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Lu W, Srijeyanthan J, Siriram A, Silverstein SM, Yanos PT, Mueser KT, Gottlieb JD, Marcello S, Kim MJ, Zeiss M. Diagnostic profiles and trauma history among treatment-seeking young adults with positive post-traumatic stress disorder screens: Findings and implications for public mental health care. Early Interv Psychiatry 2024; 18:381-388. [PMID: 38088516 PMCID: PMC11070296 DOI: 10.1111/eip.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/01/2023] [Accepted: 11/19/2023] [Indexed: 05/07/2024]
Abstract
OBJECTIVES This study examined diagnostic profiles and trauma history among treatment-seeking young adults with positive PTSD screens in public mental health care. METHODS Screening for trauma history and PTSD symptoms was implemented in a community mental health service system. 266 treatment-seeking young adults (aged 18-35) endorsed trauma exposure with a score of at least 45 on the DSM-IV PTSD Checklist, indicating probable PTSD. RESULTS Young adults with positive PTSD screens were predominantly female, minority, and diagnosed with mood disorders. Of those with positive screens, only 15% had a chart diagnosis of PTSD; 17.3% (ages 18-24) versus 14.1% (ages 25-35). Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race. CONCLUSION Routine PTSD screening for young adults receiving public mental health care should be prioritized to address long-term impacts of trauma.
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Affiliation(s)
- Weili Lu
- Rutgers University, Piscataway, New Jersey, USA
| | | | | | | | - Philip T Yanos
- John Jay College, City University of New York, New York, New York, USA
| | | | - Jennifer D Gottlieb
- Cambridge Health Alliance & Harvard Medical School, Cambridge, Massachusetts, USA
| | | | - Min J Kim
- John Jay College, City University of New York, New York, New York, USA
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Homan P, Schooler NR, Brunette MF, Rotondi A, Ben-Zeev D, Gottlieb JD, Mueser KT, Achtyes ED, Gingerich S, Marcy P, Meyer-Kalos P, Hauser M, John M, Robinson DG, Kane JM. Relapse prevention through health technology program reduces hospitalization in schizophrenia. Psychol Med 2023; 53:4114-4120. [PMID: 35634965 DOI: 10.1017/s0033291722000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychiatric hospitalization is a major driver of cost in the treatment of schizophrenia. Here, we asked whether a technology-enhanced approach to relapse prevention could reduce days spent in a hospital after discharge. METHODS The Improving Care and Reducing Cost (ICRC) study was a quasi-experimental clinical trial in outpatients with schizophrenia conducted between 26 February 2013 and 17 April 2015 at 10 different sites in the USA in an outpatient setting. Patients were between 18 and 60 years old with a diagnosis of schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified. Patients received usual care or a technology-enhanced relapse prevention program during a 6-month period after discharge. The health technology program included in-person, individualized relapse prevention planning with treatments delivered via smartphones and computers, as well as a web-based prescriber decision support program. The main outcome measure was days spent in a psychiatric hospital during 6 months after discharge. RESULTS The study included 462 patients, of which 438 had complete baseline data and were thus used for propensity matching and analysis. Control participants (N = 89; 37 females) were enrolled first and received usual care for relapse prevention followed by 349 participants (128 females) who received technology-enhanced relapse prevention. During 6-month follow-up, 43% of control and 24% of intervention participants were hospitalized (χ2 = 11.76, p<0.001). Days of hospitalization were reduced by 5 days (mean days: b = -4.58, 95% CI -9.03 to -0.13, p = 0.044) in the intervention condition compared to control. CONCLUSIONS These results suggest that technology-enhanced relapse prevention is an effective and feasible way to reduce rehospitalization days among patients with schizophrenia.
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Affiliation(s)
- Philipp Homan
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University and ETH, Zurich, Switzerland
| | - Nina R Schooler
- Department of Psychiatry, SUNY Downstate Medical School, Brooklyn, NY, USA
| | - Mary F Brunette
- Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Armando Rotondi
- Department of Critical Care Medicine, Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA, USA
- Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, Behavioral Research in Technology and Engineering (BRiTE) Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer D Gottlieb
- Cambridge Health Alliance, Division of Population Behavioral Health Innovation and Harvard Medical School Department of Psychiatry, Cambridge, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Eric D Achtyes
- Cherry Health and Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Susan Gingerich
- Independent Consultant and Trainer in Narberth, Narberth, Pennsylvania, USA
| | | | - Piper Meyer-Kalos
- University of Minnesota Medical School, Department of Psychiatry & Behavioral Sciences, Minneapolis, MN, USA
| | | | - Majnu John
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Mathematics, Hofstra University, Hempstead, NY, USA
| | - Delbert G Robinson
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - John M Kane
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Lu W, Srijeyanthan J, Mueser KT, Yanos PT, Parrott JS, Siriram A, Gottlieb JD, Marcello S, Silverstein SM. Predictors of undocumented PTSD in persons using public mental health services. Psychiatry Res 2022; 317:114892. [PMID: 36257204 DOI: 10.1016/j.psychres.2022.114892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 01/05/2023]
Abstract
Individuals diagnosed with serious mental illness (SMI) have greater trauma exposure and are at increased risk for posttraumatic stress disorder (PTSD). However, PTSD is rarely documented in their clinical records. This study investigated the predictors of PTSD documentation among 776 clients with SMI receiving public mental health services, who had probable PTSD as indicated by a PTSD Checklist score of at least 45. Only 5.3% of clients had PTSD listed as a primary diagnosis, and 8.4% had PTSD as a secondary diagnosis, with a total 13.7% documentation rate. PTSD documentation rate was highest for clients with major depression (18.8%) compared to those with schizophrenia (4.1%) or bipolar disorder (6.3%). Factors that predicted a lower likelihood of having a chart diagnosis of PTSD included being diagnosed with schizophrenia/schizoaffective disorder or bipolar disorder. Factors that predicted a higher likelihood of having a chart diagnosis of PTSD included being of non-white race, being female, and experiencing eight or more types of traumatic events. Findings highlight the need for PTSD screening and trauma informed care for clients with SMI receiving public mental health services.
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Affiliation(s)
- Weili Lu
- Rutgers University, School of Health Professions, USA
| | | | | | - Philip T Yanos
- John Jay College, City University of New York, 524W 59th St., 10th Floor, New York, NY 10019, USA.
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Burger SR, van der Linden T, Hardy A, de Bont P, van der Vleugel B, Staring ABP, de Roos C, van Zelst C, Gottlieb JD, Mueser KT, van Minnen A, de Jongh A, Marcelis M, van der Gaag M, van den Berg D. Trauma-focused therapies for post-traumatic stress in psychosis: study protocol for the RE.PROCESS randomized controlled trial. Trials 2022; 23:851. [PMID: 36199107 PMCID: PMC9532824 DOI: 10.1186/s13063-022-06808-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/30/2022] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Many people with psychotic disorders experience symptoms of post-traumatic stress disorder (PTSD). In recent years, several trauma-focused therapies (TFTs), including cognitive restructuring (CR), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) have been studied and found to be safe and effective in reducing PTSD symptoms in individuals with psychosis. However, studies were conducted in different countries, with varying inclusion criteria, therapy duration, control groups, and trial outcomes. RE.PROCESS will be the first study to compare the impact of CR, PE, and EMDR with a waiting list control condition within the same context. METHODS AND ANALYSIS This is the protocol of a pragmatic, single-blind, multicentre, superiority randomized controlled trial, in which CR, PE, and EMDR are compared to a waiting list control condition for TFT (WL) in a naturalistic treatment setting. Inclusion criteria are as follows: age ≥ 16 years; meeting full DSM-5 diagnostic criteria for PTSD on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), with a total CAPS score ≥ 23; and a psychotic disorder in the schizophrenia spectrum confirmed by the Structured Clinical Interview for DSM-5 (SCID-5). Participants (N=200) will be randomly allocated to 16 sessions of one of the TFTs or WL, in addition to receiving treatment as usual (TAU) for psychosis. The primary objective is to compare the effects of CR, PE, and EMDR to WL on researcher-rated severity of PTSD symptoms over time from baseline to 6-month follow-up. Secondary objectives are to examine these effects at the separate time-points (i.e., mid-treatment, post-treatment, and at 6-month follow-up) and to test the effects for clinician-rated presence of PTSD diagnosis, and self-rated severity of (complex) PTSD symptoms. DISCUSSION This is the first RCT to directly compare the effects of CR, PE, and EMDR within the same context to TAU on PTSD symptoms in individuals with psychosis and PTSD. Secondary effects on clinical and functional outcomes will be investigated both directly after therapy and long term. TRIAL REGISTRATION ISRCTN ISRCTN56150327 . Registered 18 June 2019.
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Affiliation(s)
- Simone R Burger
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands. .,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Tineke van der Linden
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands.,Department of Research and Innovation, GGzE Mental Health Institute, Eindhoven, the Netherlands
| | - Amy Hardy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Paul de Bont
- GGZ Oost-Brabant Mental Health Institute, Boekel, the Netherlands
| | | | | | - Carlijn de Roos
- Academic Centre for Child and Adolescent Psychiatry Level, Amsterdam University Medical Centre (location AMC), Amsterdam, The Netherlands
| | - Catherine van Zelst
- Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Jennifer D Gottlieb
- Cambridge Health Alliance & Harvard Medical School Department of Psychiatry, Cambridge, MA, USA
| | | | - Agnes van Minnen
- Behavourial Science Institute, Radboud Universiteit Nijmegen, Nijmegen, the Netherlands.,PSYTREC Mental Health Institute, Bilthoven, the Netherlands
| | - Ad de Jongh
- PSYTREC Mental Health Institute, Bilthoven, the Netherlands.,Department of Behavioral Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University, Belfast, Northern Ireland
| | - Machteld Marcelis
- Department of Research and Innovation, GGzE Mental Health Institute, Eindhoven, the Netherlands.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands.,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands.,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands
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Robinson DG, Schooler NR, Marcy P, Gibbons RD, Hendricks Brown C, John M, Mueser KT, Penn DL, Rosenheck RA, Addington J, Brunette MF, Correll CU, Estroff SE, Mayer-Kalos PS, Gottlieb JD, Glynn SM, Lynde DW, Gingerich S, Pipes R, Miller AL, Severe JB, Kane JM. Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial. Schizophr Bull 2022; 48:1021-1031. [PMID: 35689478 PMCID: PMC9434430 DOI: 10.1093/schbul/sbac053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To examine long-term effects of early intervention services (EIS) for first-episode psychosis, we compared Heinrichs-Carpenter Quality of Life (QLS) and Positive and Negative Syndrome Scale (PANSS) scores and inpatient hospitalization days over 5 years with data from the site-randomized RAISE-ETP trial that compared the EIS NAVIGATE (17 sites; 223 participants) and community care (CC) (17 sites; 181 participants). Inclusion criteria were: age 15-40 years; DSM-IV diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychotic disorder not otherwise specified; first psychotic episode; antipsychotic medication taken for ≤6 months. NAVIGATE-randomized participants could receive NAVIGATE from their study entry date until NAVIGATE ended when the last-enrolled NAVIGATE participant completed 2 years of treatment. Assessments occurred every 6 months. 61% of participants had assessments conducted ≥2 years; 31% at 5 years. Median follow-up length was CC 30 months and NAVIGATE 38 months. Primary analyses assumed data were not-missing-at-random (NMAR); sensitivity analyses assumed data were missing-at-random (MAR). MAR analyses found no significant treatment-by-time interactions for QLS or PANSS. NMAR analyses revealed that NAVIGATE was associated with a 13.14 (95%CI:6.92,19.37) unit QLS and 7.73 (95%CI:2.98,12.47) unit PANSS better improvement and 2.53 (95%CI:0.59,4.47) fewer inpatient days than CC (all comparisons significant). QLS and PANSS effect sizes were 0.856 and 0.70. NAVIGATE opportunity length (mean 33.8 (SD = 5.1) months) was not associated (P = .72) with QLS outcome; duration of untreated psychosis did not moderate (P = .32) differential QLS outcome. While conclusions are limited by the low rate of five-year follow-up, the data support long-term benefit of NAVIGATE compared to community care.
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Affiliation(s)
- Delbert G Robinson
- To whom correspondence should be addressed; The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA; tel: 718 470-8195, fax: 718 343-1659, e-mail:
| | - Nina R Schooler
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Robert D Gibbons
- Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - C Hendricks Brown
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Majnu John
- The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- Department of Mathematics, Hofstra University, Hempstead, NY, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - David L Penn
- Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Christoph U Correll
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
- Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin, Berlin, Germany
| | - Sue E Estroff
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Piper S Mayer-Kalos
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jennifer D Gottlieb
- Division of Population Behavioral Health Innovation and Harvard Medical School, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Shirley M Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - David W Lynde
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Susan Gingerich
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ronny Pipes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexander L Miller
- Department of Psychiatry and Behavioral Sciences San Antonio, UT Health San Antonio, TX, USA
| | - Joanne B Severe
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - John M Kane
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
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DeTore NR, Gottlieb JD, Mueser KT. Prevalence and correlates of PTSD in first episode psychosis: Findings from the RAISE-ETP study. Psychol Serv 2019; 18:147-153. [PMID: 31343188 DOI: 10.1037/ser0000380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) in young individuals is associated with an increased risk to develop psychosis or mania, and both trauma and PTSD rates are elevated in people with schizophrenia and other severe mental illnesses. However, less research has examined PTSD in people who have recently developed a first episode of psychosis (FEP). The present study is a secondary analysis of the baseline data collected for the National Institute of Mental Health Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study to examine the rates of trauma and PTSD, and to explore the demographic and clinical correlates of PTSD in a representative sample of 404 persons with an FEP. Approximately 80% of the study sample reported experiencing at least one traumatic event during their lives, with females more likely to report childhood sexual abuse and spousal abuse than males. A total of 20 participants (5.0%) met criteria for a lifetime diagnosis of PTSD, while another 15 participants (3.7%) met subthreshold diagnostic criteria for PTSD. Significant correlations were found between lifetime PTSD and the Calgary Depression Scale, the Mental Health Recovery Measure, the Stigma Scale, and duration of untreated psychosis, with higher scores on each variable associated with a diagnosis of PTSD. The association between PTSD and more severe depression, as well as lower perceptions of personal recovery, suggest that PTSD may be an important target for treatment programs for persons recovering from an FEP. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Browne J, Mueser KT, Meyer-Kalos P, Gottlieb JD, Estroff SE, Penn DL. The therapeutic alliance in individual resiliency training for first episode psychosis: Relationship with treatment outcomes and therapy participation. J Consult Clin Psychol 2019; 87:734-744. [PMID: 31219276 DOI: 10.1037/ccp0000418] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). METHOD The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. RESULTS Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. CONCLUSIONS A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Achtyes ED, Ben-Zeev D, Luo Z, Mayle H, Burke B, Rotondi AJ, Gottlieb JD, Brunette MF, Mueser KT, Gingerich S, Meyer-Kalos PS, Marcy P, Schooler NR, Robinson DG, Kane JM. Off-hours use of a smartphone intervention to extend support for individuals with schizophrenia spectrum disorders recently discharged from a psychiatric hospital. Schizophr Res 2019; 206:200-208. [PMID: 30551981 DOI: 10.1016/j.schres.2018.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/19/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Technology-delivered healthcare interventions may enhance dissemination of evidence-based treatments in low-resource areas. These interventions may be accessed 'on-demand,' including after hours. Patients with schizophrenia do engage with technological aids but when/how they would utilize these tools is not known. METHODS We conducted a large, prospective, ten-site, longitudinal study of four technology-assisted interventions for patients with schizophrenia spectrum disorders within 60 days of psychiatric hospital discharge, a high risk period. One tool employed was a smartphone intervention called 'FOCUS,' which could be used by patients as needed, providing help in five content areas: medications, mood, social, sleep and voices. Each login was date- and time-stamped as occurring during normal clinic hours, or 'off-hours,' and the pattern of use described. RESULTS 347 of 368 patients utilized FOCUS during the 6-month study. There were a total of 75,447 FOCUS logins; 35,739 (47.4%) were self-initiated and 38,139 (50.6%) were off-hours. 18,450 of the logins during off-hours were self-initiated (24.5%). No differences in average usage per month were found based on race/ethnicity. A subset of 'high utilizers' (n = 152, 43.8%) self-initiated use of all five FOCUS modules both on- and off-hours. They tended to be women, >35 years old, and had a high school diploma or greater. CONCLUSION Most patients with schizophrenia spectrum disorders recently discharged from the hospital utilized a smartphone intervention targeted to address troublesome residual symptoms. One quarter of the total smartphone utilization was self-initiated off-hours, indicating the potential utility of this tool to extend support for patients during periods of elevated risk.
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Affiliation(s)
- Eric D Achtyes
- Cherry Health, 100 Cherry Street, Grand Rapids, MI 49503, USA; Division of Psychiatry and Behavioral Medicine, Michigan State University, College of Human Medicine, Secchia Center, Rm 482, 15 Michigan Street, Grand Rapids, MI 49503, USA.
| | - Dror Ben-Zeev
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, 2 Pillsbury Street, Suite 401, Concord, NH 03301, USA.
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University, College of Human Medicine, B627 West Fee Hall, 909 Fee Road, East Lansing, MI 48824, USA.
| | - Heather Mayle
- Cherry Health, 100 Cherry Street, Grand Rapids, MI 49503, USA.
| | - Brandi Burke
- Division of Psychiatry and Behavioral Medicine, Michigan State University, College of Human Medicine, Secchia Center, Rm 482, 15 Michigan Street, Grand Rapids, MI 49503, USA.
| | - Armando J Rotondi
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA; Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, 151R-H, VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, USA.
| | - Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation and Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, 940 Commonwealth Avenue West, Boston, MA 02215, USA; Departments of Psychological and Brain Sciences and Psychiatry, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA.
| | - Mary F Brunette
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, 2 Pillsbury Street, Suite 401, Concord, NH 03301, USA.
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation and Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, 940 Commonwealth Avenue West, Boston, MA 02215, USA; Departments of Psychological and Brain Sciences and Psychiatry, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA.
| | - Susan Gingerich
- Independent Consultant, 14 Schiller Avenue, Narberth, PA 19072, USA.
| | - Piper S Meyer-Kalos
- University of Minnesota, School of Social Work, 170 Peters Hall, 1404 Gortner Avenue, St. Paul, MN 55108, USA.
| | - Patricia Marcy
- Vanguard Research Group, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
| | - Nina R Schooler
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA.
| | - Delbert G Robinson
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA; Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA.; Department of Psychiatry, Hofstra Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY 11549, USA..
| | - John M Kane
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA; Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA.; Department of Psychiatry, Hofstra Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY 11549, USA..
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Browne J, Bass E, Mueser KT, Meyer-Kalos P, Gottlieb JD, Estroff SE, Penn DL. Client predictors of the therapeutic alliance in individual resiliency training for first episode psychosis. Schizophr Res 2019; 204:375-380. [PMID: 30057099 DOI: 10.1016/j.schres.2018.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 07/03/2018] [Accepted: 07/22/2018] [Indexed: 02/04/2023]
Abstract
Individuals experiencing their first episode of psychosis (FEP) are often reluctant to seek treatment, and are difficult to engage and retain in mental health services. The therapeutic alliance (TA), or the affective and collaborative bond between therapist and client, is predictive of better treatment outcomes for clients with FEP; thus, it is important to understand the predictors of the TA in order to determine how best to foster a positive alliance with these individuals. The primary aim of the present study was to examine whether baseline client characteristics, including severity of symptoms, social functioning, and insight, were associated with the TA. The exploratory aim was to examine associations between demographic variables (age, race, and gender) and the TA. The present study included a subsample of participants (n = 134) who received Individual Resiliency Training (IRT) as part of the NAVIGATE treatment in the Recovery After An Initial Schizophrenia Episode Early Treatment Program study. Four trained research assistants rated the TA from early audiotaped sessions of IRT. Multilevel modeling was utilized given the nested data structure. Results indicated that more severe positive and less severe negative symptoms were significantly and uniquely associated with a better therapeutic alliance, as was female gender. The findings suggest that client symptom profiles should be considered when developing a TA with FEP clients.
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Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Emily Bass
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation and Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, MA, USA
| | - Piper Meyer-Kalos
- Minnesota Center for Chemical and Mental Health, University of Minnesota, School of Social Work, St. Paul, MN, USA
| | - Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation and Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, MA, USA
| | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Australian Catholic University, School of Psychology, Melbourne, VIC, Australia
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Mueser KT, Meyer-Kalos PS, Glynn SM, Lynde DW, Robinson DG, Gingerich S, Penn DL, Cather C, Gottlieb JD, Marcy P, Wiseman JL, Potretzke S, Brunette MF, Schooler NR, Addington J, Rosenheck RA, Estroff SE, Kane JM. Implementation and fidelity assessment of the NAVIGATE treatment program for first episode psychosis in a multi-site study. Schizophr Res 2019; 204:271-281. [PMID: 30139553 PMCID: PMC6382606 DOI: 10.1016/j.schres.2018.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/18/2018] [Accepted: 08/12/2018] [Indexed: 11/19/2022]
Abstract
The NAVIGATE program was developed for the Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared NAVIGATE to usual Community Care in a cluster randomized design involving 34 sites and 404 patients. This article describes the approach to training and implementing the NAVIGATE program at the 17 sites (including 134 practitioners) randomized to provide it, and to evaluating the fidelity of service delivery to the NAVIGATE model. Fidelity was evaluated to five different components of the program, all of which were standardized in manuals in advance of implementation. The components included four interventions (Individualized Resiliency Training, Family Education Program, Supported Employment and Education, Personalized Medication Management) and the overall organization (staffing and structure) of the NAVIGATE team. Most of the sites demonstrated acceptable or higher levels of fidelity in their implementation of the four interventions and the organization of the program, with all 17 sites demonstrating at least acceptable overall fidelity to the NAVIGATE program. The results indicate that the NAVIGATE program can be implemented with good fidelity to the treatment model in a diverse array of community mental health care settings serving persons with a first episode psychosis.
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Affiliation(s)
- Kim T Mueser
- Boston University, Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston, MA, USA.
| | - Piper S Meyer-Kalos
- University of Minnesota, School of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul, MN, USA.
| | - Shirley M Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - David W Lynde
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
| | - Delbert G Robinson
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | | | - David L Penn
- University of North Carolina-Chapel Hill, Department of Psychology, Chapel Hill, NC, USA; Australian Catholic University, School of Psychology, Melbourne, VIC, Australia
| | | | - Jennifer D Gottlieb
- Boston University, Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston, MA, USA
| | | | - Jennifer L Wiseman
- University of Minnesota, Minnesota Center for Chemical and Mental Health, St. Paul, MN, USA
| | - Sheena Potretzke
- Oregon Health and Science University, Department of Behavioral Neuroscience, Portland, OR, USA
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Bureau of Mental Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Nina R Schooler
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada
| | | | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
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11
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Browne J, Edwards AN, Penn DL, Meyer-Kalos PS, Gottlieb JD, Julian P, Ludwig K, Mueser KT, Kane JM. Factor structure of therapist fidelity to individual resiliency training in the Recovery After an Initial Schizophrenia Episode Early Treatment Program. Early Interv Psychiatry 2018; 12:1052-1063. [PMID: 27860369 DOI: 10.1111/eip.12409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/28/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evidence-based approaches and early intervention have improved the long-term prognosis of individuals with schizophrenia. However, little is known about the therapeutic processes involved in individual therapy in first-episode psychosis. A comprehensive psychosocial/psychiatric programme for this population, NAVIGATE, includes an individual therapy component, individual resiliency training (IRT). Fidelity of clinicians' adherence to the IRT protocol has been collected to ensure proper implementation of this manual-based intervention. These data can provide insight into the elements of the therapeutic process in this intervention. MATERIALS AND METHODS To achieve this goal, we first examined the factor structure of the IRT fidelity scale with exploratory factor analysis. Second, we explored the relationships among the IRT fidelity ratings with clinician years of experience and years of education, as well as client's baseline symptom severity and duration of untreated psychosis. RESULTS AND CONCLUSIONS Results supported a 2-factor structure of the IRT fidelity scale. Correlations between clinician years of education and fidelity ratings were statistically significant.
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Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandra N Edwards
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Piper S Meyer-Kalos
- Minnesota Center for Chemical and Mental Health, School of Social Work, University of Minnesota, St. Paul, Minnesota
| | - Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, Massachusetts
| | - Paul Julian
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelsey Ludwig
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, Massachusetts
| | - John M Kane
- Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, New York, New York
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12
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Gottlieb JD, Poyato N, Valiente C, Perdigón A, Vázquez C. Trauma and posttraumatic stress disorder in Spanish public mental health system clients with severe psychiatric conditions: Clinical and demographic correlates. Psychiatr Rehabil J 2018; 41:234-242. [PMID: 30160509 DOI: 10.1037/prj0000318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Compared with the general population, those with severe psychiatric conditions have a substantially higher likelihood of trauma exposure, increased probability of developing posttraumatic stress disorder (PTSD), and more severe consequences if trauma is left untreated. Nevertheless, identification of trauma/PTSD continues to be a neglected mental health system priority. In Spain, few investigations have examined the prevalence of trauma, particularly in persons with severe psychiatric conditions. METHOD This study reports findings from a trauma/PTSD screening within a large Madrid public mental health agency serving clients with severe psychiatric conditions. RESULTS Of the 323 participants, 272 (84.2%) reported at least 1 traumatic event; and 124 (38.4%) met criteria for "probable" PTSD, although none had a medical record diagnosis of PTSD. Those with probable PTSD were predominantly male, were in their mid-40s, had received mental health services for 16 years on average, and endorsed 5.64 types of lifetime traumatic events. The most frequent and distressing traumatic event was the sudden, unexpected death of a loved one. The number of traumatic event types reported was positively correlated with PTSD symptom severity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Despite lower Spanish general population prevalence of trauma/probable PTSD (compared with the United States and other Western countries), rates within those with co-occurring severe psychiatric conditions are high. These findings reinforce the importance of conducting system-wide screening in public mental health clinics serving persons with severe psychiatric conditions in Spain (and beyond), in order to address this ongoing but neglected issue, and begin to offer much-needed recovery services. (PsycINFO Database Record
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Affiliation(s)
- Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation and Department of Psychology, Boston University
| | - Natalia Poyato
- Departamento de Psicologia Clinica, Universidad Complutense de Madrid
| | - Carmen Valiente
- Departamento de Psicologia Clinica, Universidad Complutense de Madrid
| | | | - Carmelo Vázquez
- Departamento de Psicologia Clinica, Universidad Complutense de Madrid
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13
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Browne J, Estroff SE, Ludwig K, Merritt C, Meyer-Kalos P, Mueser KT, Gottlieb JD, Penn DL. Character strengths of individuals with first episode psychosis in Individual Resiliency Training. Schizophr Res 2018; 195:448-454. [PMID: 29033282 DOI: 10.1016/j.schres.2017.09.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/16/2017] [Accepted: 09/23/2017] [Indexed: 02/04/2023]
Abstract
Positive psychology interventions that integrate a person's strengths into treatment result in improvements in life satisfaction and well-being. Character strengths classified within six core virtues (wisdom/knowledge, courage, humanity, justice, temperance, and transcendence) have been the subject of substantial research. Though a number of studies have been conducted in the general population, little is known about the character strengths of individuals with first episode psychosis (FEP). Moreover, positive psychology principles, in particular a focus on personal strengths, have been increasingly integrated into FEP treatment and was a core component of Individual Resiliency Training (IRT), the individual therapy component of NAVIGATE tested in the Recovery After an Initial Schizophrenia Episode Early Treatment Program. As such, the present study offers an examination of character strengths among 105 FEP clients in specialized early intervention treatment. The present study included two primary aims: 1) to conduct a descriptive analysis of character strengths of FEP individuals and 2) to examine exploratory associations between character strengths and changes in symptomatic and recovery variables over six months. Results revealed that the most commonly identified strengths were: Honesty, Authenticity, and Genuineness (40.95%), Kindness and generosity (37.14%), Fairness, equity, and justice (29.52%), Gratitude (29.52%), and Humor and playfulness (29.52%). Three virtues (Humanity, Justice, and Transcendence) were significantly associated with improvements in symptoms, psychological well-being, and interpersonal relations over six months. Overall, the present study offers a glimpse into how persons with FEP view their strengths and how certain clusters of strengths are related to important outcomes.
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Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kelsey Ludwig
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrington Merritt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Piper Meyer-Kalos
- Minnesota Center for Chemical and Mental Health, University of Minnesota, School of Social Work, St. Paul, MN, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation and Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, MA, USA
| | - Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation and Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, MA, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Australian Catholic University, School of Psychology, Melbourne, VIC, Australia
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14
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Slade EP, Gottlieb JD, Lu W, Yanos PT, Rosenberg S, Silverstein SM, Minsky SK, Mueser KT. Cost-Effectiveness of a PTSD Intervention Tailored for Individuals With Severe Mental Illness. Psychiatr Serv 2017; 68:1225-1231. [PMID: 28712353 PMCID: PMC5711573 DOI: 10.1176/appi.ps.201600474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the cost-effectiveness of a cognitive-behavioral therapy (CBT) intervention for posttraumatic stress disorder (PTSD) that is tailored for adults with a co-occurring severe mental illness. METHODS Data were from a randomized trial involving 183 adult clients of two outpatient clinics and three partial hospitalization programs. All had a severe mental illness diagnosis (major mood disorder, schizophrenia, or schizoaffective disorder) and severe PTSD. Participants were randomly assigned to the tailored 12- to 16-session CBT intervention for PTSD (CBT-P) or a three-session breathing retraining and psychoeducation intervention (BRF). Cost estimates included intervention costs for training, supervision, fidelity assessment, personnel, and overhead and related mental health care costs for outpatient, inpatient, and emergency department services and for medications. The incremental cost-effectiveness ratio comparing CBT-P with BRF measured the added cost or savings per remission from PTSD at 12 months postintervention. Generalized linear models were used to estimate intervention effects on annual mental health care costs and the likelihood of a remission from PTSD. Ten thousand bootstrap replications were used to assess uncertainty. RESULTS Annual mean mental health care costs were $25,539 per client (in 2010 dollars) for BRF participants and $29,530 per client for CBT-P participants, a nonsignificant difference. The mean incremental cost-effectiveness ratio was $36,893 per additional PTSD remission yielded by CBT-P compared with BRF (95% confidence interval=-$33,523 to $158,914). Remissions were associated with improvements in quality of life and functioning. CONCLUSIONS An effective CBT intervention tailored for adults with severe mental illness and PTSD was not found to be more cost-effective than a brief three-session intervention.
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Affiliation(s)
- Eric P Slade
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Jennifer D Gottlieb
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Weili Lu
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Philip T Yanos
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Stanley Rosenberg
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Steven M Silverstein
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Shula K Minsky
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Kim T Mueser
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
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15
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Gottlieb JD, Gidugu V, Maru M, Tepper MC, Davis MJ, Greenwold J, Barron RA, Chiko BP, Mueser KT. Randomized controlled trial of an internet cognitive behavioral skills-based program for auditory hallucinations in persons with psychosis. Psychiatr Rehabil J 2017; 40:283-292. [PMID: 28517948 DOI: 10.1037/prj0000258] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite strong evidence supporting the effectiveness of cognitive-behavioral therapy for psychosis (CBTp), most clinicians in the United States have received little or no training in the approach and access remains very low, indicating a potential role for technology in increasing access to this intervention. Coping With Voices (CWV) is a 10-session, interactive, Web-based CBTp skills program that was developed to meet this need, and was shown to be feasible and associated with reduced severity of auditory hallucinations in a previous pilot study. To more rigorously evaluate this program, a randomized controlled trial was conducted comparing the efficacy of CWV to usual care (UC). METHOD The trial was conducted with a sample of 37 community mental health center clients with schizophrenia and moderate-to-severe auditory hallucinations, with assessments conducted at baseline, posttreatment, and 3-month follow-up. RESULTS Engagement in and satisfaction with the CWV program were high. Both the CWV and UC groups improved comparably in severity of auditory hallucinations and other symptoms over the treatment and at follow-up. However, participants in the CWV program showed significantly greater increases in social functioning and in knowledge about CBTp. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The results suggest that the CWV program has promise for increasing access to CBTp, and associated benefits in the management of distressing psychotic symptoms and improving social functioning. (PsycINFO Database Record
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Affiliation(s)
| | - Vasudha Gidugu
- Center for Psychiatric Rehabilitation, Boston University
| | - Mihoko Maru
- Center for Psychiatric Rehabilitation, Boston University
| | | | | | | | | | | | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University
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16
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Kredlow MA, Szuhany KL, Lo S, Xie H, Gottlieb JD, Rosenberg SD, Mueser KT. Cognitive behavioral therapy for posttraumatic stress disorder in individuals with severe mental illness and borderline personality disorder. Psychiatry Res 2017; 249:86-93. [PMID: 28086181 PMCID: PMC5325773 DOI: 10.1016/j.psychres.2016.12.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/19/2016] [Accepted: 12/29/2016] [Indexed: 11/30/2022]
Abstract
Secondary analyses were performed on data from two randomized controlled trials of a cognitive behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) in individuals with severe mental illness (SMI) to examine the feasibility, tolerability, and effectiveness for individuals with borderline personality disorder (BPD). In Study 1, 27 participants received CBT or treatment as usual. In Study 2, 55 participants received CBT or a Brief treatment. Feasibility and tolerability of CBT, PTSD symptoms, and other mental health and functional outcomes were examined, with assessments at baseline, post-treatment, and two follow-up time points. CBT was feasible and tolerable in this population. Study 1 participants in CBT improved significantly more in PTSD symptoms, depression, and self-reported physical health. Study 2 participants in both CBT and Brief improved significantly in PTSD symptoms, posttraumatic cognitions, depression, and overall functioning, with those in CBT acquiring significantly more PTSD knowledge, and having marginally significantly greater improvement in PTSD symptoms. CBT for PTSD was feasible and tolerated in individuals with SMI, BPD, and PTSD, and associated with improvements in PTSD symptoms and related outcomes. Prospective research is needed to evaluate CBT in individuals with BPD, including comparing it with staged interventions for this population.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States
| | - Kristin L Szuhany
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States
| | - Stephen Lo
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States
| | - Haiyi Xie
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, United States
| | - Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, United States
| | | | - Kim T Mueser
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States; Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, United States.
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Steel C, Hardy A, Smith B, Wykes T, Rose S, Enright S, Hardcastle M, Landau S, Baksh MF, Gottlieb JD, Rose D, Mueser KT. Cognitive-behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial. Psychol Med 2017; 47:43-51. [PMID: 27650432 DOI: 10.1017/s0033291716002117] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia. METHOD A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive-behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale. RESULTS Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes. CONCLUSIONS The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.
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Affiliation(s)
- C Steel
- School of Psychology and Clinical Language Sciences, University of Reading,Reading,UK
| | - A Hardy
- Department of Psychology,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - B Smith
- North East London NHS Foundation Trust,UK
| | - T Wykes
- Department of Psychology,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - S Rose
- Berkshire Healthcare NHS Foundation Trust,UK
| | - S Enright
- Berkshire Healthcare NHS Foundation Trust,UK
| | | | - S Landau
- Department of Biostatistics,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - M F Baksh
- Department of Mathematics and Statistics,University of Reading,Reading,UK
| | - J D Gottlieb
- Center for Psychiatric Rehabilitation, Boston University,Boston, MA,USA
| | - D Rose
- Health Services Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - K T Mueser
- Department of Mathematics and Statistics,University of Reading,Reading,UK
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Baumel A, Correll CU, Hauser M, Brunette M, Rotondi A, Ben-Zeev D, Gottlieb JD, Mueser KT, Achtyes ED, Schooler NR, Robinson DG, Gingerich S, Marcy P, Meyer-Kalos P, Kane JM. Health Technology Intervention After Hospitalization for Schizophrenia: Service Utilization and User Satisfaction. Psychiatr Serv 2016; 67:1035-8. [PMID: 27247171 DOI: 10.1176/appi.ps.201500317] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined patients' acceptance of the Health Technology Program (HTP), an integrative approach to relapse prevention after hospitalization of adults with schizophrenia or related disorders. The program combines use of digital tools with support from a mental health technology coach (MHTC). METHODS Patients with schizophrenia spectrum disorders received six months of treatment that began within 60 days of a psychiatric hospitalization and included the development of a personalized relapse prevention plan, three digital tools, and contacts with MHTCs. RESULTS A total of 200 patients (mean±SD age=34.6±10.6 years) had 28.2±2.0 contacts with the MHTC that lasted 38.3±14.2 minutes. The most discussed topic was case management (52%), and digital tools were discussed in 45% of meetings. Altogether, 87% of patients used at least one of the digital tools, with 96% of patients rating the HTP as satisfying to at least some extent. CONCLUSIONS These data suggest very high acceptance of the HTP, a program that integrates available human support with digital tools.
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Affiliation(s)
- Amit Baumel
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Christoph U Correll
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Marta Hauser
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Mary Brunette
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Armando Rotondi
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Dror Ben-Zeev
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Jennifer D Gottlieb
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Kim T Mueser
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Eric D Achtyes
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Nina R Schooler
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Delbert G Robinson
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Susan Gingerich
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Patricia Marcy
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Piper Meyer-Kalos
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - John M Kane
- Dr. Baumel, Dr. Correll, Dr. Hauser, Dr. Schooler, Dr. Robinson, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (e-mail: ). Dr. Baumel, Dr. Correll, Dr. Robinson, and Dr. Kane are also with Hofstra Northwell School of Medicine, Hempstead, New York. Dr. Hauser and Ms. Marcy are also with the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Brunette and Dr. Ben-Zeev are with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. Dr. Rotondi is with the Department of Critical Care Medicine, Clinical and Translational Sciences Institute, Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Achtyes is with Cherry Health and Michigan State University College of Human Medicine, East Lansing. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
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Ben-Zeev D, Scherer EA, Gottlieb JD, Rotondi AJ, Brunette MF, Achtyes ED, Mueser KT, Gingerich S, Brenner CJ, Begale M, Mohr DC, Schooler N, Marcy P, Robinson DG, Kane JM. mHealth for Schizophrenia: Patient Engagement With a Mobile Phone Intervention Following Hospital Discharge. JMIR Ment Health 2016; 3:e34. [PMID: 27465803 PMCID: PMC4999306 DOI: 10.2196/mental.6348] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND mHealth interventions that use mobile phones as instruments for illness management are gaining popularity. Research examining mobile phone‒based mHealth programs for people with psychosis has shown that these approaches are feasible, acceptable, and clinically promising. However, most mHealth initiatives involving people with schizophrenia have spanned periods ranging from a few days to several weeks and have typically involved participants who were clinically stable. OBJECTIVE Our aim was to evaluate the viability of extended mHealth interventions for people with schizophrenia-spectrum disorders following hospital discharge. Specifically, we set out to examine the following: (1) Can individuals be engaged with a mobile phone intervention program during this high-risk period?, (2) Are age, gender, racial background, or hospitalization history associated with their engagement or persistence in using a mobile phone intervention over time?, and (3) Does engagement differ by characteristics of the mHealth intervention itself (ie, pre-programmed vs on-demand functions)? METHODS We examined mHealth intervention use and demographic and clinical predictors of engagement in 342 individuals with schizophrenia-spectrum disorders who were given the FOCUS mobile phone intervention as part of a technology-assisted relapse prevention program during the 6-month high-risk period following hospitalization. RESULTS On average, participants engaged with FOCUS for 82% of the weeks they had the mobile phone. People who used FOCUS more often continued using it over longer periods: 44% used the intervention over 5-6 months, on average 4.3 days a week. Gender, race, age, and number of past psychiatric hospitalizations were associated with engagement. Females used FOCUS on average 0.4 more days a week than males. White participants engaged on average 0.7 days more a week than African-Americans and responded to prompts on 0.7 days more a week than Hispanic participants. Younger participants (age 18-29) had 0.4 fewer days of on-demand use a week than individuals who were 30-45 years old and 0.5 fewer days a week than older participants (age 46-60). Participants with fewer past hospitalizations (1-6) engaged on average 0.2 more days a week than those with seven or more. mHealth program functions were associated with engagement. Participants responded to prompts more often than they self-initiated on-demand tools, but both FOCUS functions were used regularly. Both types of intervention use declined over time (on-demand use had a steeper decline). Although mHealth use declined, the majority of individuals used both on-demand and system-prompted functions regularly throughout their participation. Therefore, neither function is extraneous. CONCLUSIONS The findings demonstrated that individuals with schizophrenia-spectrum disorders can actively engage with a clinically supported mobile phone intervention for up to 6 months following hospital discharge. mHealth may be useful in reaching a clinical population that is typically difficult to engage during high-risk periods.
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Brunette MF, Rotondi AJ, Ben-Zeev D, Gottlieb JD, Mueser KT, Robinson DG, Achtyes ED, Gingerich S, Marcy P, Schooler NR, Meyer-Kalos P, Kane JM. Coordinated Technology-Delivered Treatment to Prevent Rehospitalization in Schizophrenia: A Novel Model of Care. Psychiatr Serv 2016; 67:444-7. [PMID: 26725297 DOI: 10.1176/appi.ps.201500257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite advances in schizophrenia treatment, symptom relapses and rehospitalizations impede recovery for many people and are a principal driver of the high cost of care. Technology-delivered or technology-enhanced treatment may be a cost-effective way to provide flexible, personalized evidence-based treatments directly to people in their homes and communities. However, evidence for the safety, acceptability, and efficacy of such interventions is only now being established. The authors of this Open Forum describe a novel, technology-based approach to prevent relapse after a hospitalization for psychosis, the Health Technology Program (HTP), which they developed. HTP provides in-person relapse prevention planning that directs use of tailored, technology-based treatment based on cognitive-behavioral therapy for psychosis, family psychoeducation for schizophrenia, and prescriber decision support through a Web-based program that solicits information from clients at every visit. Technology-based treatments are delivered through smartphones and computers.
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Affiliation(s)
- Mary F Brunette
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Armando J Rotondi
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Dror Ben-Zeev
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Jennifer D Gottlieb
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Kim T Mueser
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Delbert G Robinson
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Eric D Achtyes
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Susan Gingerich
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Patricia Marcy
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Nina R Schooler
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - Piper Meyer-Kalos
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
| | - John M Kane
- Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul
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Kane JM, Robinson DG, Schooler NR, Mueser KT, Penn DL, Rosenheck RA, Addington J, Brunette MF, Correll CU, Estroff SE, Marcy P, Robinson J, Meyer-Kalos PS, Gottlieb JD, Glynn SM, Lynde DW, Pipes R, Kurian BT, Miller AL, Azrin ST, Goldstein AB, Severe JB, Lin H, Sint KJ, John M, Heinssen RK. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program. Am J Psychiatry 2016; 173:362-72. [PMID: 26481174 PMCID: PMC4981493 DOI: 10.1176/appi.ajp.2015.15050632] [Citation(s) in RCA: 458] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary aim of this study was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first-episode psychosis designed for implementation in the U.S. health care system, with community care on quality of life. METHOD Thirty-four clinics in 21 states were randomly assigned to NAVIGATE or community care. Diagnosis, duration of untreated psychosis, and clinical outcomes were assessed via live, two-way video by remote, centralized raters masked to study design and treatment. Participants (mean age, 23) with schizophrenia and related disorders and ≤6 months of antipsychotic treatment (N=404) were enrolled and followed for ≥2 years. The primary outcome was the total score of the Heinrichs-Carpenter Quality of Life Scale, a measure that includes sense of purpose, motivation, emotional and social interactions, role functioning, and engagement in regular activities. RESULTS The 223 recipients of NAVIGATE remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school compared with 181 participants in community care. The median duration of untreated psychosis was 74 weeks. NAVIGATE participants with duration of untreated psychosis of <74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in community care. Rates of hospitalization were relatively low compared with other first-episode psychosis clinical trials and did not differ between groups. CONCLUSIONS Comprehensive care for first-episode psychosis can be implemented in U.S. community clinics and improves functional and clinical outcomes. Effects are more pronounced for those with shorter duration of untreated psychosis.
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Affiliation(s)
- John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA, Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA, The Feinstein Institute for Medical Research, Manhasset, NY, USA, Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | - Delbert G. Robinson
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA, Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Nina R. Schooler
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA, SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA, USA
| | - David L. Penn
- University of North Carolina-Chapel Hill, Department of Psychology, Chapel Hill, NC, USA, Australian Catholic University, School of Psychology, Melbourne, VIC, Australia
| | | | - Jean Addington
- Hotchkiss Brain Institute Department of Psychiatry University of Calgary, Calgary, Canada
| | - Mary F. Brunette
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA, Bureau of Behavioral Health, DHHS, Concord, NH, USA
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA, Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA, The Feinstein Institute for Medical Research, Manhasset, NY, USA, Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | - Sue E. Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Patricia Marcy
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
| | | | - Piper S. Meyer-Kalos
- Minnesota Center for Chemical and Mental Health, University of Minnesota, School of Social Work, St. Paul, MN, USA
| | - Jennifer D. Gottlieb
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA, USA
| | - Shirley M. Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | - Ronny Pipes
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benji T. Kurian
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexander L. Miller
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, San Antonio, TX, USA
| | - Susan T. Azrin
- National Institute of Mental Health, Division of Services and Intervention Research, Rockville, MD, USA
| | - Amy B. Goldstein
- National Institute of Mental Health, Division of Services and Intervention Research, Rockville, MD, USA
| | - Joanne B. Severe
- National Institute of Mental Health, Division of Services and Intervention Research, Rockville, MD, USA
| | - Haiqun Lin
- Yale School of Public Health, New Haven, CT, USA
| | - Kyaw J. Sint
- Yale School of Public Health, New Haven, CT, USA
| | - Majnu John
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA, The Feinstein Institute for Medical Research, Manhasset, NY, USA, Hofstra University, Department of Mathematics, Hempstead, NY, USA
| | - Robert K. Heinssen
- National Institute of Mental Health, Division of Services and Intervention Research, Rockville, MD, USA
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Meyer PS, Gottlieb JD, Penn D, Mueser K, Gingerich S. Individual Resiliency Training: An Early Intervention Approach to Enhance Well-Being in People with First-Episode Psychosis. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-06] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Minsky SK, Lu W, Silverstein SM, Gara M, Gottlieb JD, Mueser KT. Service Use and Self-Reported Symptoms Among Persons With Positive PTSD Screens and Serious Mental Illness. Psychiatr Serv 2015; 66:845-50. [PMID: 25873024 DOI: 10.1176/appi.ps.201400192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although many studies have reported higher rates of trauma exposure and posttraumatic stress disorder (PTSD) among persons with severe mental illness, the screening, diagnosis, and treatment of PTSD in public mental health centers remain at a suboptimal level and PTSD is often overlooked and untreated. This study used routine PTSD screening and service use data in electronic medical records to determine the association of PTSD, psychiatric symptoms, and service use in a sample of individuals with serious mental illness in a community-based treatment setting. METHODS The sample included 1,834 active clients between January 2007 and November 2010 who were screened for PTSD and who completed the 24-item Behavior and Symptom Identification Scale (BASIS-24). Service data included services provided a year before and a year after the screening date. RESULTS PTSD was associated with more severe psychiatric symptoms and increased no-show rates but not with increased service use or use of high-intensity services. PTSD likelihood interacted with race in accounting for elevated scores among African Americans on the psychosis domain of the BASIS-24. CONCLUSIONS PTSD screening is feasible and recommended in service environments and may contribute significantly to better understanding of racial-ethnic and other differences in service use and diagnostic practices.
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Affiliation(s)
- Shula K Minsky
- Dr. Minsky and Dr. Gara are with the Department of Quality Improvement, Rutgers University Behavioral Health Care, Piscataway, New Jersey (e-mail: ). Dr. Minsky and Dr. Gara are also with the Department of Psychiatry, Rutgers University, Piscataway, where Dr. Silverstein is affiliated. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, New Jersey. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston
| | - Weili Lu
- Dr. Minsky and Dr. Gara are with the Department of Quality Improvement, Rutgers University Behavioral Health Care, Piscataway, New Jersey (e-mail: ). Dr. Minsky and Dr. Gara are also with the Department of Psychiatry, Rutgers University, Piscataway, where Dr. Silverstein is affiliated. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, New Jersey. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston
| | - Steven M Silverstein
- Dr. Minsky and Dr. Gara are with the Department of Quality Improvement, Rutgers University Behavioral Health Care, Piscataway, New Jersey (e-mail: ). Dr. Minsky and Dr. Gara are also with the Department of Psychiatry, Rutgers University, Piscataway, where Dr. Silverstein is affiliated. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, New Jersey. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston
| | - Michael Gara
- Dr. Minsky and Dr. Gara are with the Department of Quality Improvement, Rutgers University Behavioral Health Care, Piscataway, New Jersey (e-mail: ). Dr. Minsky and Dr. Gara are also with the Department of Psychiatry, Rutgers University, Piscataway, where Dr. Silverstein is affiliated. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, New Jersey. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston
| | - Jennifer D Gottlieb
- Dr. Minsky and Dr. Gara are with the Department of Quality Improvement, Rutgers University Behavioral Health Care, Piscataway, New Jersey (e-mail: ). Dr. Minsky and Dr. Gara are also with the Department of Psychiatry, Rutgers University, Piscataway, where Dr. Silverstein is affiliated. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, New Jersey. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston
| | - Kim T Mueser
- Dr. Minsky and Dr. Gara are with the Department of Quality Improvement, Rutgers University Behavioral Health Care, Piscataway, New Jersey (e-mail: ). Dr. Minsky and Dr. Gara are also with the Department of Psychiatry, Rutgers University, Piscataway, where Dr. Silverstein is affiliated. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Scotch Plains, New Jersey. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston
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Mueser KT, Penn DL, Addington J, Brunette MF, Gingerich S, Glynn SM, Lynde DW, Gottlieb JD, Meyer-Kalos P, McGurk SR, Cather C, Saade S, Robinson DG, Schooler NR, Rosenheck RA, Kane JM. The NAVIGATE Program for First-Episode Psychosis: Rationale, Overview, and Description of Psychosocial Components. Psychiatr Serv 2015; 66:680-90. [PMID: 25772766 PMCID: PMC4490051 DOI: 10.1176/appi.ps.201400413] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project-known as the NAVIGATE program-with a particular focus on its psychosocial components. NAVIGATE is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services provided in the NAVIGATE program include the family education program (FEP), individual resiliency training (IRT), supported employment and education (SEE), and individualized medication treatment. NAVIGATE embraces a shared decision-making approach with a focus on strengths and resiliency and on collaboration with clients and family members in treatment planning and reviews. The NAVIGATE program has the potential to fill an important gap in the U.S. health care system by providing a comprehensive intervention specially designed to meet the unique treatment needs of persons recovering from a first episode of psychosis. A cluster-randomized controlled trial comparing NAVIGATE with usual community care has recently been completed.
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Affiliation(s)
- Kim T Mueser
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - David L Penn
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jean Addington
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Mary F Brunette
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan Gingerich
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Shirley M Glynn
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - David W Lynde
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jennifer D Gottlieb
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Piper Meyer-Kalos
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan R McGurk
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Corinne Cather
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Sylvia Saade
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Delbert G Robinson
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Nina R Schooler
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Robert A Rosenheck
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - John M Kane
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
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Mueser KT, Gottlieb JD, Xie H, Lu W, Yanos PT, Rosenberg SD, Silverstein SM, Duva SM, Minsky S, Wolfe RS, McHugo GJ. Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness. Br J Psychiatry 2015; 206:501-8. [PMID: 25858178 PMCID: PMC4450219 DOI: 10.1192/bjp.bp.114.147926] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND A cognitive-behavioural therapy (CBT) programme designed for post-traumatic stress disorder (PTSD) in people with severe mental illness, including breathing retraining, education and cognitive restructuring, was shown to be more effective than usual services. AIMS To evaluate the incremental benefit of adding cognitive restructuring to the breathing retraining and education components of the CBT programme (trial registration: clinicaltrials.gov identifier: NCT00494650). METHOD In all, 201 people with severe mental illness and PTSD were randomised to 12- to 16-session CBT or a 3-session brief treatment programme (breathing retraining and education). The primary outcome was PTSD symptom severity. Secondary outcomes were PTSD diagnosis, other symptoms, functioning and quality of life. RESULTS There was greater improvement in PTSD symptoms and functioning in the CBT group than in the brief treatment group, with both groups improving on other outcomes and effects maintained 1-year post-treatment. CONCLUSIONS Cognitive restructuring has a significant impact beyond breathing retraining and education in the CBT programme, reducing PTSD symptoms and improving functioning in people with severe mental illness.
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Mueser KT, Glynn SM, Cather C, Xie H, Zarate R, Smith LF, Clark RE, Gottlieb JD, Wolfe R, Feldman J. A randomized controlled trial of family intervention for co-occurring substance use and severe psychiatric disorders. Schizophr Bull 2013; 39:658-72. [PMID: 22282453 PMCID: PMC3627753 DOI: 10.1093/schbul/sbr203] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2011] [Indexed: 11/13/2022]
Abstract
Substance use disorders have a profound impact on the course of severe mental illnesses and on the family, but little research has evaluated the impact of family intervention for this population. To address this question, a randomized controlled trial was conducted comparing a brief (2-3 mo) Family Education (ED) program with a longer-term (9-18 mo) program that combined education with teaching communication and problem-solving skills, Family Intervention for Dual Disorders (FIDD). A total of 108 clients (77% schizophrenia-spectrum) and a key relative were randomized to either ED or FIDD and assessed at baseline and every 6 months for 3 years. Rates of retention of families in both programs were moderate. Intent-to-treat analyses indicated that clients in both programs improved in psychiatric, substance abuse, and functional outcomes, as did key relatives in knowledge of co-occurring disorders, burden, and mental health functioning. Clients in FIDD had significantly less severe overall psychiatric symptoms and psychotic symptoms and tended to improve more in functioning. Relatives in FIDD improved more in mental health functioning and knowledge of co-occurring disorders. There were no consistent differences between the programs in substance abuse severity or family burden. The findings support the utility of family intervention for co-occurring disorders, and the added benefits of communication and problem-solving training, but also suggest the need to modify these programs to retain more families in treatment in order to provide them with the information and skills they need to overcome the effects of these disorders.
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Affiliation(s)
- Kim T Mueser
- Center for Psychiatric Rehabilitation, Department of Occupational Therapy, Boston University, 940 Commonwealth Avenue, West, Boston, MA 02215, USA.
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Gottlieb JD, Romeo KH, Penn DL, Mueser KT, Chiko BP. Web-based cognitive-behavioral therapy for auditory hallucinations in persons with psychosis: a pilot study. Schizophr Res 2013; 145:82-7. [PMID: 23410709 DOI: 10.1016/j.schres.2013.01.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/21/2012] [Accepted: 01/02/2013] [Indexed: 12/20/2022]
Abstract
CBT for Psychosis (CBTp) is an empirically-supported intervention for schizophrenia, but few people have access to it in the U.S. "Coping with Voices" is an interactive, computerized self-directed web-based CBTp program developed to increase access to CBTp with the objective of reducing the severity, distress, and functional impairment caused by auditory hallucinations. This open pilot study tested the feasibility and effects of this new intervention. Twenty-one individuals with schizophrenia spectrum disorders and auditory hallucinations were enrolled in the individual-based 10-session Coping with Voices program at one of 4 community mental health centers. High levels of participant satisfaction with the program were found, with most reporting that the program was engaging and helped them manage their symptoms. Seventeen participants (81%) completed more than 50% of the scheduled program sessions (i.e., 6 or more sessions), and were defined as "exposed" to the program. Exposed participants showed statistically significant reductions from baseline to post-treatment in several measures of auditory hallucinations, including overall severity and the perception of voices as an "outside entity" and intensity of "negative commentary," as well as reductions in other psychotic symptoms, and overall psychopathology. This study supports the feasibility of the web-based Coping with Voices program and its potential clinical benefits, and suggests that more rigorous research is warranted to evaluate its effects.
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Affiliation(s)
- Jennifer D Gottlieb
- Boston University, Center for Psychiatric Rehabilitation, 940 Commonwealth Ave. West, Boston, MA 02115, USA.
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Lu W, Yanos PT, Silverstein SM, Mueser KT, Rosenberg SD, Gottlieb JD, Duva SM, Kularatne T, Dove-Williams S, Paterno D, Hawthorne D, Giacobbe G. Public mental health clients with severe mental illness and probable posttraumatic stress disorder: trauma exposure and correlates of symptom severity. J Trauma Stress 2013; 26:266-73. [PMID: 23508645 PMCID: PMC3888861 DOI: 10.1002/jts.21791] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 07/25/2012] [Accepted: 10/10/2012] [Indexed: 01/20/2023]
Abstract
Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged after-effects.
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Affiliation(s)
- Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions; University of Medicine and Dentistry of New Jersey, Scotch Plains; New Jersey USA
| | - Philip T. Yanos
- John Jay College of Criminal Justice; Department of Psychology; CUNY, New York New York USA
| | - Steven M. Silverstein
- Division of Schizophrenia Research; Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey; Piscataway New Jersey USA
| | - Kim T. Mueser
- Department of Psychiatry; Dartmouth Medical School; Concord New Hampshire USA
| | | | | | - Stephanie Marcello Duva
- University Behavioral Health Care; University of Medicine and Dentistry of New Jersey; Piscataway New Jersey USA
| | - Thanuja Kularatne
- Department of Psychiatric Rehabilitation and Counseling Professions; University of Medicine and Dentistry of New Jersey, Scotch Plains; New Jersey USA
| | - Stephanie Dove-Williams
- University Behavioral Health Care; University of Medicine and Dentistry of New Jersey; Piscataway New Jersey USA
| | - Danielle Paterno
- University Behavioral Health Care; University of Medicine and Dentistry of New Jersey; Piscataway New Jersey USA
| | - Danielle Hawthorne
- University Behavioral Health Care; University of Medicine and Dentistry of New Jersey; Piscataway New Jersey USA
| | - Giovanna Giacobbe
- University Behavioral Health Care; University of Medicine and Dentistry of New Jersey; Piscataway New Jersey USA
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Lu W, Yanos PT, Gottlieb JD, Duva SM, Silverstein SM, Xie H, Rosenberg SD, Mueser KT. Use of fidelity assessments to train clinicians in the CBT for PTSD program for clients with serious mental illness. Psychiatr Serv 2012; 63:785-92. [PMID: 22854726 PMCID: PMC3888865 DOI: 10.1176/appi.ps.201000458] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE One barrier to disseminating evidence-based practices for persons with serious mental illness is the difficulty of training frontline clinicians. This study evaluated whether frontline clinicians could be trained to implement an empirically supported cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) among persons with serious mental illness when a standardized fidelity measure was used to provide clinicians with feedback on practice cases. METHODS Twenty-five clinicians (23 master's level) at five agency sites were trained in the CBT for PTSD program and delivered it to 35 clients (practice cases) over six months. Supervisors or consultants used the fidelity measure to rate audio-recorded sessions and provide feedback. A criterion of competence was established to designate program certification. Clients' PTSD and depression symptoms were monitored. Clinicians' satisfaction with training was also assessed. RESULTS Two clinicians dropped out, and 21 of the remaining 23 clinicians (91%) achieved program certification with their first case; the remaining two (9%) achieved it with their second case. Clients' symptoms, measured by the PTSD Checklist and the Beck Depression Inventory, decreased significantly during treatment, suggesting clinical benefits of the program. Clinicians reported that group supervision was very helpful and written feedback was helpful or very helpful. All rated the training as excellent. CONCLUSIONS Results support the feasibility of training frontline clinicians in the CBT for PTSD program by using regular feedback based on the fidelity measure and indicate that most clinicians can achieve competence in the model with a single practice case.
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Affiliation(s)
- Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey, Scotch Plains, New Jersey, USA
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Mueser KT, Gottlieb JD, Cather C, Glynn SM, Zarate R, Smith LF, Clark RE, Wolfe R. Antisocial Personality Disorder in People with Co-Occurring Severe Mental Illness and Substance Use Disorders: Clinical, Functional, and Family Relationship Correlates. Psychosis 2012; 4:52-62. [PMID: 22389652 PMCID: PMC3289140 DOI: 10.1080/17522439.2011.639901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Antisocial personality disorder (ASPD) is an important correlate of substance abuse severity in the addiction population and in people with co-occurring serious mental illness and addiction. Because family members often provide vital supports to relatives with co-occurring disorders, this study explored the correlates of ASPD in 103 people with co-occurring disorders (79% schizophrenia-schizoaffective, 21% bipolar disorder) in high contact with relatives participating in a family intervention study. Clients with ASPD were more likely to have bipolar disorder and to have been married, but less likely to have graduated from high school. ASPD was associated with more severe drug abuse and depression, worse functioning, and less planning-based social problem solving. The relatives of clients with ASPD also reported less planning-based problem solving, worse attitudes towards the client, and worse mental health functioning. Client ASPD was associated with less long-term exposure to family intervention. The findings suggest that clients with ASPD in addition to co-occurring disorders are a particularly disadvantaged group with greater illness severity, more impaired functioning, and more strained family relationships. These difficulties may pose special challenges to delivering family intervention for this group.
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Affiliation(s)
- Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University
- Department of Occupational Therapy, Boston University
| | - Jennifer D. Gottlieb
- Center for Psychiatric Rehabilitation, Boston University
- Department of Occupational Therapy, Boston University
| | - Corrine Cather
- Dartmouth Psychiatric Research Center, Concord, NH
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Shirley M. Glynn
- VAGreater Los Angeles Healthcare System at West Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Roberto Zarate
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
- Pacific Clinics, Los Angeles, CA
| | - Lindy F. Smith
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH
- Dartmouth Psychiatric Research Center, Concord, NH
| | - Robin E. Clark
- Center for Health Policy and Research, University of Massachusetts Medical School
| | - Rosemarie Wolfe
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH
- Dartmouth Psychiatric Research Center, Concord, NH
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Gottlieb JD, Cather C, Shanahan M, Creedon T, Macklin EA, Goff DC. D-cycloserine facilitation of cognitive behavioral therapy for delusions in schizophrenia. Schizophr Res 2011; 131:69-74. [PMID: 21723096 PMCID: PMC3389827 DOI: 10.1016/j.schres.2011.05.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/23/2011] [Accepted: 05/31/2011] [Indexed: 12/18/2022]
Abstract
Glutamatergic N-methyl-D-aspartate (NMDA) receptor hypofunction has been proposed as a mechanism underlying psychosis. D-cycloserine, a partial agonist at the glycine site of the NMDA receptor, enhances learning in animal models, although tachyphylaxis develops with repeated dosing. Once-weekly dosing of D-cycloserine produces persistent improvement when combined with cognitive behavioral therapy (CBT) in anxiety disorders. Delusional beliefs can be conceptualized as a learning deficit, characterized by the failure to use contradictory evidence to modify the belief. CBT techniques have been developed with modest success to facilitate such reality-testing (or new learning) in delusional beliefs. The current study evaluated whether D-cycloserine could potentiate beneficial effects of CBT on delusional severity. Twenty-one outpatients with schizophrenia or schizoaffective disorder and moderately severe delusions were randomized in a double-blind cross-over design to receive a single-dose of either D-cycloserine 50mg or placebo in a counterbalanced order on two consecutive weeks 1h prior to a CBT intervention involving training in the generation of alternative beliefs. Assessments were completed at baseline, 7 days following the first study drug administration and 7 days following the second study drug administration. Contrary to prediction, there was no significant d-cycloserine treatment effect on delusional distress or severity as measured by the SAPS or PSYRATS. An unexpected finding was an order effect, whereby subjects who received D-cycloserine first had significantly reduced delusional severity, distress, and belief conviction on PSYRATS compared to subjects who received placebo first. However, this finding is consistent with animal models in which D-cycloserine enhances learning only when accompanying the first exposure to training.
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Affiliation(s)
- Jennifer D. Gottlieb
- Dartmouth Medical School Department of Psychiatry/Dartmouth Psychiatric Research Center, 105 Pleasant Street, Concord, NH 03301,Massachusetts General Hospital Schizophrenia Program, Freedom Trail Clinic, 25 Staniford Street, Boston, MA 02114
| | - Corinne Cather
- Massachusetts General Hospital Schizophrenia Program, Freedom Trail Clinic, 25 Staniford Street, Boston, MA 02114,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Meghan Shanahan
- Massachusetts General Hospital Schizophrenia Program, Freedom Trail Clinic, 25 Staniford Street, Boston, MA 02114
| | - Timothy Creedon
- Massachusetts General Hospital Schizophrenia Program, Freedom Trail Clinic, 25 Staniford Street, Boston, MA 02114
| | - Eric A. Macklin
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,Massachusetts General Hospital Biostatistics Center, 50 Staniford Street, Boston, MA 02114
| | - Donald C. Goff
- Massachusetts General Hospital Schizophrenia Program, Freedom Trail Clinic, 25 Staniford Street, Boston, MA 02114,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
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Gottlieb JD, Mueser KT, Rosenberg SD, Xie H, Wolfe RS. Psychotic depression, posttraumatic stress disorder, and engagement in cognitive-behavioral therapy within an outpatient sample of adults with serious mental illness. Compr Psychiatry 2011; 52:41-9. [PMID: 21220064 PMCID: PMC3052920 DOI: 10.1016/j.comppsych.2010.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/23/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022] Open
Abstract
Depression with psychotic features afflicts a substantial number of people and has been characterized by significantly greater impairment, higher levels of dysfunctional beliefs, and poorer response to psychopharmacologic and psychosocial interventions than nonpsychotic depression. Those with psychotic depression also experience a host of co-occurring disorders, including posttraumatic stress disorder (PTSD), which is not surprising given the established relationships between trauma exposure and increased rates of psychosis and between PTSD and major depression. To date, there has been very limited research on the psychosocial treatment of psychotic depression; and even less is known about those who also suffer from PTSD. The purpose of this study was to better understand the rates and clinical correlates of psychotic depression in those with PTSD. Clinical and symptom characteristics of 20 individuals with psychotic depression and 46 with nonpsychotic depression, all with PTSD, were compared before receiving cognitive-behavioral therapy for PTSD treatment or treatment as usual. Patients with psychotic depression exhibited significantly higher levels of depression and anxiety, a weaker perceived therapeutic alliance with their case managers, more exposure to traumatic events, and more negative beliefs related to their traumatic experiences, as well as increased levels of maladaptive cognitions about themselves and the world, compared with participants without psychosis. Implications for cognitive-behavioral therapy treatment aimed at dysfunctional thinking for this population are discussed.
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Goff DC, Cather C, Gottlieb JD, Evins AE, Walsh J, Raeke L, Otto MW, Schoenfeld D, Green MF. Once-weekly D-cycloserine effects on negative symptoms and cognition in schizophrenia: an exploratory study. Schizophr Res 2008; 106:320-7. [PMID: 18799288 PMCID: PMC2628436 DOI: 10.1016/j.schres.2008.08.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 07/21/2008] [Accepted: 08/12/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Daily dosing with d-cycloserine has inconsistently improved negative symptoms in schizophrenia patients, whereas intermittent dosing significantly facilitated exposure-based therapy in two studies of patients with phobic anxiety. In animal models, single-dose administration enhances memory consolidation, but tachyphylaxis develops with repeated dosing. The objective of this exploratory study was to assess whether once-weekly dosing with d-cycloserine will produce persistent improvements in negative symptoms and cognition. METHODS Fifty stable adult schizophrenia outpatients treated with any antipsychotic except clozapine were enrolled and 38 were randomized, double-blind, in a parallel-group, eight-week add-on trial of d-cycloserine 50 mg or placebo administered once-weekly. Symptom rating scales and a cognitive battery were administered at baseline and week 8 before the dose of study drug. As an exploratory analysis of memory consolidation, the Logical Memory Test, modified to measure recall after 7 days, was administered at baseline and after the first weekly dose of d-cycloserine. The primary outcome measures were change from baseline to week 8 on the SANS total score and on a composite cognitive score. RESULTS Thirty-three subjects (87%) completed the trial. d-cycloserine significantly improved SANS total scores compared to placebo at week 8. Cognitive performance did not improve with d-cycloserine at 8 weeks. Delayed thematic recall on the Logical Memory Test was significantly improved with the first dose of d-cycloserine compared to placebo. Performance on immediate thematic recall and item recall on the Logical Memory Test did not differ between treatments. CONCLUSIONS Once-weekly dosing with d-cycloserine for 8 weeks produced persistent improvement of negative symptoms compared to placebo, although statistical significance was, in part, the result of worsening of negative symptoms with placebo. Consistent with animal models, a single dose of d-cycloserine facilitated memory consolidation tested after 7 days on a test of thematic recall. These results must be considered preliminary since a number of outcomes were examined without correction for multiple tests. These findings suggest that once-weekly dosing with d-cycloserine for the treatment of negative symptoms merits further study, as do d-cycloserine effects on memory consolidation.
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Affiliation(s)
- Donald C. Goff
- Massachusetts General Hospital, Psychiatry Department, Freedom Trail Clinic, 25 Staniford St., 2nd Floor, Boston, MA 02114, USA, Harvard Medical School, 25 Shattuck St. Boston, MA 02115, USA
| | - Corinne Cather
- Massachusetts General Hospital, Psychiatry Department, Freedom Trail Clinic, 25 Staniford St., 2nd Floor, Boston, MA 02114, USA, Harvard Medical School, 25 Shattuck St. Boston, MA 02115, USA
| | - Jennifer D. Gottlieb
- Massachusetts General Hospital, Psychiatry Department, Freedom Trail Clinic, 25 Staniford St., 2nd Floor, Boston, MA 02114, USA, Harvard Medical School, 25 Shattuck St. Boston, MA 02115, USA
| | - A. Eden Evins
- Massachusetts General Hospital, Psychiatry Department, Freedom Trail Clinic, 25 Staniford St., 2nd Floor, Boston, MA 02114, USA, Harvard Medical School, 25 Shattuck St. Boston, MA 02115, USA
| | - Jared Walsh
- Massachusetts General Hospital, Psychiatry Department, Freedom Trail Clinic, 25 Staniford St., 2nd Floor, Boston, MA 02114, USA
| | - Lisa Raeke
- Massachusetts General Hospital, Psychiatry Department, Freedom Trail Clinic, 25 Staniford St., 2nd Floor, Boston, MA 02114, USA
| | - Michael W. Otto
- Boston University Center for Anxiety and Related Disorders, 648 Beacon St, 6th Fl. Boston, MA 02215, USA
| | - David Schoenfeld
- Harvard Medical School, 25 Shattuck St. Boston, MA 02115, USA, MGH Biostatistics Center, 50 Staniford St. Boston, MA 02114, USA
| | - Michael F. Green
- UCLA Semel Institute of Neuroscience and Human Behavior and the VA Greater Los Angeles Healthcare System, BOX 956968, 300 Medical Plaza, Ste 2263, Los Angeles, CA 90095-6968 USA
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Granholm E, McQuaid JR, McClure FS, Link PC, Perivoliotis D, Gottlieb JD, Patterson TL, Jeste DV. Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. J Clin Psychiatry 2007; 68:730-7. [PMID: 17503982 DOI: 10.4088/jcp.v68n0510] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE There is an increasing need for empirically validated psychotherapy interventions that improve functioning in older people with schizophrenia. We developed a 24-session weekly group therapy intervention labeled Cognitive Behavioral Social Skills Training (CBSST), which combined cognitive-behavioral therapy with social skills and problem-solving training to improve functioning. METHOD We previously reported end-of-treatment findings from a randomized controlled trial that compared treatment as usual (TAU) with TAU plus group CBSST in 76 outpatients, 42 to 74 years of age, with schizophrenia or schizoaffective disorder (DSM-IV criteria). Twelve-month follow-up results of that trial (conducted from October 1999 to September 2004) are reported here. Blind raters obtained assessments of CBSST skill mastery, functioning, psychotic and depressive symptoms, and cognitive insight (belief flexibility). RESULTS The significantly greater skill acquisition and self-reported performance of living skills in the community seen in CBSST versus TAU patients at the end of treatment were maintained at 12-month follow-up (p < or = .05). Participants in CBSST also showed significantly greater cognitive insight at the end of treatment relative to TAU, but this improvement was not maintained at follow-up. The treatment-group effect was not significant for symptoms at any assessment point; however, symptoms were not the primary treatment target in this stable outpatient sample. CONCLUSION Older people with very chronic schizophrenia were able to learn and maintain new skills with CBSST and showed improved self-reported functioning 1 year after the treatment ended. Longer treatment and/or booster sessions may be required to maintain gains in cognitive insight.
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Affiliation(s)
- Eric Granholm
- Veterans Affairs San Diego Healthcare System, San Diego, Calif 92161, USA.
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Gottlieb JD, Pryzgoda J, Neal A, Schuldberg D. Generalization of skills through the addition of individualized coaching: Development and evaluation of a social skills training program in a rural setting. Cognitive and Behavioral Practice 2005. [DOI: 10.1016/s1077-7229(05)80055-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Persily NA, Gottlieb JD. Structuring effective IDS-AMC affiliations. Healthc Financ Manage 1999; 53:33-5. [PMID: 10558003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
IDSs able to incorporate academic medical centers (AMCs) into their organizations can realize several benefits, including access to a broad spectrum of specialty services and clinical resources that can be used to develop clinical protocols and reduce variations in care delivery practices across the system. Before pursuing such a strategy, however, IDSs also must be ready to assume the challenges associated with managing AMCs. To effectively incorporate an AMC, an IDS will need to undertake cost-control initiatives within the AMC, implement an enterprisewide information system, and transform the AMC's culture to reflect a team-oriented, community-focused approach. Most importantly, the enterprisewide information system should provide a means to seamlessly integrate the AMC into the larger organization.
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Affiliation(s)
- N A Persily
- Wertlieb Educational Institute for Long Term Care Management, Washington, DC, USA
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Gottlieb JD, Ericsson JA, Sweet RB. Venous air embolism: a review. Anesth Analg 1965; 44:773-9. [PMID: 5321192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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