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Murden R, Allan SM, Hodgekins J, Oduola S. The effectiveness of public health interventions, initiatives, and campaigns designed to improve pathways to care for individuals with psychotic disorders: A systematic review. Schizophr Res 2024; 266:165-179. [PMID: 38412687 DOI: 10.1016/j.schres.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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] [Received: 07/28/2023] [Revised: 01/19/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Lengthy duration of untreated psychosis (DUP) and duration of untreated illness (DUI) in people at clinical high-risk for psychosis (CHR-P) and first episode psychosis (FEP) is associated with poorer outcomes. However, individuals with FEP often experience negative pathways to care involving contacts with police, crisis services and requiring compulsory admissions, and evidence suggests individuals with both FEP and CHR-P often experience lengthy delays to treatment. Early detection interventions, such as public health interventions, may be one way to reduce delays. This systematic review aimed to synthesise the available evidence on such interventions. METHODS The EMBASE, PsychINFO, CINAHL, and MEDLINE databases were searched. Studies were included if they compared an intervention designed to improve timely access to treatment for individuals with FEP or CHR-P to standard treatment provision. Interventions may be targeted at potential patients, their families, the general public, or non-healthcare professionals. Outcomes of interest were DUP or DUI, and/or characteristics of pathways to care. RESULTS Nineteen studies met the inclusion criteria. All consisted of FEP populations, none of CHR-P populations. Employing narrative synthesis, we found mixed results about the effectiveness of interventions at reducing DUP and interventions appeared to differentially impact groups. Pathways to care information was limited and mixed. CONCLUSION Findings on the effectiveness of interventions designed to improve timely access to treatment were inconclusive. More research is warranted to better understand where delays occur and factors which may influence this for both FEP and CHR-P populations which may help to develop targeted interventions to address delays.
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Affiliation(s)
- Rhiannon Murden
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; Birmingham and Solihull Mental Health NHS Foundation Trust, Uffculme Centre, 52 Queensbridge Road, Moseley, Birmingham B13 8QY, UK.
| | - Sophie M Allan
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Sheri Oduola
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
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Fowler D, French P, Banerjee R, Barton G, Berry C, Byrne R, Clarke T, Fraser R, Gee B, Greenwood K, Notley C, Parker S, Shepstone L, Wilson J, Yung AR, Hodgekins J. Prevention and treatment of long-term social disability amongst young people with emerging severe mental illness with social recovery therapy (The PRODIGY Trial): study protocol for a randomised controlled trial. Trials 2017; 18:315. [PMID: 28693622 PMCID: PMC5504604 DOI: 10.1186/s13063-017-2062-9] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young people who have social disability associated with severe and complex mental health problems are an important group in need of early intervention. Their problems often date back to childhood and become chronic at an early age. Without intervention, the long-term prognosis is often poor and the economic costs very large. There is a major gap in the provision of evidence-based interventions for this group, and therefore new approaches to detection and intervention are needed. This trial provides a definitive evaluation of a new approach to early intervention with young people with social disability and severe and complex mental health problems using social recovery therapy (SRT) over a period of 9 months to improve mental health and social recovery outcomes. METHODS This is a pragmatic, multi-centre, single blind, superiority randomised controlled trial. It is conducted in three sites in the UK: Sussex, Manchester and East Anglia. Participants are aged 16 to 25 and have both persistent and severe social disability (defined as engaged in less than 30 hours per week of structured activity) and severe and complex mental health problems. The target sample size is 270 participants, providing 135 participants in each trial arm. Participants are randomised 1:1 using a web-based randomisation system and allocated to either SRT plus optimised treatment as usual (enhanced standard care) or enhanced standard care alone. The primary outcome is time use, namely hours spent in structured activity per week at 15 months post-randomisation. Secondary outcomes assess typical mental health problems of the group, including subthreshold psychotic symptoms, negative symptoms, depression and anxiety. Time use, secondary outcomes and health economic measures are assessed at 9, 15 and 24 months post-randomisation. DISCUSSION This definitive trial will be the first to evaluate a novel psychological treatment for social disability and mental health problems in young people presenting with social disability and severe and complex non-psychotic mental health problems. The results will have important implications for policy and practice in the detection and early intervention for this group in mental health services. TRIAL REGISTRATION Trial Registry: International Standard Randomised Controlled Trial Number (ISRCTN) Registry. TRIAL REGISTRATION NUMBER ISRCTN47998710 (registered 29/11/2012).
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Affiliation(s)
- David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Falmer, Brighton, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, The University of Liverpool, Liverpool, UK
| | - Robin Banerjee
- School of Psychology, Pevensey Building, University of Sussex, Falmer, Brighton, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk UK
| | - Clio Berry
- School of Psychology, Pevensey Building, University of Sussex, Falmer, Brighton, UK
- Research & Development, Sussex Education Centre, Millview Hospital, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove, BN3 7HZ UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, The University of Manchester, Oxford Road, Manchester, UK
| | - Timothy Clarke
- Research & Development, Norfolk and Suffolk NHS Foundation Trust, 80 St Stephens, Norwich, UK
| | - Rick Fraser
- Research & Development, Sussex Education Centre, Millview Hospital, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove, BN3 7HZ UK
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - Brioney Gee
- Research & Development, Norfolk and Suffolk NHS Foundation Trust, 80 St Stephens, Norwich, UK
| | - Kathryn Greenwood
- School of Psychology, Pevensey Building, University of Sussex, Falmer, Brighton, UK
- Research & Development, Sussex Education Centre, Millview Hospital, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove, BN3 7HZ UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk UK
| | - Sophie Parker
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk UK
| | - Jon Wilson
- Research & Development, Norfolk and Suffolk NHS Foundation Trust, 80 St Stephens, Norwich, UK
| | - Alison R. Yung
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Oxford Road, Manchester, UK
| | - Joanne Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk UK
- Research & Development, Norfolk and Suffolk NHS Foundation Trust, 80 St Stephens, Norwich, UK
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Labad J, Stojanovic-Pérez A, Montalvo I, Solé M, Cabezas Á, Ortega L, Moreno I, Vilella E, Martorell L, Reynolds RM, Gutiérrez-Zotes A. Stress biomarkers as predictors of transition to psychosis in at-risk mental states: roles for cortisol, prolactin and albumin. J Psychiatr Res 2015; 60:163-9. [PMID: 25466832 DOI: 10.1016/j.jpsychires.2014.10.011] [Citation(s) in RCA: 79] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
Stress and inflammation are thought to play a role in the risk of developing a psychotic disorder. We aimed to identify stress-related biomarkers for psychosis transition in help-seeking individuals with an at-risk mental state (ARMS). We studied 39 ARMS subjects who were attending an Early Intervention Service. We included a control group of 44 healthy subjects (HS) matched by sex and age. Stressful life events and perceived stress were assessed. Stress-related biomarkers were determined in serum (cortisol, prolactin, C-reactive protein and albumin), plasma (fibrinogen) or saliva (morning cortisol, cortisol awakening response). All ARMS were followed-up at our Unit for at least one year. We divided the ARMS group into two subgroups based on the development of a psychotic disorder (ARMS-P, N = 10) or not (ARMS-NP, N = 29). ARMS-P reported more stressful life events and perceived stress than HS and ARMS-NP groups. In relation to baseline stress biomarkers, ARMS-P subjects had increased prolactin and lower albumin levels in serum, when compared to ARMS-NP and HS groups. These results did not change when repeated in a subsample of antipsychotic-naïve ARMS subjects. We also found significant differences between groups in the cortisol secretion after awakening. In a multinomial logistic regression adjusting for age, sex and life stress, prolactin was a predictor of psychosis transition whereas albumin levels had a protective effect. Our study underscores the role of stress and stress-related biomarkers (cortisol awakening response, prolactin and albumin) in the pathogenesis of psychosis.
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Affiliation(s)
- Javier Labad
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
| | - Alexander Stojanovic-Pérez
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Itziar Montalvo
- Department of Psychiatry, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Montse Solé
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Ángel Cabezas
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Laura Ortega
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Irene Moreno
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Elisabet Vilella
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Lourdes Martorell
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Rebecca M Reynolds
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Alfonso Gutiérrez-Zotes
- Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
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