1
|
Jia L, Wei Z, Wang J, Zhang X, Wang H, Chen R, Zhang X. Children's early signs and developmental trajectories of psychotic-like experiences. Brain Res 2024; 1832:148853. [PMID: 38458308 DOI: 10.1016/j.brainres.2024.148853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Children who experience persistent psychotic-like experiences (PLEs) are at a higher risk of developing psychotic disorder later in life. The developmental trajectories of PLEs are influenced by various factors. Therefore, it is important to identify early characteristics that can distinguish and predict between different developmental trajectories of PLEs. METHODS Using PLEs scores from the Adolescent Brain Cognitive Development (ABCD) data across three waves, we categorized participants into five distinct PLEs trajectories groups: persistent group (n = 47), remitting group (n = 185), increasing group (n = 117), remittent group (n = 21), and no PLEs group (n = 4,476). We utilized linear mixed-effect models and generalized linear mixed-effect models to examine the differences in baseline characteristics, including psychological and behavioral problems, suicidality, trauma experiences, developmental milestones, cognitive function, physical health, family income, family history of mental illness, and brain structureamong these PLEs trajectory groups. RESULTS We found that psychological and behavioral problems (such as DSM-oriented scales/externalizing/ADHD/social/attention/thought problems) assessed by the Child Behavior Checklist (CBCL) were associated with all PLEs groups. The persistent PLEs group had greater ADHD/social/thought problems and suicidal behavior compared to the remitting PLEs group. Comparing with the no PLEs group, poor cognitive function, abnormal brain structure (such as temporal lobe and supramarginal gyrus), more trauma experiences, and lower family income were found in only one of the PLEs groups, but not all PLEs groups. CONCLUSION The development of PLEs is accompanied by changes in many domains, implying a dynamic and complex developmental process. Given that psychological and behavioral problems can predict the emergence of PLEs at any time and can be regarded as risk factors for persistent PLEs, thereby enabling early precisely interventions, it is important to place greater emphasis on assessing psychological and behavioral problems.
Collapse
Affiliation(s)
- Luxia Jia
- School of Education, Guangzhou University, Guangzhou, China; Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Ziqian Wei
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Juan Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Xuan Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Huagen Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China.
| | - Xiaoqian Zhang
- Wulituo Hospital of Beijing Shijingshan District, Beijing, China.
| |
Collapse
|
2
|
Susanti H, Brooks H, Keliat BA, Bradshaw T, Wulandari D, Fadilah R, Diorarta R, Suherman, Bee P, Lovell K, Renwick L. Stakeholder perspectives of family interventions for schizophrenia in Indonesia: a qualitative study. BMC Psychiatry 2024; 24:59. [PMID: 38254095 PMCID: PMC10804701 DOI: 10.1186/s12888-024-05504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Mental illnesses comprise the single largest source of health-related economic burden globally and low-and middle-income countries (LMICs) are disproportionately affected. Many individuals with schizophrenia do not receive evidence-based, psychosocial interventions as these are largely unavailable, undeveloped, and under-researched in LMICs. Involving service-users and carers in the design of interventions is crucial to ensure stakeholder needs are adequately addressed by the intervention and to aid successful implementation. We aimed to explore the views and perspectives of different stakeholder groups about the delivery, format, and content of family interventions for people living with schizophrenia in Indonesia as a first step towards developing evidence-based, acceptable family interventions. This study used a qualitative design comprising single stakeholder focus groups. Data were analysed separately using the framework approach incorporating deductive and inductive coding within an existing heuristic framework. 51 participants consented to take part in this study comprising six stakeholder consultation groups including service-users (n = 15), caregivers (n = 15) and healthcare professionals (n = 21). Service users were diagnosed with schizophrenia. Caregivers comprised parents (n = 10, 67%), brothers (n = 2, 13%), sister (n = 1, 7%) and husbands (n = 2, 13%). Healthcare professionals were working as nurses (n = 6, 29%), doctors (n = 5, 23%) or cadre's (n = 10, 48%). Caregiver and service-user respondents had limited knowledge or experience of structured family interventions. There was strong support for such interventions, however, for effective delivery a number of challenges exist in terms of widespread stigmatised views, low expectations for involvement in sharing decisions about care and treatment, views that healthcare professionals are expert and have the authority to delegate tasks to families such as responsibility for ensuring medication adherence and understanding the need to balance the needs of both service-users and families when there are conflicting agendas for treatment. These findings can support the development of evidence-based family interventions for families of those with schizophrenia in Indonesia, as user-informed interventions enhance engagement, satisfaction, and adherence to family interventions.
Collapse
Affiliation(s)
- Herni Susanti
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Budi-Anna Keliat
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Tim Bradshaw
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Dewi Wulandari
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Rizky Fadilah
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Raphita Diorarta
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Suherman
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Laoise Renwick
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK.
| |
Collapse
|
3
|
Le PD, Agrest M, Kankan T, Dev S, Mascayano F, Dahl C, Mitkiewicz F, Schilling S, Conover S, Fernández AR, Burrone MS, Lumerman J, Gonzalez MJJ, Fader K, Cavalcanti MT, Alvarado R, Yang LH, Susser ES. Critical Time Intervention - Task-Shifting for Individuals with Psychosis in Latin America: A Multi-stakeholder Qualitative Analysis of Implementation Barriers and Facilitators. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:325-339. [PMID: 38274494 PMCID: PMC10810049 DOI: 10.1007/s43477-023-00090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/14/2023] [Indexed: 01/27/2024]
Abstract
This article presents the results of a qualitative study conducted to understand the barriers and facilitators in implementing a pilot trial of Critical Time Intervention-Task-Shifting-a time-limited, community-based, recovery-oriented intervention for individuals with psychosis-in Rio de Janeiro, Brazil, and Santiago, Chile. Data included 40 semi-structured interviews with service users, task-shifting providers, and administrators. Analysis proceeded in three iterative phases and combined inductive and deductive approaches. Coding frameworks for implementation factors, and whether or not they acted as barriers and facilitators, were developed and refined using many domains and constructs from the Consolidated Framework for Implementation Research. Barriers and facilitators were ultimately grouped into five domains: 1-Personal; 2-Interpersonal; 3-Intervention; 4-Mental Health System; and 5-Contextual. A rating system was also developed and applied, which enabled comparisons across stakeholders and study sites. Major facilitators included intervention characteristics such as the roles of the task-shifting providers and community-based care. Top barriers included mental health stigma and community conditions (violence). Nevertheless, the findings suggest that Critical Time Intervention-Task-Shifting is largely acceptable and feasible, and could contribute to efforts to strengthen community mental health systems of care for individuals with psychosis in Latin America, especially in advancing the task-shifting strategy and the recovery-oriented approach.
Collapse
Affiliation(s)
- PhuongThao D. Le
- School of Global Public Health, New York University, New York, NY, USA
| | - Martín Agrest
- Proyecto Suma, Buenos Aires, Argentina
- Instituto de Investigaciones, Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Tanvi Kankan
- Teachers College of Columbia University, New York, NY, USA
| | - Saloni Dev
- Tufts University School of Medicine, Boston, MA, USA
| | - Franco Mascayano
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Catarina Dahl
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Sara Schilling
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Sarah Conover
- Silberman School of Social Work, City University of New York Hunter College, New York, NY, USA
| | | | | | - José Lumerman
- Instituto Austral de Salud Mental, Neuquen, Argentina
| | | | - Kim Fader
- New York State Psychiatric Institute, New York, NY, USA
| | | | - Rubén Alvarado
- Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ezra S. Susser
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
4
|
Hestmark L, Romøren M, Hansson KM, Heiervang KS, Pedersen R. Clinicians' perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study. Front Psychiatry 2023; 14:1175557. [PMID: 37293406 PMCID: PMC10244542 DOI: 10.3389/fpsyt.2023.1175557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Background Family involvement in mental health care ranges from basic practices to complex interventions such as Family psychoeducation, the latter being a well-documented treatment for psychotic disorders. The aim of this study was to explore clinicians' perceptions of the benefits and disadvantages of family involvement, including possible mediating factors and processes. Methods Nested in a randomised trial, which purpose was to implement Basic family involvement and support and Family psychoeducation in Norwegian community mental health centres during 2019-2020, this qualitative study is based on eight focus groups with implementation teams and five focus groups with ordinary clinicians. Using a purposive sampling strategy and semi-structured interview guides, focus groups were audio-recorded, transcribed verbatim, and analysed with reflexive thematic analysis. Results Four main themes were identified as perceived benefits: (1) Family psychoeducation-a concrete framework, (2) Reducing conflict and stress, (3) A triadic understanding, and (4) Being on the same team. Themes 2-4 formed an interconnected triad of mutually reinforcing elements and were further linked to three important clinician-facilitated sub-themes: a space for relatives' experiences, emotions and needs; a space for patients and relatives to discuss sensitive topics and an open line of communication between clinician and relative. Although far less frequent, three main themes were identified as perceived disadvantages or challenges: (1) Family psychoeducation-occasional poor model fit or difficulties following the framework, (2) Getting more involved than usual, and (3) Relatives as a potentially negative influence-important nonetheless. Conclusions The findings contribute to the understanding of the beneficial processes and outcomes of family involvement, as well as the critical role of the clinician in achieving these and possible challenges. They could also be used to inform future quantitative research on mediating factors and implementation efforts.
Collapse
Affiliation(s)
- Lars Hestmark
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Faculty of Health and Social Sciences, Center for Mental Health and Substance Abuse, University of South-Eastern Norway, Drammen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
5
|
Hansson KM, Romøren M, Hestmark L, Heiervang KS, Weimand B, Norheim I, Pedersen R. "The most important thing is that those closest to you, understand you": a nested qualitative study of persons with psychotic disorders' experiences with family involvement. Front Psychiatry 2023; 14:1138394. [PMID: 37255680 PMCID: PMC10225600 DOI: 10.3389/fpsyt.2023.1138394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Family interventions constitute effective treatment for persons with psychotic disorders. However, the active ingredients and beneficial processes of these interventions are insufficiently examined, and qualitative explorations of patients` experiences are lacking. This study was nested in a cluster randomised trial that implemented national guidelines on family involvement in Norwegian community mental health centres, including family psychoeducation and basic family involvement and support. The aim of this sub-study was to explore how patients with psychotic disorders experience systematic family involvement, and its significance. Methods We conducted semi-structured, individual interviews with 13 persons with a psychotic disorder after systematic family involvement. The participants were recruited through purposive sampling. Qualitative content analysis guided the analysis. Results Participants reported overall positive experiences with systematic family involvement. It was significant that the relatives increasingly understood more about psychosis and their situation, while they themselves also gained more insight into the relatives` situation. The participants emphasised the need to enable both patients and relatives to safely share experiences in a containing space, led by professionals. Shared understanding and awareness of each other's situation further improved communication, coping with the illness, reduced stress, and stimulated a more caring family environment. The therapist seemed crucial to facilitate these beneficial communication processes, and also to provide continuous support to the relatives. Reported challenges included that the participants felt vulnerable in the initial phase, a need for tailored approaches, and too late start-up. Conclusion Findings from this study suggest that persons with psychotic disorders may benefit greatly from participating in systematic family involvement. This study also gives new insight into possible mediators of positive outcomes both for the patients and the relatives. Systematic family involvement should be implemented a standard approach in the early phase of the disease, using a step-wise and tailored process.
Collapse
Affiliation(s)
- Kristiane M. Hansson
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lars Hestmark
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bente Weimand
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Irene Norheim
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
6
|
J. van Rensburg A, Brooke-Sumner C. Intersectoral and multisectoral approaches to enable recovery for people with severe mental illness in low- and middle-income countries: A scoping review. Glob Ment Health (Camb) 2023; 10:e19. [PMID: 37854420 PMCID: PMC10579663 DOI: 10.1017/gmh.2023.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
The needs of people with severe mental illness are complex and require a range of services embedded in well-coordinated systems of care to enable recovery, promote well-being and optimise social integration. The concept of recovery is strongly rooted in the centrality of multi and intersectoral systems of care, and, while multi and -intersectoral dimensions of mental health systems have been highlighted in analyses focusing on high-income regions, little has been elaborated in terms of these approaches in the recovery of people with severe mental illness (SMI) in low- and middle-income countries (LMICs). The aim of this review was to identify and describe multi and intersectoral approaches underpinning community-based SMI recovery interventions in LMICs. A scoping review was carried out following the following steps: (1) Objectives for the review were developed and refined; (2) A systematic search of databases (EbscoHost, PubMed, Google Scholar) and previous reviews were undertaken from 2012 to 2022, where relevant papers were identified; (3) Papers with a focus on SMI and recovery, a specific description of an intervention, located in LMICs, with explicit linkages between sectors, and published in English, were selected for inclusion; (4) Data were extracted and charted and (5) Findings were analysed and reported thematically. Thirty-six papers were included for analysis, from 18 countries, including qualitative studies, trials, desktop and secondary data reviews and case studies. Examples of multi- and intersectoral action included collaboration between healthcare and community support systems, collaboration in providing supported housing and supportive community spaces for recovery, and linkages between biomedical and social spheres of care. Barriers included the dominance of mental health professions in delivering care, community-based stigmatising attitudes towards SMI. Multi- and intersectoral collaboration for SMI recovery requires investments in financing, education and coordination by a governing body.
Collapse
Affiliation(s)
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
7
|
Estradé A, Onwumere J, Venables J, Gilardi L, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Bonoldi I, Kuipers E, Fusar-Poli P. The Lived Experiences of Family Members and Carers of People with Psychosis: A Bottom-Up Review Co-Written by Experts by Experience and Academics. Psychopathology 2023; 56:371-382. [PMID: 36689938 PMCID: PMC10568611 DOI: 10.1159/000528513] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/20/2022] [Indexed: 01/24/2023]
Abstract
Informal caregivers of individuals affected by psychotic disorder can play a key role in the recovery process. However, little research has been conducted on the lived experiences of carers and family members. We conducted a bottom-up (from lived experience to theory) review of first-person accounts, co-written between academics and experts by experience, to identify key experiential themes. First-person accounts of carers, relatives, and individuals with psychosis were screened and discussed in collaborative workshops involving individuals with lived experiences of psychosis, family members, and carers, representing various organizations. The lived experiences of family members and carers were characterized by experiential themes related to dealing with the unexpected news, the search for a reason behind the disorder, living with difficult and negative emotions, dealing with loss, feeling lost in fragmented healthcare systems, feeling invisible and wanting to be active partners in care, struggling to communicate with the affected person, fighting stigma and isolation, dealing with an uncertain future, and learning from one's mistakes and building resilience and hope. Our findings bring forth the voices of relatives and informal carers of people with psychosis, by highlighting some of the common themes of their lived experiences from the time of the initial diagnosis and throughout the different clinical stages of the disorder. Informal carers are key stakeholders who can play a strategic role, and their contributions in the recovery process merit recognition and active support by mental health professionals.
Collapse
Affiliation(s)
- Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Juliana Onwumere
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Ana Cabrera
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Joseba Rico
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Arif Hoque
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Jummy Otaiku
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Nicholas Hunter
- National Health System (NHS) South London and Maudsley (SLaM) Recovery College, London, UK
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), Brussels, Belgium
| | - Lily Kpodo
- South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
| | - Charlene Sunkel
- Global Mental Health Peer Network (GMHPN), Johannesburg, South Africa
| | - Jianan Bao
- Department of Forensic and Neurodevelopment Sciences, King’s College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- School of Medicine, Keele University, Staffordshire, Newcastle, UK
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Elizabeth Kuipers
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|