, with no restriction on population subgroup or disease. DATA COLLECTION AND ANALYSIS Two authors independently conducted data extraction and assessed risk of bias for each study. MAIN RESULTS Sixteen studies were identified (28,212 participants). Only two were considered to be at low risk of bias. Eleven studies contributed data to the meta-analyses but a narrative synthesis was undertaken for all 16 studies. Six studies examined mental health initiatives, of which one showed health benefit, four showed modest improvement in one or more of the outcomes measured but no clear overall health gain, and one showed no evidence of health gain. Four studies considered lifestyle improvements, of which one showed some limited short-term improvements, two failed to show health gains for the intervention population, and one showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies considered chronic disease management and all failed to demonstrate health gains. Three studies considered environmental improvements and adjustments, of which two showed some health improvements and one did not.Meta-analysis of three studies exploring the effect of collaboration on mortality showed no effect (pooled relative risk of 1.04 in favour of control, 95% CI 0.92 to 1.17). Analysis of five studies (with high heterogeneity) looking at the effect of collaboration on mental health resulted in a standardised mean difference of -0.28, a small effect favouring the intervention (95% CI -0.51 to -0.06). From two studies, there was a statistically significant but clinically modest improvement in the global assessment of function symptoms score scale, with a pooled mean difference (on a scale of 1 to 100) of -2.63 favouring the intervention (95% CI -5.16 to -0.10).For physical health (6 studies) and quality of life (4 studies) the results were not statistically significant, the standardised mean differences were -0.01 (95% CI -0.10 to 0.07) and -0.08 (95% CI -0.44 to 0.27), respectively. AUTHORS' CONCLUSIONS Collaboration between local health and local government is commonly considered best practice. However, the review did not identify any reliable evidence that interagency collaboration, compared to standard services, necessarily leads to health improvement. A few studies identified component benefits but these were not reflected in overall outcome scores and could have resulted from the use of significant additional resources. Although agencies appear enthusiastic about collaboration, difficulties in the primary studies and incomplete implementation of initiatives have prevented the development of a strong evidence base. If these weaknesses are addressed in future studies (for example by providing greater detail on the implementation of programmes; using more robust designs, integrated process evaluations to show how well the partners of the collaboration worked together, and measurement of health outcomes) it could provide a better understanding of what might work and why. It is possible that local collaborative partnerships delivering environmental Interventions may result in health gain but the evidence base for this is very limited.Evaluations of interagency collaborative arrangements face many challenges. The results demonstrate that collaborative community partnerships can be established to deliver interventions but it is important to agree goals, methods of working, monitoring and evaluation before implementation to protect programme fidelity and increase the potential for effectiveness.
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Affiliation(s)
- Sara L Hayes
- Abertawe Bro Morgannwg University Health BoardABM Headquarters1 Talbot GatewayPort TalbotUKSA12 7BR
| | - Mala K Mann
- Information Services, Cardiff UniversitySupport Unit for Research Evidence (SURE)1st Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Fiona M Morgan
- Information Services, Cardiff UniversitySupport Unit for Research Evidence (SURE)1st Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Mark J Kelly
- Cardiff University School of MedicineSouth East Wales Trials Unit, Institute of Translation, Innovation Methodologies & EngagementNeuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Alison L Weightman
- Information Services, Cardiff UniversitySupport Unit for Research Evidence (SURE)1st Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
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McGlashan TH. Treatment timing vs treatment type in first-episode psychosis: a paradigm shift in strategy and effectiveness. Schizophr Bull 2012; 38:902-3. [PMID: 22987846 PMCID: PMC3446230 DOI: 10.1093/schbul/sbs102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Evensen J, Røssberg JI, Barder H, Haahr U, Hegelstad WTV, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, Friis S. Flat affect and social functioning: a 10 year follow-up study of first episode psychosis patients. Schizophr Res 2012; 139:99-104. [PMID: 22627124 DOI: 10.1016/j.schres.2012.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/30/2012] [Accepted: 04/30/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Affective flattening has been described as enduring, but long term follow-up studies of first episode psychosis patients are lacking. OBJECTIVE The aim of this study was to follow the symptom development of flat affect (FA), over a 10 year follow-up period, with focus on prevalence, predictors and outcome factors including social functioning. METHODS Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. These were followed on PANSS item N1 (FA) from baseline through 5 follow-up assessments over 10 years. Patients were grouped as having never-present, improving, deteriorating, fluctuating or enduring FA. The groups were compared on baseline variables, variables at 10 year follow-up, and social functioning throughout the follow-up period. RESULTS Twenty nine percent never displayed FA, 66% had improving, deteriorating or fluctuating FA, while 5% of patients had enduring FA. Premorbid social function predicted enduring FA. The patients with enduring, fluctuating and deteriorating FA did poorer on all outcome variables, including remission and recovery rates. The enduring FA group did significantly poorer in social functioning over the 10 year period. CONCLUSIONS FA is expressed at some point of time in the majority of FEP patients in a 10 year follow-up period, and appears more fluctuant than expected from the relevant literature. FA is associated with poorer outcome after 10 years, and enduring FA to poorer social function at all points of assessment.
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Affiliation(s)
- Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, N-0407, Oslo, Norway.
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Cascio MT, Cella M, Preti A, Meneghelli A, Cocchi A. Gender and duration of untreated psychosis: a systematic review and meta-analysis. Early Interv Psychiatry 2012; 6:115-27. [PMID: 22380467 DOI: 10.1111/j.1751-7893.2012.00351.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Duration of untreated psychosis (DUP) can influence the prognosis of schizophrenia. Previous studies have suggested that gender may influence the length of DUP. This study reports the result of the first systematic literature review and meta-analysis on the role of gender in influencing DUP in first-episode psychosis. METHOD Systematic literature search in PubMed/Medline and Ovid/PsychINFO. Twenty-seven studies presenting data on 4721 patients diagnosed with psychosis at their first episode (2834 males and 1887 females) were included in the analysis. RESULTS Samples had a higher proportion of males: odds ratio = 2.5 (95% confidence interval: 1.8-3.3). Mean age at first contact was 25.4 for males and 27.5 for females. Patients from non-Western countries were older at first contact than patients from Western countries. Average DUP in schizophrenia was 64 weeks and did not differ between genders but was shorter in Western compared with non-Western countries. CONCLUSION Earlier age at first contact and larger incidence in males support the existence of specific gender differences in first-episode psychosis; however, these are not associated with DUP length.
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Affiliation(s)
- Maria Teresa Cascio
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
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Apathy in first episode psychosis patients: a ten year longitudinal follow-up study. Schizophr Res 2012; 136:19-24. [PMID: 22285655 DOI: 10.1016/j.schres.2011.12.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/12/2011] [Accepted: 12/25/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored. OBJECTIVE The aims of the study were twofold: 1) to examine prevalence and predictors of apathy at 10 years, and 2) to examine the relationship between apathy at 10 years and concurrent symptoms, functioning and outcome, including subjective quality of life. METHODS Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. Of these, 178 patients completed the Apathy Evaluation Scale (AES-S-Apathy). Patients were classified as having apathy (AES-S-Apathy≥27) or not. The relationship between apathy and baseline variables (Demographics, Diagnosis, Duration of Untreated Psychosis), measures of symptomatology (Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning Scale, Strauss Carpenter Level of Functioning Scale) and subjective quality of life (Lehman's Quality of Life Interview) were estimated through correlation analyses and blockwise multiple hierarchical regression analysis. RESULTS Nearly 30% of patients met the threshold for being apathetic at follow-up. No baseline variables predicted apathy significantly at 10 years. Apathy was found to contribute independently to functioning and subjective quality of life, even when controlling for other significant correlates. CONCLUSIONS Apathy is a common symptom in a FEP cohort 10 years after illness debut, and its presence relates to impaired functioning and poorer subjective quality of life.
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Chen EYH, Tang JYM, Hui CLM, Chiu CPY, Lam MML, Law CW, Yew CWS, Wong GHY, Chung DWS, Tso S, Chan KPM, Yip KC, Hung SF, Honer WG. Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Early Interv Psychiatry 2011; 5:315-23. [PMID: 21726421 DOI: 10.1111/j.1751-7893.2011.00279.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Although phase-specific early intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early intervention in first-episode psychosis. METHOD In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal behaviour and service utilization from clinical records. RESULTS Patients in the early intervention group had longer full-time employment or study (P<0.001), fewer days of hospitalization (P<0.001), less severe positive symptoms (P=0.006), less severe negative symptoms (P =0.001), fewer suicides (P=0.009) and fewer disengagements (P=0.002) than the historical control group. Additionally, more patients in the early intervention group experienced a period of recovery (P=0.001), but the two groups had similar rates of relapse (P=0.08) and durations of untreated psychosis (P=0.72). CONCLUSIONS The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate of relapse.
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Affiliation(s)
- Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital Department of Psychiatry, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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Hayes SL, Mann MK, Morgan FM, Kitcher H, Kelly MJ, Weightman AL. Collaboration between local health and local government agencies for health improvement. Cochrane Database Syst Rev 2011:CD007825. [PMID: 21678371 DOI: 10.1002/14651858.cd007825.pub5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In many countries, national, regional and local inter- and intra-agency collaborations have been introduced in order to improve health outcomes. Evidence is needed on the effectiveness of locally-developed partnerships which target changes in individual health outcomes and behaviours. OBJECTIVES To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes. SEARCH STRATEGY Twenty-five databases were searched using a highly sensitive search strategy. 'Snowballing' methods were also used, including expert contact, website searching and reference list follow up. SELECTION CRITERIA Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) where the study reported on interagency collaboration between health and local government agencies. Studies were selected independently in duplicate by two of five authors. DATA COLLECTION AND ANALYSIS From the team of five review authors, two authors independently conducted data extraction and assessed risk of bias for each study. MAIN RESULTS Eleven studies were identified, presenting information on a total of 26,686 participants. Owing to the heterogeneity between studies a narrative synthesis was undertaken. The included studies covered a range of topics. Six studies examined mental health initiatives, of which one study showed health benefit; four showed modest improvement in one or more of the outcomes measured, but no clear overall health gain; and one study showed no evidence of health gain. Two studies were related to lifestyle improvements of which one failed to show health gains for the intervention population, while the other showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies were related to chronic disease management and all three failed to demonstrate health gains. AUTHORS' CONCLUSIONS Collaboration between local health and local government is commonly considered best practice. However, the review did not identify any reliable evidence that inter‑agency collaboration, compared to standard services, leads to health improvement. A few studies identified component benefits but these were not reflected in overall outcome scores and could have resulted from the use of significant additional resources. Although agencies appear enthusiastic about collaboration, methodological flaws in the primary studies and incomplete implementation of initiatives have prevented the development of a strong evidence base. If these flaws are addressed in future studies (for example by providing greater detail on the implementation of programs, using more robust designs, with integrated process evaluations and measurement of health outcomes) it could provide a better understanding of what might work and why.When updating this review, we will analyse any partnership or process evaluations of our included studies to try to identify markers of success in local collaborative partnerships that could inform policy developments in the future.
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Affiliation(s)
- Sara L Hayes
- on secondment to Department of Public Health and Health Professions, Welsh Assembly Government, 4th Floor North Wing, Welsh Assembly Government, Cathays Park, Cardiff, Wales, UK, CF10 3NQ
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Álvarez-Jiménez M, Parker AG, Hetrick SE, McGorry PD, Gleeson JF. Preventing the second episode: a systematic review and meta-analysis of psychosocial and pharmacological trials in first-episode psychosis. Schizophr Bull 2011; 37:619-30. [PMID: 19900962 PMCID: PMC3080698 DOI: 10.1093/schbul/sbp129] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The majority of first-episode psychosis (FEP) patients reach clinical remission; however, rates of relapse are high. This study sought to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness of pharmacological and non-pharmacological interventions to prevent relapse in FEP patients. METHODS Systematic review and meta-analysis of RCTs. RESULTS Of 66 studies retrieved, 18 were eligible for inclusion. Nine studies investigated psychosocial interventions and 9 pharmacological treatments. The analysis of 3 RCTs of psychosocial interventions comparing specialist FEP programs vs treatment as usual involving 679 patients demonstrated the former to be more effective in preventing relapse (odds ratio [OR]=1.80, 95% confidence interval [CI]=1.31-2.48; P<.001; number needed to treat [NNT]=10). While the analysis of 3 different cognitive-behavioral studies not specifically intended at preventing relapse showed no further benefits compared with specialist FEP programs (OR=1.95, 95% CI=0.76-5.00; P=.17), the combination of specific individual and family intervention targeted at relapse prevention may further improve upon these outcomes (OR=4.88, 95% CI=0.97-24.60; P=.06). Only 3 small studies compared first-generation antipsychotics (FGAs) with placebo with no significant differences regarding relapse prevention although all individual estimates favored FGAs (OR=2.82, 95% CI=0.54-14.75; P=.22). Exploratory analysis involving 1055 FEP patients revealed that relapse rates were significantly lower with second-generation antipsychotics (SGAs) compared with FGAs (OR=1.47, 95% CI=1.07-2.01; P<.02; NNT=10). CONCLUSIONS Specialist FEP programs are effective in preventing relapse. Cognitive-based individual and family interventions may need to specifically target relapse to obtain relapse prevention benefits that extend beyond those provided by specialist FEP programs. Overall, the available data suggest that FGAs and SGAs have the potential to reduce relapse rates. Future trials should examine the effectiveness of placebo vs antipsychotics in combination with intensive psychosocial interventions in preventing relapse in the early course of psychosis. Further studies should identify those patients who may not need antipsychotic medication to be able to recover from psychosis.
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Affiliation(s)
- Mario Álvarez-Jiménez
- Department of Psychiatry, “Marques de Valdecilla” Public Foundation–Research Institute (FMV-IFIMAV) Av. Valdecilla s/n, 39009, Santander, Spain,ORYGEN Youth Health Research Centre, 35 Poplar Road, Parkville, Melbourne, Victoria 3054, Australia,ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia,To whom correspondence should be addressed; tel: 03-9342-2800, e-mail:
| | - Alexandra G. Parker
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah E. Hetrick
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D. McGorry
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - John F. Gleeson
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia,Department of Psychology, The University of Melbourne and Northwestern Mental Health Program, Melbourne, Victoria, Australia
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Early intervention in psychosis: specialized intervention and early case identification. Encephale 2011; 36 Suppl 3:S38-45. [PMID: 21095391 DOI: 10.1016/s0013-7006(10)70029-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Specialized early intervention (SEI) approach to treatment of a First Episode of Psychosis (FEP) consists of two equally important components, namely, a phase specific treatment program and early case identification. In this article we report a brief update on our knowledge about both aspects of SEI services. We then provide a description of a prototypical SEI service within the Canadian context, examine the pathways to care for patients with FEP and report on different methods of reducing delay in treatment. We also provide a description of a novel method of reducing delay in treatment using principles of academic detailing targeting all health care and educational services within a defined catchment area in combination with quick access to the SEI service.
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Evensen J, Røssberg JI, Haahr U, ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld H, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Sundet K, Vaglum P, Friis S, McGlashan T. Contrasting monosymptomatic patients with hallucinations and delusions in first-episode psychosis patients: a five-year longitudinal follow-up study. Psychopathology 2011; 44:90-7. [PMID: 21228615 PMCID: PMC3031149 DOI: 10.1159/000319789] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 07/29/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The main aim of this study was to identify subgroups of patients characterized by having hallucinations only or delusions only and to examine whether these groups differed with regard to demographic characteristics, clinical characteristics and outcome factors, including suicidality. METHODS Out of 301 consecutively admitted patients with first-episode psychosis, individuals with delusions only (D) and hallucinations only (H) were identified based on Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations) scores at baseline and through 4 follow-up interviews over 5 years. The subgroups were compared with regard to demographic data, premorbid functioning, duration of untreated psychosis, clinical variables, time to remission and suicidality. RESULTS Two groups of patients were identified; H (n = 16) and D (n = 106). 179 patients experienced both hallucinations and delusions (dual symptom group). The H group was significantly younger, had a longer duration of untreated psychosis, poorer premorbid function and better insight than the D group. Notably, the H group scored higher on measures of suicidality, and at 5 years follow-up a significantly higher proportion of patients was lost to suicide in this group. The dual symptom group was closer to the D group on significant parameters, including suicidality and suicide rate. CONCLUSIONS Patients with hallucinations only can be separated from patients with delusions only and the subgroups differ with regard to demographical data, clinical variables and notably with regard to suicidality. These findings suggest distinctions in the underlying biological and psychological processes involved in hallucinations and in delusions.
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Affiliation(s)
- Julie Evensen
- Division of Psychiatry, Oslo University Hospital, Oslo, Norway.
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Baharnoori M, Bartholomeusz C, Boucher AA, Buchy L, Chaddock C, Chiliza B, Föcking M, Fornito A, Gallego JA, Hori H, Huf G, Jabbar GA, Kang SH, El Kissi Y, Merchán-Naranjo J, Modinos G, Abdel-Fadeel NA, Neubeck AK, Ng HP, Novak G, Owolabi O, Prata DP, Rao NP, Riecansky I, Smith DC, Souza RP, Thienel R, Trotman HD, Uchida H, Woodberry KA, O'Shea A, DeLisi LE. The 2nd Schizophrenia International Research Society Conference, 10-14 April 2010, Florence, Italy: summaries of oral sessions. Schizophr Res 2010; 124:e1-62. [PMID: 20934307 PMCID: PMC4182935 DOI: 10.1016/j.schres.2010.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 01/06/2023]
Abstract
The 2nd Schizophrenia International Research Society Conference, was held in Florence, Italy, April 10-15, 2010. Student travel awardees served as rapporteurs of each oral session and focused their summaries on the most significant findings that emerged from each session and the discussions that followed. The following report is a composite of these reviews. It is hoped that it will provide an overview for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.
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Affiliation(s)
- Moogeh Baharnoori
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, Quebec, Canada H4H 1R3, phone (514) 761-6131 ext 3346,
| | - Cali Bartholomeusz
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Level 2-3, Alan Gilbert Building, 161 Barry St, Carlton South, Victoria 3053, Australia, phone +61 3 8344 1878, fax +61 3 9348 0469,
| | - Aurelie A. Boucher
- Brain and Mind Research Institute, 100 Mallett Street, Camperdown NSW 2050, Australia, phone +61 (0)2 9351 0948, fax +61 (0)2 9351 0652,
| | - Lisa Buchy
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Verdun, Québec, Canada, H4H 1R3 phone: 514-761-6131 x 3386, fax: 514-888-4064,
| | - Christopher Chaddock
- PO67, Section of Neuroimaging, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, phone 020 7848 0919, mobile 07734 867854 fax 020 7848 0976,
| | - Bonga Chiliza
- Department of Psychiatry, University of Stellenbosch, Tygerberg, 7505, South Africa, phone: +27 (0)21 9389227, fax +27 (0)21 9389738,
| | - Melanie Föcking
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland, phone +353 1 809 3857, fax +353 1 809 3741,
| | - Alex Fornito
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Downing Site, Downing St, Cambridge, UK, CB2 3EB, phone +44 (0) 1223 764670, fax +44 (0) 1223 336581,
| | - Juan A. Gallego
- The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd St, Glen Oaks, NY 11004, phone 718-470-8177, fax 718-343-1659,
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, NCNP, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, JAPAN, phone: +81 42 341 2711; fax: +81 42 346 1744,
| | - Gisele Huf
- National Institute of Quality Control in Health - Oswaldo Cruz Foundation.Av. Brasil 4365 Manguinhos Rio de Janeiro RJ BRAZIL 21045-900, phone + 55 21 38655112, fax + 55 21 38655139,
| | - Gul A. Jabbar
- Clinical Research Coordinator, Harvard Medical School Department of Psychiatry, 940 Belmont Street 2-B, Brockton, MA 02301, office (774) 826-1624, cell (845) 981-9514, fax (774) 286-1076,
| | - Shi Hyun Kang
- Seoul National Hospital, 30-1 Junggok3-dong Gwangjin-gu, Seoul, 143-711, Korea, phone +82-2-2204-0326, fax +82-2-2204-0394,
| | - Yousri El Kissi
- Psychiatry department, Farhat Hached Hospital. Ibn Jazzar Street, 4002 Sousse. Tunisia. phone + 216 98468626, fax + 216 73226702,
| | - Jessica Merchán-Naranjo
- Adolescent Unit. Department of Psychiatry. Hospital General Universitario Gregorio Marañón. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain. C/Ibiza 43, C.P:28009, phone +34 914265005, fax +34 914265004,
| | - Gemma Modinos
- Department of Psychosis Studies (PO67), Institute of Psychiatry, King's College London, King's Health Partners, De Crespigny Park, SE5 8AF London, United Kingdo, phone +44 (0)20 78480917, fax +44 (0)20 78480976,
| | - Nashaat A.M. Abdel-Fadeel
- Minia University, Egypt, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, phone 617 953 0414, fax 617-998-5007, ,
| | - Anna-Karin Neubeck
- Project Manager at Karolinska Institute, Skinnarviksringen 12, 117 27 Stockholm, Sweden, phone +46708777908,
| | - Hsiao Piau Ng
- Singapore Bioimaging Consortium, A*STAR, Singapore; Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, phone 857-544-0192, fax 617-525-6150,
| | - Gabriela Novak
- University of Toronto, Medical Sciences Building, Room 4345, 1 King's College Circle, Toronto, Ontario, M5S 1A8, phone (416) 946-8219, fax (416) 971-2868,
| | - Olasunmbo.O. Owolabi
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Science University of Ilorin, Ilorin, Nigeria, phone +2348030764811,
| | - Diana P. Prata
- Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK, phone +44(0)2078480917, fax +44(0)2078480976,
| | - Naren P. Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029 Karnataka, India, phone +91 9448342379,
| | - Igor Riecansky
- Address: Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Sienkiewiczova 1, 813 71 Bratislava, Slovakia, phone +421-2-52 92 62 76, fax +421-2-52 96 85 16,
| | - Darryl C. Smith
- 3336 Mt Pleasant St. NW #2, Washington, DC 20010, phone 202.494.3892,
| | - Renan P. Souza
- Centre for Addiction and Mental Health 250 College St R31 Toronto - Ontario - Canada M5T1R8, phone +14165358501 x4883, fax +14169794666,
| | - Renate Thienel
- Postdoctoral Research Fellow, PRC Brain and Mental Health, University of Newcastle, Mc Auley Centre Level 5, Mater Hospital, Edith Street, Waratah NSW 2298, phone +61 (2) 40335636,
| | - Hanan D. Trotman
- 36 Eagle Row, Atlanta, GA 30322, phone 404-727-8384, fax 404-727-1284,
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Psychopharmacology Research Program, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, phone +81.3.3353.1211(x62454), fax +81.3.5379.0187,
| | - Kristen A. Woodberry
- Landmark Center 2 East, 401 Park Drive, Boston, MA 02215, phone 617-998-5022, fax 617-998-5007,
| | - Anne O'Shea
- Coordinator of reports. Harvard Medical School, VA Boston Healthcare System, 940 Belmont Street, Brockton, MA 02301, phone 774-826-1374, anne_o’
| | - Lynn E. DeLisi
- VA Boston Healthcare System and Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, phone 774-826-1355, fax 774-826-2721
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Tang JYM, Wong GHY, Hui CLM, Lam MML, Chiu CPY, Chan SKW, Chung DWS, Tso S, Chan KPM, Yip KC, Hung SF, Chen EYH. Early intervention for psychosis in Hong Kong--the EASY programme. Early Interv Psychiatry 2010; 4:214-9. [PMID: 20712726 DOI: 10.1111/j.1751-7893.2010.00193.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. METHODS In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. RESULTS An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. CONCLUSIONS The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed.
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Affiliation(s)
- Jennifer Y M Tang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
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