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Role of Executive Function in Response to a Problem Solving Based Psychoeducational Intervention in Adolescents with Psychosis: The PIENSA Trial Revisited. J Clin Med 2019; 8:jcm8122108. [PMID: 31810220 PMCID: PMC6947315 DOI: 10.3390/jcm8122108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 02/01/2023] Open
Abstract
An improvement in negative symptoms and a reduction in the number of visits to the emergency department have been reported in a problem solving based psychoeducational group intervention (PE) for adolescents with psychosis relative to a nonstructured group (NS). One of the factors that may play a role on the response to PE treatment is executive function (EF), a crucial cognitive domain for problem-solving performance. We aimed to examine the role of EF in response to PE treatment versus an NS group. We examined the associations between changes in cognition and in clinical/functional variables within each treatment group using Spearman-ranked and partial correlation analyses. A total of 22 individuals (mean age: 16.3) were randomized to PE (N = 10) and NS (N = 12). We found an association between improvements in EF performance and a reduction in positive symptoms (rs = –0.756, p = 0.030 for semantic fluency), reduction in negative symptoms (r = 0.758, p = 0.029 for semantic; rs = –0,733, p = 0.025 for verbal fluency), and reduction in the number of visits to the emergency department (r = –0,743, p = 0.035 for semantic fluency) in the PE group. No associations were found in the NS group. Our results suggest that EF may play a role in the specific improvements observed in the PE group. This may have implications in the development of new areas of clinical intervention focusing on the role of cognitive functioning in response to psychosocial treatments in psychosis.
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Gaspar PA, Castillo RI, Maturana A, Villar MJ, Ulloa K, González G, Ibaceta O, Ortiz A, Corral S, Mayol R, De Angel V, Aburto MB, Martínez A, Corcoran CM, Silva H. Early psychosis detection program in Chile: A first step for the South American challenge in psychosis research. Early Interv Psychiatry 2019; 13:328-334. [PMID: 30548415 PMCID: PMC6436982 DOI: 10.1111/eip.12766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/04/2018] [Indexed: 12/16/2022]
Abstract
AIM Early detection and intervention (EDI) is a main challenge in psychosis research. The Chilean schizophrenia (SZ) national program has universal support and treatment by law for all SZ patients, but this does not yet extend to earlier stages of illness. Therefore, we have piloted an ultra-high risk (UHR) program to demonstrate the utility and feasibility of this public health approach in Chile. METHODS We introduce "The University of Chile High-risk Intervention Program," which is the first national EDI program for UHR youths. Longitudinal follow-up included clinical and cognitive assessments, and monitoring of physiological sensory and cognitive indices, through electroencephalographic techniques. RESULTS We recruited 27 UHR youths over 2 years. About 92.6% met criteria for attenuated psychosis syndrome (APS). Mean Scale of Psychosis-Risk Symptoms (SOPS) ratings in the cohort were 6.9 (SD 4.6) for positive, 9.1 (SD 8.3) for negative, 5.4 (SD 5.3) for disorganized and 6.3 (SD 4.1) for general symptoms. About 14.8% met criteria for comorbid anxiety disorders and 44.4% for mood disorders. Most participants received cognitive behavioural therapy (62.9%) and were prescribed low dose antipsychotics (85.2%). The transition rate to psychosis was 22% within 2 years. CONCLUSIONS We describe our experience in establishing the first EDI program for UHR subjects in Chile. Our cohort is similar in profile and risk to those identified in higher-income countries. We will extend our work to further optimize psychosocial and preventive interventions, to promote its inclusion in the Chilean SZ national program and to establish a South American collaboration network for SZ research.
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Affiliation(s)
- Pablo A Gaspar
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Rolando I Castillo
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Alejandro Maturana
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - María J Villar
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Karen Ulloa
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gabriel González
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Osvaldo Ibaceta
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Andrea Ortiz
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sebastián Corral
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rocío Mayol
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Valeria De Angel
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - María B Aburto
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Antígona Martínez
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, New York.,Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Cheryl M Corcoran
- New York State Psychiatric Institute, New York, New York.,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hernán Silva
- Department of North Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
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Barbeito S, Sánchez-Gutiérrez T, Mayoral M, Moreno M, Ríos-Aguilar S, Arango C, Calvo A. Mobile App-Based Intervention for Adolescents With First-Episode Psychosis: Study Protocol for a Pilot Randomized Controlled Trial. Front Psychiatry 2019; 10:27. [PMID: 30804818 PMCID: PMC6370739 DOI: 10.3389/fpsyt.2019.00027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/16/2019] [Indexed: 01/26/2023] Open
Abstract
Introduction: Previous studies have shown an improvement in the access to treatment for patients with first-episode psychosis (FEP), specifically young patients, through mobile app-based interventions. The aim of this study is to test the effectiveness of a mobile app-based intervention to improve community functioning in adolescents with FEP. Mobile app-based interventions could increase quality of life and disease awareness, which improve adherence to treatment and reduce the frequency of relapses and rehospitalizations in adolescents with FEP. Methods: This article describes a mobile app treatment and the pilot trial protocol for patients with FEP. We will perform a single-blind randomized clinical trial (RCT) including patients with FEP aged 14-19 years recruited from Gregorio Marañón Hospital, Madrid, Spain. Patients will be randomly assigned to an intervention group, which will receive treatment as usual plus five modules of a psychological intervention through the mobile app (psychoeducation, recognition of symptoms and prevention of relapses, problem solving, mindfulness, and contact wall), or to a control group (standard care). The effectiveness of the intervention will be assessed by means of an extensive battery of clinical tests at baseline and at 3 months of follow-up. The primary outcome is reduction in psychotic and depressive symptoms; secondary outcomes comprise adherence, awareness, use of drugs, and quality of life. Data will be analyzed on an intention-to-treat (ITT) basis. Mixed model repeated-measures analysis will be used to explore the following effect: group × time interaction between the control group and the intervention group for clinical and functional variables during the follow-up period. Discussion: This is an innovative study for the assessment of a psychological intervention through a mobile app for patients with FEP during the critical period. This pilot RCT is intended to be a precursor to larger studies, which in turn could facilitate dissemination of mobile app therapy for patients with FEP. Ethics and Dissemination: The local ethics committee approved the study protocol. All participants must sign the informed consent, to participate. After finalizing the study, the results will be published. Trial registration: NCT03161249. NCT clinicaltrials.gov. Date of registration in primary registry 02 May 2017. clinicaltrials.gov.
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Affiliation(s)
- Sara Barbeito
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | | | - María Mayoral
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Miguel Moreno
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Logroño, Spain.,Mental Health Network of Guipuzcoa, Biodonostia, San Sebastian, Spain
| | - Sergio Ríos-Aguilar
- School of Engineering and Technology, Universidad Internacional de La Rioja (UNIR), Logroño, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Ana Calvo
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
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Calvo A, Moreno M, Ruiz-Sancho A, Rapado-Castro M, Moreno C, Sánchez-Gutiérrez T, Arango C, Mayoral M. Psychoeducational Group Intervention for Adolescents With Psychosis and Their Families: A Two-Year Follow-Up. J Am Acad Child Adolesc Psychiatry 2015; 54:984-90. [PMID: 26598473 DOI: 10.1016/j.jaac.2015.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate whether the beneficial effects of a structured, psychoeducational, parallel-group program for adolescents with early-onset psychosis and their families observed immediately after the intervention were maintained 2 years later. METHOD The present study examines the longitudinal efficacy of a randomized controlled trial based on a psychoeducational, problem-solving, structured group intervention for adolescents with early-onset psychosis and their families (PE) and compares it with that of a nonstructured group intervention (NS) after a 2-year follow-up. We analyzed whether the differences between PE and NS found after the intervention persisted 2 years later. Intergroup differences in number and duration of hospitalizations, symptoms, and functioning were also assessed. RESULTS After 2 years of follow-up, we were able to reassess 89% of patients. In the PE group, 13% of patients had visited the emergency department, compared with 50% in the NS group (p = .019). However, no statistically significant differences were found between the groups for negative symptoms or number and duration of hospitalizations. A significant improvement in Positive and Negative Syndrome Scale (PANSS) general symptoms was observed in the PE group. CONCLUSION Our psychoeducational group intervention showed sustained effects by diminishing the number of visits to emergency departments 2 years after the intervention. Our findings indicate that this psychoeducational intervention could provide patients with long-lasting resources to manage crises more effectively. Clinical trial registration information-Intervention Module AGES (AGES-CM); http://clinicaltrials.gov/; NCT02101372.
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Affiliation(s)
- Ana Calvo
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid.
| | - Miguel Moreno
- Gipuzkoako Osasun Mentaleko Sarea, Red de Salud Mental de Guipuzcoa, Biodonostia, San Sebastian, Spain
| | - Ana Ruiz-Sancho
- VocAcción Director-Group Processes and Institutional Consulting, Madrid
| | - Marta Rapado-Castro
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Melbourne Neuropsychiatry Centre, the University of Melbourne and Melbourne Health, Carlton South, Australia
| | - Carmen Moreno
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - Teresa Sánchez-Gutiérrez
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - María Mayoral
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
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Calvo A, Moreno M, Ruiz-Sancho A, Rapado-Castro M, Moreno C, Sánchez-Gutiérrez T, Arango C, Mayoral M. Intervention for adolescents with early-onset psychosis and their families: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2014; 53:688-96. [PMID: 24839887 DOI: 10.1016/j.jaac.2014.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with early-onset psychosis and their families. The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease, to mitigate crises, and to prevent relapses. METHOD We performed a 9-month, randomized, rater-blinded clinical trial involving 55 adolescent patients with early-onset psychosis and either or both of their parents. A psychoeducational problem-solving group intervention (n = 27) was compared with a nonstructured group intervention (n = 28). The primary outcomes were number of hospitalizations, days of hospitalization, and visits to the emergency department. The secondary outcome measures were clinical variables and family environment. RESULTS Assessments were performed before and after the intervention. At the end of the group intervention, 15% of patients in the psychoeducational group and 39% patients in the nonstructured group had visited the emergency department (χ² = 3.62, df = 1, p = .039). The improvement in negative symptoms was more pronounced in the psychoeducational group (12.84 [7.87]) than in the nonstructured group (15.81 [6.37]) (p = .039). CONCLUSION A parallel psychoeducational group intervention providing written instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-solving strategies within the family, thus reducing the number of visits to the emergency department. Negative symptoms improved in adolescents in the psychoeducational group. Clinical trial registration information--Intervention Module AGES (AGES-CM); http://clinicaltrials.gov/; NCT02101372. [corrected].
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Affiliation(s)
- Ana Calvo
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Miguel Moreno
- Gipuzkoako Osasun MentalekoSarea, Red de Salud Mental de Guipuzcoa, San Sebastian, Spain
| | - Ana Ruiz-Sancho
- VocAcción Director-Group Processes and Institutional Consulting, Madrid, Spain
| | - Marta Rapado-Castro
- Hospital General Universitario Gregorio Maranon School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Orygen Youth Health Research Centre, Centre for Youth Mental Health, and Melbourne Neuropsychiatry Centre, the University of Melbourne, and Melbourne Health, Australia
| | - Carmen Moreno
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Teresa Sánchez-Gutiérrez
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - María Mayoral
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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