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van der Pluijm M, Wengler K, Reijers PN, Cassidy CM, Tjong Tjin Joe K, de Peuter OR, Horga G, Booij J, de Haan L, van de Giessen E. Neuromelanin-Sensitive MRI as Candidate Marker for Treatment Resistance in First-Episode Schizophrenia. Am J Psychiatry 2024:appiajp20220780. [PMID: 38476044 DOI: 10.1176/appi.ajp.20220780] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Markers for treatment resistance in schizophrenia are needed to reduce delays in effective treatment. Nigrostriatal hyperdopaminergic function plays a critical role in the pathology of schizophrenia, yet antipsychotic nonresponders do not show increased dopamine function. Neuromelanin-sensitive MRI (NM-MRI), which indirectly measures dopamine function in the substantia nigra, has potential as a noninvasive marker for nonresponders. Increased NM-MRI signal has been shown in psychosis, but has not yet been assessed in nonresponders. In this study, the authors investigated whether nonresponders show lower NM-MRI signal than responders. METHODS NM-MRI scans were acquired in 79 patients with first-episode psychosis and 20 matched healthy control subjects. Treatment response was assessed at a 6-month follow-up. An a priori voxel-wise analysis within the substantia nigra tested the relation between NM-MRI signal and treatment response in patients. RESULTS Fifteen patients were classified as nonresponders and 47 patients as responders. Seventeen patients were excluded, primarily because of medication nonadherence or change in diagnosis. Voxel-wise analysis revealed 297 significant voxels in the ventral tier of the substantia nigra that were negatively associated with treatment response. Nonresponders and healthy control subjects had significantly lower NM-MRI signal than responders. Receiver operating characteristic curve analysis showed that NM-MRI signal separated nonresponders with areas under the curve between 0.62 and 0.85. In addition, NM-MRI signal in patients did not change over 6 months. CONCLUSIONS These findings provide further evidence for dopaminergic differences between medication responders and nonresponders and support the potential of NM-MRI as a clinically applicable marker for treatment resistance in schizophrenia.
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Affiliation(s)
- Marieke van der Pluijm
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Kenneth Wengler
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Pascalle N Reijers
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Clifford M Cassidy
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Kaithlyn Tjong Tjin Joe
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Olav R de Peuter
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Guillermo Horga
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Jan Booij
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Lieuwe de Haan
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine (van der Pluijm, Reijers, Tjong Tjin Joe, Booij, van de Giessen) and Department of Psychiatry (van der Pluijm, de Haan), Amsterdam UMC, University of Amsterdam, Amsterdam; Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (Wengler, Horga); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Cassidy); Arkin Mental Health Care, Amsterdam (de Peuter)
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2
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Kosteletos I, Hatzimanolis A, Xenaki LA, Ralli I, Dimitrakopoulos S, Vlahos I, Selakovic M, Foteli S, Soldatos RF, Nianiakas N, Kollias K, Stefanis N. The relationship between bullying and symptom presentation in first-episode psychosis. Psychiatriki 2023. [PMID: 37793035 DOI: 10.22365/jpsych.2023.021] [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] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Multiple recent studies have indicated that adverse psycho-traumatic experiences are particularly significant, if not the most significant, among the environmental factors that participate in the aetiology of schizophrenic spectrum disorders. The prevalence of bullying in the adolescent population has increased dramatically compared to earlier reports. This may be related to the recent development of communication technology and the use of social media, which have expanded the means by which bullying can be practiced. The present study aims to investigate the association between bullying victimisation and psychotic symptoms in First-Episode Psychosis (FEP) patients, hypothesising that patients who have a bullying history may have increased psychotic symptoms and a more unfavourable early trajectory after treatment as usual compared to patients who do not have a bullying history. Research data were collected from a sample of men and women of the Greek general population aged between 16 and 45 (N=225) who experienced a FEP in the context of the Athens First-Episode Psychosis (FEP) Study. The assessment of bullying was performed using the Retrospective Bullying Questionnaire (RBQ). Assessment of positive and negative psychotic symptoms and general psychopathology was performed using the corresponding subscales of the Positive and Negative Syndrome Scale (PANSS) at baseline and after 4 weeks of treatment as usual. Clinical remission was assessed based on the baseline and follow-up values of the PANSS and on Andreasen's symptomatic criteria. Methodologically, Pearson's chi-square test was used to compare the history of bullying between men and women, while linear and logistic regression models were used to check the correlations between history of bullying and symptom severity at baseline and 4-week follow-up, as well as the correlation between history of bullying and remission. The prevalence of bullying history in our sample of patients (N:225) with a FEP was 51.4% (114/225). Bullying was recorded in our study participants with equal frequency in women and men. According to the analysis results, the patients who had experienced bullying did not present at baseline with significantly increased psychotic symptoms compared to the patients who did not have a history of bullying. In addition, bullying was not associated with reduced remission according to Andreasen's criteria. However, the patients who had experienced bullying were found to have significantly increased negative symptoms (B=1.66; SE=0.70; p=0.018) and increased PANSS total score (B=4.81; SE=2.34; p=0.041) at 4-week follow-up. Our results highlight the persistence of negative and overall symptoms as an impact of bullying on the development of the FEP and align with studies that support the consideration of a history of bullying during both the diagnostic and therapeutic processes.
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Affiliation(s)
- Ioannis Kosteletos
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Alexandros Hatzimanolis
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Lida-Alkisti Xenaki
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Irene Ralli
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Stefanos Dimitrakopoulos
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Ilias Vlahos
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Mirijana Selakovic
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Stefania Foteli
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Rigas-Filippos Soldatos
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Nikolaos Nianiakas
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Konstantinos Kollias
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
| | - Nikos Stefanis
- The Athens First Episode Psychosis Research Study Group. 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens
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3
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O'Keeffe D, Kinsella A, Waddington JL, Clarke M. 20-Year Prospective, Sequential Follow-Up Study of Heterogeneity in Associations of Duration of Untreated Psychosis With Symptoms, Functioning, and Quality of Life Following First-Episode Psychosis. Am J Psychiatry 2022; 179:288-297. [PMID: 35360921 DOI: 10.1176/appi.ajp.2021.20111658] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Determining the extent to which relationships between duration of untreated psychosis (DUP) and outcome endure longitudinally across the lifetime course of psychotic illness requires prospective, systematic studies of epidemiologically representative incidence cohorts across decades. Transience, persistence, or heterogeneity in associations between DUP and distinct outcome domains are yet to be investigated over such time frames. METHODS Prospective, sequential follow-up studies of an epidemiologically representative first-episode psychosis incidence cohort in Ireland were conducted at 6 months and 4, 8, 12, and 20 years (N=171). Linear mixed-model analyses were applied to determine whether prospective associations of DUP with symptoms, functioning, and quality of life were consistent or varied across psychotic illness trajectory over a 20-year period. Evaluations included time, DUP quartile, and DUP quartile-by-time interaction effects. RESULTS Prospective, sequential follow-ups showed positive and negative symptoms, function, and quality of life to exhibit distinct trajectories of improvement in relation to shorter DUP. Despite heterogeneity in course and relationship to premorbid features, associations between shorter DUP and greater improvement were still evident 20 years after the first psychotic episode. Across the long-term course of psychotic illness, trajectories of association between shorter DUP and better outcome differed between domains of psychopathology, functionality, and quality of life. Nevertheless, such associations with shorter DUP were sustained for at least 20 years. CONCLUSIONS These profiles indicate that while associations between DUP and long-term outcome can vary according to the domain of outcome, they are sustained across decades in a manner that could not be fully accounted for in terms of premorbid features or lead-time bias.
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Affiliation(s)
- Donal O'Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
| | - Anthony Kinsella
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
| | - John L Waddington
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
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4
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Amsalem D, Markowitz JC, Jankowski SE, Yang LH, Valeri L, Lieff SA, Neria Y, Dixon LB. Sustained Effect of a Brief Video in Reducing Public Stigma Toward Individuals With Psychosis: A Randomized Controlled Trial of Young Adults. Am J Psychiatry 2021; 178:635-642. [PMID: 33900809 DOI: 10.1176/appi.ajp.2020.20091293] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/01/2022]
Abstract
OBJECTIVE Public stigma is a barrier to care and increases the duration of untreated psychosis among individuals with first-episode psychosis. The authors recently demonstrated the efficacy of a 90-second social contact-based video intervention in reducing such stigma. That proof-of-concept study was the first to employ so brief an antistigma intervention in a sample of young adults. The authors now present a randomized controlled replication study with baseline, postintervention, and 30-day follow-up assessments. The authors aimed to replicate their previous findings and to show a persisting benefit for the video intervention. METHODS Using a crowdsourcing platform (Amazon Mechanical Turk), the authors recruited and assigned 1,055 participants ages 18-30 years to a brief video-based intervention, to a written vignette intervention containing the same material, or to a nonintervention control condition. In the 90-second video, a 22-year-old African American woman with schizophrenia humanized the illness through her emotional description of living a meaningful and productive life. RESULTS A three-by-three group-by-time multivariate analysis of variance showed a significant group-by-time interaction for the total scores of all five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery. Post hoc pairwise tests showed greater reductions in the video group compared with the vignette and control groups at the postintervention and 30-day follow-up assessments, while the vignette group differed from the control group at the postintervention assessment but not at the 30-day assessment. CONCLUSIONS This randomized controlled study replicated and strengthened the authors' earlier findings, further showing month-long sustained stigma reduction in the social contact-based video intervention arm. A 90-second video sufficed to humanize schizophrenia and reduce stigma. Further research should examine longer-term sustainability, assess changes in behavior, and determine optimal effective video length.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Lawrence H Yang
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Linda Valeri
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Sarah A Lieff
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Amsalem, Markowitz, Jankowski, Neria, Dixon); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York (Yang, Lieff); Department of Epidemiology (Yang) and Department of Biostatistics (Valeri), Columbia University Mailman School of Public Health, New York; Department of Epidemiology, Columbia University Irving Medical Center, New York (Neria)
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5
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Esposito CM, D'Agostino A, Dell Osso B, Fiorentini A, Prunas C, Callari A, Oldani L, Fontana E, Gargano G, Viscardi B, Giordano B, D'Angelo S, Wiedenmann F, Macellaro M, Giorgetti F, Turtulici N, Gambini O, Brambilla P. Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, italy. Psychiatry Res 2021; 298:113802. [PMID: 33592401 PMCID: PMC7874958 DOI: 10.1016/j.psychres.2021.113802] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023]
Abstract
The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.
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Affiliation(s)
- C M Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A D'Agostino
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - B Dell Osso
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - A Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Prunas
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Callari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Fontana
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gargano
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Viscardi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Giordano
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - S D'Angelo
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Wiedenmann
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - M Macellaro
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Giorgetti
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - Ne Turtulici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - O Gambini
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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6
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Jonas KG, Fochtmann LJ, Perlman G, Tian Y, Kane JM, Bromet EJ, Kotov R. Lead-Time Bias as a Potential Explanation for the Link Between Duration of Untreated Psychosis and Outcome: Response to Iyer et al. Am J Psychiatry 2020; 177:1181-1183. [PMID: 33256448 DOI: 10.1176/appi.ajp.2020.20030299r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Laura J Fochtmann
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Yuan Tian
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - John M Kane
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Evelyn J Bromet
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
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7
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Affiliation(s)
- Vinod H. Srihari
- Department of Psychiatry, Yale University School of Medicine, New
Haven, Conn
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New
Haven, Conn
| | - Svein Friis
- Department of Research and Development, Division of Mental Health
and Addiction, Oslo University Hospital, Oslo
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8
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Jonas KG, Fochtmann LJ, Perlman G, Tian Y, Kane JM, Bromet EJ, Kotov R. Duration of Untreated Psychosis: Getting Both the Timing and the Sample Right: Response to Woods et al. Am J Psychiatry 2020; 177:1183-1185. [PMID: 33256442 DOI: 10.1176/appi.ajp.2020.20040389r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Laura J Fochtmann
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Yuan Tian
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - John M Kane
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Evelyn J Bromet
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
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9
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Affiliation(s)
- Scott W Woods
- Department of Psychiatry and Connecticut Mental Health Center, Yale University School of Medicine, New Haven, Conn. (Woods, McGlashan); Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia (Yung, McGorry)
| | - Alison R Yung
- Department of Psychiatry and Connecticut Mental Health Center, Yale University School of Medicine, New Haven, Conn. (Woods, McGlashan); Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia (Yung, McGorry)
| | - Patrick D McGorry
- Department of Psychiatry and Connecticut Mental Health Center, Yale University School of Medicine, New Haven, Conn. (Woods, McGlashan); Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia (Yung, McGorry)
| | - Thomas H McGlashan
- Department of Psychiatry and Connecticut Mental Health Center, Yale University School of Medicine, New Haven, Conn. (Woods, McGlashan); Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia (Yung, McGorry)
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10
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Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Laura J Fochtmann
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Yuan Tian
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - John M Kane
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Evelyn J Bromet
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
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11
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Iyer SN, Anderson KK, Malla A, Shah J, Norman R. The Case for Cautious Interpretation and Replication: Lead-Time Bias as a Potential Explanation for the Link Between Duration of Untreated Psychosis and Outcome. Am J Psychiatry 2020; 177:1180-1181. [PMID: 33256452 DOI: 10.1176/appi.ajp.2020.20030299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Srividya N Iyer
- Department of Psychiatry and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Iyer, Malla, Shah); Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada (Iyer, Malla, Shah); Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (Anderson, Norman)
| | - Kelly K Anderson
- Department of Psychiatry and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Iyer, Malla, Shah); Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada (Iyer, Malla, Shah); Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (Anderson, Norman)
| | - Ashok Malla
- Department of Psychiatry and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Iyer, Malla, Shah); Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada (Iyer, Malla, Shah); Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (Anderson, Norman)
| | - Jai Shah
- Department of Psychiatry and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Iyer, Malla, Shah); Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada (Iyer, Malla, Shah); Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (Anderson, Norman)
| | - Ross Norman
- Department of Psychiatry and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Iyer, Malla, Shah); Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada (Iyer, Malla, Shah); Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (Anderson, Norman)
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12
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Smith TE, Kurk M, Sawhney R, Bao Y, Nossel I, Cohen DE, Dixon LB. Estimated Staff Time Effort, Costs, and Medicaid Revenues for Coordinated Specialty Care Clinics Serving Clients With First-Episode Psychosis. Psychiatr Serv 2019; 70:425-427. [PMID: 30914002 DOI: 10.1176/appi.ps.201900039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 11/30/2022]
Abstract
As coordinated specialty care for first-episode psychosis is implemented nationally, questions arise regarding financial sustainability. To address this, New York State undertook a time study in which 13 coordinated specialty care sites reported all activities provided to 75 randomly selected Medicaid clients with first-episode psychosis over a 2-week period. The average estimated cost was $1,375 per client per month, yet under optimal billing conditions, estimated revenues were only $662 per client per month, or 48% of the costs. These results underscore the need for continued subsidies and novel payment schemes for coordinated specialty care.
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Affiliation(s)
- Thomas E Smith
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Margaret Kurk
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Rishi Sawhney
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Yuhua Bao
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Ilana Nossel
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Dana E Cohen
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Lisa B Dixon
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
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Birnbaum ML, Rizvi AF, Faber K, Addington J, Correll CU, Gerber C, Lahti AC, Loewy RL, Mathalon DH, Nelson LA, Voineskos AN, Walker EF, Ward E, Kane JM. Digital Trajectories to Care in First-Episode Psychosis. Psychiatr Serv 2018; 69:1259-1263. [PMID: 30256181 PMCID: PMC6408281 DOI: 10.1176/appi.ps.201800180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The emphasis on reducing the duration of untreated psychosis (DUP) has highlighted complex barriers to accessing appropriate services. Internet and social media use by individuals with first-episode psychosis (FEP) was examined to explore how these platforms might be used to facilitate treatment initiation. METHODS Participants ages 15-35 were interviewed with the Pathways to Care for Psychosis Questionnaire, an 81-item instrument designed to explore online activity during symptom emergence. RESULTS Of 112 participants, 90% used the Internet and social media daily. The Internet was listed as the most used resource (62%) for information while symptoms were emerging. A minority (19%) shared concerns via social media, and 76% responded favorably to the possibility of receiving online mental health support. CONCLUSIONS The Internet and social media were part of daily life for participants with FEP. Activity continued throughout the DUP, offering the prospect of earlier intervention. Participants expressed positive attitudes toward Internet-based outreach and engagement efforts.
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Affiliation(s)
- Michael L Birnbaum
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Asra F Rizvi
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Keren Faber
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Jean Addington
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Christoph U Correll
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Carla Gerber
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Adrienne C Lahti
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Rachel L Loewy
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Daniel H Mathalon
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Leigh Anne Nelson
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Aristotle N Voineskos
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Elaine F Walker
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - Elise Ward
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
| | - John M Kane
- Dr. Birnbaum, Mrs. Rizvi, Ms. Faber, Dr. Correll, and Dr. Kane are with the Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York. Dr. Birnbaum, Mrs. Rizvi, and Dr. Kane are also with the Feinstein Institute for Medical Research, Manhasset, New York. Dr. Correll is also with the Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin. Dr. Addington is with Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. Ms. Gerber is with the Department of Behavioral Health, Peacehealth Medical Group, Eugene, Oregon. Dr. Lahti is with the Department of Psychiatry, University of Alabama at Birmingham. Dr. Loewy and Dr. Mathalon are with the Department of Psychiatry, University of California, San Francisco. Dr. Mathalon is also with the Department of Veterans Affairs San Francisco Healthcare System, San Francisco. Dr. Nelson is with the School of Pharmacy, University of Missouri-Kansas City. Dr. Voineskos is with the Department of Psychiatry, University of Toronto, and the Center for Addiction and Mental Health, Toronto, Canada. Dr. Walker is with the Department of Psychology, Emory University, Atlanta. Ms. Ward is with Henderson Behavioral Health, Lauderdale Lakes, Florida
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Anderson KK, Norman R, MacDougall A, Edwards J, Palaniyappan L, Lau C, Kurdyak P. Effectiveness of Early Psychosis Intervention: Comparison of Service Users and Nonusers in Population-Based Health Administrative Data. Am J Psychiatry 2018; 175:443-452. [PMID: 29495897 DOI: 10.1176/appi.ajp.2017.17050480] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early psychosis intervention (EPI) programs improve clinical and functional outcomes for people with first-episode psychosis. Less is known about the impact of these programs on the larger health care system. The authors sought to compare indicators of health service use, self-harm, suicide, and mortality between people with first-episode psychosis who were using EPI services and a propensity-matched group of concurrent control subjects who were not accessing EPI services. METHOD A retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses in London, Ontario, between 1997 and 2013 was constructed using health administrative data. This cohort was linked to primary data from the same program to identify people who used EPI services. Outcomes for people who used EPI services and those who did not were compared using Cox proportional hazards models. RESULTS People who used EPI services had substantially lower rates of all-cause mortality in the 2-year period after EPI program admission (hazard ratio=0.24, 95% CI=0.11-0.53), although a significant difference in self-harm (hazard ratio=0.86, 95% CI=0.18-4.24) and suicide (hazard ratio=0.73, 95% CI=0.29-1.80) between the two groups was not observed. Those who used EPI services also had lower rates of emergency department presentation (hazard ratio=0.71, 95% CI=0.60-0.83) but higher rates of hospitalization (hazard ratio=1.42, 95% CI=1.18-1.71). These benefits were not observed after 2 years, when EPI care is typically stepped down to medical management. CONCLUSIONS People with first-episode psychosis who used EPI services had mortality rates that were four times lower than those with first-episode psychosis who did not use these services, as well as better outcomes across several health care system indicators. These findings support the effectiveness of EPI services for the treatment of first-episode psychosis in the larger context of the overall health care system.
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Affiliation(s)
- Kelly K Anderson
- From the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; the Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ross Norman
- From the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; the Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Arlene MacDougall
- From the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; the Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Edwards
- From the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; the Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lena Palaniyappan
- From the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; the Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Cindy Lau
- From the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; the Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- From the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; the Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Alghamdi W, Stamate D, Stahl D, Zamyatin A, Murray R, Di Forti M. A New Machine Learning Framework for Understanding the Link Between Cannabis Use and First-Episode Psychosis. Stud Health Technol Inform 2018; 248:9-16. [PMID: 29726413] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lately, several studies started to investigate the existence of links between cannabis use and psychotic disorders. This work proposes a refined Machine Learning framework for understanding the links between cannabis use and 1st episode psychosis. The novel framework concerns extracting predictive patterns from clinical data using optimised and post-processed models based on Gaussian Processes, Support Vector Machines, and Neural Networks algorithms. The cannabis use attributes' predictive power is investigated, and we demonstrate statistically and with ROC analysis that their presence in the dataset enhances the prediction performance of the models with respect to models built on data without these specific attributes.
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Affiliation(s)
- Wajdi Alghamdi
- Data Science & Soft Computing Lab, and Department of Computing, Goldsmiths, University of London, UK
| | - Daniel Stamate
- Data Science & Soft Computing Lab, and Department of Computing, Goldsmiths, University of London, UK
| | - Daniel Stahl
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Alexander Zamyatin
- Faculty of Informatics, Department of Applied Informatics, National Research Tomsk State University, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Marta Di Forti
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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16
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Humensky J, Scodes J, Wall M, Malinovsky I, Marino L, Smith T, Sederer L, Nossel I, Bello I, Dixon L. Disability Enrollment in a Community-Based Coordinated Specialty Care Program. Am J Psychiatry 2017; 174:1224-1225. [PMID: 29191038 PMCID: PMC5839472 DOI: 10.1176/appi.ajp.2017.17070752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer Humensky
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | | | - Melanie Wall
- New York State Psychiatric Institute,Columbia/Mailman School of Public Health
| | - Igor Malinovsky
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | | | - Thomas Smith
- Columbia University College of Physicians and Surgeons,New York State Office of Mental Health
| | - Lloyd Sederer
- Columbia/Mailman School of Public Health,New York State Office of Mental Health
| | - Ilana Nossel
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | - Iruma Bello
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | - Lisa Dixon
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
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Rosenheck RA, Estroff SE, Sint K, Lin H, Mueser KT, Robinson DG, Schooler NR, Marcy P, Kane JM. Incomes and Outcomes: Social Security Disability Benefits in First-Episode Psychosis. Am J Psychiatry 2017; 174:886-894. [PMID: 28427286 DOI: 10.1176/appi.ajp.2017.16111273] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Social Security Administration (SSA) disability benefits are an important source of income for people with psychoses and confer eligibility for health insurance. The authors examined the impact of coordinated specialty care on receipt of such benefits in first-episode psychosis, along with the correlates and consequences of receiving them. METHOD The Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial, compared NAVIGATE, a coordinated specialty care program, to usual community care over 2 years. Receipt of SSA benefits and clinical outcomes were assessed at program entry and every 6 months for 2 years. Piecewise regression analysis was used to identify relative change in outcome trajectories after receipt of disability benefits. RESULTS Among 399 RAISE-ETP participants, 36 (9%) were receiving SSA disability benefits at baseline; of the remainder, 124 (34.1%) obtained benefits during the 2-year study period. The NAVIGATE intervention improved quality of life, symptoms, and employment but did not significantly reduce the likelihood of receiving SSA disability benefits. Obtaining benefits was predicted by more severe psychotic symptoms and greater dysfunction and was followed by increased total income but fewer days of employment, reduced motivation (e.g., sense of purpose, greater anhedonia), and fewer days of intoxication. CONCLUSIONS A 2-year coordinated specialty care intervention did not reduce receipt of SSA disability benefits. There were some advantages for those who obtained SSA disability benefits over the 2-year treatment period, but there were also some unintended adverse consequences. Providing income supports without impeding recovery remains an important policy challenge.
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Affiliation(s)
- Robert A Rosenheck
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - Sue E Estroff
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - Kyaw Sint
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - Haiqun Lin
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - Kim T Mueser
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - Delbert G Robinson
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - Nina R Schooler
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - Patricia Marcy
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
| | - John M Kane
- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
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- From the Department of Psychiatry, Yale Medical School, New Haven, Conn.; the Department of Psychology, University of North Carolina at Chapel Hill; the Center for Psychiatric Rehabilitation and the Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, N.Y.; and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, N.Y
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Compton MT, Berez C, Walker EF. The Relative Importance of Family History, Gender, Mode of Onset, and Age at Onsetin Predicting Clinical Features of First-Episode Psychotic Disorders. ACTA ACUST UNITED AC 2014; 11:143-150. [PMID: 25367167 DOI: 10.3371/csrp.cobe.103114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Family history of psychosis, gender, mode of onset, and age at onset are considered prognostic factors important to clinicians evaluating first-episode psychosis; yet, clinicians have little guidance as to how these four factors differentially predict early-course substance abuse, symptomatology, and functioning. We conducted a "head-to-head comparison" of these four factors regarding their associations with key clinical features at initial hospitalization. We also assessed potential interactions between gender and family history with regard to age at onset of psychosis and symptom severity. METHODS Consecutively admitted first-episode patients (n=334) were evaluated in two studies that rigorously assessed a number of early-course variables. Associations among variables of interest were examined using Pearson correlations, χ2 tests, Student's t-tests, and 2×2 factorial analyses of variance. RESULTS Substance (nicotine, alcohol, and cannabis) abuse and positive symptom severity were predicted only by male gender. Negative symptom severity and global functioning impairments were predicted by earlier age at onset of psychosis. General psychopathology symptom severity was predicted by both mode of onset and age at onset. Interaction effects were not observed with regard to gender and family history in predicting age at onset or symptom severity. CONCLUSIONS The four prognostic features have differential associations with substance abuse, domains of symptom severity, and global functioning. Gender and age at onset of psychosis appear to be more predictive of clinical features at the time of initial evaluation (and thus presumably longer term outcomes) than the presence of a family history of psychosis and a more gradual mode of onset.
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Abstract
AIM Early engagement in care is thought to reduce disabling social losses related to the duration of untreated psychosis (DUP), such as school dropout, homelessness, and incarceration, which contribute to chronic disability. Early-intervention services that promote recovery will not be effective if eligible persons drop out of treatment after an initial hospitalization for a psychotic disorder. We had the unique opportunity to examine the treatment disengagement rate of patients with early psychosis after an initial hospitalization. METHODS In a predominantly male, African-American, and socioeconomically disadvantaged group of 33 participants with first-episode psychosis assessed at initial hospitalization and six months after discharge, we compared clinical characteristics (medication adherence attitudes and behaviors, knowledge about schizophrenia, insight, symptom severity, and persistence of alcohol and drug use) among those who disengaged and people who engaged in care. RESULTS More than half (18, 54.5%) attended <3 outpatient appointments in the six months after hospital discharge and, of those, nearly all (15, 83.3%) attended no outpatient appointments. Disengaged people were much less adherent to medications in the past month and six months, and scored lower on medication adherence attitudes, knowledge about psychosis, and insight. They had greater positive symptom severity and a higher likelihood of continuing drug use. Clinical Relevancy: Initial treatment disengagement is very common among young people with first-episode psychosis and is associated with poorer clinical status. More research is needed on the causes of disengagement during this critical period and ways to improve initial treatment engagement among people with first-episode psychosis.
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Domínguez-Martínez T, Medina-Pradas C, Kwapil TR, Barrantes-Vidal N. Relatives׳ illness attributions mediate the association of expressed emotion with early psychosis symptoms and functioning. Psychiatry Res 2014; 218:48-53. [PMID: 24768246 DOI: 10.1016/j.psychres.2014.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 08/07/2013] [Revised: 02/21/2014] [Accepted: 04/02/2014] [Indexed: 11/15/2022]
Abstract
The mechanisms underlying the association between expressed emotion (EE) and the prognosis in early psychosis are still not well understood. Based on the attributional model, this study investigated the association of criticism and Emotional Over-Involvement (EOI) with symptoms and functioning in At-Risk Mental State (ARMS) and First-Episode Psychosis (FEP) patients, and whether these associations were mediated by relatives׳ attributions of control and blame. Forty-four patients (20 ARMS and 24 FEP) and their relatives were included. Findings indicated that relatives׳ criticism was associated with positive, negative, and general symptoms. EOI was related to negative and general symptoms. Both indices were related with impaired functioning. Most of the relations between EE indices and illness severity were mediated by relatives׳ attributions of blame toward the patient. Relatives׳ self-blaming attributions and attributions of control over the disorder by either relatives or patients were not associated with patients׳ variables or EE. Findings highlight the importance of family emotional environment in the early stages of psychosis, as well as the mediating role that relatives׳ beliefs can exert in those relationships. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.
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Affiliation(s)
- Tecelli Domínguez-Martínez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico; Coordinación de Investigación Científica, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - Cristina Medina-Pradas
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
| | - Thomas R Kwapil
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, USA
| | - Neus Barrantes-Vidal
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, USA; Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain; Departament de Salut Mental, Sant Pere Claver-Fundació Sanitària. Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
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Hui C, Morcillo C, Russo DA, Stochl J, Shelley GF, Painter M, Jones PB, Perez J. Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis. Schizophr Res 2013; 148:175-80. [PMID: 23773297 PMCID: PMC3744805 DOI: 10.1016/j.schres.2013.05.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [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: 03/07/2013] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders, which may indicate that the focus of research in individuals at high risk (HR) for psychosis needs updating. In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers. METHOD Between February 2010 and September 2012 60 help-seeking HR individuals, aged 16-35, were recruited from CAMEO Early Intervention in Psychosis Service, Cambridgeshire, UK. Forty-five age- and gender-matched healthy volunteers were randomly recruited from the same geographical area. Sociodemographic, psychiatric morbidity, functioning and quality of life measures were compared between both groups. RESULTS HR individuals suffered a wide range of DSM-IV psychiatric disorders, mainly within the affective and anxiety diagnostic spectra. In comparison to healthy volunteers, young people at HR reported more suicidal ideation/intention, depressive and anxiety symptoms and presented with remarkably poor functioning and quality of life. CONCLUSION The presence of co-morbid moderate or severe depressive and anxiety symptoms was common in our sample of young people at enhanced risk for psychosis. A HR mental state may be associated not only with an increased risk for psychosis, but also other psychiatric disorders. Our findings may have implications for the future implementation of therapeutic interventions that this population could benefit from.
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Affiliation(s)
- Christy Hui
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Carmen Morcillo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Debra A. Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Gillian F. Shelley
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Michelle Painter
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,Corresponding author at: Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EE, UK. Tel.: + 44 1223884360; fax: + 44 1223884362.
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