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Öngür D, Carter CS, Gur RE, Perkins D, Sawa A, Seidman LJ, Tamminga C, Huggins W, Hamilton C. Common Data Elements for National Institute of Mental Health-Funded Translational Early Psychosis Research. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:10-22. [PMID: 31439493 DOI: 10.1016/j.bpsc.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/20/2022]
Abstract
The National Institutes of Health has established the PhenX Toolkit as a web-based resource containing consensus measures freely available to the research community. The National Institute of Mental Health (NIMH) has introduced the Mental Health Research Core Collection as part of the PhenX Toolkit and recently convened the PhenX Early Psychosis Working Group to generate the PhenX Early Psychosis Specialty Collection. The Working Group consisted of two complementary panels for clinical and translational research. We review the process, deliberations, and products of the translational research panel. The Early Psychosis Specialty Collection rationale for measure selection as well as additional information and protocols for obtaining each measure are available on the PhenX website (https://www.phenxtoolkit.org). The NIMH strongly encourages investigators to use instruments from the PhenX Mental Health Research Collections in NIMH-funded studies and discourages use of alternative measures to collect similar data without justification. We also discuss some of the potential advances that can be achieved by collecting common data elements across large-scale longitudinal studies of early psychosis.
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Affiliation(s)
- Dost Öngür
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, Davis, California
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Akira Sawa
- Department of Psychiatry, The Johns Hopkins University, Baltimore, Maryland
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Carol Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas
| | - Wayne Huggins
- RTI International, Research Triangle Park, North Carolina
| | - Carol Hamilton
- RTI International, Research Triangle Park, North Carolina
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Iorfino F, Cross SP, Davenport T, Carpenter JS, Scott E, Shiran S, Hickie IB. A Digital Platform Designed for Youth Mental Health Services to Deliver Personalized and Measurement-Based Care. Front Psychiatry 2019; 10:595. [PMID: 31507465 PMCID: PMC6716201 DOI: 10.3389/fpsyt.2019.00595] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
Mental disorders that commonly emerge during adolescence and young adulthood are associated with substantial immediate burden and risks, as well as potentially imparting lifetime morbidity and premature mortality. While the development of health services that are youth focused and prioritize early intervention has been a critical step forward, an ongoing challenge is the heterogeneous nature of symptom profiles and illness trajectories. Consequently, it is often difficult to provide quality mental health care, at scale, that addresses the broad range of health, social, and functional needs of young people. Here, we describe a new digital platform designed to deliver personalized and measurement-based care. It provides health services and clinicians with the tools to directly address the multidimensional needs of young people. The term "personalized" describes the notion that the assessment of, and the sequence of interventions for, mental disorders are tailored to the young person-and their changing needs over time, while "measurement-based" describes the use of systematic and continuing assessment of a young person's outcomes over the entire course of clinical care. Together, these concepts support a framework for care that transcends a narrow focus on symptom reduction or risk reduction. Instead, it prioritizes a broader focus on enhancing social, health, and physical outcomes for young people and a commitment to tracking these outcomes throughout this key developmental period. Now, with twenty-first century technologies, it is possible to provide health services with the tools needed to deliver quality mental health care.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | - Shane P. Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Tracey Davenport
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | | | - Elizabeth Scott
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Sagit Shiran
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Strålin P, Hetta J. Medication, hospitalizations and mortality in 5 years after first-episode psychosis in a Swedish nation-wide cohort. Early Interv Psychiatry 2019; 13:902-907. [PMID: 29888512 DOI: 10.1111/eip.12697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/03/2018] [Accepted: 05/16/2018] [Indexed: 12/13/2022]
Abstract
AIM To investigate medication, rehospitalizations and mortality after first-episode hospital-treated psychosis. METHODS A population-based nation-wide cohort (n = 2488) with a first hospitalization for psychosis at ages between 16 and 25 was identified. Cases were followed for up to 5 years after the first psychosis hospitalization with regard to mortality, hospitalizations and dispensations of antipsychotics and benzodiazepines. RESULTS The proportion of patients dispensing antipsychotics decreased from 80% year 1 after first discharge to 55% year 5. The proportion of patients having episodes of inpatient care also decreased year by year from 46% year 1 to 27% year 5. Of 863 cases with 5 years of observation time 41% had dispensations of antipsychotics every year; 21% had no dispensation of antipsychotics or hospitalization after the first year. The cumulative 5-year mortality was 3.9%. Cumulative suicide mortality was 2.4%. Incidence of suicide was highest in the first year. Male gender, benzodiazepines, recent hospital-discharge and self-harm were identified as risk factors for suicide. CONCLUSIONS The proportion of cases dispensing antipsychotics decreases year by year after first discharge. Mortality and rates of rehospitalization also decrease year by year from high levels the first year.
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Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jerker Hetta
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Jones N, Godzikovskaya J, Zhao Z, Vasquez A, Gilbert A, Davidson L. Intersecting disadvantage: Unpacking poor outcomes within early intervention in psychosis services. Early Interv Psychiatry 2019; 13:488-494. [PMID: 29076244 DOI: 10.1111/eip.12508] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/07/2017] [Accepted: 08/20/2017] [Indexed: 11/27/2022]
Abstract
AIM In order to strengthen specialized early intervention in psychosis (EIP) services, a contextually nuanced understanding of psychosocial forces driving suboptimal treatment response is critical. This study sought to examine factors driving poor outcomes through a systematic emic coding of psychosocial assessments for discharged EIP clients categorized as leaving with all treatment goals met (AG) or no treatment goals met (NG). METHODS Psychosocial assessments at baseline, 1 year, 2 years and discharge were extracted from an EIP research registry and systematically coded. One hundred and thirty clients met the study's inclusion criteria (72 NG, 58 AG) from a larger pool of 278. Assessments were coded, quantized and analysed using a combination of basic inferential statistics and thematic analysis. RESULTS Structural adversity, individual trauma, history of aggression/violence, limited insight and long treatment histories prior to EIP, were strong and significant predictors of poor client outcomes (NG), while motivation for treatment, college goals or preparedness at baseline, baseline engagement in constructive activities, social strengths, individual strengths, talents and family support strongly predicted better outcomes (AG). Race/ethnicity also significantly predicted outcome group. Analyses underscore the powerful impact of multiple converging forms of structural disadvantage, on the one hand, and individual, family and social strengths and supports on the other, in shaping clients' response to EIP treatment. CONCLUSIONS Findings emphasize the importance of greater empirical attention to background structural and socio-economic conditions among early psychosis clients and their multifaceted impacts and underscore the potential value of programmatic components explicitly designed to support clients from multiply disadvantaged backgrounds.
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Affiliation(s)
- Nev Jones
- Department of Mental Health Law and Policy, Louis de la Parte Mental Health Institute, University of South Florida, Tampa, Florida.,Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut
| | - Julia Godzikovskaya
- Division for Client Centered Outcomes Research in Public Mental Health, Felton Institute, San Francisco, California
| | - Zhen Zhao
- Division for Client Centered Outcomes Research in Public Mental Health, Felton Institute, San Francisco, California
| | - Anthony Vasquez
- Division for Client Centered Outcomes Research in Public Mental Health, Felton Institute, San Francisco, California
| | - Al Gilbert
- Division for Client Centered Outcomes Research in Public Mental Health, Felton Institute, San Francisco, California
| | - Larry Davidson
- Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut
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Hansen H, Stige SH, Moltu C, Johannessen JO, Joa I, Dybvig S, Veseth M. "We all have a responsibility": a narrative discourse analysis of an information campaign targeting help-seeking in first episode psychosis. Int J Ment Health Syst 2019; 13:32. [PMID: 31086563 PMCID: PMC6507175 DOI: 10.1186/s13033-019-0289-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns. METHODS A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info's website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data. RESULTS Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along). CONCLUSION Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients' recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking.
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Affiliation(s)
- Hege Hansen
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Postbox 7030, 5020 Bergen, Norway
| | | | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jan Olav Johannessen
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Sveinung Dybvig
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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"What is the efficacy of specialised early intervention in mental health targeting simultaneously adolescents and young adults?'' An HTA. Int J Technol Assess Health Care 2019; 35:134-140. [PMID: 31017562 DOI: 10.1017/s0266462319000084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Current service organization is not adapted for youth with or at risk of mental illness. Access, engagement and continuity of care are notorious challenges, particularly during transition from adolescence to adulthood, when youths are transferred to adult services. An HTA was initiated to evaluate the efficacy of programs for which admission is not a function of the legal age of majority. METHODS A systematic review of systematic reviews identified literature published between 2000 and 2017 in 4 databases. To be selected, studies had to focus on specialised mental healthcare early intervention (EI) programs targeting both adolescents and young adults. Contextual and experiential data were collected through interviews with local leading experts. Article selection and quality assessment using ROBIS were conducted with inter rater agreement. The analytical framework developed includes 4 domains: access, engagement and continuity, recovery as well as meaningfulness and acceptability. RESULTS 1841 references were identified. Following inclusion/exclusion criteria, 5 studies were selected, 3 of which focused on EI for psyschosis. EI programs alone do not seem to decrease duration of untreated psychosis. EI including a multi focus campaign were more successful. EI does, however, seem to decrease hospitalisation for psychosis. The experience of service users and professionals with inter agency collaboration and person-centred care models were analysed to identify facilitating and inhibiting implementation factors. CONCLUSIONS Healthcare policies need to support further research and development of EI where admission is not a function of the legal age of majority and diagnostic, particularly for youths at risk.
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Trovão N, Prata J, VonDoellinger O, Santos S, Barbosa M, Coelho R. Peripheral Biomarkers for First-Episode Psychosis-Opportunities from the Neuroinflammatory Hypothesis of Schizophrenia. Psychiatry Investig 2019; 16:177-184. [PMID: 30836740 PMCID: PMC6444098 DOI: 10.30773/pi.2018.12.19.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Schizophrenia is a disabling disorder of unknown aetiology, lacking definite diagnostic method and cure. A reliable biological marker of schizophrenia is highly demanded, for which traceable immune mediators in blood could be promising candidates. We aimed to gather the best findings of neuroinflammatory markers for first-episode psychosis (FEP). METHODS We performed an extensive narrative review of online literature on inflammation-related markers found in human FEP patients only. RESULTS Changes to cytokine levels have been increasingly reported in schizophrenia. The peripheral levels of IL-1 (or its receptor antagonist), soluble IL-2 receptor, IL-4, IL-6, IL-8, and TNF-α have been frequently reported as increased in FEP, in a suggestive continuum from high-risk stages for psychosis. Microglia and astrocytes establish the link between this immune signalling and the synthesis of noxious tryptophan catabolism products, that cause structural damage and directly hamper normal neurotransmission. Amongst these, only 3-hydroxykynurenine has been consistently described in the blood of FEP patients. CONCLUSION Peripheral molecules stemming from brain inflammation might provide insightful biomarkers of schizophrenia, as early as FEP or even prodromal phases, although more time- and clinically-adjusted studies are essential for their validation.
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Affiliation(s)
- Nuno Trovão
- Department of Psychiatry, Vila Nova de Gaia/ Espinho Hospital Center, Vila Nova de Gaia, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Joana Prata
- Department of Psychiatry, Vila Nova de Gaia/ Espinho Hospital Center, Vila Nova de Gaia, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Orlando VonDoellinger
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Tâmega e Sousa Hospital Center, Penafiel, Portugal
| | - Susana Santos
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - Mário Barbosa
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Rui Coelho
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
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Wright AC, Davies G, Fowler D, Greenwood K. Three-Year Follow-Up Study Exploring Metacognition and Function in Individuals With First Episode Psychosis. Front Psychiatry 2019; 10:182. [PMID: 31031648 PMCID: PMC6473558 DOI: 10.3389/fpsyt.2019.00182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/13/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction: Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition. Metacognitive ability has been demonstrated to mediate between neurocognition and functional outcome in First Episode Psychosis (FEP). Whether metacognition also predicts longer-term recovery in first episode psychosis is unknown. This study assessed whether neurocognition, functional capacity and metacognitive ability in FEP predicted functional outcome three years later. Methods: Eighty individuals with First Episode Psychosis were re-contacted after an average 3 years (range: 26-45 month follow-up) from baseline. Twenty-six participants (33%) completed completed measures of neurocognition, metacognition, functional capacity, functional outcome (hours spent in structured activity per week) and psychopathology at baseline and at follow-up. Results: Individual regression analyses demonstrated neurocognition, functional capacity, and metacognitive ability at baseline significantly predicted functional outcome at three years. However, when baseline functional outcome was controlled, only metacognitive ability was a significant predictor of change in functional outcome from baseline to follow-up, p < 0.001. This model explained 72% (adjusted r 2 = 0.69) of the variance in functional outcome at follow-up. Negative symptoms did not change the model. Discussion: This study demonstrated that better metacognitive ability significantly predicted improvement in functioning in FEP across a 3-year period. This highlights the potential value of clinical interventions that focus on improving metacognitive ability at first point of illness to maximize recovery.
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Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom.,Center of Excellence for Psychosocial and Systemic Research, Massachusetts General Hospital, Boston, MA, United States
| | - Geoff Davies
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
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Peters-Strickland T, Baker RA, Such P, Zhang P, Madera JJ. The effect of aripiprazole once-monthly on personal and social functioning: post hoc analyses of acute and long-term studies. Neuropsychiatr Dis Treat 2019; 15:1659-1669. [PMID: 31296992 PMCID: PMC6598750 DOI: 10.2147/ndt.s198241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/16/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effect of aripiprazole once-monthly 400 mg (AOM 400; Abilify Maintena®) on personal and social functioning in patients with schizophrenia in both the acute treatment and maintenance therapy settings. METHODS Post hoc analyses were conducted on data from Study 291 (NCT01663532), a 12-week, randomized, double-blind, placebo-controlled trial conducted in patients who were experiencing an acute psychotic episode, and Study 248 (NCT00731549), a 52-week open-label extension of two randomized, controlled trials of AOM 400 as maintenance therapy. Assessment of functioning was made using the Personal and Social Performance (PSP) scale. In Study 291, results were stratified by age (≤35 years or >35 years). RESULTS In Study 291, 340 patients were included in the analysis (n=168 randomized to AOM 400 [n=49 aged ≤35 years, n=119 aged >35 years]; n=172 randomized to placebo [n=54 aged ≤35 years, n=118 aged >35 years]). In Study 248, 1,081 patients entered the open-label maintenance phase and 858 completed the study. In Study 291, AOM 400, compared with placebo, resulted in a significant increase (improvement) in PSP scores based on LSM (SE) changes from baseline to Week 12 in patients aged ≤35 years (20.6 [1.9] for AOM 400 vs 9.5 [2.4] for placebo; P=0.001) and a numerically (but not significantly) larger increase in PSP scores in patients aged >35 years (16.1 [1.7] for AOM 400 vs 12.5 [1.9] for placebo; P=0.093). Improvements in both age groups met criteria for a minimally important clinical difference (7-10 points). In Study 248, AOM 400 resulted in either numerical improvements (increases) from baseline in PSP total score or maintenance of stable baseline values throughout the study. CONCLUSION AOM 400 was effective in improving personal and social functioning during acute treatment and maintaining function during long-term treatment.
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Affiliation(s)
- Timothy Peters-Strickland
- Global Clinical Development, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Ross A Baker
- Global Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Pedro Such
- Medical Affairs Psychiatry, H. Lundbeck A/S, Valby, Denmark
| | - Peter Zhang
- Biostatistics, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Jessica J Madera
- Global Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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Strålin P, Skott M, Cullberg J. Early recovery and employment outcome 13 years after first episode psychosis. Psychiatry Res 2019; 271:374-380. [PMID: 30529874 DOI: 10.1016/j.psychres.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 12/23/2022]
Abstract
175 cases of first episode psychosis were recruited to the Parachute project in 1996-97. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion. Outcome-data for year 13 after inclusion, were retrieved from Swedish population registries on 161 of the original cases. During the first year after inclusion the cohort improved in the scores of the Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Function (GAF) to median levels that later remained rather stable. By month 12 the median GAF score was 65. 68% of the cases were in remission from psychotic symptoms as assessed with BPRS. 38% of the cases in remission and 60% not in remission had prescriptions of antipsychotic medication by month 12. By year 13 after inclusion, 42% were in employment and 55% had any dispensation of antipsychotic medication. 70% of the cases with employment had no dispensations of antipsychotic medication. In conclusion, Many first episode psychosis cases that were offered extensive psychosocial support and cautious use of antipsychotic medication had good early recovery and good late employment outcome.
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Affiliation(s)
- Pontus Strålin
- Department of clinical neuroscience, Karolinska institute, Stockholm, Sweden.
| | - Maria Skott
- Department of clinical neuroscience, Karolinska institute, Stockholm, Sweden
| | - Johan Cullberg
- Department of medicine, Karolinska institute, Stockholm, Sweden
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Chang WC, Kwong VWY, Or Chi Fai P, Lau ESK, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Motivational impairment predicts functional remission in first-episode psychosis: 3-Year follow-up of the randomized controlled trial on extended early intervention. Aust N Z J Psychiatry 2018; 52:1194-1201. [PMID: 29475381 DOI: 10.1177/0004867418758918] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Functional remission represents an intermediate functional milestone toward recovery. Differential relationships of negative symptom sub-domains with functional remission in first-episode psychosis are understudied. We aimed to examine rate and predictors of functional remission in people with first-episode psychosis in the context of a 3-year follow-up of a randomized controlled trial comparing 1-year extension of early intervention (i.e. 3-year early intervention) with step-down psychiatric care (i.e. 2-year early intervention). METHOD A total of 160 participants were recruited upon completion of a 2-year specialized early intervention program for first-episode psychosis in Hong Kong and underwent a 1-year randomized controlled trial comparing 1-year extended early intervention with step-down care. Participants were followed up and reassessed 3 years after inclusion to the trial (i.e. 3-year follow-up). Functional remission was operationalized as simultaneous fulfillment of attaining adequate functioning (measured by Social and Occupational Functioning Scale and Role Functioning Scale) at 3-year follow-up and sustained employment in the last 6 months of 3-year study period. Negative symptom measure was delineated into amotivation (i.e. motivational impairment) and diminished expression (i.e. reduced affect and speech output). Data analysis was based on 143 participants who completed follow-up functional assessments. RESULTS A total of 31 (21.7%) participants achieved functional remission status at 3-year follow-up. Multivariate regression analysis showed that lower levels of amotivation (p = 0.010) and better functioning at study intake (p = 0.004) independently predicted functional remission (Final model: Nagelkerke R2 = 0.40, χ2 = 42.9, p < 0.001). Extended early intervention, duration of untreated psychosis and diminished expression did not predict functional remission. CONCLUSION Only approximately one-fifths of early psychosis patients were found to achieve functional remission. Functional impairment remains an unmet treatment need in the early stage of psychotic illness. Our results further suggest that amotivation may represent a critical therapeutic target for functional remission attainment in early psychosis.
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Affiliation(s)
- Wing Chung Chang
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Vivian Wing Yan Kwong
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | | | - Emily Sin Kei Lau
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Gloria Hoi Kei Chan
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Olivia Tsz Ting Jim
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Christy Lai Ming Hui
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Sherry Kit Wa Chan
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Edwin Ho Ming Lee
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Queen Mary Hospital and Department of Psychiatry, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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Neuropil contraction in relation to Complement C4 gene copy numbers in independent cohorts of adolescent-onset and young adult-onset schizophrenia patients-a pilot study. Transl Psychiatry 2018; 8:134. [PMID: 30026462 PMCID: PMC6053402 DOI: 10.1038/s41398-018-0181-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 02/08/2023] Open
Abstract
A recent report suggested Complement 4 (C4A) gene copy numbers (GCN) as risk factors for schizophrenia. Rodent model showed association of C4 with synaptic pruning suggesting its pathophysiological significance (Sekar, A. et al. (2016)). We, therefore, predicted that C4A GCN would be positively correlated with neuropil contraction in the human brain among schizophrenia patients showing more prominent correlations in ventral regions among young adults and dorsal regions among adolescents since neuromaturation progresses dorsoventrally. Whole-brain, multi-voxel, in vivo phosphorus magnetic resonance spectroscopy (31P MRS) assessed neuropil changes by estimating levels of membrane phospholipid (MPL) precursors and catabolites. Increased MPL catabolites and/or decreased MPL precursors indexed neuropil contraction. Digital droplet PCR-based assay was used to estimate C4A and C4B GCN. We evaluated two independent cohorts (young adult-onset early-course schizophrenia (YASZ = 15) and adolescent-onset schizophrenia (AOSZ = 12) patients), and controls matched for each group, n = 22 and 15, respectively. Separate forward stepwise linear regression models with Akaike information Criterion were built for MPL catabolites and precursors. YASZ cohort: Consistent with the rodent model (Sekar, A. et al. 2016)), C4A GCN positively correlated with neuropil contraction (increased pruning/decreased formation) in the inferior frontal cortex and inferior parietal lobule. AOSZ cohort: C4A GCN positively correlated with neuropil contraction in the dorsolateral prefrontal cortex and thalamus. Exploratory analysis of C4B GCN showed positive correlation with neuropil contraction in the cerebellum and superior temporal gyrus among YASZ while AOSZ showed neuropil contraction in the prefrontal and subcortical structures. Thus, C4A and C4B GCN are associated with neuropil contraction in regions often associated with schizophrenia, and may be neuromaturationally dependent.
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Thompson A, Winsper C, Marwaha S, Haynes J, Alvarez-Jimenez M, Hetrick S, Realpe A, Vail L, Dawson S, Sullivan SA. Maintenance antipsychotic treatment versus discontinuation strategies following remission from first episode psychosis: systematic review. BJPsych Open 2018; 4:215-225. [PMID: 29988997 PMCID: PMC6034451 DOI: 10.1192/bjo.2018.17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/28/2018] [Accepted: 03/16/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice. METHOD A systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP. RESULTS Seven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis. CONCLUSIONS There is a higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples. The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies. DECLARATION OF INTEREST A.T. has received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended meetings supported by Sunovion Pharmaceuticals.
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Affiliation(s)
- Andrew Thompson
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick and North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire National Health Service Partnership Trust, UK
| | - Catherine Winsper
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick and Affective Disorders Service, Coventry and Warwickshire National Health Service Partnership Trust, Tile Hill, UK
| | - Jon Haynes
- 2gether National Health Service Foundation Trust, Gloucester, UK
| | | | - Sarah Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia
| | - Alba Realpe
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Laura Vail
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Sarah Dawson
- Centre for Academic Mental Health, University of Bristol, UK
| | - Sarah A Sullivan
- Centre for Academic Mental Health, University of Bristol and National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West, UK
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Volavka J, Vevera J. Very long-term outcome of schizophrenia. Int J Clin Pract 2018; 72:e13094. [PMID: 29691957 DOI: 10.1111/ijcp.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. METHOD PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5 years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. RESULTS The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. CONCLUSION The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.
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Affiliation(s)
- Jan Volavka
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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65
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Murphy BP, Brewer WJ. Early intervention in psychosis: strengths and limitations of services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.110.008573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryEarly intervention services were established on the basis of a number of fundamental principles, including the notions that intervening in the early stages of psychosis alters illness trajectory and prognosis, that multicomponent interventions promote psychosocial recovery and reduce iatrogenic damage, and that early targeting of non-responders reduces treatment resistance. There is growing evidence of the benefits of specialised early intervention services. These include improved clinical, social and vocational outcomes, reduced in-patient stays and better engagement. Early intervention services can also significantly reduce the risk of a second episode and are highly valued by service users and carers. Duration of treatment appears to determine long-term outcome and there remains uncertainty about how long such intensive intervention should last and whether all patients need the same length of care. Budgetary constraints are pervasive and are particularly likely to affect prodrome clinics and community awareness programmes.
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Abstract
SummaryThis issue of Advances carries two articles from Melbourne, Australia, outlining the rationale for, and implementation of, early psychosis services. Their publication provides an opportunity to address some of the more contentious issues relating to the early psychosis intervention movement.
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Onwumere J, Shiers D, Gaughran F. Physical Health Problems in Psychosis: Is It Time to Consider the Views of Family Carers? Front Psychiatry 2018; 9:668. [PMID: 30574099 PMCID: PMC6292134 DOI: 10.3389/fpsyt.2018.00668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/20/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.,Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Hansen H, Stige SH, Davidson L, Moltu C, Veseth M. How Do People Experience Early Intervention Services for Psychosis? A Meta-Synthesis. QUALITATIVE HEALTH RESEARCH 2018; 28:259-272. [PMID: 29039239 DOI: 10.1177/1049732317735080] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We conducted a study to explore how people diagnosed with first-episode psychosis experienced their contact with early intervention services for psychosis and the way these experiences relate to their recovery processes. Our aim was to integrate and describe the service users' experiences in a rigorous and comprehensive way. A broad literature search was performed in June and July 2016. After screening, 17 qualitative studies were included. We analyzed the findings in two main steps: (a) translating studies into one another and (b) synthesizing the findings from the studies. Through these interpretative processes, we found five new and overarching themes: (a) something is wrong, (b) do for myself, (c) it's about people, (d) a price to pay, and (e) ongoing vulnerability. We describe these themes as a process that service users' maneuver through in their contact with the services. Our findings are discussed in light of relevant research.
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Affiliation(s)
- Hege Hansen
- 1 Western Norway University of Applied Sciences, Bergen, Norway
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Abstract
A major factor associated with poor prognostic outcome after a first psychotic break is cannabis misuse, which is prevalent in schizophrenia and particularly common in individuals with recent-onset psychosis. Behavioral interventions aimed at reducing cannabis use have been unsuccessful in this population. Cannabidiol (CBD) is a phytocannabinoid found in cannabis, although at low concentrations in modern-day strains. CBD has a broad pharmacological profile, but contrary to ∆9-tetrahydrocannabinol (THC), CBD does not activate CB1 or CB2 receptors and has at most subtle subjective effects. Growing evidence indicates that CBD acts as an antipsychotic and anxiolytic, and several reports suggest neuroprotective effects. Moreover, CBD attenuates THC's detrimental effects, both acutely and chronically, including psychotogenic, anxiogenic, and deleterious cognitive effects. This suggests that CBD may improve the disease trajectory of individuals with early psychosis and comorbid cannabis misuse in particular-a population with currently poor prognostic outcome and no specialized effective intervention.
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Affiliation(s)
- Britta Hahn
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD,To whom correspondence should be addressed; tel: 001-410-402-6112, fax: 001-410-402-7198, e-mail:
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Lally J, Ajnakina O, Stubbs B, Cullinane M, Murphy KC, Gaughran F, Murray RM. Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. Br J Psychiatry 2017; 211:350-358. [PMID: 28982659 DOI: 10.1192/bjp.bp.117.201475] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/06/2017] [Accepted: 06/10/2017] [Indexed: 01/17/2023]
Abstract
BackgroundRemission and recovery rates for people with first-episode psychosis (FEP) remain uncertain.AimsTo assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators.MethodWe conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators.ResultsSeventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions.ConclusionsRemission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery.
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Affiliation(s)
- John Lally
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Olesya Ajnakina
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Michael Cullinane
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kieran C Murphy
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robin M Murray
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
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Humphries S, King R, Dunne MP, Nguyen CH. Early psychosis in central Vietnam: A longitudinal study of short-term functional outcomes and their predictors. Int J Soc Psychiatry 2017; 63:602-613. [PMID: 28817993 DOI: 10.1177/0020764017724589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few longitudinal studies have investigated the functional outcomes of individuals with recent-onset psychotic illness in low- and middle-income countries. AIMS To investigate short-term functional remission and its predictors in a central Vietnamese sample. METHODS A naturalistic 6-month prospective cohort study recruited 79 patients of public health facilities who had experienced a first episode of schizophrenia or related illness in the past 18 months. Individuals and their family members were interviewed using standardised assessments of community functioning, symptoms, treatment, demographics and various psychosocial variables. Rates of functional remission (i.e. no or minimal impairment) were calculated based on rigorous, culturally appropriate criteria. Generalised estimating equations were used to explore predictors of remission. RESULTS Rates of global functional remission were 28% at baseline and 53% at follow-up. In individual functional domains, remission was least common for occupational activities, intermediate for relationships and relatively common for daily living activities. Global functional remission was significantly associated with absence of negative and cognitive symptoms, average or better household economic status and unimpaired premorbid functioning. CONCLUSION Remission rates appeared similar to those seen in many international intervention studies. However, individuals from poor households had markedly unfavourable outcomes, suggesting the need for community-based interventions targeting low-socioeconomic status (SES) groups.
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Affiliation(s)
- Seiji Humphries
- 1 School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.,2 Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue City, Vietnam
| | - Robert King
- 1 School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michael P Dunne
- 2 Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue City, Vietnam.,3 School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cat Huu Nguyen
- 4 Department of Psychiatry, Hue University of Medicine and Pharmacy, Hue City, Vietnam
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Hanlon MC, Campbell LE, Single N, Coleman C, Morgan VA, Cotton SM, Stain HJ, Castle DJ. Men and women with psychosis and the impact of illness-duration on sex-differences: The second Australian national survey of psychosis. Psychiatry Res 2017. [PMID: 28633054 DOI: 10.1016/j.psychres.2017.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We aimed to examine and compare sex-differences in people receiving treatment for psychotic illnesses in community settings, based on long or short duration of illness; expecting association between longer illness-duration and worse outcomes in women and men. Clinical, demographic and service-use data from the Survey of High Impact Psychosis were analysed by sex and duration of illness (≤5 years; ≥6 years), using independent t-tests, chi-square tests, one-way ANOVA, and Cramer's V. Of the 1825 participants, 47% had schizophrenia, 17.5% bipolar and 16.1% schizo-affective disorders. More women than men had undertaken post-school education, maintained relationships, and been living in their own homes. Women with a shorter-illness-duration showed social functioning equivalent to non-ill women in the general population. Men tended to have an early illness onset, show premorbid dysfunction, be single, show severe disability, and to use illicit substances. Men with a longer-illness-duration were very socially disadvantaged and isolated, often experiencing homelessness and substance use. Men with a short-illness-duration were most likely to be in paid employment, but two-thirds earned less than $AUD500 per fortnight. Men with longer-illness-duration showed most disability, socially and globally. Interventions should be guided by diagnosis, but also by a person's sex and duration of illness.
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Affiliation(s)
- Mary-Claire Hanlon
- The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; Calvary Mater Newcastle, Waratah, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Linda E Campbell
- The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Priority Research Centre GrowUpWell and the School of Psychology, University of Newcastle, Australia
| | | | | | - Vera A Morgan
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, WA, Australia; North Metropolitan Health Service Mental Health, Perth, WA, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen J Stain
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; School of Social and Health Sciences, Leeds Trinity University, Horsforth, Leeds, UK
| | - David J Castle
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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Leonhardt BL, Huling K, Hamm JA, Roe D, Hasson-Ohayon I, McLeod HJ, Lysaker PH. Recovery and serious mental illness: a review of current clinical and research paradigms and future directions. Expert Rev Neurother 2017; 17:1117-1130. [PMID: 28885065 DOI: 10.1080/14737175.2017.1378099] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways: as an objective outcome versus a subjective process. Areas covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.
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Affiliation(s)
- Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - Kelsey Huling
- c School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Jay A Hamm
- b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - David Roe
- d Department of Community Mental Health, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | | | - Hamish J McLeod
- f Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,g Department of Psychiatry , Richard L. Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA
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Lambert M, Schöttle D, Ruppelt F, Rohenkohl A, Sengutta M, Luedecke D, Nawara LA, Galling B, Falk AL, Wittmann L, Niehaus V, Sarikaya G, Rietschel L, Gagern C, Schulte-Markwort M, Unger HP, Ott S, Romer G, Daubmann A, Wegscheider K, Correll CU, Schimmelmann BG, Wiedemann K, Bock T, Gallinat J, Karow A. Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study. Acta Psychiatr Scand 2017; 136:188-200. [PMID: 28589683 DOI: 10.1111/acps.12762] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC). METHODS ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care. RESULTS In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted non-remission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052). CONCLUSIONS EDIC lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC, offering psychotherapeutic interventions.
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Affiliation(s)
- M Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - F Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
| | - L A Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - B Galling
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
| | - A-L Falk
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - V Niehaus
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - G Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Rietschel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - C Gagern
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - M Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
| | - H-P Unger
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - S Ott
- Center for Mental Health, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - G Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - A Daubmann
- Department of Medical Biometry and Epidemiology, UKE, Hamburg, Germany
| | - K Wegscheider
- Department of Medical Biometry and Epidemiology, UKE, Hamburg, Germany
| | - C U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
| | - B G Schimmelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany.,University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - K Wiedemann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - T Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
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75
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Chang WC, Kwong VWY, Lau ESK, So HC, Wong CSM, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Sustainability of treatment effect of a 3-year early intervention programme for first-episode psychosis. Br J Psychiatry 2017; 211:37-44. [PMID: 28385705 DOI: 10.1192/bjp.bp.117.198929] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 01/16/2023]
Abstract
BackgroundEvidence indicates that the positive effects of 2-year early intervention services for psychosis are not maintained after service withdrawal. Optimal duration of early intervention in sustaining initial improved outcomes remains to be determined.AimsTo examine the sustainability of the positive effects of an extended, 3-year, early intervention programme for patients with first-episode psychosis (FEP) after transition to standard care.MethodA total of 160 patients, who had received a 2-year early intervention programme for FEP, were enrolled to a 12-month randomised-controlled trial (ClinicalTrials.gov: NCT01202357) comparing a 1-year extension of the early intervention (3-year specialised treatment) with step-down care (2-year specialised treatment). Participants were followed up and reassessed 2 and 3 years after inclusion to the trial.ResultsThere were no significant differences between the treatment groups in outcomes on functioning, symptom severity and service use during the post-trial follow-up period.ConclusionsThe therapeutic benefits achieved by the extended, 3-year early intervention were not sustainable after termination of the specialised service.
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Affiliation(s)
- Wing Chung Chang
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Vivian Wing Yan Kwong
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Emily Sin Kei Lau
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Hon Cheong So
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Gloria Hoi Kei Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Olivia Tsz Ting Jim
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Sherry Kit Wa Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
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Cotter J, Zabel E, French P, Yung AR. Prolonged duration of untreated psychosis: a problem that needs addressing. Early Interv Psychiatry 2017; 11:263-268. [PMID: 26801870 DOI: 10.1111/eip.12308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 12/15/2015] [Indexed: 12/01/2022]
Abstract
AIM The duration of untreated psychosis (DUP) refers to the period of time between the emergence of psychotic symptoms and the initiation of appropriate clinical treatment. Prolonged DUP is associated with a range of adverse consequences, including more severe illness course, cognitive deficits and poor functioning. Problems with recognition of illness and in seeking help contribute to DUP, but another major cause of prolonged DUP is delays within secondary mental health services. In an attempt to reduce these delays, National Health Service England and the Department of Health have set new targets to improve access to early intervention services which will come into effect in April 2016. Given this background, we aimed to examine the DUP and pathways to care of new patients entering an early intervention service. We also examined whether they were receiving National Institute for Health and Care Excellence (NICE) concordant treatment. This will enable us to establish a baseline so that the impact of the new targets can be determined and to assess the degree of change that will be required to implement these. METHODS De-identified electronic records of 165 patients accepted into the service over a 12-month period were analysed. RESULTS Median DUP was 6 months. There was a median of 2 contacts prior to service entry. Community Mental Health Teams were the largest source of referrals. CONCLUSIONS The majority of patients had a DUP exceeding the international target of 3 months. The findings appear to support previous evidence that this may be partially attributable to significant delays within the mental health care system.
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Affiliation(s)
- Jack Cotter
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Elisabeth Zabel
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.,Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
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77
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Guo ZH, Li ZJ, Ma Y, Sun J, Guo JH, Li WX, Wang ZQ, Xu HL, Ng RMK, Turkington D, Kingdon D. Brief cognitive-behavioural therapy for patients in the community with schizophrenia: randomised controlled trial in Beijing, China. Br J Psychiatry 2017; 210:223-229. [PMID: 28069563 DOI: 10.1192/bjp.bp.116.183285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/17/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022]
Abstract
BackgroundBrief cognitive-behavioural therapy (CBT) is an emerging treatment for schizophrenia in community settings; however, further trials are needed, especially in non-Western countries.AimsTo test the effects of brief CBT for Chinese patients with schizophrenia in the community (trial registration: ChiCTR-TRC-13003709).MethodA total of 220 patients with schizophrenia from four districts of Beijing were randomly assigned to either brief CBT plus treatment as usual (TAU) or TAU alone. Patients were assessed at baseline, post-treatment and at 6- and 12-month follow-ups by raters masked to group allocation.ResultsAt the post-treatment assessment and the 12-month follow-up, patients who received brief CBT showed greater improvement in overall symptoms, general psychopathology, insight and social functioning. In total, 37.3% of those in the brief CBT plus TAU group experienced a clinically significant response, compared with only 19.1% of those in the TAU alone group (P = 0.003).ConclusionsBrief CBT has a positive effect on Chinese patients with schizophrenia in the community.
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Affiliation(s)
- Zhi-Hua Guo
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Zhan-Jiang Li
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Yun Ma
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Jing Sun
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Jun-Hua Guo
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Wen-Xiu Li
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Zhi-Qiang Wang
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Hui-Li Xu
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Roger M K Ng
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Douglas Turkington
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - David Kingdon
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
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Tungaraza TE, Ahmed W, Chira C, Turner E, Mayaki S, Nandhra HS, Edwards T, Farooq S. Prescribing pattern of clozapine and other antipsychotics for patients with first-episode psychosis: a cross-sectional survey of early intervention teams. Ther Adv Psychopharmacol 2017; 7:103-111. [PMID: 28348730 PMCID: PMC5354130 DOI: 10.1177/2045125316683151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To describe the pattern of antipsychotic drug prescribing in patients with first episode psychosis, with more emphasis in the use of clozapine in this group of patients. METHOD A cross-sectional survey involving six early intervention service (EIS) teams in the West Midlands was conducted. Data was extracted from case notes and electronic records by clinicians working in each participating team. The pattern of antipsychotic prescribing and the changes that took place after being accepted in EIS, including the use of clozapine, was established. Clinicians involved in the treatment of patients in each team rated the overall clinical response to treatment based on the presence or absence of positive psychotic symptoms. RESULT 431 patients with FEP were included in the final analysis. Low antipsychotic discontinuation rate was observed, with the majority (88.2%) still being prescribed antipsychotics. Most (77.3%) were prescribed second-generation antipsychotic drugs, with olanzapine (21.8%) and aripiprazole (19.7%) being the most frequently prescribed antipsychotics. There was low rate use of antipsychotic combinations (7.4%), high dose antipsychotic regime (3.9%), low depot antipsychotic prescribing (9.3%), and clozapine use was low (9.7%). On average, three antipsychotics were tried before clozapine was initiated and it took on average 19.5 months from being accepted into EIS to clozapine being initiated. CONCLUSION The majority of patients were prescribed antipsychotics within the guidelines. EIS was associated with an overall low antipsychotic discontinuation. There was also a short waiting time before clozapine was initiated following patients being accepted into EIS.
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Affiliation(s)
- Tongeji E Tungaraza
- Consultant General Adult Psychiatrist (Rehabilitation), Partnerships in Care Ltd., Beverley House, 527-529 City Road, Birmingham, B617 8LL (Formerly Consultant EIS, Wolverhampton), UK
| | - Wakil Ahmed
- Consultant General Adult Psychiatrist, MHHTT, Park House, North Manchester, Manchester Mental Health & Social Care Trust, UK
| | - Chinonyelum Chira
- Consultant in Child and Adolescent Psychiatry, Birmingham Children's Hospital, UK
| | - Erin Turner
- Consultant Solihull Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, UK
| | - Susan Mayaki
- Consultant General Adult Psychiatrist, Assertive Outreach Team, and Rehabilitation, Hereford, UK
| | - Harpal Singh Nandhra
- Consultant Psychiatrist, C&W Partnership Trust. Ashton house, Leamington Spa, UK
| | - Tom Edwards
- Consultant Psychiatrist, Dudley and Walsall Mental Health Partnership NHS Trust, Walsall Assertive Outreach Team and Walsall North Community Recovery Service, Dorothy Pattison Hospital, Alumwell Close, Walsall, West Midlands, UK
| | - Saeed Farooq
- Clinical Senior Lecturer, Research Institute for Primary Care & Health Sciences, Keele University, UK Honorary Consultant Psychiatrist, South Staffordshire and Shropshire NHS Foundation Trust, UK
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79
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Kirkbride JB, Hameed Y, Ankireddypalli G, Ioannidis K, Crane CM, Nasir M, Kabacs N, Metastasio A, Jenkins O, Espandian A, Spyridi S, Ralevic D, Siddabattuni S, Walden B, Adeoye A, Perez J, Jones PB. The Epidemiology of First-Episode Psychosis in Early Intervention in Psychosis Services: Findings From the Social Epidemiology of Psychoses in East Anglia [SEPEA] Study. Am J Psychiatry 2017; 174:143-153. [PMID: 27771972 PMCID: PMC5939990 DOI: 10.1176/appi.ajp.2016.16010103] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few studies have characterized the epidemiology of first-episode psychoses in rural or urban settings since the introduction of early intervention psychosis services. To address this, the authors conducted a naturalistic cohort study in England, where such services are well established. METHOD All new first-episode psychosis cases, 16-35 years old, presenting to early intervention psychosis services in the East of England were identified during 2 million person-years follow-up. Presence of ICD-10 F10-33 psychotic disorder was confirmed using OPCRIT [operational criteria for psychotic illness]. Incidence rate ratios were estimated following multivariable Poisson regression, adjusting for age, sex, ethnicity, socioeconomic status, neighborhood-level deprivation, and population density. RESULTS Of 1,005 referrals, 687 participants (68.4%) fulfilled epidemiological and diagnostic criteria for first-episode psychosis (34.0 new cases per 100,000 person-years; 95% CI=31.5-36.6). Median age at referral was similar for men (22.5 years; interquartile range: 19.5-26.7) and women (23.4 years; interquartile range: 19.5-29.1); incidence rates were highest for men and women before 20 years of age. Rates increased for ethnic minority groups (incidence rate ratio: 1.4; 95% CI=1.1-1.6), as well as with lower socioeconomic status (incidence rate ratio: 1.3; 95% CI=1.2-1.4) and in more urban (incidence rate ratio: 1.4;95%CI=1.0-1.8) and deprived (incidence rate ratio: 2.1; 95% CI=1.3-3.3) neighborhoods, after adjustment for confounders. CONCLUSIONS Pronounced variation in psychosis incidence, peaking before 20 years old, exists in populations served by early intervention psychosis services. Excess rates were restricted to urban and deprived communities, suggesting that a threshold of socioenvironmental adversity may be necessary to increase incidence. This robust epidemiology can inform service development in various settings about likely population-level need.
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Affiliation(s)
- James B. Kirkbride
- PsyLife group, Division of Psychiatry, UCL, London, W1T 7NF,Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ,Corresponding author: Dr James Kirkbride, Sir Henry Dale Fellow, Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, UCL, London, W1T 7NF, UK. Tel: +44 (0) 20 7679 9297
| | - Yasir Hameed
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE
| | | | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ,Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF
| | - Carolyn M. Crane
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF
| | - Mukhtar Nasir
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE
| | - Nikolett Kabacs
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF
| | | | - Oliver Jenkins
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE
| | - Ashkan Espandian
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF
| | - Styliani Spyridi
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF
| | - Danica Ralevic
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE
| | | | - Ben Walden
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE
| | - Adewale Adeoye
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ,Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ,Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF
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80
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Kim SW, Lee BJ, Kim JJ, Yu JC, Lee KY, Won SH, Lee SH, Kim SH, Kang SH, Chung YC. Design and Methodology of the Korean Early Psychosis Cohort Study. Psychiatry Investig 2017; 14:93-99. [PMID: 28096881 PMCID: PMC5240457 DOI: 10.4306/pi.2017.14.1.93] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/21/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022] Open
Abstract
The present study details the rationale and methodology of the Korean Early Psychosis Cohort Study (KEPS), which is a clinical cohort investigation of first episode psychosis patients from a Korean population. The KEPS is a prospective naturalistic observational cohort study that follows the participants for at least 2 years. This study includes patients between 18 and 45 years of age who fulfill the criteria for one of schizophrenia spectrum and other psychotic disorders according to the diagnostic criteria of DSM-5. Early psychosis is defined as first episode patients who received antipsychotic treatment for fewer than 4 consecutive weeks after the onset of illness or stabilized patients in the early stages of the disorder whose duration of illness was less than 2 years from the initiation of antipsychotic treatment. The primary outcome measures are treatment response, remission, recovery, and relapse. Additionally, several laboratory tests are conducted and a variety of objective and subjective psychiatric measures assessing early life trauma, lifestyle pattern, and social and cognitive functioning are administered. This long-term prospective cohort study may contribute to the development of early intervention strategies and the improvement of long-term outcomes in patients with schizophrenia.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bong Ju Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung Jin Kim
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Je-Chun Yu
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kyu Young Lee
- Department of Psychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea
| | - Seung-Hee Won
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University College of Medicine, Goyang, Republic of Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University College of Medicine, Guro Hospital, Seoul, Republic of Korea
| | - Shi Hyun Kang
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Republic of Korea
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81
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Allott KA, Killackey E, Sun P, Brewer WJ, Velligan DI. Feasibility and acceptability of cognitive adaptation training for first-episode psychosis. Early Interv Psychiatry 2016; 10:476-484. [PMID: 25496290 DOI: 10.1111/eip.12207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
Abstract
AIM Cognitive and functioning impairments are present early in the course of psychotic disorder and remain one of the greatest treatment challenges. Cognitive adaptation training (CAT) is a compensatory approach to psychosocial intervention that is underpinned by a model that incorporates the role of cognition in daily functioning. CAT has established effectiveness in chronic schizophrenia but has received limited investigation in first-episode psychosis (FEP). The aim of this study was to examine the feasibility and acceptability of CAT in young people with FEP. METHODS This was a single-arm feasibility study of CAT conducted at the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. Five FEP participants received manually guided CAT from a fully trained CAT therapist. A range of feasibility and acceptability measures were recorded throughout the study, including participant and case manager satisfaction ratings. RESULTS All participants completed the CAT intervention and session attendance rates were very high (95.3%). Participants and their case managers indicated strong satisfaction with CAT as indicated by positive mean ratings on all satisfaction items, although there was a greater range in the participant ratings. Importantly, CAT did not have a negative effect on existing case management, with case managers reporting that CAT enhanced their treatment. CONCLUSIONS This study provides evidence that CAT is a highly feasible and acceptable intervention in FEP, which may be easily integrated within existing services. The effectiveness of CAT in improving functional outcomes in FEP is worthy of investigation in a larger trial.
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Affiliation(s)
- Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pamela Sun
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Warrick J Brewer
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dawn I Velligan
- Health Science Center, University of Texas, San Antonio, Texas, USA
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Effects of Community Mental Health Service in Subjects with Early Psychosis: One-Year Prospective Follow Up. Community Ment Health J 2016; 52:724-30. [PMID: 26615392 DOI: 10.1007/s10597-015-9966-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
Abstract
The use of a multidisciplinary team approach is essential for increasing the likelihood of recovery among individuals with early psychosis. The aim of the present study was to investigate the effects of community-based mental health services on the symptoms and socio-occupational functioning of subjects with early psychosis. The study included participants who were referred to our Mental Health Promotion Center and who agreed to participate in diverse individual and group programs. During the 1-year follow-up, the medication adherence rate remained high, the recovery rate substantially increased, and the scores on the Positive and Negative Syndrome Scale, Psychotic Symptom Rating Scale-Delusion and Auditory Hallucinations subscales, Global Assessment of Functioning, Interpersonal Sensitivity Measure, and Social Functioning Questionnaire significantly improved over time. The findings suggest that the 1-year outcome of subjects with early psychosis can be improved by diverse community-based psychosocial interventions.
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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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84
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Chang WC, Kwong VWY, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of functional remission in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong. Schizophr Res 2016; 173:79-83. [PMID: 27017490 DOI: 10.1016/j.schres.2016.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Functional remission (FR) is an intermediate and necessary step toward recovery, but is understudied in first-episode psychosis (FEP). We aimed to examine the rate and predictors of FR in FEP patients in the context of a randomized-controlled trial (RCT) comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment and personality, clinical profiles, functioning, and treatment characteristics were conducted. FR was operationalized as simultaneous fulfillment of attaining adequate functional levels (measured by Social and Occupational Functioning Scale and Role Functioning Scale) and competitive employment at 6 and 12 months. Data analysis was based on 156 subjects who completed follow-up functional assessments. RESULTS Thirty-one (19.9%) patients achieved FR status. Multivariate binary regression analysis showed that female gender, lower degrees of premorbid schizoid-schizotypal traits, Extended EI treatment condition, lower levels of positive symptoms at intake, and better baseline functioning independently predicted FR. CONCLUSION This is the first RCT providing supportive evidence to an extension of EI service beyond 2-year treatment duration on further enhancing the likelihood of FR attainment in FEP. Our findings that only approximately 20% of patients achieved FR indicate an unmet therapeutic need for promoting sustained adequate functional improvement in the early stage of psychotic illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
| | - Vivian Wing Yan Kwong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Gloria Hoi Kei Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Olivia Tsz Ting Jim
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Emily Sin Kei Lau
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
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85
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Calvo A, Moreno M, Ruiz-Sancho A, Rapado-Castro M, Moreno C, Sánchez-Gutiérrez T, Arango C, Mayoral M. Psychoeducational Group Intervention for Adolescents With Psychosis and Their Families: A Two-Year Follow-Up. J Am Acad Child Adolesc Psychiatry 2015; 54:984-90. [PMID: 26598473 DOI: 10.1016/j.jaac.2015.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate whether the beneficial effects of a structured, psychoeducational, parallel-group program for adolescents with early-onset psychosis and their families observed immediately after the intervention were maintained 2 years later. METHOD The present study examines the longitudinal efficacy of a randomized controlled trial based on a psychoeducational, problem-solving, structured group intervention for adolescents with early-onset psychosis and their families (PE) and compares it with that of a nonstructured group intervention (NS) after a 2-year follow-up. We analyzed whether the differences between PE and NS found after the intervention persisted 2 years later. Intergroup differences in number and duration of hospitalizations, symptoms, and functioning were also assessed. RESULTS After 2 years of follow-up, we were able to reassess 89% of patients. In the PE group, 13% of patients had visited the emergency department, compared with 50% in the NS group (p = .019). However, no statistically significant differences were found between the groups for negative symptoms or number and duration of hospitalizations. A significant improvement in Positive and Negative Syndrome Scale (PANSS) general symptoms was observed in the PE group. CONCLUSION Our psychoeducational group intervention showed sustained effects by diminishing the number of visits to emergency departments 2 years after the intervention. Our findings indicate that this psychoeducational intervention could provide patients with long-lasting resources to manage crises more effectively. Clinical trial registration information-Intervention Module AGES (AGES-CM); http://clinicaltrials.gov/; NCT02101372.
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Affiliation(s)
- Ana Calvo
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid.
| | - Miguel Moreno
- Gipuzkoako Osasun Mentaleko Sarea, Red de Salud Mental de Guipuzcoa, Biodonostia, San Sebastian, Spain
| | - Ana Ruiz-Sancho
- VocAcción Director-Group Processes and Institutional Consulting, Madrid
| | - Marta Rapado-Castro
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Melbourne Neuropsychiatry Centre, the University of Melbourne and Melbourne Health, Carlton South, Australia
| | - Carmen Moreno
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - Teresa Sánchez-Gutiérrez
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - María Mayoral
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
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86
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Del Rey-Mejías Á, Fraguas D, Díaz-Caneja CM, Pina-Camacho L, Castro-Fornieles J, Baeza I, Espliego A, Merchán-Naranjo J, González-Pinto A, de la Serna E, Payá B, Graell M, Arango C, Parellada M. Functional deterioration from the premorbid period to 2 years after the first episode of psychosis in early-onset psychosis. Eur Child Adolesc Psychiatry 2015; 24:1447-59. [PMID: 25726022 DOI: 10.1007/s00787-015-0693-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/10/2015] [Indexed: 01/10/2023]
Abstract
The aim of the study was to analyze changes in functional adjustment from childhood to 2 years after the first episode of psychosis (FEP) in patients with early-onset schizophrenia spectrum disorders (SSD) and affective psychoses (AFP) and a good or intermediate level of premorbid adjustment. We followed 106 adolescents (aged 12-17 years) with FEP for 2 years after recruitment. Premorbid adjustment in childhood was assessed in 98 patients with the childhood subscale of the Cannon-Spoor Premorbid Adjustment Scale (c-PAS). Global functioning was assessed 2 years after the FEP with the Children's Global Assessment Scale (c-GAS) or the Global Assessment of Functioning scale (GAF), as appropriate. Functional deterioration was defined as a downward shift in the level of functional adjustment from childhood to 2 years after the FEP. In patients with good or intermediate premorbid adjustment, functional deterioration was observed in 28.2 % (26.5 % of the AFP group, 29.4 % of the SSD group). Longer duration of untreated psychosis (Beta = 0.01; P = 0.01) and higher symptom severity at the FEP, as measured with the Clinical Global Impression Scale (Beta = 1.12; P = 0.02), significantly predicted the presence of functional deterioration, accounting for 21.4 % of the variance. Irrespective of diagnosis (SSD or AFP), almost one-third of adolescents with FEP and good or intermediate premorbid adjustment showed functional deterioration from the premorbid period to 2 years after the FEP.
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Affiliation(s)
- Ángel Del Rey-Mejías
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain.
| | - David Fraguas
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Ana Espliego
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Jessica Merchán-Naranjo
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Ana González-Pinto
- Mood Disorders Research Center, 03-RC-003, Hospital Santiago Apóstol, CIBERSAM, Vitoria, Spain
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489CIBERSAM. Institute Clinic of Neurosciences, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Beatriz Payá
- Department of Child Psychiatry, Hospital Universitario Marqués de Valdecilla, CIBERSAM, Santander, Spain
| | - Montserrat Graell
- Section of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesus, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
| | - Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Ibiza 43, 28009, Madrid, Spain
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87
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Shmukler AB, Gurovich IY, Agius M, Zaytseva Y. Long-term trajectories of cognitive deficits in schizophrenia: A critical overview. Eur Psychiatry 2015; 30:1002-10. [PMID: 26516984 DOI: 10.1016/j.eurpsy.2015.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/15/2015] [Accepted: 08/18/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cognitive disturbances are widely pronounced in schizophrenia and schizophrenia spectrum disorders. Whilst cognitive deficits are well established in the prodromal phase and are known to deteriorate at the onset of schizophrenia, there is a certain discrepancy of findings regarding the cognitive alterations over the course of the illness. METHODS We bring together the results of the longitudinal studies identified through PubMed which have covered more than 3 years follow-up and to reflect on the potential factors, such as sample characteristics and stage of the illness which may contribute to the various trajectories of cognitive changes. RESULTS A summary of recent findings comprising the changes of the cognitive functioning in schizophrenia patients along the longitudinal course of the illness is provided. The potential approaches for addressing cognition in the course of schizophrenia are discussed. CONCLUSIONS Given the existing controversies on the course of cognitive changes in schizophrenia, differentiated approaches specifically focusing on the peculiarities of the clinical features and changes in specific cognitive domains could shed light on the trajectories of cognitive deficits in schizophrenia and spectrum disorders.
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Affiliation(s)
- A B Shmukler
- Moscow Research Institute of Psychiatry, Moscow, Russian Federation.
| | - I Y Gurovich
- Moscow Research Institute of Psychiatry, Moscow, Russian Federation
| | - M Agius
- Clare College Cambridge, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK; East London NHS Foundation Trust, London, UK
| | - Y Zaytseva
- Moscow Research Institute of Psychiatry, Moscow, Russian Federation; National Institute of Mental Health, Klecany, Charles University in Prague, Prague, Czech Republic; Department of Psychiatry and Medical Psychology, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Human Science Centre and Institute of Medical Psychology, Ludwig-Maximilians Universität, Munich, Germany
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88
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Abstract
High-quality services for people with psychosis are essential. However, in this debate David Castle questions whether separate early intervention services are the best option and argues instead for an integrated approach. Swaran Singh responds, robustly defending the value of early intervention services.
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Affiliation(s)
- David J Castle
- For: David J. Castle, MD, FRCPsych, FRANZCP, St Vincent's Mental Health Service and The University of Melbourne, PO Box 2900, Fitzroy, Victoria, Australia 3065. ; Against: Swaran P. Singh, MBBS, MD, FRCPsych, DM, Mental Health and Wellbeing, Warwick Medical School University of Warwick, Coventry, and Birmingham and Solihull Mental Health. Foundation Trust, Birmingham, and Equality and Human Rights Commission.
| | - Swaran P Singh
- For: David J. Castle, MD, FRCPsych, FRANZCP, St Vincent's Mental Health Service and The University of Melbourne, PO Box 2900, Fitzroy, Victoria, Australia 3065. ; Against: Swaran P. Singh, MBBS, MD, FRCPsych, DM, Mental Health and Wellbeing, Warwick Medical School University of Warwick, Coventry, and Birmingham and Solihull Mental Health. Foundation Trust, Birmingham, and Equality and Human Rights Commission.
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89
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Austin SF, Mors O, Budtz-Jørgensen E, Secher RG, Hjorthøj CR, Bertelsen M, Jeppesen P, Petersen L, Thorup A, Nordentoft M. Long-term trajectories of positive and negative symptoms in first episode psychosis: A 10year follow-up study in the OPUS cohort. Schizophr Res 2015; 168:84-91. [PMID: 26265299 DOI: 10.1016/j.schres.2015.07.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/25/2015] [Accepted: 07/13/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Knowledge about course of illness can help clinicians to develop effective interventions and improve treatment outcomes. The goal of this study was to construct positive and negative symptom trajectories based on structured clinical assessments collected over 10years within a cohort of people with first episode psychosis. METHOD A cohort of 496 people with first episode psychosis (ICD-10, F20-28) originally recruited for the OPUS study (1998-2000) and treated in community psychiatric services were rated on clinical symptoms at 5 different occasions across ten years. Psychopathology was assessed using the Scales for Assessment of Positive and Negative Symptoms. Symptom trajectories were constructed using Latent Class Analysis. RESULTS Five distinct trajectories were identified for positive symptoms (response - 47%, delayed response - 12%, relapse - 15%, non-response - 13% and episodic response - 13%). Four distinct trajectories were identified for negative symptoms (response - 28%, delayed response - 19%, relapse - 26% and non-response - 27%). Multivariable regression analysis of baseline characteristics identified that longer duration of untreated psychosis (OR 1.27-1.47, p<0.05) and substance abuse (OR 3.47-5.90, p<0.01) were associated with poorer positive symptom trajectories (higher levels of psychotic symptoms) while poor social functioning (OR 1.34-5.55, p<0.05), disorganized symptoms (OR 2.01-2.38, p<0.05) and schizophrenia diagnosis (OR 5.70-8.86, p<0.05) were associated with poorer negative symptom trajectories (higher levels of negative symptoms). A proportion of people displayed significant changes in symptoms several years after diagnosis. CONCLUSIONS Trajectories of illness for positive and negative symptoms were heterogeneous among people with first episode psychosis. Positive symptoms showed a general pattern of reduction and stabilization over time while negative symptoms typically showed less variation over the ten years. Results have implications for the focus, timing and length of interventions in first episode psychosis.
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Affiliation(s)
- Stephen F Austin
- Centre for Psychiatric Research, Aarhus University, Aarhus, Denmark; Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
| | - Ole Mors
- Centre for Psychiatric Research, Aarhus University, Aarhus, Denmark
| | | | - Rikke Gry Secher
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Carsten R Hjorthøj
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Mette Bertelsen
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Pia Jeppesen
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Lone Petersen
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Anne Thorup
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
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90
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Bond GR, Drake RE, Luciano A. 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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 05/12/2014] [Accepted: 06/06/2014] [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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Affiliation(s)
- G. R. Bond
- Department of Psychiatry, Geisel Medical School at Dartmouth, Hanover, NH, USA
| | - R. E. Drake
- Department of Psychiatry, Geisel Medical School at Dartmouth, Hanover, NH, USA
| | - A. Luciano
- Department of Psychiatry, Geisel Medical School at Dartmouth, Hanover, NH, USA
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91
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Chang WC, Cheung R, Hui CLM, Lin J, Chan SKW, Lee EHM, Chen EYH. Rate and risk factors of depressive symptoms in Chinese patients presenting with first-episode non-affective psychosis in Hong Kong. Schizophr Res 2015; 168:99-105. [PMID: 26235752 DOI: 10.1016/j.schres.2015.07.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptoms are a distinct symptom dimension in psychotic disorders and are associated with elevated suicide risk, and poorer clinical and functional outcomes. Previous research on depressive symptoms mainly focused on chronic patients and few studies were conducted to investigate factors associated with depression in the early illness course. We aimed to examine the prevalence and risk factors of depressive symptoms, and their impacts on functioning, subjective quality of life (QoL) and self-efficacy in first-episode non-affective psychosis. METHOD Three hundred fifty-one Hong Kong Chinese aged 26-55years presenting with first-episode non-affective psychosis to early intervention service were recruited. Assessments encompassing sociodemographics, premorbid adjustment, clinical and treatment profiles, functioning, QoL and perceived self-efficacy were conducted. Patients who had Calgary Depression Scale for Schizophrenia (CDSS) total score ≥6 were classified as having depressive symptoms. RESULTS Fifty-three (15.1%) patients exhibited depressive symptoms at entry. Depressed patients had worse functioning, poorer QoL and lower level of self-efficacy than non-depressed counterparts. Multivariate regression analysis showed that previous exposure to stressful life events, unemployment, being married, more severe positive symptoms, higher level of antipsychotic-induced Parkinsonism and negative attitude towards medication treatment were independently associated with depression status. CONCLUSIONS Depressive symptoms were frequently observed in adult patients with first-episode nonaffective psychosis, and were linked to poor functioning and QoL. Our findings indicated that, aside from social and clinical risk factors, presence of drug-induced Parkinsonism and negative treatment attitude may render patients more vulnerable to developing depression in the early stage of psychotic illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
| | - Rowan Cheung
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Jingxia Lin
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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92
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Fervaha G, Foussias G, Agid O, Remington G. Motivational deficits in early schizophrenia: prevalent, persistent, and key determinants of functional outcome. Schizophr Res 2015; 166:9-16. [PMID: 25982811 DOI: 10.1016/j.schres.2015.04.040] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/26/2015] [Accepted: 04/29/2015] [Indexed: 01/31/2023]
Abstract
Negative symptoms, in particular motivational deficits, are reported as impediments to functional recovery in patients with schizophrenia. This study examined the prevalence of motivational deficits in patients early in the illness, and the impact these deficits have on community functioning. Patients with schizophrenia between the ages of 18 and 35years, and within 5years of initiating antipsychotic treatment were included in the present investigation (N=166). The impact of motivation and cognition on concurrent and longitudinal functioning was evaluated. Motivational impairments were found in more than 75% of participants, and were not associated with receipt of social support. These deficits served as the most robust and reliable predictor of functional outcome, while neurocognition demonstrated significantly weaker associations with outcome. When considered together, motivational deficits demonstrated a reliable link with concurrent and longitudinal functioning, with cognition not offering any independent predictive value. Moreover, motivation was found to mediate the relationship between cognition and outcome. Changes in motivation were linked to changes in functioning; however, this was not the case for changes in cognitive performance. Motivation emerged as a significant predictor of functioning even after selected demographic and clinical characteristics (e.g., positive symptoms) were accounted for. These data indicate that motivational deficits are prevalent in patients with schizophrenia, even in the early stages of the illness, and these deficits stand as one of the most robust barriers to people with schizophrenia achieving functional recovery. Greater understanding of the mechanisms underlying these deficits is critical to effective treatment innovation.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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93
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Kam SM, Singh SP, Upthegrove R. What needs to follow early intervention? Predictors of relapse and functional recovery following first-episode psychosis. Early Interv Psychiatry 2015; 9:279-83. [PMID: 24251970 DOI: 10.1111/eip.12099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/22/2013] [Indexed: 11/27/2022]
Abstract
AIM As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis (FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning. METHOD An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service (EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning. RESULTS Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive 'Not in Education Employment or Training' status at end-point include being in a minority ethnic group, substance misuse and number of relapses. CONCLUSIONS Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery.
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Affiliation(s)
- Shi Mei Kam
- College of Medical and Dental Sciences, The University of Birmingham
| | - Swaran P Singh
- Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham.,Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Upthegrove
- College of Medical and Dental Sciences, The University of Birmingham.,Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham
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94
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McGorry PD. Australian Early Psychosis Research Network: national collaboration, international competitive advantage. Med J Aust 2015; 202:170-1. [PMID: 25716588 DOI: 10.5694/mja14.00914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/22/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick D McGorry
- ORYGEN Youth Health Research Centre, University of Melbourne, Melbourne, VIC, Australia.
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Roy L, Rousseau J, Fortier P, Mottard JP. Postsecondary academic achievement and first-episode psychosis: A mixed-methods study. The Canadian Journal of Occupational Therapy 2015; 83:42-52. [DOI: 10.1177/0008417415575143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Postsecondary academic achievement as an area of functional recovery for young adults living with mental illness has received little research attention. Purpose. This study had three purposes: to compare rates of participation, performance, and satisfaction in postsecondary education between young adults with first-episode psychosis and closely matched young adults; to identify characteristics associated with academic participation; and to explore the processes associated with educational experiences. Method. One hundred young adults ages 18 to 30 participated in the study. Quantitative data on academic engagement, performance, and satisfaction, and qualitative data ( n = 52) on academic experiences were integrated through pattern analyzes. Findings. Young adults with psychosis were significantly less likely to be engaged in postsecondary education. No difference appeared for the extent of engagement, but performance and satisfaction were lower among participants with psychosis. Participants engaged in reflexive decision making to access postsecondary education and to maintain adequate academic performance. Strategies used by successful students with mental illness were identified. Implications. Assessment and intervention focused on educational needs and skills should become landmark practices for psychiatric rehabilitation practitioners, including occupational therapists.
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96
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Chang WC, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. Br J Psychiatry 2015; 206:492-500. [PMID: 25657355 DOI: 10.1192/bjp.bp.114.150144] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous early intervention services targeting young people with psychosis have been established, based on the premise that reducing treatment delay and providing intensive treatment in the initial phase of psychosis can improve long-term outcome. AIMS To establish the effect of extending a specialised early intervention treatment for first-episode psychosis by 1 year. METHOD A randomised, single-blind controlled trial (NCT01202357) compared a 1-year extension of specialised early intervention with step-down care in patients who had all received a 2-year intensive early intervention programme for first-episode psychosis. RESULTS Patients receiving an additional year of specialised intervention had better outcomes in functioning, negative and depressive symptoms and treatment default rate than those managed by step-down psychiatric care. CONCLUSIONS Extending the period of specialised early intervention is clinically desirable but may not be feasible in lower-income countries.
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Affiliation(s)
- Wing Chung Chang
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Gloria Hoi Kei Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Olivia Tsz Ting Jim
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Emily Sin Kei Lau
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Christy Lai Ming Hui
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Sherry Kit Wa Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Edwin Ho Ming Lee
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
| | - Eric Yu Hai Chen
- Wing Chung Chang, MRCPsych, FHKCPsych, Gloria Hoi Kei Chan, MPhil, Olivia Tsz Ting Jim, BsocSc, Department of Psychiatry, University of Hong Kong; Emily Sin Kei Lau, BsocSc, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Christy Lai Ming Hui, PhD, Sherry Kit Wa Chan, MRCPsych, Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, University of Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, University of Hong Kong and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong
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97
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Abstract
Optimal outcome in schizophrenia is thought to include remission of symptoms, functional recovery, and improved subjective well-being. The present study examined the characteristics of individuals with schizophrenia who report being satisfied with their life in general. Individuals with schizophrenia who participated in the Clinical Antipsychotic Trial of Intervention Effectiveness study were included in the present analysis. Approximately half of the individuals evaluated reported a high level of life satisfaction, even while many concurrently described themselves as at least moderately ill and experiencing moderate-severe symptoms and manifested severe functional deficits. Of all individuals evaluated, only about 1% experienced what was considered to be optimal outcome. Individuals with schizophrenia are able to experience a high level of life satisfaction, despite experiencing severe illness and functional deficits. Those involved in care should be aware that life satisfaction as an outcome is not necessarily associated with symptom remission and superior functioning.
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98
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Fung G, Cheung C, Chen E, Lam C, Chiu C, Law CW, Leung MK, Deng M, Cheung V, Qi L, Nailin Y, Tai KS, Yip L, Suckling J, Sham P, McAlonan G, Chua SE. MRI predicts remission at 1 year in first-episode schizophrenia in females with larger striato-thalamic volumes. Neuropsychobiology 2015; 69:243-8. [PMID: 24993979 DOI: 10.1159/000358837] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The Remission in Schizophrenia Working Group has defined remission as 'a low-mild symptom intensity level, maintained for a minimum of 6 months, where such symptoms do not affect an individual's behaviour' [Andreasen et al.: Am J Psychiatry 2005;162:441-449]. Since brain morphology relates to symptomatology, treatment and illness progression, MRI may assist in predicting remission. METHODS Thirty-nine patients newly diagnosed with DSM-IV schizophrenia underwent MRI brain scan prior to antipsychotic exposure. The Global Assessment of Functioning (GAF) score was entered into a voxel-based analysis to evaluate its relationship with cerebral grey matter volume from the baseline MRI. We entered age, total intracranial volume and intake GAF score as co-variates. Males and females were analysed separately because gender is a potent determinant of outcome. RESULTS Males had lower GAF scores than females, both at intake and at 1 year. Males comprised only 40% (12 out of 39) of the early remission group. For females only, early remission was strongly and positively correlated with bilateral lentiform and striatal volumes. For males, there was no such relationship. CONCLUSION Larger striato-thalamic volume correlated with early remission in females only. These baseline MRI findings were unlikely to be confounded by antipsychotic treatment and chronicity. These brain morphological markers show gender dimorphism and may assist in the prediction of early remission in newly diagnosed schizophrenia.
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Affiliation(s)
- Germaine Fung
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
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De Maio M, Graham P, Vaughan D, Haber L, Madonick S. Review of international early psychosis programmes and a model to overcome unique challenges to the treatment of early psychosis in the United States. Early Interv Psychiatry 2015; 9:1-11. [PMID: 24576137 DOI: 10.1111/eip.12132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022]
Abstract
AIM This article presents a literature review of treatments for first-episode psychosis throughout the world and describes the POTENTIAL (Patient-Oriented Treatment for Early or New onset schizophrenia To Initiate A Long-term recovery) Early Psychosis Programme in detail, explaining the model and the rationale, as well as the uniqueness of the programme. METHODS An international search was conducted for English articles using PubMed, PsycINFO and PsycARTICLES, as well as the reference lists of published studies and reviews. One article that is currently in press was included, which was not part of the original literature search. Inclusion criteria included any published or in press study focused upon treatment programmes for early psychosis. Out of the 62 articles collected, 27 publications met this criterion and were utilized. In addition to identifying clinical programmes, gaps in treatment for this population were identified. RESULTS The primary method in the United States for the treatment of early psychosis is randomized trial for new pharmacological treatments where patients are research subjects. Although there are a multitude of both research and clinical programmes internationally, the few programmes that exist in the United States that focus upon first-episode psychosis are either research based or focus upon prodromal symptoms. Clinical programmes such as the POTENTIAL programme are nearly non-existent. CONCLUSIONS Although the POTENTIAL programme has been successful both clinically and financially, there are still more strides to be taken to improve upon young adult services. Future development of the programme is continuing with the incorporation of outcome data and outreach into the community.
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Affiliation(s)
- Mara De Maio
- Young Adult Services, Institute of Living, Hartford, Connecticut, USA
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100
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Valencia M, Fresán A, Barak Y, Juárez F, Escamilla R, Saracco R. Predicting functional remission in patients with schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome. Neuropsychiatr Dis Treat 2015; 11:2339-48. [PMID: 26396518 PMCID: PMC4574884 DOI: 10.2147/ndt.s87335] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND New approaches to assess outcome in schizophrenia include multidimensional measures such as remission, cognition, psychosocial functioning, and quality of life. Clinical and psychosocial measures have been recently introduced to assess functional outcome. OBJECTIVE The study presented here was designed to examine the rates of symptomatic remission, psychosocial remission, global functioning, and clinical global impressions in a sample of schizophrenia outpatients in order to assess functional remission and to identify predictive factors for functional remission. METHODS A total of 168 consecutive Mexican outpatients receiving pharmacological treatment at the National Institute of Psychiatry in Mexico City were enrolled in a cross-sectional study. Symptomatic remission was assessed according to the definition and criteria proposed by the Remission in Schizophrenia Working Group using the Positive and Negative Symptom Scale. Psychosocial remission was assessed according to Barak criteria using the Psychosocial Remission in Schizophrenia scale. Functioning was measured with the Global Assessment of Functioning, and clinical outcome with the Clinical Global Impressions (CGI) Scale. RESULTS Findings showed that 45.2% of patients fulfilled the symptomatic remission criteria, 32.1% achieved psychosocial remission, and 53% reported adequate functioning. However, the combination of these three outcome criteria - symptomatic, psychosocial remission, and functioning - indicated that 14.9% of the patients achieved our predefined functional remission outcome. The logistic regression model included five predictive variables for functional remission: (1) being employed, (2) use of atypical antipsychotics, (3) lower number of medications, (4) lower negative symptom severity, and (5) lower excitement symptom severity. CONCLUSION The study demonstrated that symptomatic remission, psychosocial remission, and functioning could be achievable goals for a considerable number of patients. The outcome of functional remission was achieved by a minority of patients, less than 15%. New approaches should include multidimensional measures to assess functional outcome in schizophrenia research.
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Affiliation(s)
- Marcelo Valencia
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Ana Fresán
- Division of Clinical Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Yoram Barak
- Psychiatry Department, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Francisco Juárez
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Raul Escamilla
- Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Ricardo Saracco
- Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
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