1
|
Hamdan M, Lecardeur L, Habert M, Okassa M, Lacroix A, Calvet B. Staging's determinants in early intervention youth: a retrospective study. L'ENCEPHALE 2023:S0013-7006(23)00179-3. [PMID: 37985255 DOI: 10.1016/j.encep.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES Since 2019 our early intervention unit has assessed help-seekers, mainly referred by psychiatric departments, and we have conducted a descriptive retrospective study. Our objective was to identify clinical determinants associated to staging at assessment for our three groups: "no psychosis", "ultra-high risk" and "first episode psychosis". METHODS One hundred and thirteen participants (mean age 20.05±3.28) were enrolled, mainly referred by adult psychiatry (81.4%). We tested the association of each group with the following determinants: age, gender, family history of psychosis, referral (adolescent or adult psychiatry), cognitive, depressive complaint, cannabis active consumption, and current activity (scholar or employment). RESULTS Multivariate analyses showed significant association with depressive symptoms (P=0.019) but an absence of family history of psychosis (P=0.002) or current activity (P=0.09) for "no psychosis" group. "Ultra-high risk" was significantly correlated with a family history of psychosis (P=0.001) and adolescent psychiatry referral (P=0.044) but an absence of depressive complaint (P=0.04). As for "first episode psychosis", we found significant cognitive complaint (P=0.026), family history (P=0.024) and current activity (0.026). CONCLUSIONS As all our participants were seen in tertiary care, adolescent psychiatrists were more efficient in detecting a high-risk state. "No psychosis" help-seekers presented in fact mood issues, which have been confused with attenuated psychotic symptoms by their addressers, who have probably been misled by their absence of activity integration. High-risk and characterized psychotic episodes were logically correlated with family history. Surprisingly, "first episode psychosis" youth were currently integrated in scholarly or professional life despite an active cognitive complaint. Robust studies, especially prospective cohorts, are needed to test these associations.
Collapse
Affiliation(s)
- Mirvat Hamdan
- Department of Adult Psychiatry, Early Intervention Unit, Centre Hospitalier Esquirol, 87000 Limoges, France; Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, Limoges, France; Inserm UMR1094, IRD U270, University Limoges, CHU de Limoges, EpiMaCT- Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
| | | | - Marine Habert
- Department of Adult Psychiatry, Early Intervention Unit, Centre Hospitalier Esquirol, 87000 Limoges, France
| | - Mireille Okassa
- Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, Limoges, France
| | - Aurélie Lacroix
- Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, Limoges, France; Inserm UMR1094, IRD U270, University Limoges, CHU de Limoges, EpiMaCT- Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Benjamin Calvet
- Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, Limoges, France; Inserm UMR1094, IRD U270, University Limoges, CHU de Limoges, EpiMaCT- Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| |
Collapse
|
2
|
Milton A, Powell T, Conn K, Einboden R, Buus N, Glozier N. Experiences of service transitions in Australian early intervention psychosis services: a qualitative study with young people and their supporters. BMC Psychiatry 2022; 22:788. [PMID: 36514052 PMCID: PMC9749227 DOI: 10.1186/s12888-022-04413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Different Early Intervention Psychosis Service (EIPS) models of care exist, but many rely upon community-based specialist clinical teams, often with other services providing psychosocial care. Time-limited EIPS care creates numerous service transitions that have potential to interrupt continuity of care. We explored with young people (YP) and their support people (SP) their experiences of these transitions, how they affected care and how they could be better managed. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been hospitalised at some stage, and twelve SP (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration into secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician and academic researchers) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, themes were developed and refined in ongoing team discussion. RESULTS The analysis identified four major service-related transitions in a YP's journey with the EIPS that were described as reflecting critical moments of care, including: transitioning into EIPS; within service changes; transitioning in and out of hospital whilst in EIPS care; and, EIPS discharge. These service-related transition affected continuity of care, whilst within service changes, such as staff turnover, affected the consistency of care and could result in information asymmetry. At these transition points, continuity of care, ensuring service accessibility and flexibility, person centredness and undertake bio-psychosocial support and planning were recommended. State and federally funded services both had high levels of service satisfaction, however, there was evidence of higher staff turnover in federally funded services. CONCLUSION Service transitions were identified as vulnerable times in YP and SP continuity of care. Although these were often well supported by the EIPS, participants provided illustrative examples for service improvement. These included enhancing continuity and consistency of care, through informed and supportive handovers when staff changes occur, and collaborative planning with other services and the YP, particularly during critical change periods such as hospitalisation.
Collapse
Affiliation(s)
- Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW, 2050, Camperdown, Australia. .,The University of Sydney and Australian Research Council (ARC) Centre of Excellence for Children and Families over the Life Course, Sydney, Australia.
| | - Tacita Powell
- Adolescent Court and Community Team Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Katrina Conn
- grid.1013.30000 0004 1936 834XSydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW 2050 Camperdown, Australia ,grid.461941.f0000 0001 0703 8464NSW Department of Education, Sydney, Australia
| | - Rochelle Einboden
- grid.28046.380000 0001 2182 2255Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada ,grid.1013.30000 0004 1936 834XSusan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Niels Buus
- grid.1002.30000 0004 1936 7857School of Nursing and Midwifery, Monash University, Clayton, Australia ,grid.10825.3e0000 0001 0728 0170Department Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nicholas Glozier
- grid.1013.30000 0004 1936 834XSydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW 2050 Camperdown, Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney and Australian Research Council (ARC) Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| |
Collapse
|
3
|
Arango C, Buitelaar JK, Correll CU, Díaz-Caneja CM, Figueira ML, Fleischhacker WW, Marcotulli D, Parellada M, Vitiello B. The transition from adolescence to adulthood in patients with schizophrenia: Challenges, opportunities and recommendations. Eur Neuropsychopharmacol 2022; 59:45-55. [PMID: 35550205 DOI: 10.1016/j.euroneuro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Schizophrenia is a severely debilitating neurodevelopmental disorder that requires continuous multidisciplinary treatment. Early onset schizophrenia (EOS, onset before 18) is associated with poorer outcomes than the adult-onset type. The transition from adolescent to adult mental healthcare services (AMHS) poses various challenges for maintaining continuity of care. The heterogeneous availability of specialized mental health services and resources for people with schizophrenia across Europe and the inadequacy of training programs in creating a shared culture and knowledge base between child and adult mental health professionals are major challenges at the policy level. More flexible and individualized transition timing is also needed. While changes in the relationship between patients, caregivers and mental health professionals at a time when young people should acquire full responsibility for their own care are challenges common to all mental health disorders, these are particularly relevant to the care of schizophrenia because of the severe associated disability. This Expert Opinion Paper examines the main aspects of transitioning of care in schizophrenia with the aim of identifying the challenges and the potential approaches that could enhance continuity of care.
Collapse
Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, the Netherlands
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | | | | | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| |
Collapse
|