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Benrimoh D, Dlugunovych V, Wright AC, Phalen P, Funaro MC, Ferrara M, Powers AR, Woods SW, Guloksuz S, Yung AR, Srihari V, Shah J. On the proportion of patients who experience a prodrome prior to psychosis onset: A systematic review and meta-analysis. Mol Psychiatry 2024; 29:1361-1381. [PMID: 38302562 DOI: 10.1038/s41380-024-02415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Preventing or delaying the onset of psychosis requires identification of those at risk for developing psychosis. For predictive purposes, the prodrome - a constellation of symptoms which may occur before the onset of psychosis - has been increasingly recognized as having utility. However, it is unclear what proportion of patients experience a prodrome or how this varies based on the multiple definitions used. METHODS We conducted a systematic review and meta-analysis of studies of patients with psychosis with the objective of determining the proportion of patients who experienced a prodrome prior to psychosis onset. Inclusion criteria included a consistent prodrome definition and reporting the proportion of patients who experienced a prodrome. We excluded studies of only patients with a prodrome or solely substance-induced psychosis, qualitative studies without prevalence data, conference abstracts, and case reports/case series. We searched Ovid MEDLINE, Embase (Ovid), APA PsycInfo (Ovid), Web of Science Core Collection (Clarivate), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, APA PsycBooks (Ovid), ProQuest Dissertation & Thesis, on March 3, 2021. Studies were assessed for quality using the Critical Appraisal Checklist for Prevalence Studies. Narrative synthesis and proportion meta-analysis were used to estimate prodrome prevalence. I2 and predictive interval were used to assess heterogeneity. Subgroup analyses were used to probe sources of heterogeneity. (PROSPERO ID: CRD42021239797). RESULTS Seventy-one articles were included, representing 13,774 patients. Studies varied significantly in terms of methodology and prodrome definition used. The random effects proportion meta-analysis estimate for prodrome prevalence was 78.3% (95% CI = 72.8-83.2); heterogeneity was high (I2 97.98% [95% CI = 97.71-98.22]); and the prediction interval was wide (95% PI = 0.411-0.936). There were no meaningful differences in prevalence between grouped prodrome definitions, and subgroup analyses failed to reveal a consistent source of heterogeneity. CONCLUSIONS This is the first meta-analysis on the prevalence of a prodrome prior to the onset of first episode psychosis. The majority of patients (78.3%) were found to have experienced a prodrome prior to psychosis onset. However, findings are highly heterogenous across study and no definitive source of heterogeneity was found despite extensive subgroup analyses. As most studies were retrospective in nature, recall bias likely affects these results. While the large majority of patients with psychosis experience a prodrome in some form, it is unclear if the remainder of patients experience no prodrome, or if ascertainment methods employed in the studies were not sensitive to their experiences. Given widespread investment in indicated prevention of psychosis through prospective identification and intervention during the prodrome, a resolution of this question as well as a consensus definition of the prodrome is much needed in order to effectively direct and organize services, and may be accomplished through novel, densely sampled and phenotyped prospective cohort studies that aim for representative sampling across multiple settings.
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Affiliation(s)
- David Benrimoh
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada.
- Department of Psychiatry, Stanford University, Stanford, CA, USA.
| | | | - Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter Phalen
- Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Scott W Woods
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Sinan Guloksuz
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology Maastricht University Medical Center, Maastricht, Netherlands
| | - Alison R Yung
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Melbourne, Australia
| | - Vinod Srihari
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Jai Shah
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada
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Pöthe B, Conus P, Golay P. Impact of a family history of mental disorders on the characteristics of patients with early psychosis. Early Interv Psychiatry 2024. [PMID: 38572759 DOI: 10.1111/eip.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
AIM Children of parents with psychiatric illness have a higher risk of developing psychiatric disorders. This is particularly the case for psychoses and the evolution of these disorders could likely differ. The aim of this study was to study the impact of a first-degree and second-degree family history of psychiatric disorders (FHPD) on the characteristics of patients with early psychosis in a specialized programme. METHOD This research is a prospective study based on 408 patients aged 18-35 years enrolled in the Treatment and Early Intervention in Psychosis Program (TIPP) with a three-years follow-up. Various characteristics were compared between patients with first-degree-FHPD and those without, then between patients with 2nd degree-FHPD and those without. The influence of the number of parents with first or second degree FHPD on clinical characteristics was also studied. RESULTS Our results showed an influence of FHPD on the characteristics of patients presenting a first episode of psychosis. Over the 3 years of follow-up, patients with at least one second-degree relative showed more negative and depressive symptoms and poorer general functioning than patient who did not. The number of parents with first or second degree FHPD was also negatively associated with several clinical variables. CONCLUSION The results of this study confirm the existence of a distinct premorbid profile and a different evolution in patients with FHPD, which is not limited to first-degree relatives. This suggests the importance of specific needs that should be addressed during treatment.
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Affiliation(s)
- Barbara Pöthe
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Golay
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
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Onay Z, Sidis A, Robinson L, Deane FP. Young people's pathways to a specialist suicide prevention service and the influence of caregiver prior suicidality and mental health treatment. Early Interv Psychiatry 2024. [PMID: 38356407 DOI: 10.1111/eip.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/13/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
AIM Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognized, caregivers also play a significant role in these pathways. Caregiver's familiarity with mental health issues may influence an adolescent's PtC. This study explores the relationship between a caregiver's prior suicidality and mental health treatment on their children's pathways to entering a specialist suicide prevention treatment program. METHOD Caregivers (n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child's onset of symptoms, help-seeking, PtC and the caregiver's prior suicidality and mental health treatment. RESULTS Parents were the source most likely to recognize the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration. CONCLUSION Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver's prior experience of suicidality to these pathways. These complexities warrant further exploration to minimize obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers.
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Affiliation(s)
- Zozan Onay
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anna Sidis
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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Ng BHM, Yu BCL, Leung JSY. Investigation on the association between perceived family expressed emotion, self-stigma, and subjective quality of life in people with early psychosis in Hong Kong: A cross-sectional approach. Schizophr Res 2024; 264:394-401. [PMID: 38237361 DOI: 10.1016/j.schres.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Bernice H M Ng
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong.
| | - Ben C L Yu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Joey S Y Leung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
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Wang XQ, Wang Y, Yu K, Ma R, Zhang JY, Zhou YQ. Experiences of care-seeking by schizophrenia patients with delayed diagnosis and treatment in rural China: A qualitative study. Int J Soc Psychiatry 2023; 69:1453-1461. [PMID: 37036139 DOI: 10.1177/00207640231164010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patients with schizophrenia in rural areas of China face severe delays in getting appropriate treatment due to poverty, transportation, and limited availability of mental healthcare services. However, the experiences of care-seeking among patients with delayed diagnosis and treatment in rural areas remain poorly understood, and it remains unclear how these experiences influence patients' medical mistrust or expectations of care. This study aims to fill that void. METHODS We applied a qualitative phenomenological method. Patients were recruited through purposive sampling at a psychiatric hospital in Harbin, China. Semi-structured, one-to-one interviews were conducted, guided by an interview outline. Thematic analysis was performed using Colaizzi's seven-step method. RESULTS Data saturation was achieved after interviewing 13 participants aged 21 to 53 years. Three themes with eight subthemes were identified: (i) Barriers to seeking care, (ii) Feelings for psychiatric treatment, and (iii) Demand for mental healthcare. Several factors that may impede the timely diagnosis and treatment were identified, including patients, physicians, and institutions. The participants described their feelings of adverse treatment experiences, as well as expectations arising from this process. It predominantly covers awareness of the disease, supportive access to care, and geographic accessibility of services. CONCLUSION Patients with delayed diagnosis and treatment in rural areas often have negative experiences and various needs for mental health services in the pursuit of effective treatments. Policymakers and health planners should seriously consider the current challenges in rural mental healthcare to develop comprehensive strategies for improving prehospital delays and medical experience for this group of patients.
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Affiliation(s)
- Xiao-Qing Wang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Wang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Kai Yu
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rui Ma
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia-Yuan Zhang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
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Nakanishi M, Tanaka T, Nishida A, Mandai N, Kitamura N, Yoshii H. An online intervention to promote mental health literacy for psychosis amongst parents of adolescents: A pilot randomized controlled trial. Early Interv Psychiatry 2023. [PMID: 36627726 DOI: 10.1111/eip.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/02/2022] [Accepted: 01/01/2023] [Indexed: 01/12/2023]
Abstract
AIM This study evaluated an online mental health literacy intervention to improve help-seeking for psychosis amongst parents of adolescents. METHODS A total of 2496 parents of first-grade junior high school students, recruited from a Japan-based survey company, participated in a randomized controlled trial in July 2016; participants were randomly allocated to the intervention (n = 1248) or control group (n = 1248). They were assessed at baseline and one-week post intervention. The intervention group received a 30-minute online educational programme that included a narrative of the mother of an adolescent with psychosis. RESULTS There were no between-group differences in changes in the rate of 'no help-seeking' in any hypothetical situations of a child's psychosis and prodromal symptoms. CONCLUSIONS The intervention might have been suboptimal to improve mental health literacy for psychosis amongst parents of adolescents. A narrative message from a service user may be helpful to encourage parents in help-seeking.
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Affiliation(s)
- Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan.,Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Takahiro Tanaka
- Clinical and Translational Research Center, Niigata University, Niigata-shi, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Nozomu Mandai
- Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga-shi, Japan.,Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ami-machi, Japan
| | - Nobutaka Kitamura
- Clinical and Translational Research Center, Niigata University, Niigata-shi, Japan
| | - Hatsumi Yoshii
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan
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Clustering of Socioeconomic Data in Hong Kong for Planning Better Community Health Protection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312617. [PMID: 34886341 PMCID: PMC8656856 DOI: 10.3390/ijerph182312617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022]
Abstract
The concept of socioeconomic vulnerability has made a substantial contribution to the understanding and conceptualization of health risk. To assess the spatial distribution of multi-dimensional socioeconomic vulnerability in an urban context, a vulnerability assessment scheme was proposed to guide decision-making in disaster resilience and sustainable urban development to reduce health risk. A two-stage approach was applied in Hong Kong to identify subgroups among Tertiary Planning Units (TPU) (i.e., the local geographic areas) with similar characteristics. In stage 1, principal components analysis was used for dimension reduction and to de-noise the socioeconomic data for each TPU based on the variables selected, while in stage 2, Gaussian mixture modeling was used to partition all the TPUs into different subgroups based on the results of stage 1. This study summarized socioeconomic-vulnerability-related data into five principal components, including indigenous degree, family resilience, individual productivity, populous grassroots, and young-age. According to these five principal components, all TPUs were clustered into five subgroups/clusters. Socioeconomic vulnerability is a concept that could be used to help identify areas susceptible to health risk, and even identify susceptible groups in affluent areas. More attention should be paid to areas with high populous grassroots scores and low young-age score since they were associated with a higher mortality rate.
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Takizawa P, Hakham P, Sirikul C, Sarapat W, Mongkolnaowarat W, Kinorn P, Wanna P, Ichikawa M. Characteristics of delayed and timely treatment seekers for first-episode schizophrenia in Thailand. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2020.1869377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Patcharapim Takizawa
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Pimchanok Hakham
- Department of Psychiatry, Prasrimahabhodi Psychiatric Hospital, Ubon Ratchathani, Thailand
| | - Chanon Sirikul
- Department of Psychiatry, King Narai Hospital, Lop Buri, Thailand
| | - Wiwat Sarapat
- Department of Psychiatry, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Warith Mongkolnaowarat
- Department of Psychiatry, HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Nakhon Nayok, Thailand
| | - Patraporn Kinorn
- Department of Psychiatry, Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT), Pathum Thani, Thailand
| | - Piyanut Wanna
- Department of Psychiatry, Sisaket Hospital, Sisaket, Thailand
| | - Masao Ichikawa
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Chen H, Wang T, Wang D, Gao X. Time delay in seeking treatment for first-episode schizophrenia: a retrospective study. Early Interv Psychiatry 2020; 14:553-558. [PMID: 31591818 DOI: 10.1111/eip.12879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/30/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
AIM A longer duration of untreated psychosis (DUP) is associated with higher risk of relapse and a poorer overall prognosis. The study is designed to explore the duration of untreated schizophrenia and associated factors in Northwest China. METHODS A total of 7252 patients with first-episode schizophrenia registered from 1 January 2011 to 31 December 2018 in Yulin of China were included. The median delay time was estimated by Kaplan-Meier survival curve. Two-level mixed-effects survival model was used to calculate the hazard ratio and 95% confidence interval for factors associated with treatment delay. The outcome variable of interest was defined as 'receiving antipsychotic treatment'. RESULTS Up to 40.4% of patients with schizophrenia were illiterate and 78% were farmers and 75.6% were living under the national poverty line. The median treatment delay was 30 months (Interquartile range: 2-217). Older age at onset (age group 21-28, HR 1.3; 29-39, HR 1.3; 40 above, HR 1.4), female gender (HR 1.1), unmarried status(HR 1.1) and high educational level (primary, HR 1.4; Junior HR 1.8 and high school and above, HR 1.8) were found to be associated with lower risk of treatment delay. Widowed status (HR 0.6) was associated with an increased risk of treatment delay. CONCLUSIONS The median duration of untreated schizophrenia in this study was longer than findings reported in many prior studies. Early age of onset, male patients, widowed status and low education level were at high risk of treatment delay. Early detection, diagnosis and treatment of schizophrenia in northwest China should be strengthened.
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Affiliation(s)
- Hongguang Chen
- Peking University Sixth Hospital (Institute of Mental Health), Ministry of Health (Peking University), Beijing, China
| | - Tingwei Wang
- Yulin Center for Disease Control and Prevention, Yulin, Shaanxi, China
| | - Dandan Wang
- Yulin Mental Health Center, Yulin, Shaanxi, China
| | - Xiangqi Gao
- Yulin Center for Disease Control and Prevention, Yulin, Shaanxi, China
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Kaminga AC, Dai W, Liu A, Myaba J, Banda R, Wen SW. Effects of socio-demographic characteristics, premorbid functioning, and insight on duration of untreated psychosis in first-episode schizophrenia or schizophreniform disorder in Northern Malawi. Early Interv Psychiatry 2019; 13:1455-1464. [PMID: 30706661 PMCID: PMC6900171 DOI: 10.1111/eip.12794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/24/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Abstract
AIM Long duration of untreated psychosis (DUP) is prevalent and has been shown to be associated with poorer prognosis. Thus, knowledge of its determinants may help to target early interventions to reduce DUP on the needed population. Previous studies seeking to understand determinants of DUP have been inconclusive. Therefore, this study aimed to investigate the effects of socio-demographic characteristics, premorbid functioning, and insight on DUP in patients with first-episode schizophrenia or schizophreniform disorder. METHODS This cross-sectional study recruited 110 subjects (aged 18-65) during a pilot early intervention service for psychosis in Northern Malawi, between June 2009 and September 2012. Short DUP was defined as ≤6 months, whereas long DUP was defined as >6 months. Unadjusted and adjusted analyses were performed to identify determinants of DUP. RESULTS Of the 110 subjects, 99 (90%) had schizophrenia. Median DUP was 27.5 months, while mean (SD) DUP was 71.24 (92.32) months. In addition, at least 75% had long DUP, which was associated with lower level of education, poor insight, younger age at onset, and at least one parent deceased. CONCLUSIONS Long DUP is prevalent in Northern Malawi. Thus, early interventions to reduce DUP are warranted in this population. Although having at least one parent deceased predicted long DUP in this study, this remains speculative because factors, such as timing of parents' death and grief reactions of the patients were not assessed. Therefore, further investigations incorporating these factors are needed to ascertain this result.
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Affiliation(s)
- Atipatsa C. Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- Department of Mathematics and StatisticsMzuzu UniversityMzuzuMalawi
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Japhet Myaba
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Richard Banda
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Shi W. Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramOttawaOntarioCanada
- School of Epidemiology, Public Health, and Preventive Medicine, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
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Hui CL, Honer WG, Lee EH, Chang WC, Chan SK, Chen ES, Pang EP, Lui SS, Chung DW, Yeung WS, Ng RM, Lo WT, Jones PB, Sham P, Chen EY. Predicting first-episode psychosis patients who will never relapse over 10 years. Psychol Med 2019; 49:2206-2214. [PMID: 30375301 DOI: 10.1017/s0033291718003070] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode. METHOD Patients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning. RESULTS Out of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders. CONCLUSIONS Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.
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Affiliation(s)
- Christy Lm Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Edwin Hm Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - W C Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Sherry Kw Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Emily Sm Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - Edwin Pf Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Simon Sy Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | | | - W S Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Roger Mk Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - William Tl Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Pak Sham
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
- Centre for Genomic Sciences, University of Hong Kong, Hong Kong
| | - Eric Yh Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
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Souaiby L, Gauthier C, Kazes M, Mam-Lam-Fook C, Daban C, Plaze M, Gaillard R, Krebs MO. Individual factors influencing the duration of untreated psychosis. Early Interv Psychiatry 2019; 13:798-804. [PMID: 29575691 DOI: 10.1111/eip.12562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 09/14/2017] [Accepted: 02/04/2018] [Indexed: 11/30/2022]
Abstract
AIM Duration of untreated psychosis (DUP), or the time between onset of psychosis and treatment initiation, is a prognostic factor of schizophrenia. However, few studies evaluated the relative influence of individual-related factors on this duration. The objective of this study was to evaluate the influence of socio-demographic, clinical and cannabis use on DUP. METHODS This study was part of a large prospective study in help-seeking individuals referred to our specialized early detection / intervention clinic in the Service Hospitalo-Universitaire of Sainte-Anne Hospital in Paris (ICAAR study). We explored 33 consecutive patients who crossed the CAARMS' threshold of psychosis. The DUP and cannabis consumption history were explored during the baseline comprehensive assessment using all available sources (direct interviews of patients, parents, practitioners). Correlations between socio-demographic, clinical and cannabis use, and DUP were studied. A multiple linear regression model was used to determine the variables that could significantly predict DUP. RESULTS When considered individually, none of the socio-demographic and disease characteristic factors was associated with DUP, with the exception of level of education. In the multivariate analysis, age at inclusion, negative symptoms and history of cannabis use significantly influenced DUP. CONCLUSION The determinants of DUP are multi-factorial and include individual centred factors, such as age, cannabis and negative symptoms. The identification of factors resulting in delayed access to care may promote the development of effective strategies to reduce DUP in early psychosis and target effective early intervention.
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Affiliation(s)
- Lama Souaiby
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Department of Psychiatry, Saint Joseph University, Beirut, Lebanon
| | - Claire Gauthier
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France.,CNRS GDR3557, Institut de Psychiatrie, France
| | - Mathilde Kazes
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France.,CNRS GDR3557, Institut de Psychiatrie, France
| | - Célia Mam-Lam-Fook
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France.,CNRS GDR3557, Institut de Psychiatrie, France
| | - Claire Daban
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France.,CNRS GDR3557, Institut de Psychiatrie, France
| | - Marion Plaze
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France.,CNRS GDR3557, Institut de Psychiatrie, France
| | - Raphaël Gaillard
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France.,CNRS GDR3557, Institut de Psychiatrie, France
| | | | - Marie-Odile Krebs
- Centre Hospitalier Sainte - Anne, Faculty of Medicine Paris Descartes, Service Hospitalo-Universitaire, Paris, France.,Université Paris Descartes, INSERM UMR S894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Paris, France.,CNRS GDR3557, Institut de Psychiatrie, France
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13
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Lau KW, Chan SKW, Hui CLM, Lee EHM, Chang WC, Chong CSY, Lo WTL, Chen EYH. Rates and predictors of disengagement of patients with first-episode psychosis from the early intervention service for sychosis service (EASY) covering 15 to 64 years of age in Hong Kong. Early Interv Psychiatry 2019; 13:398-404. [PMID: 28984042 DOI: 10.1111/eip.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
AIM This study aims at assessing the rate and predictors of disengagement of patients with first-episode psychosis (FEP) from the early intervention (EI) service in Hong Kong (EASY) that covers age 15 to 64. METHODS All FEP patients aged 15 to 64 years who were newly registered with the EASY programme of Kowloon West Psychiatric Unit from January to December 2012 were included. Data on socio-demographic, clinical characteristics and disengagement over 3 years of the EI service were obtained retrospectively through systematic clinical record review. Predictors of 3 different types of disengagement and their rate of occurrence were identified: complete disengagement (type I), disengaged and re-engaged through hospitalization (type II) and re-engaged as outpatient (type III). RESULTS Among the 277 patients included for analysis, 36 patients (13%) had type I disengagement, 17.2% (N = 21) were of age 15 to 25 and 9.7% (N = 15) were of age 25 to 64. Type II and type III disengagements were 4.3% and 13.4%, respectively. Early-stage poor drug compliance significantly predicted type I and type II disengagements. History of substance use, suicidal attempts and poor drug compliance predicted type III disengagement. Younger patients had significant earlier disengagement (χ2 = 5.01, df = 1, P = .025). CONCLUSION Results of the current study highlighted the different patterns of disengagement for different age groups and the importance of identifying the high-risk group at early stage of the illness. With the expansion of EI service for wider age group, studies of the differential needs of patient with different ages would be important to guide the future service development.
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Affiliation(s)
- Ka Wa Lau
- Department of Psychiatry, Kwai Chung Hospital, Kowloon, Hong Kong
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | | | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
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14
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Qiu Y, Li L, Gan Z, Wang J, Zheng L, Zhao J, Guan N, Wei Q. Factors related to duration of untreated psychosis of first episode schizophrenia spectrum disorder. Early Interv Psychiatry 2019; 13:555-561. [PMID: 29164787 DOI: 10.1111/eip.12519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/28/2017] [Accepted: 09/30/2017] [Indexed: 01/22/2023]
Abstract
AIM Duration of untreated psychosis (DUP) is associated with outcome and functioning. It is expected that scientists will find factors that modulate DUP, but thus far, research on this topic has shown inconsistent results. Furthermore, similar studies in China are insufficient. This study aims to explore social and clinical factors for DUP in South China and to learn the influence that family plays on DUP through their awareness of psychosis. METHODS Participants included 216 patients with first episode schizophrenia spectrum disorder. The Nottingham Onset Schedule was used to assess DUP. The relationship between DUP and social and clinical characteristics were then analysed by correlation analysis, survival analysis and Cox regression analysis. The awareness of the patient's family for the cause of psychosis, the reason for treatment and the cause for delay of treatment were investigated using a questionnaire. RESULTS The median DUP was 64.5 days. Insidious onset and being unemployed were found to be risk factors for a long DUP. The family attributed the main cause of psychosis to stress. The main cause for the delay of treatment was because families misjudged the patients' disease. More family members of long DUP patients compared to short DUP patients thought the causes were due to ideological problems or puberty, rather than to mental health. CONCLUSION The results of this study indicated that some social or clinical characteristics influence DUP. The family's awareness plays an important role when seeking help. To reduce DUP, the public needs more knowledge of mental illness.
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Affiliation(s)
- Yong Qiu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Leijun Li
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhaoyu Gan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jihui Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liangrong Zheng
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiaoshi Zhao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Nianhong Guan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qinling Wei
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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15
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Chan SKW, Chau EHS, Hui CLM, Chang WC, Lee EHM, Chen EYH. Long term effect of early intervention service on duration of untreated psychosis in youth and adult population in Hong Kong. Early Interv Psychiatry 2018; 12:331-338. [PMID: 26801970 DOI: 10.1111/eip.12313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/15/2005] [Indexed: 11/30/2022]
Abstract
AIM The current study explored the effect of an early intervention (EI) service for psychosis in Hong Kong (EASY) on the reduction of the duration of untreated psychosis (DUP) at 10 years, in adolescent and adult patients. METHOD Data from three first-episode psychosis (FEP) studies conducted over 10 years using the same DUP assessment was analysed. FEP study 1 year before the EI service (2000) was used as a control, with those aged <25 comprising the youth psychosis control group and those aged over 25 comprising the adult psychosis control group. Data from the EASY service collected in 2010 constituted the youth psychosis EI group and data from an adult EI service collected from 2009 to 2011 constituted the adult psychosis EI group. DUP of EI and control groups was compared. The effect of the mode of onset and family history of psychosis on DUP was studied. RESULTS DUP in the adult group was significantly reduced from median of 180 days to 93 days after 10 years (U = 12 906.50, P = 0.01), particularly in those with gradual onset and without family history. However, no significant change of DUP was found in the youth psychosis group. CONCLUSIONS Results of the current study provide evidence that EI programmes with public awareness campaign can significantly reduce DUP of adult patients but not in youth group. The effect is more specific in those with long DUP. Further research should explore the specific factors contributed to the long DUP of patients of different age groups so as to establish targeted intervention strategies.
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Affiliation(s)
- Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Esther H S Chau
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Wing C Chang
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hongkong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hongkong
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16
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Duration of untreated illness as a key to early intervention in schizophrenia: A review. Neurosci Lett 2018; 669:59-67. [DOI: 10.1016/j.neulet.2016.10.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 09/05/2016] [Accepted: 10/02/2016] [Indexed: 12/25/2022]
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17
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Family history of psychosis and outcome of people with schizophrenia in rural China: 14-year follow-up study. Asian J Psychiatr 2018; 32:14-19. [PMID: 29197709 DOI: 10.1016/j.ajp.2017.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/07/2017] [Accepted: 11/28/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family history of psychosis in a rural community in China. METHODS All participants with schizophrenia (n=510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. RESULTS Individuals with positive family history of schizophrenia had significantly younger age of first onset than those with negative family history of schizophrenia in 1994 and 2004. Compared with individuals with negative family history of schizophrenia, those with positive family history of schizophrenia had significantly higher rate of homelessness and lower rate of death due to other reasons in 10-year (2004) and 14-year follow-up (2008). There were no significantly differences of mean scores on PANSS, SDSS and GAF in 2008 between positive and negative family history groups. CONCLUSIONS The positive family history of schizophrenia is strongly related to younger age of onset, and may predict a poorer long-term outcome (e.g., higher rate of homelessness) in persons with schizophrenia in the rural community. The findings have implications for further studies on specific family-related mechanisms on clinical treatment and rehabilitation, as well as for planning and delivering of community-based mental health services.
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18
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Paruk S, Jhazbhay K, Singh K, Sartorius B, Burns JK. The clinical impact of a positive family history of psychosis or mental illness in psychotic and non-psychotic mentally ill adolescents. J Child Adolesc Ment Health 2017; 29:219-229. [PMID: 29092669 DOI: 10.2989/17280583.2017.1389741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A family history of psychosis is associated with negative clinical characteristics of psychosis. AIM We aimed to determine the relationship between a family history (in first-degree relatives) of psychosis (FHP) or of any mental illness (FHM), and the clinical features (including cannabis use) of first episode early onset psychosis (EOP). METHOD Forty-five adolescents with first episode EOP presenting to psychiatric services were assessed by clinical interview with the following tools: socio-demographic questionnaire, Positive and Negative Syndrome Scale (PANSS), Symptom Onset in Schizophrenia (SOS) inventory, and the World Health Organisation's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) for cannabis misuse. Forty-five gender and age matched controls with incident non-psychotic mental illness were recruited from the same clinical sites. RESULTS While there was evidence of trend associations, EOP adolescents and controls did not differ in terms of either FHP or FHM. However, adolescents with a non-psychotic mental illness (controls) were significantly more likely to have a family history of non-psychotic mental illness (EOP = 13%; controls = 47%, p = 0.001). In EOP adolescents, a positive FHP was associated with a significantly lower mean PANSS positive score (p = 0.009), but not with other clinical features. CONCLUSION FHP may be a diagnostic clue in adolescents and is not necessarily associated with negative clinical characteristics at disease onset in EOP. However, this requires further research.
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Affiliation(s)
- Saeeda Paruk
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Khatija Jhazbhay
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Keshika Singh
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Benn Sartorius
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
| | - Jonathan K Burns
- a Department of Psychiatry , University of KwaZulu-Natal , Durban , South Africa
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19
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Hasan AA, Musleh M. Barriers to Seeking Early Psychiatric Treatment amongst First-episode Psychosis Patients: A Qualitative Study. Issues Ment Health Nurs 2017; 38:669-677. [PMID: 28485998 DOI: 10.1080/01612840.2017.1317307] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study was to explore the family members' determinant of the delay in seeking psychiatric care to patients diagnosed with psychosis. METHODS Qualitative semi-structured interviews were carried out with twenty-seven family members of patients with psychosis at psychiatric outpatient clinics in Amman, Jordan. RESULTS The findings revealed that perceived stigma and fears about being labelled are the main barriers to requesting early psychiatric health care. The participants cited many different reasons linked to finding help led to delay in seeking help in the early stages of the illness including misattribution of the cause and symptoms of mental illness, family and financial factors. CONCLUSIONS The study highlights the importance of enhancing knowledge about the schizophrenia-related spectrum to ensure patients seek treatment in a more timely manner.
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Affiliation(s)
- Abd Alhadi Hasan
- a Nursing Department , Dr Soliman Fakeeh College of Nursing and Medical Sciences , Jeddah , Saudi Arabia
| | - Mahmoud Musleh
- b Nursing Department , Fakeeh College for Medical Sciences , Jeddah , Saudi Arabia
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20
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Kvig EI, Brinchmann B, Moe C, Nilssen S, Larsen TK, Sørgaard K. Geographical accessibility and duration of untreated psychosis: distance as a determinant of treatment delay. BMC Psychiatry 2017; 17:176. [PMID: 28486982 PMCID: PMC5424409 DOI: 10.1186/s12888-017-1345-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The duration of untreated psychosis is determined by both patient and service related factors. Few studies have considered the geographical accessibility of services in relation to treatment delay in early psychosis. To address this, we investigated whether treatment delay is co-determined by straight-line distance to hospital based specialist services in a mainly rural mental health context. METHODS A naturalistic cross-sectional study was conducted among a sample of recent onset psychosis patients in northern Norway (n = 62). Data on patient and service related determinants were analysed. RESULTS Half of the cohort had a treatment delay longer than 4.5 months. In a binary logistic regression model, straight-line distance was found to make an independent contribution to delay in which we controlled for other known risk factors. CONCLUSIONS The determinants of treatment delay are complex. This study adds to previous studies on treatment delay by showing that the spatial location of services also makes an independent contribution. In addition, it may be that insidious onset is a more important factor in treatment delay in remote areas, as the logistical implications of specialist referral are much greater than for urban dwellers. The threshold for making a diagnosis in a remote location may therefore be higher. Strategies to reduce the duration of untreated psychosis in rural areas would benefit from improving appropriate referral by crisis services, and the detection of insidious onset of psychosis in community based specialist services.
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Affiliation(s)
- Erling Inge Kvig
- Nordland hospital Trust, Bodø, Norway. .,UIT The Arctic University of Norway, Tromsø, Norway.
| | - Beate Brinchmann
- grid.420099.6Nordland hospital Trust, Bodø, Norway ,0000000122595234grid.10919.30UIT The Arctic University of Norway, Tromsø, Norway
| | | | | | - Tor Ketil Larsen
- 0000 0004 0627 2891grid.412835.9Stavanger University Hospital, Stavanger, Norway ,0000 0004 1936 7443grid.7914.bUniversity of Bergen, Bergen, Norway
| | - Knut Sørgaard
- grid.420099.6Nordland hospital Trust, Bodø, Norway ,0000000122595234grid.10919.30UIT The Arctic University of Norway, Tromsø, Norway
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21
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Al Fayez H, Lappin J, Murray R, Boydell J. Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia. Early Interv Psychiatry 2017; 11:47-56. [PMID: 25582595 DOI: 10.1111/eip.12214] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/09/2014] [Indexed: 11/29/2022]
Abstract
AIM Recent studies of 'duration of untreated psychosis' (DUP) indicate that some patients remain untreated in the community for some time. Considerable emphasis has been placed on reducing the DUP. However, most studies investigating DUP have been conducted in Western countries, where well-developed primary care systems are available. This study aims to describe DUP and its association with both demographic factors and pathways to care in Riyadh, Saudi Arabia. METHODS A retrospective study of 421 new case records of all Saudi schizophrenia patients over a 2-year period in six governmental hospitals in Riyadh, Saudi Arabia. RESULTS The median DUP was 1.41 years (interquartile range 0.35-2.81 years). The longest time to contact was 9.86 years but 90% had a DUP shorter than 5 years. Older age at onset, single marital status and higher educational level were associated with shorter DUP. Long DUP was associated with help seeking from traditional healers. CONCLUSION In Saudi Arabia, it usually takes longer for patients to seek help from psychiatric services after their first psychosis onset than it does in Western countries. The results suggest that the DUP is influenced by both demographic factors and pathways to care.
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Affiliation(s)
- Hanan Al Fayez
- Institute of Psychiatry, Psychosis Studies, King's College London, London, UK
| | - Julia Lappin
- Institute of Psychiatry, Psychosis Studies, King's College London, London, UK
| | - Robin Murray
- Institute of Psychiatry, Psychosis Studies, King's College London, London, UK
| | - Jane Boydell
- Institute of Psychiatry, Psychosis Studies, King's College London, London, UK
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22
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Okasha T, Zaki N, Meguid MAE, El-Missiry M, Sabry W, Ismaeil MK, Fouad SM. Duration of untreated psychosis in an Egyptian sample: Sociodemographic and clinical variables. Int J Soc Psychiatry 2016; 62:661-671. [PMID: 27683283 DOI: 10.1177/0020764016670429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Duration of untreated psychosis (DUP) has been considered as a poor prognostic factor for psychotic disorder. Several studies have been investigating different predictors of DUP in Western countries, while in Egypt only a few studies have examined various predictors of DUP. AIMS To study DUP in Egyptian patients with psychotic disorders and to investigate how certain illnesses, patient, socio-cultural risk factors and help-seeking behaviour are correlated with prolonged DUP. METHOD The sample included 100 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) diagnosis of psychotic disorder were selected and interviewed to assess DUP. They were interviewed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scale. RESULTS Mean (±standard deviation ( SD)) of DUP was found to be 36.93(±45.27) months. DUP was correlated with various sociodemographic and clinical variables. Following log transformation of DUP, correlation with PANSS scores was done and revealed highly significant statistical relation of DUP to PANSS negative and PANSS positive scores. In linear regression analysis, it was found that age of patients, the age of onset, residence, being illiterate, the insidious mode of onset, negative family history of psychiatric disorder and the severity of illness as indicated by PANSS are among DUP predictors. CONCLUSION Longer DUP results from multiple patient- and illness-related factors. This has many implications in targeting early intervention with specific consideration to cultural factors.
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Affiliation(s)
- Tarek Okasha
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Nivert Zaki
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Marwa Abd El Meguid
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Marwa El-Missiry
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Walaa Sabry
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Mostafa Kamel Ismaeil
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Samar M Fouad
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Ain Shams University, Cairo, Egypt
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23
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Marthoenis M, Aichberger MC, Schouler-Ocak M. Patterns and Determinants of Treatment Seeking among Previously Untreated Psychotic Patients in Aceh Province, Indonesia: A Qualitative Study. SCIENTIFICA 2016; 2016:9136079. [PMID: 27382501 PMCID: PMC4921139 DOI: 10.1155/2016/9136079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 06/01/2023]
Abstract
Immediate treatment of first-episode psychosis is essential in order to achieve a positive outcome. However, Indonesian psychiatric patients often delay accessing health services, the reason for which is not yet fully understood. The current study aimed to understand patterns of treatment seeking and to reveal determinants of the delay in accessing psychiatric care among first-time user psychotic patients. Qualitative interviews were conducted with sixteen family members who accompanied the patients to a psychiatric hospital. Many families expressed beliefs that mental illness appertains to village sickness and not hospital sickness; therefore, they usually take the patients to traditional or religious healers before taking them to a health professional. They also identified various factors that potentially delay accessing psychiatric treatment: low literacy and beliefs about the cause of the illness, stigmatisation, the role of extended family, financial problems, and long distance to the psychiatric hospital. On the other hand, the family mentioned various factors related to timely help seeking, including being a well-educated family, living closer to health facilities, previous experience of successful psychotic therapy, and having more positive symptoms of psychosis. The findings call for mental health awareness campaigns in the community.
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Affiliation(s)
- Marthoenis Marthoenis
- University Psychiatric Clinic of Charité at St. Hedwig's Hospital, Große Hamburger Strasse 5-11, 10115 Berlin, Germany
| | - Marion C. Aichberger
- Departments of Psychiatry and Psychotherapy, Charite Universitätsmedizin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Meryam Schouler-Ocak
- University Psychiatric Clinic of Charité at St. Hedwig's Hospital, Große Hamburger Strasse 5-11, 10115 Berlin, Germany
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24
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Lee EHM, Hui CLM, Lin JX, Ching EYN, Li SP, Leung WG, Chang WC, Chan SKW, Chen EYH. Incidence of hospitalization and its associated factors in first-episode psychosis in Hong Kong. Early Interv Psychiatry 2016; 10:263-6. [PMID: 25702936 DOI: 10.1111/eip.12231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/19/2014] [Indexed: 11/26/2022]
Abstract
AIM This study examined the incidence of hospitalization and its associated factors in patients with first-episode psychosis in Hong Kong. METHOD From 2009 to 2011, 360 patients were recruited consecutively as part of a controlled study of an early psychosis intervention service (the Jockey Club Early Psychosis project) in Hong Kong. Demographic and clinical information were obtained from face-to-face interviews and was reconfirmed using medical records. Factors relating to hospitalization during first episode were explored. RESULTS The incidence of hospitalization during first-episode psychosis was 57.2%. Patients who were hospitalized had higher antipsychotics chlorpromazine equivalent dosage, higher positive and negative syndrome scale total score, higher Udvalg for Kliniske Undersøgelser others mean score and were more likely to have an acute mode of onset compared with those who were not hospitalized. CONCLUSIONS Hospitalization was common in first-episode psychosis. Future studies are needed to explore possible programmes to prevent hospitalization in patients with first-episode psychosis.
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Affiliation(s)
- Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - J X Lin
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Elaine Y N Ching
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S P Li
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W G Leung
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Lutgens D, Malla A, Joober R, Iyer S. The impact of caregiver familiarity with mental disorders on timing of intervention in first-episode psychosis. Early Interv Psychiatry 2015; 9:388-96. [PMID: 24472653 DOI: 10.1111/eip.12121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 12/07/2013] [Indexed: 11/28/2022]
Abstract
AIM Based on prior research, we hypothesized that personal or family familiarity with psychosis would have a different effect on pathways to care as compared to personal or family familiarity with mental disorders. METHODS Caregivers of 32 patients receiving treatment for a first episode of psychosis at a specialized early intervention centre provided information regarding their familiarity with psychosis and mental disorders. Information on the duration of untreated psychosis (DUP) and on the duration of untreated illness (DUI) was collected from patients and their caregivers. RESULTS Although we found a trend in the direction of lowered DUP and longer DUI for those with personal or family familiarity with psychosis, these effects were not statistically significant. A trend was found for a higher DUI for those with personal or family familiarity with mental disorders in general, but this effect was not significant. CONCLUSION We did not find that differential familiarity with mental disorders and by extension, personal or family familiarity, affected measures of delay in treatment of a first episode of psychosis. Trends in our findings in the hypothesized directions suggest that a larger sample size may reveal significant differential effects of previous experience with mental disorders in general and psychosis in particular on delay in help seeking during different phases of the illness.
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Affiliation(s)
- Danyael Lutgens
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Hui CLM, Lau WWY, Leung CM, Chang WC, Tang JYM, Wong GHY, Chan SKW, Lee EHM, Chen EYH. Clinical and social correlates of duration of untreated psychosis among adult-onset psychosis in Hong Kong Chinese: the JCEP study. Early Interv Psychiatry 2015; 9:118-25. [PMID: 24119045 DOI: 10.1111/eip.12094] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 08/18/2013] [Indexed: 12/22/2022]
Abstract
AIM Understanding factors that contribute to treatment delay would inform early detection and intervention strategies in psychotic disorders. However, existing data were mixed and primarily conducted among early-onset young patients. We examined duration of untreated psychosis (DUP) and its clinical and sociodemographic correlates in a large cohort of adult-onset patients with psychosis. METHODS A total of 360 patients with first-onset psychosis aged 26-55 years were recruited consecutively as part of a controlled study of an early psychosis intervention service in Hong Kong Chinese. Demographic, sociodemographic and clinical characteristics relating to DUP were assessed within 4 months of onset. RESULTS The population had a mean onset age of 36.6 years (SD = 8.7). The mean and median DUP were 515 days (SD = 1091) and 93 days (inter-quartile range from 20 to 382.3), respectively. Multivariate regression analysis suggested that insidious mode of onset, hospitalization, a diagnosis of schizophrenia, poorer insight and younger age at onset significantly prolonged DUP. DUP was not related to premorbid functioning, family involvement during help seeking and living alone. CONCLUSIONS The initial period of untreated psychosis is determined by multiple factors. Whether family involvement is considered a kind of social support in shortening or prolonging DUP needs further examination. Local early intervention program for psychosis should take reference from these findings when formulating personalized plans to reduce delay.
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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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Mo'tamedi H, Rezaiemaram P, Aguilar-Vafaie ME, Tavallaie A, Azimian M, Shemshadi H. The relationship between family resiliency factors and caregiver-perceived duration of untreated psychosis in persons with first-episode psychosis. Psychiatry Res 2014; 219:497-505. [PMID: 25017617 DOI: 10.1016/j.psychres.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/08/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
Abstract
Although the family has an important role in the early detection and intervention of first-episode psychosis (FEP), there are few findings reporting associations between family strengths and early treatment-seeking experiences. This study aimed to investigate, within the framework of the resiliency model of family stress, adjustment, and adaptation, the association between family coping strategies, resource management factors and duration of untreated psychosis (DUP) in Iranian families with one adult child with FEP. Hundred and seven individuals referred to three medical centers in Tehran and diagnosed with FEP participated in this study. Caregiver-perceived DUP was measured via semi-structured interviews administered to primary caregivers. They also completed two questionnaires regarding family resources of stress management and family coping strategies. Data analysis indicated that the Family Inventory of Resources of Management (FIRM) total scale score did not significantly explain the variance of caregiver-perceived DUP, but one of the FIRM subscales, the Extended Family Social Support, and the Family Crisis-Oriented Personal Evaluation scale (F-COPES) total score and one its subscales, the Acquiring Social Support, explained a significant amount of the variance of caregiver-perceived DUP. The results suggest that higher family resiliency, especially social support, facilitates the family's appropriate adaptive reaction (i.e., treatment-seeking), with the consequent decrease of DUP.
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Affiliation(s)
- Hadi Mo'tamedi
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peyman Rezaiemaram
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
| | - Maria E Aguilar-Vafaie
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Abaas Tavallaie
- Behavioral Sciences Research Center, Baqiyatallah Medical University, Tehran, Iran
| | - Mojtaba Azimian
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hashem Shemshadi
- Department of Clinical Sciences and Speech Reconstructive Surgery, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Cheng C, Dewa CS, Langill G, Fata M, Loong D. Rural and remote early psychosis intervention services: the Gordian knot of early intervention. Early Interv Psychiatry 2014; 8:396-405. [PMID: 23841694 DOI: 10.1111/eip.12076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 06/02/2013] [Indexed: 11/26/2022]
Abstract
AIM One of the basic challenges of Early Psychosis Intervention (EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models (hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada. METHODS This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chi-square tests were used to test differences between two groups. RESULTS The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%). CONCLUSIONS The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations.
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Affiliation(s)
- Chiachen Cheng
- First Place Clinic and Regional Resource Centre, Canadian Mental Health Association, Thunder Bay, Ontario, Canada; Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Apeldoorn SY, Sterk B, van den Heuvel ER, Schoevers RA, Islam MA, Bruggeman R, Cahn W, deHaan L, Kahn RS, Meijer CJ, Myin-Germeys I, van Os J, Wiersma D. Factors contributing to the duration of untreated psychosis. Schizophr Res 2014; 158:76-81. [PMID: 25043913 DOI: 10.1016/j.schres.2014.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/25/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shortening the duration of untreated psychosis (DUP) - with the aim of improving the prognosis of psychotic disorders - requires an understanding of the causes of treatment delay. Current findings concerning several candidate risk factors of a longer DUP are inconsistent. Our aim was to identify factors contributing to DUP in a large sample that represents the treated prevalence of non-affective psychotic disorders. METHOD Patients with a non-affective psychotic disorder were recruited from mental health care institutes from 2004 to 2008. Of the 1120 patients enrolled, 852 could be included in the present analysis. Examined candidate factors were gender, educational level, migration status, premorbid adjustment and age at onset of the psychotic disorder. DUP was divided into five ordinal categories: less than one month, one month to three months, three months to six months, six months to twelve months and twelve months and over. An ordinal logistic regression analysis was used to identify the risk factors of a longer DUP. RESULTS Median DUP was less than one month (IQR 2). The factors migration status (p=0.028), age at onset of the psychotic disorder (p=0.003) and gender (p=0.034) were significantly associated with DUP in our analysis. CONCLUSION First generation immigrant patients, patients with an early onset of their psychotic disorder and male patients seem at risk of a longer DUP. These findings can assist in designing specific interventions to shorten treatment delay.
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Affiliation(s)
- S Y Apeldoorn
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands; Rob Giel Research Centre, University Medical Centre Groningen, University of Groningen, the Netherlands.
| | - B Sterk
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, the Netherlands; Department of Psychiatry, University Medical Centre Nijmegen, the Netherlands
| | - E R van den Heuvel
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - R A Schoevers
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - M A Islam
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands; Rob Giel Research Centre, University Medical Centre Groningen, University of Groningen, the Netherlands
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Morita K, Kobayashi H, Takeshi K, Tsujino N, Nemoto T, Mizuno M. Poor outcome associated with symptomatic deterioration among help-seeking individuals at risk for psychosis: a naturalistic follow-up study. Early Interv Psychiatry 2014; 8:24-31. [PMID: 23343086 DOI: 10.1111/eip.12032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 09/30/2012] [Indexed: 11/26/2022]
Abstract
AIMS It remains debatable whether early intervention for psychosis is capable of meeting the needs of at-risk subjects. The aims of this study were to describe the actual impact of interventions on subjective difficulties and to explore the factors that may be associated with a poor outcome. METHODS Participants were help-seeking outpatients at a university hospital who met the Criteria of Prodromal Syndromes. Changes in the symptoms, subjective experience and current insight were assessed using the Scales of Prodromal Symptoms, the Subjective Well-being under Neuroleptics, and the Scale to Assess Unawareness of Mental Disorder, respectively. Global functioning, social functioning and subjective quality of life were evaluated using the Global Assessment of Functioning Scale, the Social Functioning Scale, and the WHO-Quality of Life 26, respectively. These measures were assessed both at baseline and after 1 year. RESULTS Forty-six patients agreed to participate. Of the 27 patients who completed the reassessment at the follow-up point, 13 patients (48%) showed little improvement in their positive/negative symptoms, subjective well-being or awareness of their symptoms. Additionally, less severe negative symptoms, more severe general symptoms and lower subjective well-being at baseline significantly predicted a deterioration of positive/negative symptoms after 1 year. CONCLUSION Our findings suggest that the current strategy for reducing psychosis risk based on positive symptoms should be reappraised.
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Affiliation(s)
- Keiko Morita
- Department of Neuropsychiatry, School of Medicine, Toho University, Tokyo, Japan
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Hui CLM, Tang JYM, Wong GHY, Chang WC, Chan SKW, Lee EHM, Chen EYH. Predictors of help-seeking duration in adult-onset psychosis in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1819-28. [PMID: 23620097 DOI: 10.1007/s00127-013-0688-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Delay in receiving treatment in psychosis may lead to adverse consequences. We examined the predictors for help-seeking duration in adult-onset psychosis Chinese patients in Hong Kong. We hypothesized that factors which are more related to the illness manifestation would be predictive of waiting time before any help-seeking initiation, and factors which are more related to one's knowledge about mental health services would be predictive of help-seeking duration. METHODS First-episode patients with psychosis were recruited from the Jockey Club Early Psychosis project. They were asked to report retrospectively all help-seeking behaviors involved since their first occurrence of psychotic symptoms until receipt of effective psychiatric treatment. Baseline characteristics, pre-morbid functioning and traits, and mode of illness onset were assessed. RESULTS Help-seeking pattern was analyzed in 360 patients who had subsequently reached the psychiatric services. They had an average of 2.5 help-seeking contacts. Nearly half of the first help-seeking process was initiated by family members. Only 1 % approached priests or traditional healers as the first step in help-seeking. Whereas a gradual mode of onset was significantly associated with longer waiting time to first help-seeking initiation, more premorbid schizoid and schizotypal traits and a migrant status were related to longer help-seeking duration. CONCLUSIONS Current findings suggested that family members were the key decision makers in initiating help-seeking. Longer help-seeking duration in migrants has significant implications to both local and global mental health policy.
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Affiliation(s)
- Christy L M Hui
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, 102, Pokfulam Road, Hong Kong SAR, China,
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Chang WC, Tang JYM, Hui CLM, Lam MML, Wong GHY, Chan SKW, Chiu CPY, Chung DWS, Law CW, Tso S, Chan K, Hung SF, Chen EYH. Duration of untreated psychosis: relationship with baseline characteristics and three-year outcome in first-episode psychosis. Psychiatry Res 2012; 198:360-5. [PMID: 22425475 DOI: 10.1016/j.psychres.2011.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 07/12/2011] [Accepted: 09/10/2011] [Indexed: 12/01/2022]
Abstract
Duration of untreated psychosis (DUP) has been considered as one of the few potentially malleable prognostic factors in psychotic illness. The literature demonstrated that prolonged DUP predicted the level of positive symptoms, but its relationships with negative symptoms and functional outcome were less clear-cut. Thus far, most first-episode studies have been conducted in western countries. Yet, it is known that illness outcome might be modified by socio-cultural factors. In this study, we aimed to examine the impact of DUP on baseline characteristics, clinical and vocational outcomes over 3 years in 700 Chinese young people who presented with first-episode psychosis to a specialized early intervention service in Hong Kong. Our results showed that prolonged DUP was associated with male sex, younger age of onset, schizophrenia-spectrum diagnosis, insidious development of psychosis, fewer baseline positive symptoms and less likelihood of hospitalization at intake. Regression analyses revealed that prolonged DUP was significantly predictive of outcome on positive symptoms, recovery and sustained full-time employment in our first-episode psychosis cohort. Taken together, our study provided further supportive evidence regarding the prognostic value of DUP on illness outcome. Additionally, it suggested that an adverse impact of treatment delay for psychosis may likely be applied across regions of various ethno-cultural backgrounds.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
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Esterberg M, Compton M. Family history of psychosis negatively impacts age at onset, negative symptoms, and duration of untreated illness and psychosis in first-episode psychosis patients. Psychiatry Res 2012; 197:23-8. [PMID: 22503358 PMCID: PMC3612976 DOI: 10.1016/j.psychres.2012.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 12/08/2011] [Accepted: 03/01/2012] [Indexed: 11/25/2022]
Abstract
Family history (FH) of psychosis has been a focus of investigations attempting to explain the heterogeneity in schizophrenia. Previous studies have demonstrated that FH is associated with earlier age at onset, severity of positive and negative symptoms, and the duration of untreated illness (DUI). The current study examined the impact of FH on the clinical presentation and help-seeking behaviors of a well-characterized, first-episode sample. The present study utilized the Symptom Onset in Schizophrenia (SOS) Inventory, the Positive and Negative Syndrome Scale (PANSS), and structured interviews on FH to examine these relationships in a large (n=152) sample of predominantly African American patients. Results showed that patients with a first-degree FH of psychosis had a younger age at onset of both the prodrome and psychosis, but did not differ in duration of prodromal period. Furthermore, FH and sex interacted to influence severity of negative, but not positive symptoms. Finally, FH interacted with sex to influence both the DUI and DUP in that only males with FH had longer DUI and DUP. The findings have implications for understanding the impact of specific family-related mechanisms on both clinical and help-seeking factors, as well as for informing future family-based intervention efforts.
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Affiliation(s)
- Michelle Esterberg
- VA Puget Sound Health Care System, Center for Excellence in Substance Abuse Treatment and Education, Mental Health Service, Mail Stop S-116, 1660 South Columbian Way, Seattle, WA 98108, TEL: 206-277-1027
| | - Michael Compton
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, 2150 Pennsylvania Avenue, N.W., Room #8-429, Washington, DC, 20037, TEL: 202-741-3554, FAX: 202-741-2891
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Wong GHY, Hui CLM, Tang JYM, Chang WC, Chan SKW, Xu JQ, Lin JJX, Lai DC, Tam W, Kok J, Chung D, Hung SF, Chen EYH. Early intervention for psychotic disorders: Real-life implementation in Hong Kong. Asian J Psychiatr 2012; 5:68-72. [PMID: 26878952 DOI: 10.1016/j.ajp.2012.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/11/2012] [Indexed: 11/16/2022]
Abstract
Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education.
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Affiliation(s)
- Gloria H Y Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jennifer Y M Tang
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Wing-Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jia-Qi Xu
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jessie J X Lin
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Dik-Chee Lai
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Wendy Tam
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Joy Kok
- Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Dicky Chung
- Hong Kong Early Psychosis Intervention Society, Hong Kong; Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - S F Hung
- Hong Kong Early Psychosis Intervention Society, Hong Kong; Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
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Duration of untreated psychosis in two Arab samples from Egypt and Saudi Arabia. MIDDLE EAST CURRENT PSYCHIATRY 2011. [DOI: 10.1097/01.xme.0000403822.37436.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Madianos MG, Zartaloudi A, Alevizopoulos G, Katostaras T. Attitudes toward help-seeking and duration of untreated mental disorders in a sectorized Athens area of Greece. Community Ment Health J 2011; 47:583-93. [PMID: 21547570 DOI: 10.1007/s10597-011-9404-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
The purpose of the present study was to investigate the association of opinions towards seeking psychiatric help with the duration of untreated mental disorders in a sectorized Athens area, served by a Community Mental Health Centre. The sample consisted of 134 individuals who had sought help from health or mental health non sectorized services prior to their visit to the Centre (group A) and 156 individuals whose visit to the Center was their first ever contact with a mental health service (group B). Opinions were assessed by the "Attitudes Toward Seeking Professional Psychological Help scale. Both groups were selected from a total of 1,008 individuals who had visited the Centre in four consecutive years. The duration of untreated mental disorders was found to be shorter in group A compared to group B. Males and females of both groups, who had visited the Centre in a time period shorter than 12 months since the onset of their psychopathology, expressed more positive views towards help-seeking, compared to their counterparts with longer duration of untreated mental disorder. The variables of gender (females), age at symptom onset (younger) and education (higher) predicted a shorter duration without psychiatric treatment and more positive views about the necessity of help-seeking. More severe type of diagnoses was associated with shorter durations before accessing care. Our findings underline that mental health awareness programs are clearly required in order to strengthen the early recognition of the need for help- seeking. The development of liaison and outreach activities could also prevent prolonged delays in psychiatric treatment.
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Affiliation(s)
- Michael G Madianos
- The School of Health Sciences, Department of Mental Health and Behavioral Sciences, Zografou Community Mental Health Center, University of Athens, 42 Davaki-Pindou Street, 157 73, Athens, Greece.
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Lowenstein JA, Butler DW, Ashcroft K. The efficacy of a cognitively orientated carers group in an early intervention in psychosis service--a pilot study. J Psychiatr Ment Health Nurs 2010; 17:628-35. [PMID: 20712686 DOI: 10.1111/j.1365-2850.2010.01564.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A significant amount of evidence has demonstrated that families and carers play an important role in an individual's recovery from a first episode of psychosis (FEP) and can significantly reduce relapse rates. This, in addition to the fact that caring for an individual experiencing their FEP can be incredibly stressful, suggests that the development of appropriate support for carers must be an integral part of any Early Intervention in Psychosis Service (EIPS). This study examines the efficacy of a closed structured group designed for carers of individuals experiencing their FEP based in Southampton city. A 12-session cognitively orientated group programme covering a range of areas was attended by 18 carers over a 6-month period. Following the group, a significant decrease was found in the carer's negative appraisals of the impact of psychosis, feelings of burden, depression and anxiety rates as measured by the Experience of Caregiving Inventory (ECI), Caregiver Burden Inventory (CBI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). A significant positive correlation was also found between carer's negative appraisals and their anxiety and depression rates, although further research is needed to clarify the causality of this relationship.
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Affiliation(s)
- J A Lowenstein
- Hampshire Early Intervention in Psychosis Service, Fairways House, Mount Pleasant Industrial Estate, Southampton, UK
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Tang JYM, Wong GHY, Hui CLM, Lam MML, Chiu CPY, Chan SKW, Chung DWS, Tso S, Chan KPM, Yip KC, Hung SF, Chen EYH. Early intervention for psychosis in Hong Kong--the EASY programme. Early Interv Psychiatry 2010; 4:214-9. [PMID: 20712726 DOI: 10.1111/j.1751-7893.2010.00193.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. METHODS In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. RESULTS An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. CONCLUSIONS The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed.
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Affiliation(s)
- Jennifer Y M Tang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
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Esterberg ML, Trotman HD, Holtzman C, Compton MT, Walker EF. The impact of a family history of psychosis on age-at-onset and positive and negative symptoms of schizophrenia: a meta-analysis. Schizophr Res 2010; 120:121-30. [PMID: 20303240 DOI: 10.1016/j.schres.2010.01.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 01/15/2010] [Accepted: 01/19/2010] [Indexed: 01/31/2023]
Abstract
The results of research on the relation of family history (FH) of psychosis with clinical presentation in schizophrenia have been mixed. To date, there have been no comprehensive reviews that have examined this body of research. The current review quantitatively evaluates research on the relation of FH with two aspects of schizophrenia, age-at-onset and symptom presentation. Studies investigating the influence of a FH on age-at-onset (N=15 studies), age-at-onset and sex (N=12 studies), and/or positive (N=11 studies) and negative symptoms (N=12 studies) in patients with schizophrenia were included in the meta-analyses. Results showed that FH has a small but significant impact on age-at-onset as well as negative symptoms. Of most interest was the finding that sex differences in age-at-onset are not observed in samples with a FH. Furthermore, there was a significant interaction between FH and sex with respect to negative symptoms. The findings of the current review are discussed in light of the diathesis-stress model. Theoretical assumptions and empirical research are reviewed to support the notion that FH influences susceptibility and presentation through similar mechanisms. Implications of the current findings, limitations of the review, and directions for future research are highlighted.
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Affiliation(s)
- Michelle L Esterberg
- Emory University Graduate School of Arts and Sciences, Department of Psychology, 36 Eagle Row, Atlanta, Georgia 30322, USA.
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Oliveira AM, Menezes PR, Busatto GF, McGuire PK, Murray RM, Scazufca M. Family context and duration of untreated psychosis (DUP): results from the Sao Paulo Study. Schizophr Res 2010; 119:124-30. [PMID: 19767177 DOI: 10.1016/j.schres.2009.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 08/27/2009] [Accepted: 08/27/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Duration of untreated psychosis (DUP) depends on several factors, including socio-demographic, socioeconomic, clinical and contextual circumstances, such as availability of mental health services. Living arrangements may also play a role, especially in low- and middle-income countries, where most people who develop psychosis live with their relatives. METHODS Population-based study of first-episode psychosis in São Paulo, Brazil. Participants were aged 18-64 years, lived in a defined geographic area of the city and had a first contact in life with mental health services due to a psychotic episode. Duration of untreated psychosis was defined as the period between onset of first psychotic symptom and first contact with health service due to psychosis. The median DUP was used to classify participants into short and long DUP. Psychopathology, social adjustment and psychiatric diagnoses were made with standardized assessments. Type of service sought and living arrangements were examined. RESULTS Two hundred participants were included (52% women, 61% non-affective psychoses). The median DUP was 4.1 weeks (inter-quartile range: 1.9-11.4), and was shorter for affective psychoses. Most participants had their first contact with psychiatric emergency services. Those who did not live with a relative (children older than 18 years, parents, partner) were more likely to present long DUP (OR: 2.63; 95%CI: 0.98-7.04); p=0.05). CONCLUSION The DUP in São Paulo was shorter than expected. Living arrangements may play an important role in shortening the DUP in urban centres of low- and middle income countries that have a network of mental health services.
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Affiliation(s)
- Alexandra M Oliveira
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, Rua Ovídio Pires de Campos 785, CEP 05403-010, São Paulo, SP, Brazil
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Social dysfunction predicts two years clinical outcome in people at ultra high risk for psychosis. J Psychiatr Res 2010; 44:294-301. [PMID: 19836755 DOI: 10.1016/j.jpsychires.2009.08.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 08/13/2009] [Accepted: 08/26/2009] [Indexed: 10/20/2022]
Abstract
The experience of a first psychotic episode is associated with a marked impairment in psychosocial functioning. However, the decline may be already evident in the pre-psychotic phases and play a significant role in the etiopathology of the disease onset. A sample of subjects at ultra high clinical risk for psychosis ("At Risk Mental State", ARMS, n=152) was compared with a demographically-matched general population (n=98,072) on different measures of psychosocial functioning. The proportion of subjects with an ARMS living in communal establishments or living at home with their parents was significantly higher than that of the local population (p<0.001). Subjects with an ARMS showed also higher rates of unemployment as compared to the general population (p<0.001). GAF scores at baseline were significantly lower in unemployed ARMS as compared to students and employed ARMS (p=0.002). ARMS subjects living in communal establishments presented higher rates of co-morbid psychiatric conditions (p=0.007) and lower GAF scores at baseline (p=0.017). Finally, baseline unemployment and living in a communal establishment were associated with an increased risk of developing a psychotic episode within the following two years (p<0.05). We concluded that the "At Risk Mental State" is a clinical condition which is characterized by marked psychosocial impairment and by an increased vulnerability to psychosis. Unemployment at the first contact with the prodromal service may be a risk factor for the development of a psychotic episode.
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Guzzetta F, Miglio R, Santone G, Picardi A, Norcio B, Bracco R, de Girolamo G. First-ever admitted psychiatric inpatients in Italy: clinical characteristics and reasons contributing to admission: findings from a national survey. Psychiatry Res 2010; 176:62-8. [PMID: 20089315 DOI: 10.1016/j.psychres.2008.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 11/09/2008] [Accepted: 11/11/2008] [Indexed: 11/26/2022]
Abstract
The aim of this study was to describe the sociodemographic, clinical and treatment-related characteristics of patients admitted to any acute psychiatric inpatient facilities in Italy for the first time in their life, and to identify reasons contributing to admission. Data from the PROGRES-Acute Project, a national survey on facilities admitting acute psychiatric patients in Italy, were used. A cluster analysis was carried out in order to identify patients' groups sharing similar sociodemographic and clinical characteristics. Among patients admitted during the index period, 337 were at their first-ever admission. Median age at admission was 40, and about 46% of patients were not receiving any treatment in the month prior to admission. Social/work functioning problems, social withdrawal and conflict with family members were the most common reasons contributing to admission. Cluster analysis yielded four patient groups: two groups of younger subjects, differentiating each other for frequency of antisocial behaviors, compulsory admissions, treatment at time of admission and family support; two groups of older subjects, with high rates of affective disorders, who showed remarkable differences with regard to their living situation and family support. Our study shows that first-ever admitted patients represent a highly heterogeneous group. Early intervention research should take this sociodemographic and clinical diversity into account, in order to better allocate resources and develop special intervention programs.
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Affiliation(s)
- Francesca Guzzetta
- Mental Health Department, Azienda USL Ravenna, Via Baliatico, 3, Faenza (RA), Italy
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O'Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley SD, McWilliams S, Behan C, Fetherstone A, Kinsella A. First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol 2010; 45:381-91. [PMID: 19578801 DOI: 10.1007/s00127-009-0081-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 06/01/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND People experience delays in receiving effective treatment for many illnesses including psychosis. These delays have adverse consequences in heart disease and cancer, and their causes have been the subject of much research but only in recent years have pathways to care in psychosis received such attention. We sought to establish if, when and where people seek help in the early phase of psychosis in a representative sample. METHODS One hundred and sixty-five people with first episode psychosis, referred from community-based psychiatric services and a private psychiatric facility to an early intervention service over 18 months, were interviewed with the Structured Clinical Interview for DSM-IV diagnoses. Symptoms were measured using the Schedule for the Assessment of Positive Symptoms, Schedule for the Assessment of Negative Symptoms and the Calgary Scale. Duration of untreated illness (DUI) and duration of untreated psychosis (DUP) were established using the Beiser Scale. Pathways to mental health services were systematically detailed through interviews with patients and their families. RESULTS The final sample consisted of 142 (88M, 54F) cases after those with psychosis due to a general medical condition and those without pathway and DUP data were excluded. Less than half of participants initiated help seeking themselves. Of those who did seek help (n = 57) 25% did so during the DUI. Those who had a positive family history of mental illness and poorer premorbid adjustment were significantly less likely to seek help for themselves and those who did not seek help were more likely to require hospitalisation. Families were involved in help seeking for 50% of cases and in 1/3 of cases did so without the affected individual participating in the contact. Being younger and having more negative symptoms were associated with having one's family involved in help seeking. Delays to effective treatment from the onset of psychosis were evenly split between "help-seeking delays" and "health-system delays". Having a family member involved in help seeking and better premorbid adjustment were independently associated with shorter help-seeking delays when measured from the onset of psychosis. Being female, having better premorbid adjustment and fewer negative symptoms were associated with shorter help-seeking delays from the onset of illness. Those with a non-affective psychosis had significantly longer system delays. CONCLUSION Many people with first episode psychosis do not initiate help-seeking for themselves particularly those with a relative affected by mental illness. Those with poor premorbid adjustment are at particular risk of longer delays. Poor premorbid adjustment compounded by long delays to effective treatment reduces the likelihood of a good outcome. Families play a vital role in hastening receipt of effective treatment.
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Affiliation(s)
- Eadbhard O'Callaghan
- Early Intervention Psychosis Service, DETECT, Avila House, Block 5, Blackrock Business Park, Blackrock Co., Dublin, Ireland.
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Cultural themes associated with pathways to initial use of psychiatric services in a tri-ethnic community sample of adults with schizophrenia. Schizophr Res 2009; 115:375-6. [PMID: 19545978 DOI: 10.1016/j.schres.2009.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 05/10/2009] [Accepted: 05/12/2009] [Indexed: 11/21/2022]
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Compton MT, Goulding SM, Gordon TL, Weiss PS, Kaslow NJ. Family-level predictors and correlates of the duration of untreated psychosis in African American first-episode patients. Schizophr Res 2009; 115:338-45. [PMID: 19833482 PMCID: PMC2783750 DOI: 10.1016/j.schres.2009.09.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 09/18/2009] [Accepted: 09/22/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain. METHODS From a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazard models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP - mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level. RESULTS The median DUP was 24.5 weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP. CONCLUSIONS Whereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
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Compton MT, Ramsay CE, Shim RS, Goulding SM, Gordon TL, Weiss PS, Druss BG. Health services determinants of the duration of untreated psychosis among African-American first-episode patients. Psychiatr Serv 2009; 60:1489-94. [PMID: 19880467 PMCID: PMC5854470 DOI: 10.1176/ps.2009.60.11.1489] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The duration of untreated psychosis is associated with poor outcomes in multiple domains in the early course of nonaffective psychotic disorders, although relatively little is known about determinants of this critical period, particularly health services-level determinants. This study examined three hypothesized predictors of duration of untreated psychosis (lack of insurance, financial problems, and broader barriers) among urban, socioeconomically disadvantaged African Americans, while controlling for the effects of three patient-level predictors (mode of onset of psychosis, living with family versus alone or with others before hospitalization, and living above versus below the federally defined poverty level). METHODS Analyses included data from 42 patient-family member dyads from a larger sample of 109 patients with a first episode of nonaffective psychosis. The duration of untreated psychosis and all other variables were measured in a rigorous, standardized fashion in a study designed specifically to examine determinants of treatment delay. Survival analyses and Cox regression assessed the effects of the independent predictors on time from onset of psychosis to hospital admission for initial evaluation and treatment. RESULTS The median duration of untreated psychosis was 24.5 weeks. When the analyses controlled for the three patient-level covariates, patients without health insurance, with financial problems, or with barriers to seeking help had a significantly longer duration of untreated psychosis. CONCLUSIONS Health services-related factors, such as lack of insurance, are predictive of longer treatment delay. Efforts to eliminate uninsurance and underinsurance, as well as minimize barriers to treatment, would be beneficial for improving the prognosis of young patients with emerging nonaffective psychotic disorders.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA 30303, USA.
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Faridi K, Pawliuk N, King S, Joober R, Malla AK. Prevalence of psychotic and non-psychotic disorders in relatives of patients with a first episode psychosis. Schizophr Res 2009; 114:57-63. [PMID: 19666214 DOI: 10.1016/j.schres.2009.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 06/29/2009] [Accepted: 07/06/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family members of individuals with schizophrenia suffer from elevated rates of schizophrenia-spectrum disorders (SSD) and other forms of psychopathology. However, few studies have examined familial psychopathology in probands with a first episode of psychosis (FEP). We systematically evaluated family history in patients experiencing an affective or non-affective FEP. METHODS The Family Interview for Genetic Studies was used to obtain diagnostic information on all first- and second-degree relatives of probands admitted to a specialized FEP program. Probands were 94 previously untreated patients suffering from a first-episode of affective or schizophrenia spectrum psychosis, aged 14 to 30. The interview ascertained diagnoses of psychotic disorders, affective disorders, substance-use disorders (SUD), and schizophrenia-related personality disorders. RESULTS One in five probands (19.1%) had a history of psychosis among their first-degree relatives, while 34.0% had any relative with psychosis. Fewer probands had a family history of SSD (7.4% with a first-degree history and 18.1% with a history among any relatives). Over half (53.2%) of probands had a first-degree relative with Major Depressive Disorder, and 38.3% had a first-degree relative with a SUD. Overall, 69.9% of probands had a first-degree relative with a mental disorder. The proportion of probands with a family history of any of these diagnoses did not vary by proband diagnosis (affective or SS Psychosis), though probands with co-morbid SUD were more likely to have a family history of substance abuse. CONCLUSIONS Diverse psychopathology is commonly present in families of FEP patients and may imply a generalized vulnerability to psychiatric disorders to be greater in such families compared to specific vulnerability to SS or affective psychosis. These findings may also have implications for provision of care for the probands.
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Affiliation(s)
- Kia Faridi
- Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada
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Sharifi V, Kermani-Ranjbar T, Amini H, Alaghband-rad J, Salesian N, Seddigh A. Duration of untreated psychosis and pathways to care in patients with first-episode psychosis in Iran. Early Interv Psychiatry 2009; 3:131-6. [PMID: 21352186 DOI: 10.1111/j.1751-7893.2009.00119.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This is the first study on the duration of untreated psychosis and pathways to care among patients with first-episode psychosis in Iran as a developing country. METHODS Ninety-one patients with a first episode of non-organic psychosis admitted to a university-affiliated psychiatric hospital in Iran were assessed for duration of untreated psychosis (DUP), pathways to care and mode of onset. RESULTS Median DUP was 11 weeks (mean = 52.3 weeks). Following the onset of psychosis, most patients were first seen by a psychiatrist (n = 23, 25.3%), a traditional healer (n = 21, 23.1%) or a general practitioner (n = 16, 17.6%). Most referrals to the psychiatric hospital were made by the family (n = 30, 33.1%), or health professionals (n = 29, 31.9%). Acute onset and rural place of residence were associated with shorter DUP in multivariate analysis. CONCLUSIONS Median DUP was not long in an inpatient sample with first-episode psychosis, which may be due to the preponderance of affective and acute psychoses in this sample and some help-seeking or service variables.
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Affiliation(s)
- Vandad Sharifi
- Department of Psychiatry, Roozbeh Hospital, Tehran, Iran.
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Chua SE, Deng Y, Chen EYH, Law CW, Chiu CPY, Cheung C, Wong JCH, Lienenkaëmper N, Cheung V, Suckling J, McAlonan GM. Early striatal hypertrophy in first-episode psychosis within 3 weeks of initiating antipsychotic drug treatment. Psychol Med 2009; 39:793-800. [PMID: 18713487 DOI: 10.1017/s0033291708004212] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We and others have reported that patients experiencing their first episode of psychosis already have significant structural brain abnormalities. Antipsychotics seem to reverse subcortical volume deficits after months of treatment. However, the early impact of medication on brain morphology is not known. METHOD Forty-eight individuals in their first episode of psychosis underwent magnetic resonance imaging (MRI) brain scanning. Twenty-six were antipsychotic naive and 22 were newly treated with antipsychotic medication for a median period of 3 weeks. In each group, 80% of subjects received a diagnosis of schizophrenia. The two groups were balanced for age, sex, handedness, ethnicity, height, years of education, paternal socio-economic status (SES) and Positive and Negative Syndrome Scale (PANSS) score. Group differences in whole-brain grey matter were compared voxel by voxel, using Brain Activation and Morphological Mapping (BAMM) software. We also conducted testing of group differences with region-of-interest (ROI) measurements of the caudate nucleus. RESULTS Relative to the untreated group, those receiving antipsychotic medication for 3-4 weeks had significantly greater grey-matter volumes in the bilateral caudate and cingulate gyri, extending to the left medial frontal gyrus. ROI analysis confirmed that, in treated patients, the right and left caudate nuclei were significantly larger by 10% (p<0.039, two-tailed) and 9% (p<0.048, two-tailed) respectively. CONCLUSIONS Early striatal grey-matter enlargement may occur within the first 3-4 weeks of antipsychotic treatment. Possible reasons for putative striatal hypertrophy and its implications are discussed.
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Affiliation(s)
- S E Chua
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, S.A.R. China
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