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Ballesteros A, Sánchez-Torres AM, López-Ilundain JM, Cabrera B, Lobo A, González-Pinto AM, Díaz-Caneja C, Corripio I, Vieta E, de la Serna E, Bobes J, Usall J, Contreras F, Lorente-Omeñaca R, Mezquida G, Bernardo M, Cuesta MJ. Is cognitive impairment associated with antipsychotic dose and anticholinergic equivalent loads in first-episode psychosis? Psychol Med 2018; 48:2247-2256. [PMID: 29331153 DOI: 10.1017/s0033291717003774] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups. METHODS Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively]. RESULTS Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup. CONCLUSIONS Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.
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Affiliation(s)
| | | | | | - Bibiana Cabrera
- Barcelona Clínic Schizophrenia Unit,Neuroscience Institute,Hospital Clínic de Barcelona,Barcelona,Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry,University of Zaragoza. Aragon Institute for Health Research (IIS Aragon),Zaragoza,Spain
| | | | | | - Iluminada Corripio
- Network Centre for Biomedical Research in Mental Health (CIBERSAM),Madrid,Spain
| | - Eduard Vieta
- Network Centre for Biomedical Research in Mental Health (CIBERSAM),Madrid,Spain
| | - Elena de la Serna
- Network Centre for Biomedical Research in Mental Health (CIBERSAM),Madrid,Spain
| | - Julio Bobes
- Network Centre for Biomedical Research in Mental Health (CIBERSAM),Madrid,Spain
| | - Judith Usall
- Network Centre for Biomedical Research in Mental Health (CIBERSAM),Madrid,Spain
| | - Fernando Contreras
- Network Centre for Biomedical Research in Mental Health (CIBERSAM),Madrid,Spain
| | | | - Gisela Mezquida
- Barcelona Clínic Schizophrenia Unit,Neuroscience Institute,Hospital Clínic de Barcelona,Barcelona,Spain
| | - Miguel Bernardo
- Barcelona Clínic Schizophrenia Unit,Neuroscience Institute,Hospital Clínic de Barcelona,Barcelona,Spain
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Caruana E, Cotton SM, Farhall J, Parrish EM, Chanen A, Davey CG, Killackey E, Allott K. A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology. Community Ment Health J 2018; 54:831-841. [PMID: 29159496 DOI: 10.1007/s10597-017-0197-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 11/04/2017] [Indexed: 12/13/2022]
Abstract
Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15-25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.
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Affiliation(s)
- E Caruana
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. .,La Trobe University, Bundoora, VIC, 3083, Australia.
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - J Farhall
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.,North Western Mental Health, Parkville, VIC, Australia
| | - E M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - A Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,North Western Mental Health, Parkville, VIC, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - K Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
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Abstract
BACKGROUND One goal within positive psychiatry is to support the personal recovery of persons with mental illness and providing opportunities for well-being. AIM The current article aims to introduce readers to the concept of personal recovery and the potential and importance of recovery-oriented services and measures. METHODS A literature review was conducted to help consider the domains of 'personal recovery', 'recovery-oriented services/interventions', and 'measures'. A database search was complemented with a web-based search. Both medical subject heading (MESH) terms and free-text search terms were used. RESULTS Literature from research journals, grey literature, and websites were included. Within this context, recovery does not refer to a cure but involves a process in which a person acts as an agent to develop new goals and meaning in life, despite and beyond limitations posed by the illness and its consequences. A positive focus on recovery is in sharp contrast to historical deterministic and pessimistic concepts of mental illnesses. Recovery-oriented services such as peer support, assertive community treatment, supported employment/education/housing, illness self-management, and decreasing self-stigma are highlighted. A review of 27 measures that focus on personal recovery and promotion of well-being are also discussed. CONCLUSIONS The literature overview presents perspectives and knowledge of how to develop positive psychiatry, how mental health services and their partner organizations may become more recovery oriented and help persons reach well-being and a better quality of life. This study is limited to a narrative review and may precede future systematic reviews.
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Affiliation(s)
- Ulrika Bejerholm
- a Department of Health Sciences/Mental Health, Activity and Participation , Lund University , Lund , Sweden.,b Center for Evidence-based Psychosocial Interventions (CEPI) , Lund University , Lund , Sweden
| | - David Roe
- c Department of Community Mental Health , University of Haifa , Haifa , Israel.,d Department of Medicine , Aalborg University , Aalborg , Denmark
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Read H, Roush S, Downing D. Early Intervention in Mental Health for Adolescents and Young Adults: A Systematic Review. Am J Occup Ther 2018; 72:7205190040p1-7205190040p8. [DOI: 10.5014/ajot.2018.033118] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. The purpose of this systematic review was to describe the evidence for the effectiveness of early intervention to improve and maintain performance in occupations for youths with or at risk for serious mental illness (SMI).
METHOD. Titles and abstracts of 670 articles were reviewed, 234 were retrieved for full review, and 30 met inclusion criteria.
RESULTS. Moderate to strong evidence supports cognitive remediation (CR) and mixed evidence supports cognitive–behavioral therapy (CBT) as an adjunct modality to improve general functioning. Moderate to strong evidence supports use of supported employment and supported education (SE/E) to improve social and occupational outcomes in employment and academics. Strong evidence supports family psychoeducation (FPE) to prevent relapse and rehospitalization and improve problem-solving skills and general functioning.
CONCLUSION. Occupational therapy practitioners should integrate CR, SE/E, and FPE into early intervention with youth with or at risk for SMI. In addition, CBT is an effective modality for use with this population.
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Affiliation(s)
- Halley Read
- Halley Read, MOT, OTR/L, QMHP, is Clinical Assistant Professor, School of Occupational Therapy, Pacific University, Forest Grove, OR;
| | - Sean Roush
- Sean Roush, OTD, OTR/L, QMHP, is Associate Professor, School of Occupational Therapy, Pacific University, Forest Grove, OR
| | - Donna Downing
- Donna Downing, MS, OTR/L, is Family Psychoeducation Consultant, Maine Medical Center, Portland
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Hamilton JE, Srivastava D, Womack D, Brown A, Schulz B, Macakanja A, Walker A, Wu MJ, Williamson M, Cho RY. Treatment Retention Among Patients Participating in Coordinated Specialty Care for First-Episode Psychosis: a Mixed-Methods Analysis. J Behav Health Serv Res 2018; 46:415-433. [PMID: 29873034 DOI: 10.1007/s11414-018-9619-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Young adults experiencing first-episode psychosis have historically been difficult to retain in mental health treatment. Communities across the United States are implementing Coordinated Specialty Care to improve outcomes for individuals experiencing first-episode psychosis. This mixed-methods research study examined the relationship between program services and treatment retention, operationalized as the likelihood of remaining in the program for 9 months or more. In the adjusted analysis, male gender and participation in home-based cognitive behavioral therapy were associated with an increased likelihood of remaining in treatment. The key informant interview findings suggest the shared decision-making process and the breadth, flexibility, and focus on functional recovery of the home-based cognitive behavioral therapy intervention may have positively influenced treatment retention. These findings suggest the use of shared decision-making and improved access to home-based cognitive behavioral therapy for first-episode psychosis patients may improve outcomes for this vulnerable population.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, 1941 East Road, Suite 1204, Houston, TX, 77054, USA.
| | | | - Danica Womack
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ashlie Brown
- Harris Center for Mental Health and IDD, Houston, TX, USA
| | - Brian Schulz
- Harris Center for Mental Health and IDD, Houston, TX, USA
| | | | - April Walker
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mon-Ju Wu
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, 1941 East Road, Suite 1204, Houston, TX, 77054, USA
| | | | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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56
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Correll CU, Galling B, Pawar A, Krivko A, Bonetto C, Ruggeri M, Craig TJ, Nordentoft M, Srihari VH, Guloksuz S, Hui CLM, Chen EYH, Valencia M, Juarez F, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA, Marcy P, Addington J, Estroff SE, Robinson J, Penn D, Severe JB, Kane JM. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry 2018; 75:555-565. [PMID: 29800949 PMCID: PMC6137532 DOI: 10.1001/jamapsychiatry.2018.0623] [Citation(s) in RCA: 441] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal. OBJECTIVE To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis. DATA SOURCES Systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017. STUDY SELECTION Randomized trials comparing EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders. DATA EXTRACTION AND SYNTHESIS This systematic review was conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup and meta-regression analyses. MAIN OUTCOMES AND MEASURES The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric hospitalization during the treatment period. RESULTS Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24 months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13; 95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom severity at 18-24 months). CONCLUSIONS AND RELEVANCE In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.
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Affiliation(s)
- Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Britta Galling
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Aditya Pawar
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Anastasia Krivko
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Chiara Bonetto
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Thomas J. Craig
- Institute of Psychiatry, King’s College London, London, England
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
| | - Vinod H. Srihari
- Department of Psychiatry, Yale University, New Haven, Connecticut,Specialized Treatment Early in Psychosis (STEP) Program, Connecticut Mental Health Center, New Haven
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University, New Haven, Connecticut,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Eric Y. H. Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China,State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong, China
| | - Marcelo Valencia
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
| | - Francisco Juarez
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
| | - Delbert G. Robinson
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Nina R. Schooler
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry, SUNY Downstate Medical Center, New York, New York
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire,Bureau of Behavioral Health, College of Health and Human Services (CHHS), Dartmouth, New Hampshire
| | - Kim T. Mueser
- Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts,Department of Psychiatry, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts,Department of Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
| | - Robert A. Rosenheck
- Department of Psychiatry, Yale University, New Haven, Connecticut,Department of Epidemiology, Yale University, New Haven, Connecticut,Department of Public Health, Yale University, New Haven, Connecticut
| | - Patricia Marcy
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Jean Addington
- The Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Sue E. Estroff
- Department of Social Medicine, The University of North Carolina at Chapel Hill
| | | | - David Penn
- Department of Psychology, The University of North Carolina at Chapel Hill
| | | | - John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York
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57
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Dixon LB, Goldman HH, Srihari VH, Kane JM. Transforming the Treatment of Schizophrenia in the United States: The RAISE Initiative. Annu Rev Clin Psychol 2018; 14:237-258. [PMID: 29328779 PMCID: PMC8990328 DOI: 10.1146/annurev-clinpsy-050817-084934] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
The schizophrenia spectrum disorders are neurodevelopmental illnesses with a lifetime prevalence near 1%, producing extensive functional impairment and low expectations for recovery. Until recently, treatment in the United States has largely attempted to stabilize individuals with chronic schizophrenia. The identification and promotion of evidence-based practices for schizophrenia via the Patient Outcomes Research Team, combined with international studies supporting the value of early intervention, provided the foundation for the Recovery After an Initial Schizophrenia Episode (RAISE) project. The RAISE studies further supported the value of reducing the duration of untreated psychosis and providing a multi-element treatment called coordinated specialty care (CSC) to improve outcomes for patients in usual treatment settings. Although CSC programs have proliferated rapidly in the United States, many challenges remain in the treatment and recovery of individuals with schizophrenia in the aftermath of RAISE.
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Affiliation(s)
- Lisa B Dixon
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032, USA;
| | - Howard H Goldman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA
| | - John M Kane
- Zucker Hillside Hospital and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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58
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Strategies to Support the Education Goals of Youth and Young Adults with Serious Mental Health Conditions: A Case Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:661-671. [PMID: 29423557 DOI: 10.1007/s10488-018-0852-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This manuscript describes efforts to support youth and young adults living with serious mental health conditions (SMHC) as they pursue their education goals. Case studies were conducted with three supported education initiatives across the US. Data were collected through individual interviews and focus groups. Key ingredients exist across various settings (e.g., mental health, post-secondary education) to support the pursuit of education goals for students living with SMHC, while individual settings have unique circumstances to address. Findings can inform stakeholders of relevant core components and implementation strategies across settings that support education goals for students with SMHCs.
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59
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Metcalfe JD, Drake RE, Bond GR. Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull 2018; 44:22-31. [PMID: 29036727 PMCID: PMC5768052 DOI: 10.1093/schbul/sbx132] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
As Individual Placement and Support (IPS) has become the international standard for vocational rehabilitation of adults with serious mental illness, researchers must consider the relationship between IPS and local environments. This meta-analysis used mixed-effects meta-regressions to assess the impact of site-level moderators on the likelihood that IPS recipients, compared with recipients of alternative vocational services, achieved competitive employment. Potential moderators included change in gross domestic product (GDP), local unemployment and unionization rates, and indices describing employment protection regulations, level of disability benefits compensation, and efforts to integrate people with disabilities into the workforce. Regulatory moderators represent facilitators and barriers to employment that may reinforce or detract from the effectiveness of IPS. Across 30 sites drawn from 21 randomized controlled trials in 12 countries (33% in the United States), IPS recipients were 2.31 (95% CI 1.99-2.69) times more likely to find competitive employment than recipients of alternative vocational rehabilitation services. The significant competitive-employment rate advantage of IPS over control services increased in the presence of weaker employment protection legislation and integration efforts, and less generous disability benefits. Policy makers should recognize and account for the fact that labor and disability regulations can create an arrangement of incentives that reduces the relative efficacy of supported employment.
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Affiliation(s)
- Justin D Metcalfe
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Robert E Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.,IPS Employment Center, Westat Inc., Lebanon, NH
| | - Gary R Bond
- IPS Employment Center, Westat Inc., Lebanon, NH
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60
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Abstract
SummaryThis editorial addresses the question of whether some of the basic tenets of the recovery model – optimism about outcome, the value of work, the importance of empowerment of patients and the utility of user-run programmes – are supported by the scientific research.
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61
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Killackey E, Allott K, Woodhead G, Connor S, Dragon S, Ring J. Individual placement and support, supported education in young people with mental illness: an exploratory feasibility study. Early Interv Psychiatry 2017; 11:526-531. [PMID: 27121481 DOI: 10.1111/eip.12344] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/07/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to evaluate the feasibility and effectiveness of adapting individual placement and support (IPS) to education for young people presenting to a tertiary mental health service who wished to re-engage with or be supported in their education. METHODS The study was an uncontrolled trial. Twenty young people with severe mental illness were recruited and worked with an educational specialist providing adapted IPS for education (IPSed). Demographic, educational and symptom measures were collected at baseline. Educational outcome was collected at the end of the 6-month intervention. Data presented are descriptive. RESULTS Individual placement and support for education was found to be feasible with 95% of the participants successfully completing the intervention. Eighteen of the 19 who participated through to the conclusion of the intervention achieved positive educational outcomes. CONCLUSIONS It is well established that education is the foundation of career, but many people with mental illness drop out of their education with the onset of illness in adolescence or early adulthood. There has been a dearth of interventions to reconnect people with mental illness to secondary education and training. This study demonstrates that it is feasible to adapt IPS to focus exclusively on education at the outset of illness. Further larger studies are needed to confirm these results and create an evidence base for implementation of IPSed in routine practice for the treatment of early stage mental illness.
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Affiliation(s)
- Eóin Killackey
- Orygen - The National Centre for Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Kelly Allott
- Orygen - The National Centre for Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Gina Woodhead
- Orygen Youth Health Clinical Program, Parkville, Australia
| | - Sue Connor
- Orygen Youth Health Clinical Program, Parkville, Australia.,Travancore School, Travancore, Victoria, Australia
| | - Susan Dragon
- Orygen - The National Centre for Excellence in Youth Mental Health, Parkville, Australia
| | - Judy Ring
- Orygen Youth Health Clinical Program, Parkville, Australia.,Travancore School, Travancore, Victoria, Australia
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Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
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Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
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Conus P, Cotton S, Schimmelmann BG, McGorry PD, Lambert M. Rates and predictors of 18-months remission in an epidemiological cohort of 661 patients with first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1089-1099. [PMID: 28477070 DOI: 10.1007/s00127-017-1388-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/01/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Most first episode psychosis (FEP) outcome studies are based on patient samples enrolled through an informed consent procedure, which may induce important biases. Our aim was to study the 18-month outcome of FEP in an epidemiological sample of patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC). METHODS The files of 661 FEP patients treated for up to 18 months between 1998 and 2000 were assessed. Symptomatic remission was defined as receiving a score ≤3 on the Clinical Global Impressions (CGI) scales, and functional remission as concurrent fulfillment of occupation/employment and independent living. Predictors were analyzed using stepwise logistic regression models. RESULTS At endpoint, 63% of FEP patients had reached symptomatic remission and 44% functional remission. Duration of untreated psychosis, baseline symptom intensity, time in service and decrease or remission of substance use, predicted both symptomatic and functional outcome. A history of suicide attempt or non-adherence to medication was linked to lower likelihood to reach symptomatic remission while pre-morbid GAF and employment at baseline were linked to functional outcome. CONCLUSIONS The development of early intervention strategies should be pursued, in order both to provide treatment before symptoms reach a high intensity and to maintain social integration. Specific strategies need to promote engagement, facilitate adherence to medication and to create a framework where key issues such as substance abuse co-morbidity can be addressed.
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Affiliation(s)
- Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008, Prilly, Switzerland. .,Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.
| | - Sue Cotton
- Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.,Centre for Youth Mental Health University of Melbourne, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia
| | - Benno G Schimmelmann
- Department of Child- and Adolescent Psychiatry, University of Bern, Bern, Switzerland.,Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.,Centre for Youth Mental Health University of Melbourne, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Social and academic premorbid adjustment domains predict different functional outcomes among youth with first episode mania. J Affect Disord 2017; 219:133-140. [PMID: 28550765 DOI: 10.1016/j.jad.2017.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/21/2017] [Accepted: 05/19/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Premorbid characteristics may help predict the highly variable functional and illness outcomes of young people with early stage Bipolar Disorder (BD). We sought to examine the relationships between premorbid adjustment and short to medium-term outcomes after a first treated episode of mania. METHODS We examined the baseline and 18-month follow-up characteristics of 117 participants with first episode of mania, treated at two tertiary early intervention services in Melbourne, Australia. The baseline demographic, family history, diagnoses, comorbidity and clinical features were determined using unstructured questionnaires and structured diagnostic interviews. Premorbid adjustment was determined using the Premorbid Adjustment Scale (PAS), the components of which were identified using a principal component analysis. Eighteen-month follow-up outcome measures included the Clinical Global Impressions scale, Social and Occupational Functioning Assessment Scale and the Heinrichs' Quality of Life Scale (QLS). Correlations and linear regressions were utilised to examine the relationships between component scores and outcomes, while controlling for baseline and follow-up confounders. RESULTS The social adjustment component of the PAS correlated with the interpersonal relations (rs = -0.46, p<0.001) domain of QLS while the academic adjustment component of the PAS correlated with the vocational functioning domain of QLS (rs =-0.39, p = 0.004). Premorbid adjustment did not predict illness severity or objective functioning. LIMITATIONS Lack of information on cognition, personality factors and prodromal symptoms limited the assessment of their impact on outcomes. CONCLUSIONS Impairments in domains of premorbid adjustment may be early markers of persistent difficulties in social and vocational functioning and may benefit from targeted interventions.
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Bowman S, McKinstry C, McGorry P. Youth mental ill health and secondary school completion in Australia: time to act. Early Interv Psychiatry 2017; 11:277-289. [PMID: 27381567 DOI: 10.1111/eip.12357] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/01/2016] [Indexed: 12/30/2022]
Abstract
AIM This paper reviews the evidence of youth mental ill health and its impact on secondary school educational attainment. METHODS This narrative review presents the current research related to the mental ill health of young people in urban and rural Australia, their educational attainment and the effectiveness of mental health strategies implemented in secondary schools. RESULTS The prevalence of mental ill health is high for Australian young people and the onset of depression, anxiety, substance-use disorders and first episode psychosis (FEP) commonly occurs when the individual is at school. The prevalence is reported to be higher for rural young people and barriers to treatment exist. Current evidence suggests that 40% of young people experiencing depression or anxiety disorders are not completing secondary school. Further evidence shows that over 50% of individuals who experience FEP do not finish secondary school. Current mental health promotion strategies employed in secondary schools have not been shown to reduce rates of depression or anxiety in adolescence nor identify prodromal or acute FEP. These strategies have not led to interventions that assist young people with mental ill health to finish school. CONCLUSIONS Not completing secondary school can limit employment options, lead to severe levels of disadvantage and increased burden on welfare and healthcare systems. All young people, including those in rural areas, have the right to education and should not be disadvantaged in their educational aspirations because they have an emerging or current mental illness.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, Community and Clinical Allied Health & LaTrobe Rural Health School, College of Science, Health and Engineering, LaTrobe University, Melbourne, Victoria, Australia
| | - Carol McKinstry
- Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Bendigo, Victoria, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
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Herniman SE, Allott KA, Killackey E, Hester R, Cotton SM. The psychometric validity of the Center for Epidemiological Studies - Depression Scale (CES-D) in first episode schizophrenia spectrum. Psychiatry Res 2017; 252:16-22. [PMID: 28237759 DOI: 10.1016/j.psychres.2017.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/21/2017] [Accepted: 02/10/2017] [Indexed: 02/02/2023]
Abstract
Depressive pathology is common in first-episode schizophrenia spectrum disorders (FES), and is frequently assessed using the Center for Epidemiological Studies - Depression Scale (CES-D), an instrument designed for use in community samples. Despite its widespread use, no prior study has examined the psychometric validity of the CES-D in assessing depressive pathology in FES. The aim of this study was to examine the psychometric validity of the CES-D in FES. This study involved secondary analysis of baseline data from a single blind, randomized controlled trial of vocational intervention for individuals with FES (N=91; age range: 15-25 years). Measures used were: CES-D, Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and Structured Clinical Interview for DSM-IV-TR (SCID-I/P). The CES-D strongly correlated with the depression subscale of the BPRS, and with the presence of full-threshold depressive disorder on the SCID-I/P. There was minimal overlap between the CES-D and SANS, with weak correlations emerging for avolition and anhedonia, and not for affective flattening, alogia, and attention. The CES-D cut-off of ≥23 produced high sensitivity and specificity values for determining full-threshold comorbid depressive disorder. Such findings indicate that the CES-D is effective for assessing and measuring depressive pathology in FES.
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Affiliation(s)
- Sarah E Herniman
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Australia.
| | - Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Robert Hester
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
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67
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Long-term employment among people at ultra-high risk for psychosis. Schizophr Res 2017; 184:26-31. [PMID: 27903412 DOI: 10.1016/j.schres.2016.11.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychotic disorders are associated with high rates of sustained unemployment, however, little is known about the long-term employment outcome of people at ultra-high risk (UHR) of developing psychosis. We sought to investigate the long-term unemployment rate and baseline predictors of employment status at follow-up in a large UHR cohort. METHOD 268 UHR patients recruited from the Personal Assessment and Crisis Evaluation clinic in Melbourne, Australia were followed-up over 2-14years after initial presentation to the service. Individuals in no form of employment or education were classed as unemployed. Logistic regression analyses were used to examine predictors of employment outcome. RESULTS A high rate of unemployment was present at follow-up in this UHR sample (23%). At baseline, those who were unemployed at follow-up had a longer duration of untreated illness, more severe negative symptoms, lower IQ, poorer social and occupational functioning and reported more childhood trauma than the employed group. At follow-up, unemployed individuals exhibited significantly more severe symptoms on all measures and were more likely to have been diagnosed with a mood, anxiety, psychotic or substance use disorder. Childhood trauma and the duration of untreated illness at baseline were significant independent predictors of employment status at follow-up in the multivariate analyses. CONCLUSIONS Nearly a quarter of this UHR sample was unemployed at long-term follow-up. The duration of untreated illness and the effects of childhood trauma are potentially modifiable risk factors for long-term employment outcome in this group. Vocational support may be beneficial for many UHR patients presenting to services.
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Predictors of functional status at service entry and discharge among young people with first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2017; 52:575-585. [PMID: 28233045 DOI: 10.1007/s00127-017-1358-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients with poor functioning and the features influencing functional status over time may pave the way to better treatment. METHOD A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status). RESULTS 52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functioning and education, and were more likely to have self-reported histories of learning disability, forensic issues, traumatic experiences and substance use. At service entry, they had more severe symptoms and poorer global functioning. 37% of these patients maintained a poor functional status at discharge, and 18% of those with a good functional status at service entry experienced a decline. CONCLUSIONS Although psychosocial interventions might assist a young person with FEP with working towards functional goals, for some, the impact of factors such as ongoing substance use and forensic issues on functional status needs to be addressed.
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69
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Rosenheck R, Mueser KT, Sint K, Lin H, Lynde DW, Glynn SM, Robinson DG, Schooler NR, Marcy P, Mohamed S, Kane JM. Supported employment and education in comprehensive, integrated care for first episode psychosis: Effects on work, school, and disability income. Schizophr Res 2017; 182:120-128. [PMID: 27667369 DOI: 10.1016/j.schres.2016.09.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Participation in work and school are central objectives for first episode psychosis (FEP) programs, but evidence effectiveness has been mixed in studies not focused exclusively on supported employment and education (SEE). Requirements for current motivation to work or go to school limit the generalizability of such studies. METHODS FEP participants (N=404) at thirty-four community treatment clinics participated in a cluster randomized trial that compared usual Community Care (CC) to NAVIGATE, a comprehensive, team-based treatment program that included ≥5h of SEE services per week, , grounded in many of the principles of the Individual Placement and Support model of supported employment combined with supported education services. All study participants were offered SEE regardless of their initial interest in work or school. Monthly assessments over 24months recorded days of employment and attendance at school, days of participation in SEE, and both employment and public support income (including disability income). General Estimation Equation models were used to compare CC and NAVIGATE on work and school participation, employment and public support income, and the mediating effect of receiving ≥3 SEE visits on these outcomes. RESULTS NAVIGATE treatment was associated with a greater increase in participation in work or school (p=0.0486) and this difference appeared to be mediated by SEE. No group differences were observed in earnings or public support payments. CONCLUSION A comprehensive, team-based FEP treatment approach was associated with greater improvement in work or school participation, and this effect appears to be mediated, in part, by participation in SEE.
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Affiliation(s)
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
| | - Kyaw Sint
- Yale Medical School, New Haven, CT, USA
| | | | - David W Lynde
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
| | - Shirley M Glynn
- Semel Institute for Neuroscience and Brain Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Delbert G Robinson
- Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Nina R Schooler
- Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Patricia Marcy
- Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA
| | | | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
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Gleeson J, Lederman R, Herrman H, Koval P, Eleftheriadis D, Bendall S, Cotton SM, Alvarez-Jimenez M. Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial. Trials 2017; 18:27. [PMID: 28095883 PMCID: PMC5240433 DOI: 10.1186/s13063-016-1775-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/29/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND First-episode psychosis most often has its onset during late adolescence. In caring for the young person, families endure high levels of stress and depression. Meanwhile, the social networks of families often erode. Our group has previously shown that family cognitive behaviour therapy (CBT) leads to significantly improved perceived stress compared with specialist first-episode treatment as usual; however, there are well-known barriers to the dissemination of effective family interventions. To address this, we have developed a novel online intervention entitled 'Altitudes' that fully integrates purpose-built online social networking, expert and peer moderation, and evidence-based psychoeducation within a single application. The primary aim of this trial is to evaluate the effectiveness of Altitudes in reducing stress in carers over a 6-month period. METHODS/DESIGN We describe here a single-blinded cluster randomised controlled trial (cRCT) with permutated blocks. The clusters comprise individual families. The two treatment conditions include Altitudes plus Specialist Treatment as Usual (STAU) and STAU alone. Altitudes involves participation in our novel online programme whereas STAU comprises specialist family work at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. We aim to recruit 160 family members of young, 15-27 year-old, patients registered for treatment for first-episode psychosis (FEP) at EPPIC. The design includes two assessment time points, namely, baseline and 6-month follow-up. The study is due for completion within 2 years including an 18-month recruitment period and a 6-month treatment phase. The primary outcome is carers' perceived stress at 6 months. Secondary outcome measures include a biomarker of stress, depressive symptoms, worry, substance use, loneliness, social support, satisfaction with life, and a range of measures that tap into coping resources. We seek to gain a dynamic picture of carer stress through our Smartphone Ecological Momentary Assessment (SEMA) tool. DISCUSSION This is the first randomised controlled trial designed to evaluate an online intervention for carers of young people recovering from FEP. It has the potential to produce evidence in support of a highly novel, accessible, and cost-effective intervention to reduce stress in carers who are providing support to young people at a critical phase in their recovery from psychosis. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry, identifier: ACTRN12616000968471 . Retrospectively registered on 22 July 2016.
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Affiliation(s)
- John Gleeson
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - Reeva Lederman
- The Department of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Helen Herrman
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Peter Koval
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Dina Eleftheriadis
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Sarah Bendall
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Sue M. Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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Kirsh B. Client, Contextual and Program Elements Influencing Supported Employment: A Literature Review. Community Ment Health J 2016; 52:809-20. [PMID: 27055809 DOI: 10.1007/s10597-015-9936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/02/2015] [Indexed: 11/29/2022]
Abstract
Supported employment is an evidence-based practice with a well-established research base. Most studies track such outcomes as employment rates, time to employment and wages earned. Few studies address client and contextual factors that impact outcomes or consider program elements beyond those that comprise the individual placement and support model. This paper reviews existing literature to shed light on the following questions: (1) What impact do labour market trends have on the effectiveness of SE? (2) How lasting are the effects of SE and what factors influence longevity of SE effects? (3) What levels and types of employment are targeted by SE? (4) What are the characteristics of people who benefit from SE? (5) What is the role of peer support in SE? and (6) What are the barriers to effective SE implementation? Research findings are synthesized and suggestions for service enhancements are offered so that the model can continue to evolve.
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Affiliation(s)
- Bonnie Kirsh
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, Canada. .,Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, Canada.
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Bond GR, Drake RE, Campbell K. Effectiveness of individual placement and support supported employment for young adults. Early Interv Psychiatry 2016; 10:300-7. [PMID: 25138195 PMCID: PMC4417652 DOI: 10.1111/eip.12175] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Abstract
AIM The individual placement and support (IPS) model of supported employment was first developed in community mental health centres for adults with severe mental illness. While IPS is an established evidence-based practice in this broad population, evidence on its effectiveness focused specifically on young adults has been limited. The current study aimed to address this gap. METHODS To investigate the effects of IPS on young adults, the authors conducted a secondary analysis on a pooled sample of 109 unemployed young adults (under age 30) from four randomized controlled trials employing a common research protocol that included a standardized measurement battery and rigorous fidelity monitoring. Researchers assessed these participants over 18 months on nine competitive employment outcome measures. RESULTS On all measures, the IPS group had significantly better employment outcomes. Overall, 40 (82%) of IPS participants obtained employment during follow-up compared with 25 (42%) of control participants, χ(2) = 17.9, P < .001. IPS participants averaged 25.0 weeks of employment, compared with 7.0 weeks for control participants, t = 4.50, P < .001. CONCLUSIONS The current analysis supports a small number of previous studies in showing that IPS is highly effective in helping young adults with severe mental illness to attain competitive employment. When young adults acquire competitive jobs and initiate a path towards normal adult roles, they may avoid the cycle of disability and psychiatric patient roles that are demeaning and demoralizing.
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Affiliation(s)
- Gary R. Bond
- Department of Psychiatry, Geisel Medical School at Dartmouth, Lebanon, NH, USA
| | - Robert E. Drake
- Department of Psychiatry, Geisel Medical School at Dartmouth, Lebanon, NH, USA
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Sveinsdottir V, Tveito TH, Bond GR, Grasdal AL, Lie SA, Reme SE. Protocol for the SEED-trial: Supported Employment and preventing Early Disability. BMC Public Health 2016; 16:579. [PMID: 27422271 PMCID: PMC4947309 DOI: 10.1186/s12889-016-3280-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. METHODS/DESIGN The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. DISCUSSION The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age. TRIAL REGISTRATION Clinicaltrials.gov, registration number NCT02375074 . Registered on December 3rd 2014.
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Affiliation(s)
| | | | - Gary R. Bond
- />Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic St., Suite B4-1, Lebanon, NH 03766 USA
| | | | - Stein Atle Lie
- />Department of Clinical Dentistry, University of Bergen, POB 7804, 5020 Bergen, Norway
| | - Silje Endresen Reme
- />Uni Research Health, Uni Research, POB 7810, 5020 Bergen, Norway
- />Department of Psychology, University of Oslo, POB 1094, 0317 Oslo, Norway
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Modini M, Tan L, Brinchmann B, Wang MJ, Killackey E, Glozier N, Mykletun A, Harvey SB. Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence. Br J Psychiatry 2016; 209:14-22. [PMID: 27103678 DOI: 10.1192/bjp.bp.115.165092] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individual placement and support (IPS) is a vocational rehabilitation programme that was developed in the USA to improve employment outcomes for people with severe mental illness. Its ability to be generalised to other countries and its effectiveness in varying economic conditions remains to be ascertained. AIMS To investigate whether IPS is effective across international settings and in different economic conditions. METHOD A systematic review and meta-analysis of randomised controlled trials comparing IPS with traditional vocational services was undertaken; 17 studies, as well as 2 follow-up studies, were included. Meta-regressions were carried out to examine whether IPS effectiveness varied according to geographic location, unemployment rates or gross domestic product (GDP) growth. RESULTS The overall pooled risk ratio for competitive employment using IPS compared with traditional vocational rehabilitation was 2.40 (95% CI 1.99-2.90). Meta-regressions indicated that neither geographic area nor unemployment rates affected the overall effectiveness of IPS. Even when a country's GDP growth was less than 2% IPS was significantly more effective than traditional vocational training, and its benefits remained evident over 2 years. CONCLUSIONS Individual placement and support is an effective intervention across a variety of settings and economic conditions and is more than twice as likely to lead to competitive employment when compared with traditional vocational rehabilitation.
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Affiliation(s)
- Matthew Modini
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Leona Tan
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Beate Brinchmann
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Min-Jung Wang
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Eoin Killackey
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Nicholas Glozier
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Arnstein Mykletun
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Samuel B Harvey
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
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Drake RE, Bond GR, Goldman HH, Hogan MF, Karakus M. Individual Placement And Support Services Boost Employment For People With Serious Mental Illnesses, But Funding Is Lacking. Health Aff (Millwood) 2016; 35:1098-105. [DOI: 10.1377/hlthaff.2016.0001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robert E. Drake
- Robert E. Drake is a professor of health policy and clinical practice at the Dartmouth Institute, Geisel Medical School at Dartmouth, in Lebanon, New Hampshire
| | - Gary R. Bond
- Gary R. Bond is a professor of psychiatry at the Geisel Medical School at Dartmouth
| | - Howard H. Goldman
- Howard H. Goldman is a professor of psychiatry in the Department of Mental Health Policy Studies at the University of Maryland School of Medicine, in Baltimore
| | - Michael F. Hogan
- Michael F. Hogan is principal at Hogan Health Solutions, in Delmar, New York
| | - Mustafa Karakus
- Mustafa Karakus is a senior health economist at Westat, in Rockville, Maryland
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76
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Lo TL, Warden M, He Y, Si T, Kalyanasundaram S, Thirunavukarasu M, Amir N, Hatim A, Bautista T, Lee C, Emsley R, Olivares J, Yang YK, Kongsakon R, Castle D. Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region. Asia Pac Psychiatry 2016; 8:154-71. [PMID: 27062665 PMCID: PMC4834614 DOI: 10.1111/appy.12234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Abstract
Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.
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Affiliation(s)
| | - Matthew Warden
- Hobart and Southern CMHTTasmanian Health Organisation – SouthTasmaniaAustralia
| | - Yanling He
- Department of Epidemiology Shanghai Mental Health CenterShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Tianmei Si
- Department of PsychopharmacologyPeking University Institute of Mental HealthPekingChina
| | | | | | - Nurmiati Amir
- Department of Psychiatry National General HospitalCiptomangunkusumo/Faculty of MedicineUniversity of IndonesiaJakartaIndonesia
| | - Ahmad Hatim
- Department of Psychological MedicineUniversity of MalayaKuala LumpurMalaya
| | - Tomas Bautista
- College of Medicine Philippine General HospitalUniversity of the PhilippinesManilaPhilippines
| | - Cheng Lee
- Department of Community PsychiatryInstitute of Mental HealthSingapore
| | - Robin Emsley
- Department of PsychiatryUniversity of StellenboschStellenboschSouth Africa
| | - Jose Olivares
- Department of PsychiatryComplejo Hospitalario Universitario de VigoVigoSpain
| | - Yen Kuang Yang
- Department of PsychiatryNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan CityTaiwan
| | | | - David Castle
- Department of PsychiatrySt. Vincent's HospitalThe University of MelbourneMelbourneAustralia
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Beyond Clinical Remission in First Episode Psychosis: Thoughts on Antipsychotic Maintenance vs. Guided Discontinuation in the Functional Recovery Era. CNS Drugs 2016; 30:357-68. [PMID: 27106296 DOI: 10.1007/s40263-016-0331-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Treatment guidelines for first episode psychosis (FEP) recommend at least 1 year of antipsychotic treatment following remission; however, in light of some recent research and the preference of some individuals to discontinue their medication sooner, this recommendation can be questioned. The aim of this article is to appraise the current discontinuation studies given our views on how this field should progress. We conducted a review of randomized controlled trials investigating dose-reduction/medication discontinuation compared with treatment maintenance in clinically remitted FEP patients. Seven trials were identified, and these reported a higher rate of relapse in the dose reduction or discontinuation groups. Relapse rates were higher when a lower threshold for relapse was utilized. However, only three studies specified that concurrent psychosocial interventions were also provided, despite an evidence base for these interventions in reducing symptom severity and relapse. Length of follow-up may also be important, as the study with the longest follow-up (7 years), albeit with some methodological shortcomings, found greater functional recovery in the dose-reduction group and that relapse rates between the two groups (dose-reduction vs. maintenance) were equal after 3 years. Finally, in addition to discontinuation or dose reduction, a diagnosis of schizophrenia, a longer duration of illness, and poor premorbid functioning were associated with a greater risk of relapse. Further trials are needed in this area to establish the long-term risk-benefit ratio of antipsychotic medication in FEP. Meanwhile, young people with FEP who do not fulfil criteria for a diagnosis of a schizophrenia disorder, achieve clinical remission for at least 3 months, attain early functional recovery, and have good social support may be possible candidates for discontinuation of antipsychotic medication bolstered by effective psychosocial interventions provided in the context of a specialized FEP service.
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Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 502] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
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Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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79
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Williams PL, Lloyd C. A review of job tenure under the Job in Jeopardy programme in first episode psychosis. Br J Occup Ther 2016. [DOI: 10.1177/0308022615625649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This paper explores what happens to young people with psychosis who have competitive employment when they first engage in treatment. Method 11 of 39 (28%) of programme participants of an individual placement and support programme who received vocational assistance under the Job in Jeopardy funding were identified. A prospective observational design was used to evaluate programme outcomes over a minimum of 6 months. Results It is of interest that the majority of young people who were at risk of losing their job and were receiving assistance did not manage to sustain employment. At the completion of data collection only two people continued to be engaged in competitive employment. Conclusion Although the sample is very small, there appears to be a clear trend demonstrating that being engaged in competitive employment at the point of experiencing a first episode of psychosis does not protect an individual against losing that job. It is evident that staff involved with this group of clients need to assist those with employment to maintain it. There is the potential for occupational therapists to play a key role in assisting these young people to secure and maintain meaningful occupation.
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Affiliation(s)
| | - Chris Lloyd
- Senior Research Officer, Recovery Services, Schizophrenia Fellowship of New South Wales, Gladesville, Australia; Honorary Senior Fellow, Illawarra Institute of Mental Health, University of Wollongong, Australia
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80
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McGahey E, Waghorn G, Lloyd C, Morrissey S, Williams PL. Formal plan for self-disclosure enhances supported employment outcomes among young people with severe mental illness. Early Interv Psychiatry 2016; 10:178-85. [PMID: 25345473 DOI: 10.1111/eip.12196] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/16/2014] [Indexed: 11/28/2022]
Abstract
AIM Young people with mental illness experience high levels of unemployment, which can be related to stigma and discrimination. This may result from poor choices in disclosing personal information, such as their mental illness diagnosis, in the workplace. The aim of this study was to investigate the predictive validity of a formal plan to manage personal information (PMPI) during the early stages of supported employment. The focal question was: does the use of a brief structured PMPI lead to more employment outcomes for young people with a mental illness? METHODS A sample of 40 young unemployed mental health service users (mean age 23.9 years), who were also attending employment services on the Gold Coast, was asked about their disclosure preferences. If they preferred not to disclose at all, they did not complete a plan for managing personal information. If they preferred to disclose some personal information, they were provided with assistance to complete a PMPI. Baseline information was gathered from two equal groups of 20 individuals. Employment status was ascertained at a 6-week follow-up interview. RESULTS Those who completed a plan to manage their personal information had 4.9 times greater odds of employment at 6 weeks than those who preferred not to disclose any personal information. CONCLUSIONS A formal PMPI has promising predictive validity with respect to job seekers not opposed to pragmatic forms of self-disclosure. Further research is needed to examine other properties of this decision-making tool.
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Affiliation(s)
- Ellie McGahey
- School of Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Geoffrey Waghorn
- Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,Behavioural Basis of Health, Griffith University, Brisbane, Queensland, Australia.,The School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Lloyd
- Behavioural Basis of Health, Griffith University, Brisbane, Queensland, Australia
| | - Shirley Morrissey
- School of Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Philip Lee Williams
- Early Psychosis Service, Gold Coast Health Service District, Gold Coast, Queensland, Australia
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81
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Di Rezze B, Nguyen T, Mulvale G, Barr NG, Longo CJ, Randall GE. A scoping review of evaluated interventions addressing developmental transitions for youth with mental health disorders. Child Care Health Dev 2016; 42:176-87. [PMID: 26638809 DOI: 10.1111/cch.12306] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Youth with mental health disorders often experience challenges when transitioning into adult roles (e.g. independent living, work and community engagement). Health interventions that address the needs of youth with mental health disorders during these challenges in their development (i.e. developmental transitions) have not been reviewed in the literature. This scoping review examines the peer-reviewed research that describes evaluated interventions addressing developmental transitions for youth with mental health disorders. METHODS A search of four prominent health literature databases (CINAHL, Embase, MEDLINE and PsycINFO) was conducted to identify evaluated developmental transition interventions for adolescents and youth (12-25 years) with mental health disorders. Study selection and analysis were guided by a methodological framework for conducting scoping reviews. Selected studies were described, assessed for quality and collated based on ten dimensions from two notable conceptual frameworks in developmental transitions and disability. RESULTS Nine studies met the inclusion criteria. The interventions within these studies demonstrated five specialized and four multi-faceted programmes (i.e. multiple domains). All domains from the two conceptual frameworks were represented differently across studies. The sub-domains from these studies were most frequently related to vocational-focused interventions, least frequently related to social activities and living situation and did not explicitly map onto the sexuality sub-domain. Three multi-faceted interventions incorporated all domains and utilized each intervention approach. Study quality was rated for seven of the nine studies. Quantitative methodology for five of the seven studies was rated as higher quality. CONCLUSIONS Evaluated interventions described in the transitions literature for youth with mental health disorders predominantly focus on vocational needs. The least studied areas were the personal and interpersonal domains. These domains were only incorporated within interventions addressing multiple domains of developmental transitions. These insights can be helpful in guiding evidence-based practice and policy development, as well as informing gaps for future research programmes.
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Affiliation(s)
- B Di Rezze
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - T Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - G Mulvale
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - N G Barr
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - C J Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - G E Randall
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Barbato A, D’Avanzo B. Historical and Conceptual Developments of Psychosocial Rehabilitation: Beyond Illness and Disability in a Humanistic Framework. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2016. [DOI: 10.1080/00207411.2015.1132896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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83
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Early psychosis research at Orygen, The National Centre of Excellence in Youth Mental Health. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1-13. [PMID: 26498752 DOI: 10.1007/s00127-015-1140-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 10/13/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Specialised early intervention (SEI) programs have offered individuals with psychotic disorders and their families new hope for improving illness trajectories and outcomes. The Early Psychosis Prevention and Intervention Centre (EPPIC) was one of the first SEI programs developed in the world, providing services for young people experiencing their first episode of psychosis. METHODS We conducted a narrative synthesis of controlled and uncontrolled studies that have been conducted at EPPIC. DISCUSSION The history of the EPPIC model is first described. This is followed by a discussion of clinical research emerging from EPPIC, including psychopharmacological, psychotherapeutic trials and outcome studies. Neurobiological studies are also described. Issues pertaining to the conduct of clinical research and future research directions are then described. Finally, the impact of the EPPIC model on the Australian environment is discussed.
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Tapfumaneyi A, Johnson S, Joyce J, Major B, Lawrence J, Mann F, Chisholm B, Rahaman N, Wooley J, Fisher HL. Predictors of vocational activity over the first year in inner-city early intervention in psychosis services. Early Interv Psychiatry 2015; 9:447-58. [PMID: 26104585 DOI: 10.1111/eip.12125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 12/20/2013] [Indexed: 11/28/2022]
Abstract
AIM Work and educational activities are an important part of recovery for young people with psychosis, and improving vocational outcomes is a key target for early intervention services (EIS). This study evaluated predictors of vocational activity for first-episode psychosis (FEP) patients during the first year of EIS care. It was hypothesized that longer duration of untreated psychosis (DUP) and minority ethnic status would predict poorer vocational outcomes, whereas a history of good vocational functioning would predict better vocational functioning during follow up. METHODS FEP patients aged 14-35 years, who presented to seven EIS in London, UK, between 2003 and 2010, were followed for 1 year. Sociodemographic, clinical and vocational information (qualifications obtained and paid employment) were collected using the MiData audit tool at entry to EIS and 1 year later. RESULTS Approximately one-third of patients (n = 345/1013) were studying or employed at some point during the first year of EIS care. Baseline vocational activity was the strongest predictor of vocational functioning during 1 year of follow up. Moreover, employment prior to entry into EIS strongly predicted change in vocational activity during 1 year of follow up. Individuals with DUP <6 months or of Asian or black African origin were more likely to be studying than their white British counterparts. CONCLUSION This study confirms that a significant proportion of FEP patients are able to engage in meaningful vocational activities even within the first year of EIS care. However, services need to focus more resources on getting patients with poor educational or employment histories into training programmes to improve their vocational outcomes.
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Affiliation(s)
- Andrew Tapfumaneyi
- Lewisham Early Intervention Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sonia Johnson
- Camden and Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK.,Mental Health Sciences Unit, University College London, London, UK
| | - John Joyce
- Lewisham Early Intervention Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Barnaby Major
- EQUIP, Hackney, East London NHS Foundation Trust, London, UK
| | - Jo Lawrence
- STEP, Southwark, South London and Maudsley NHS Foundation Trust, London, UK
| | - Farhana Mann
- Mental Health Sciences Unit, University College London, London, UK
| | - Brock Chisholm
- Wandsworth Early Intervention Service, Southwest London & St Georges' Mental Health NHS Trust, London, UK
| | - Nikola Rahaman
- Kensington, Chelsea, Westminster and Brent Early Intervention Service, Central & North West London NHS Foundation Trust, London, UK
| | - James Wooley
- Wandsworth Early Intervention Service, Southwest London & St Georges' Mental Health NHS Trust, London, UK
| | - Helen L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
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85
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Azrin ST, Goldstein AB, Heinssen RK. Early Intervention for Psychosis: The Recovery After an Initial Schizophrenia Episode Project. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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86
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Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiol Psychiatr Sci 2015; 24:446-57. [PMID: 25016950 PMCID: PMC8367356 DOI: 10.1017/s2045796014000419] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS Young adults with early psychosis want to pursue normal roles - education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes. METHODS We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies. RESULTS Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio = 3.66 [1.93-6.93], p < 0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services. CONCLUSIONS In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services.
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Waghorn G, Dias S, Gladman B, Harris M. Measuring what matters: Effectiveness of implementing evidence-based supported employment for adults with severe mental illness. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.9.411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Geoffrey Waghorn
- Head of Social Inclusion Research, Queensland Centre for Mental Health Research, Australia
| | - Shannon Dias
- Research officer, Queensland Centre for Mental Health Research, and Honorary research fellow in the School of Medicine, University of Queensland, Australia
| | - Beverley Gladman
- Senior research scientist, Queensland Centre for Mental Health Research, PhD candidate and Honorary research fellow, University of Queensland School of Medicine, Australia
| | - Meredith Harris
- Senior research fellow, School of Public Health, University of Queensland, and Honorary principal researcher, Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
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Mueser KT, Penn DL, Addington J, Brunette MF, Gingerich S, Glynn SM, Lynde DW, Gottlieb JD, Meyer-Kalos P, McGurk SR, Cather C, Saade S, Robinson DG, Schooler NR, Rosenheck RA, Kane JM. The NAVIGATE Program for First-Episode Psychosis: Rationale, Overview, and Description of Psychosocial Components. Psychiatr Serv 2015; 66:680-90. [PMID: 25772766 PMCID: PMC4490051 DOI: 10.1176/appi.ps.201400413] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project-known as the NAVIGATE program-with a particular focus on its psychosocial components. NAVIGATE is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services provided in the NAVIGATE program include the family education program (FEP), individual resiliency training (IRT), supported employment and education (SEE), and individualized medication treatment. NAVIGATE embraces a shared decision-making approach with a focus on strengths and resiliency and on collaboration with clients and family members in treatment planning and reviews. The NAVIGATE program has the potential to fill an important gap in the U.S. health care system by providing a comprehensive intervention specially designed to meet the unique treatment needs of persons recovering from a first episode of psychosis. A cluster-randomized controlled trial comparing NAVIGATE with usual community care has recently been completed.
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Affiliation(s)
- Kim T Mueser
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - David L Penn
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jean Addington
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Mary F Brunette
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan Gingerich
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Shirley M Glynn
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - David W Lynde
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jennifer D Gottlieb
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Piper Meyer-Kalos
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan R McGurk
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Corinne Cather
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Sylvia Saade
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Delbert G Robinson
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Nina R Schooler
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Robert A Rosenheck
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - John M Kane
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
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Dixon LB, Goldman HH, Bennett ME, Wang Y, McNamara KA, Mendon SJ, Goldstein AB, Choi CWJ, Lee RJ, Lieberman JA, Essock SM. Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program. Psychiatr Serv 2015; 66:691-8. [PMID: 25772764 PMCID: PMC5637730 DOI: 10.1176/appi.ps.201400281] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program Implementation and Evaluation Study developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. This article describes the treatment model and reports on service utilization and outcomes. It was hypothesized that individuals' symptoms and functioning would improve over time. METHODS A total of 65 individuals in RAISE Connection Program treatment across two sites (Baltimore and New York City) were enrolled and received services for up to two years. Primary outcomes, including social and occupational functioning and symptoms, were evaluated. Trajectories for individuals' outcomes over time were examined with linear and quadratic mixed-effects models with repeated measures. RESULTS Measures of occupational and social functioning improved significantly over time, symptoms declined, and rates of remission improved. Visits were most frequent during the first three months, with a mean±SD of 23.2±11.5 unduplicated staff encounters per quarter. Such encounters decreased to 8.8±5.2 in the final quarter of year 2. CONCLUSIONS The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced. The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model and the associated high rates of engagement among individuals who are typically difficult to engage in treatment. Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.
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Affiliation(s)
- Lisa B Dixon
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Howard H Goldman
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Melanie E Bennett
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Yuanjia Wang
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Karen A McNamara
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Sapna J Mendon
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Amy B Goldstein
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Chien-Wen J Choi
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Rufina J Lee
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jeffrey A Lieberman
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan M Essock
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
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Williams PL, Lloyd C, Waghorn G, Machingura T. Implementing evidence-based practices in supported employment on the Gold Coast for people with severe mental illness. Aust Occup Ther J 2015; 62:316-25. [PMID: 26098404 DOI: 10.1111/1440-1630.12202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Philip Lee Williams
- Early Psychosis Gold Coast; Gold Coast University Hospital; Southport Queensland Australia
| | - Chris Lloyd
- Behavioural Basis of Health; Griffith University Gold Coast Campus; Southport Queensland Australia
| | - Geoffrey Waghorn
- Department of Recovery and Social Inclusion; The Queensland Centre for Mental Health Research; West Moreton Hospital and Health Service; The Park Centre for Mental health; Wacol Queensland Australia
| | - Tawanda Machingura
- Department of Occupational Therapy; Mental Health Recovery Service; Gold Coast University Hospital; Southport Queensland Australia
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Kane JM, Schooler NR, Marcy P, Correll CU, Brunette MF, Mueser KT, Rosenheck RA, Addington J, Estroff SE, Robinson J, Penn DL, Robinson DG. The RAISE early treatment program for first-episode psychosis: background, rationale, and study design. J Clin Psychiatry 2015; 76:240-6. [PMID: 25830446 PMCID: PMC7477907 DOI: 10.4088/jcp.14m09289] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/22/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The premise of the National Institute of Mental Health Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) is to combine state-of-the-art pharmacologic and psychosocial treatments delivered by a well-trained, multidisciplinary team in order to significantly improve the functional outcome and quality of life for first-episode psychosis patients. The study is being conducted in non-academic (ie, real-world) treatment settings, using primarily extant reimbursement mechanisms. METHOD We developed a treatment model and training program based on extensive literature review and expert consultation. Our primary aim is to compare the experimental intervention to "usual care" on quality of life. Secondary aims include comparisons on remission, recovery, and cost-effectiveness. Patients 15-40 years old with a first episode of schizophrenia, schizoaffective disorder, schizophreniform disorder, psychotic disorder not otherwise specified, or brief psychotic disorder according to DSM-IV and no more than 6 months of treatment with antipsychotic medications were eligible. Patients are followed for a minimum of 2 years, with major assessments conducted by blinded, centralized raters using live, 2-way video. We selected 34 clinical sites in 21 states and utilized cluster randomization to assign 17 sites to the experimental treatment and 17 to usual care. Enrollment began in July 2010 and ended in July 2012 with 404 subjects. The results of the trial will be published separately. The goal of the article is to present both the overall development of the intervention and the design of the clinical trial to evaluate its effectiveness. CONCLUSIONS We believe that we have succeeded in both designing a multimodal treatment intervention that can be delivered in real-world clinical settings and implementing a controlled clinical trial that can provide the necessary outcome data to determine its impact on the trajectory of early phase schizophrenia. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01321177.
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Affiliation(s)
- John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA,Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nina R. Schooler
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA,SUNY Downstate Medical Center, NY, USA
| | - Patricia Marcy
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA,Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mary F. Brunette
- Geisel School of Medicine at Dartmouth, Dartmouth, NH, USA,Bureau of Behavioral Health, CHHS, Dartmouth, NH, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA, USA
| | - Robert A. Rosenheck
- Yale Departments of Psychiatry and Epidemiology and Public Health, New Haven, CT, USA
| | - Jean Addington
- Hotchkiss Brain Institute Department of Psychiatry University of Calgary, Calgary, Canada
| | - Sue E. Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Delbert G. Robinson
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA,Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
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92
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The association between economic inactivity and mental health among young people: a longitudinal study of young adults who are not in employment, education or training. Ir J Psychol Med 2015; 32:155-160. [PMID: 30185278 DOI: 10.1017/ipm.2014.85] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Increasing rates of young people not in education, employment or training (NEETs) are a cause of concern both in Ireland and internationally, but little longitudinal research has examined the link between psychiatric disorder in young people and NEET status. METHODS The Challenging Times (CT) Study is a longitudinal, population-based study of psychopathology among 212 young Irish people. Clinical interviews were performed at two time points: 12-15 years and 19-24 years. RESULTS NEET status in young adulthood was associated with a sevenfold increased risk of current suicidal ideation. This result was independent of prior adolescent mental disorder. NEET young people had a fourfold increased odds of being diagnosed with a mental disorder in childhood or early adolescence compared with their economically active peers. NEET young people were at an almost threefold increased risk of any mental health disorder a twofold increased risk of anxiety disorder and threefold increased odds of suicide attempts over their lifetime compared with economically active peers. CONCLUSIONS NEET young people are at increased risk for mental disorder and suicidal ideation. The association is bidirectional, as prior mental disorder in adolescence appeared to account for much of the association between NEET status and current mental health problems. However, economic inactivity conveys an increased risk for suicidal ideation over and above that due to prior disorder. Our findings provide a compelling economic and societal argument for early intervention and treatment of mental disorder and the importance of vocational interventions for reducing suicide risk in young adults.
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Hodgekins J, French P, Birchwood M, Mugford M, Christopher R, Marshall M, Everard L, Lester H, Jones P, Amos T, Singh S, Sharma V, Morrison AP, Fowler D. Comparing time use in individuals at different stages of psychosis and a non-clinical comparison group. Schizophr Res 2015; 161:188-93. [PMID: 25541138 DOI: 10.1016/j.schres.2014.12.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/27/2014] [Accepted: 12/06/2014] [Indexed: 11/26/2022]
Abstract
Social functioning difficulties are a common and disabling feature of psychosis and have also been identified in the prodromal phase. However, debate exists about how such difficulties should be defined and measured. Time spent in structured activity has previously been linked to increased psychological wellbeing in non-clinical samples and may provide a useful way of assessing social functioning in clinical settings. The current study compared hours in structured activity, assessed with the Time Use Survey, in three clinical groups at different stages of psychosis: individuals with at-risk mental states (N=199), individuals with first-episode psychosis (N=878), and individuals with delayed social recovery following the remission of psychotic symptoms (N=77). Time use in the three clinical groups was also compared with norms from an age-matched non-clinical group (N=5686) recruited for the Office for National Statistics UK 2000 Time Use Survey. Cutoff scores for defining social disability and recovery were examined. All three clinical groups spent significantly fewer hours per week in structured activity than individuals in the non-clinical group. Reduced activity levels were observed before the onset of psychosis in individuals with at-risk mental states. Additional reductions in activity were observed in the first-episode psychosis and delayed recovery groups compared to the at-risk mental state group. Assessing time spent in structured activity provides a useful way to assess social disability and recovery across the spectrum of psychosis.
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Affiliation(s)
- Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Paul French
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Max Birchwood
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Miranda Mugford
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Rose Christopher
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Max Marshall
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Linda Everard
- Birmingham and Solihull NHS Mental Health Foundation Trust, Birmingham, UK
| | - Helen Lester
- University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Peter Jones
- University of Cambridge, Cambridge CB2 1TN, UK
| | - Tim Amos
- University of Bristol, Bristol BS8 1TH, UK
| | - Swaran Singh
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Vimal Sharma
- Cheshire and Wirral Partnership NHS Foundation Trust, University of Chester, UK
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Purcell R, Jorm AF, Hickie IB, Yung AR, Pantelis C, Amminger GP, Glozier N, Killackey E, Phillips L, Wood SJ, Mackinnon A, Scott E, Kenyon A, Mundy L, Nichles A, Scaffidi A, Spiliotacopoulos D, Taylor L, Tong JPY, Wiltink S, Zmicerevska N, Hermens D, Guastella A, McGorry PD. Transitions Study of predictors of illness progression in young people with mental ill health: study methodology. Early Interv Psychiatry 2015; 9:38-47. [PMID: 23889887 DOI: 10.1111/eip.12079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 06/09/2013] [Indexed: 11/28/2022]
Abstract
AIM An estimated 75% of mental disorders begin before the age of 24 and approximately 25% of 13-24-year-olds are affected by mental disorders at any one time. To better understand and ideally prevent the onset of post-pubertal mental disorders, a clinical staging model has been proposed that provides a longitudinal perspective of illness development. This heuristic model takes account of the differential effects of both genetic and environmental risk factors, as well as markers relevant to the stage of illness, course or prognosis. The aim of the Transitions Study is to test empirically the assumptions that underpin the clinical staging model. Additionally, it will permit investigation of a range of psychological, social and genetic markers in terms of their capacity to define current clinical stage or predict transition from less severe or enduring to more severe and persistent stages of mental disorder. METHOD This paper describes the study methodology, which involves a longitudinal cohort design implemented within four headspace youth mental health services in Australia. Participants are young people aged 12-25 years who have sought help at headspace and consented to complete a comprehensive assessment of clinical state and psychosocial risk factors. A total of 802 young people (66% female) completed baseline assessments. Annual follow-up assessments have commenced. CONCLUSIONS The results of this study may have implications for the way mental disorders are diagnosed and treated, and progress our understanding of the pathophysiologies of complex mental disorders by identifying genetic or psychosocial markers of illness stage or progression.
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Affiliation(s)
- R Purcell
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria
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95
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Schubert KO, Clark SR, Baune BT. The use of clinical and biological characteristics to predict outcome following First Episode Psychosis. Aust N Z J Psychiatry 2015; 49:24-35. [PMID: 25430911 DOI: 10.1177/0004867414560650] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Psychotic illnesses such as schizophrenia and other non-affective psychoses are heterogeneous in disease course and functional outcomes. We review evidence from investigations in clinical psychiatry, neuroimaging, neurocognition, and blood biomarker research suggesting that distinct bio-psycho-social patterns exist at the onset and during the early phase of a First Episode Psychosis (FEP), which can describe the risk of individual illness progression and functional trajectories. METHOD A selective literature review was performed on articles drawn from Medline searches for relevant key words. A simulation model was constructed from data derived from two recent publications, selected as examples of studies that investigated multivariate predictors of long-term outcome following FEP. RESULTS We illustrate how illness trajectories following FEP could be described based on multimodal sociodemographic, clinical, psychological, and neurobiological information. A clinical modeling simulation shows thatrisk trajectories for achieving long-term favorable or unfavorable outcomes can differ significantly depending on baseline characteristics in combination with MRI and functional measurements within 6 months of disease onset. CONCLUSIONS Multimodal trajectory modeling may be useful to describe longitudinal outcomes following FEP. Richlongitudinal data on predictors and outcomes, and better integration of multimodal (sociodemographic, clinical, psychological, biological) data, are required to operationalize this approach. This technique may improve our understanding of course of illness and help to provide a more personalized approach to the assessment and treatment of people presenting with FEP.
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Affiliation(s)
- K Oliver Schubert
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
| | - Scott R Clark
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
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96
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O'Dea B, Glozier N, Purcell R, McGorry PD, Scott J, Feilds KL, Hermens DF, Buchanan J, Scott EM, Yung AR, Killacky E, Guastella AJ, Hickie IB. A cross-sectional exploration of the clinical characteristics of disengaged (NEET) young people in primary mental healthcare. BMJ Open 2014; 4:e006378. [PMID: 25537785 PMCID: PMC4275674 DOI: 10.1136/bmjopen-2014-006378] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. DESIGN Cross-sectional data from a longitudinal cohort study. SETTING Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. PARTICIPANTS Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. MEASURES Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning were assessed using clinical interview and self-report. RESULTS A total of 19% (n=130/696) were NEET. NEETs were more likely to be male, older, have a history of criminal charges, risky cannabis use, higher level of depression, poorer social functioning, greater disability and economic hardship, and a more advanced stage of mental illness than those engaged in education, training or work. Demographics such as postsecondary education, immigrant background and indigenous background, were not significantly associated with NEET status in this sample. CONCLUSIONS One in five young people seeking help for mental health problems were not in any form of education, employment and training. The commonly observed risk factors did not appear to influence this association, instead, behavioural factors such as criminal offending and cannabis use appeared to require targeted intervention.
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Affiliation(s)
- Bridianne O'Dea
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Glozier
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary Purcell
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Kristy-Lee Feilds
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel F Hermens
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - John Buchanan
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- The University of Sydney Business School, Sydney, New South Wales, Australia
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Eoin Killacky
- Orygen Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Adam J Guastella
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
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97
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Iyer SN, Malla AK. Intervention précoce pour la psychose : concepts, connaissances actuelles et orientations futures. ACTA ACUST UNITED AC 2014. [DOI: 10.7202/1027840ar] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cet article fournit un survol de la logique de l’intervention précoce pour psychose, de ses fondements théoriques et de la littérature essentielle sur le concept. L’intervention précoce repose sur l’hypothèse de la période critique, qui vient accentuer l’importance des premiers stades de la maladie, et sur les résultats d’études dans le domaine, qui suggère que la durée d’une psychose non traitée en influence le pronostic. L’intervention précoce facilite l’accès à un traitement spécialisé adapté à la phase de la maladie par un processus de recommandations médicales plus ouvert, des délais rapides et l’éducation du public et des praticiens sur la psychose. L’intervention précoce, qui dure généralement deux ans à partir du dépistage, comprend une prise en charge intensive et des médicaments antipsychotiques à faible dose. L’accent est mis sur le fonctionnement social, l’intervention familiale, l’attention précoce aux troubles connexes ainsi qu’une alliance thérapeutique entre le jeune et sa famille. Selon les données scientifiques disponibles, une telle intervention donne de meilleurs résultats que les soins typiquement offerts. Les critiques du concept visent la qualité des études en sa faveur, sa mise en oeuvre, la répartition des ressources en intervention précoce et son utilité pour les personnes présentant un risque élevé de psychose. En termes de disponibilité et d’élaboration de politiques en intervention précoce, le Royaume-Uni détient une avance certaine, alors que le Canada se situe au milieu, et les États-Unis au bas de l’échelle. Au Québec, les résultats varient et d’autres études et investissements sont nécessaires. Récemment, le concept d’intervention précoce a servi d’exemple à des mesures plus importantes visant la transformation des soins de santé mentale des jeunes, ce qui constitue une toute nouvelle percée au Canada.
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Affiliation(s)
- Srividya N. Iyer
- Auteure-ressource, Professeure adjointe, Département de psychiatrie, Université McGill, Montréal, Canada
- Coordonnatrice du Programme d’évaluation, d’intervention et de prévention des psychoses de Montréal, Institut universitaire en santé mentale Douglas, Montréal, Canada
| | - Ashok K. Malla
- Programme d’évaluation, d’intervention et de prévention des psychoses de Montréal (PEPP-Montréal), Institut universitaire en santé mentale Douglas, Montréal, Canada
- Département de psychiatrie, Université McGill, Montréal, Canada
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98
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Luciano A, Bond GR, Drake RE. Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophr Res 2014; 159:312-21. [PMID: 25278105 DOI: 10.1016/j.schres.2014.09.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This review synthesized prospective evidence to assess whether achieving employment alters the course of schizophrenia-spectrum disorder. METHOD Researchers identified relevant analyses for review via PubMed, expert referral, and reference review and systematically applied two levels of screening to 1484 citations using seven a priori criteria. RESULTS A total of 12 analyses representing eight cohorts, or 6844 participants, compared illness course over time by employment status in majority schizophrenia-spectrum samples. Employment was consistently associated with reductions in outpatient psychiatric treatment (2 of 2 studies) as well as improved self-esteem (2 of 2 studies). Employment was inconsistently associated with positive outcomes in several other areas, including symptom severity, psychiatric hospitalization, life satisfaction, and global wellbeing. Employment was consistently unrelated to worsening outcomes. DISCUSSION Achieving employment does not cause harm among people with schizophrenia-spectrum disorder and other severe mental illnesses. Further detailed mechanistic analyses of adequately powered long-term follow-up studies using granular descriptions of employment are needed to clarify the nature of associations between employment and hypothesized benefit.
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Affiliation(s)
- Alison Luciano
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
| | - Gary R Bond
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
| | - Robert E Drake
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
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99
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Waghorn G, Hielscher E. The availability of evidence-based practices in supported employment for Australians with severe and persistent mental illness. Aust Occup Ther J 2014; 62:141-4. [DOI: 10.1111/1440-1630.12162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Geoffrey Waghorn
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health; Brisbane Queensland Australia
- Behavioural Basis of Health; Griffith University, Mount Gravatt; Brisbane Queensland Australia
- The School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Emily Hielscher
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health; Brisbane Queensland Australia
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100
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Waghorn G, Dias S, Gladman B, Harris M, Saha S. A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness. Aust Occup Ther J 2014; 61:424-36. [DOI: 10.1111/1440-1630.12148] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Geoffrey Waghorn
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
- Behavioural Basis of Health; Griffith Health Institute; Griffith University
- The School of Medicine; The University of Queensland
| | - Shannon Dias
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
| | - Beverley Gladman
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
| | - Meredith Harris
- The School of Population Health; The University of Queensland; Brisbane Queensland Australia
| | - Sukanta Saha
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
- The School of Medicine; The University of Queensland
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