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Zaher F, Diallo M, Achim AM, Joober R, Roy MA, Demers MF, Subramanian P, Lavigne KM, Lepage M, Gonzalez D, Zeljkovic I, Davis K, Mackinley M, Sabesan P, Lal S, Voppel A, Palaniyappan L. Speech markers to predict and prevent recurrent episodes of psychosis: A narrative overview and emerging opportunities. Schizophr Res 2024; 266:205-215. [PMID: 38428118 DOI: 10.1016/j.schres.2024.02.036] [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] [Received: 10/15/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
Preventing relapse in schizophrenia improves long-term health outcomes. Repeated episodes of psychotic symptoms shape the trajectory of this illness and can be a detriment to functional recovery. Despite early intervention programs, high relapse rates persist, calling for alternative approaches in relapse prevention. Predicting imminent relapse at an individual level is critical for effective intervention. While clinical profiles are often used to foresee relapse, they lack the specificity and sensitivity needed for timely prediction. Here, we review the use of speech through Natural Language Processing (NLP) to predict a recurrent psychotic episode. Recent advancements in NLP of speech have shown the ability to detect linguistic markers related to thought disorder and other language disruptions within 2-4 weeks preceding a relapse. This approach has shown to be able to capture individual speech patterns, showing promise in its use as a prediction tool. We outline current developments in remote monitoring for psychotic relapses, discuss the challenges and limitations and present the speech-NLP based approach as an alternative to detect relapses with sufficient accuracy, construct validity and lead time to generate clinical actions towards prevention.
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Affiliation(s)
- Farida Zaher
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Mariama Diallo
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Amélie M Achim
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, QC, Canada; Vitam - Centre de Recherche en Santé Durable, Québec City, QC, Canada; Centre de Recherche CERVO, Québec City, QC, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, QC, Canada; Centre de Recherche CERVO, Québec City, QC, Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Québec City, QC, Canada; Faculté de Pharmacie, Université Laval, Québec City, QC, Canada
| | - Priya Subramanian
- Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada
| | - Katie M Lavigne
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Daniela Gonzalez
- Prevention and Early Intervention Program for Psychosis, London Health Sciences Center, Lawson Health Research Institute, London, ON, Canada
| | - Irnes Zeljkovic
- Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada
| | - Kristin Davis
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michael Mackinley
- Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada; Prevention and Early Intervention Program for Psychosis, London Health Sciences Center, Lawson Health Research Institute, London, ON, Canada
| | - Priyadharshini Sabesan
- Lakeshore General Hospital and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Shalini Lal
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
| | - Alban Voppel
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada; Robarts Research Institute, Western University, London, ON, Canada.
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2
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Gleeson JF, McGuckian TB, Fernandez DK, Fraser MI, Pepe A, Taskis R, Alvarez-Jimenez M, Farhall JF, Gumley A. Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders. Clin Psychol Rev 2024; 107:102357. [PMID: 38065010 DOI: 10.1016/j.cpr.2023.102357] [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: 03/08/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade. METHOD We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms. RESULTS Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = -0.01, 1.63). CONCLUSIONS Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.
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Affiliation(s)
- J F Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia.
| | - T B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - D K Fernandez
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M I Fraser
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - A Pepe
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - R Taskis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - J F Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | - A Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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3
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Allan S, Beedie S, McLeod HJ, Farhall J, Gleeson J, Bradstreet S, Morton E, Bell I, Wilson-Kay A, Whitehill H, Matrunola C, Thomson D, Clark A, Gumley A. Using EMPOWER in daily life: a qualitative investigation of implementation experiences. BMC Psychiatry 2023; 23:597. [PMID: 37592231 PMCID: PMC10433590 DOI: 10.1186/s12888-023-05096-x] [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] [Received: 12/19/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Digital self-management tools blended with clinical triage and peer support have the potential to improve access to early warning signs (EWS) based relapse prevention in schizophrenia care. However, the implementation of digital interventions in psychosis can be poor. Traditionally, research focused on understanding how people implement interventions has focused on the perspectives of mental health staff. Digital interventions are becoming more commonly used by patients within the context of daily life, which means there is a need to understand implementation from the perspectives of patients and carers. METHODS Semi-structured one-on-one interviews with 16 patients who had access to the EMPOWER digital self-management intervention during their participation in a feasibility trial, six mental health staff members who supported the patients and were enrolled in the trial, and one carer participant. Interviews focused on understanding implementation, including barriers and facilitators. Data were coded using thematic analysis. RESULTS The intervention was well implemented, and EMPOWER was typically perceived positively by patients, mental health staff and the carer we spoke to. However, some patients reported negative views and reported ideas for intervention improvement. Patients reported valuing that the app afforded them access to things like information or increased social contact from peer support workers that went above and beyond that offered in routine care. Patients seemed motivated to continue implementing EMPOWER in daily life when they perceived it was creating positive change to their wellbeing, but seemed less motivated if this did not occur. Mental health staff and carer views suggest they developed increased confidence patients could self-manage and valued using the fact that people they support were using the EMPOWER intervention to open up conversations about self-management and wellbeing. CONCLUSIONS The findings from this study suggest peer worker supported digital self-management like EMPOWER has the potential to be implemented. Further evaluations of these interventions are warranted, and conducting qualitative research on the feasibility gives insight into implementation barriers and facilitators, improving the likelihood of interventions being usable. In particular, the views of patients who demonstrated low usage levels would be valuable.
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Affiliation(s)
| | | | | | | | - John Gleeson
- Australian Catholic University, Melbourne, Australia
| | | | - Emma Morton
- University of British Columbia, Vancouver, Canada
| | - Imogen Bell
- Orygen Centre of Youth Mental Health, Melbourne, Australia
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4
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Yu H, Sun YJ, Qin MN, Ren JX, Yu K, Song J, Zhou YQ, Liu L. Perception of risk of relapse among patients with first episode and recurrent schizophrenia: a descriptive phenomenological study. BMC Psychiatry 2023; 23:582. [PMID: 37563579 PMCID: PMC10413637 DOI: 10.1186/s12888-023-05023-0] [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: 03/08/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Patients suffering from schizophrenia are at a higher risk of relapse. The perception of the risk of relapse in patients is critical for relapse prevention. In the field of psychiatry, the study of risk perception of relapse has been neglected. METHODS We carried out a qualitative study using a descriptive phenomenological approach. Data were collected at two psychiatric hospitals in China. In total, 22 patients with schizophrenia were recruited through purposive sampling. Face to face semi-structured in-depth interviews were conducted. Interview recordings were transcribed by the research team, and transcripts were analysed by two independent coders with Colaizzi's descriptive analysis framework. The consolidated criteria for reporting qualitative research checklist were used for reporting. RESULTS The data of first-episode patients yielded three themes: (i) lack of knowledge about disease recognition and medical treatment; (ii) overoptimistic estimation of the risk of relapse; (iii) perceived importance of treatment. For first-relapse patients : (i) initial awareness of relapse warning signs; (ii) lack of systematic and accurate assessment of disease information; (iii) the perception that drug withdrawal is related to relapse. Patients with multiple relapses: (i) susceptibility to relapse: confusion and powerlessness; (ii) the severity of relapse: suicidal thoughts and behavior; (iii) effects of perceived benefits and barriers of medication behaviour. CONCLUSIONS In schizophrenic patients with first-episode, first-relapse, and multiple relapses, there were dynamic changes in the perception of disease relapse risk and medication behaviour. Medical workers must improve risk awareness education. They should provide patients with scientific, accurate, and timely communication channels, and dynamically assess and manage the risk of relapse in various patients.
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Affiliation(s)
- Hong Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Yu-Jing Sun
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Meng-Nan Qin
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Jia-Xin Ren
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Kai Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Jin Song
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China.
| | - Li Liu
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
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Marin L, Guàrdia A, González-Rodríguez A, Haba-Rubio J, Natividad M, Bosch E, Domínguez N, Monreal JA. Sleep Disturbances in At-Risk Mental States and First Episode of Psychosis: A Narrative Review on Interventions. Clocks Sleep 2023; 5:249-259. [PMID: 37218866 DOI: 10.3390/clockssleep5020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Sleep disturbances are a common yet often overlooked symptom of psychosis that can drastically affect the quality of life and well-being of those living with the condition. Sleep disorders are common in people diagnosed with schizophrenia and have significant negative effects on the clinical course of the illness and the functional outcomes and quality of life of patients. There is a limited number of studies addressing this question in first-episode psychosis (FEP). In this narrative review, we aimed to provide an overview of sleep disorders in populations with FEP and at-risk mental states (ARMS). The review was focused on the various treatments currently used for sleep disorders, including both non-pharmacological and pharmacological treatments. A total of 48 studies were included. We found that sleep disturbances are associated with attenuated psychotic symptoms and other psychopathological symptoms in ARMSs. The association of sleep disturbances with the transition to psychosis has been poorly investigated. Sleep disturbances have an impact on the quality of life and the psychopathological symptoms of people suffering from FEP. The non-pharmacological treatments include cognitive behavioral therapy for insomnia, bright light therapy, cognitive restructuring techniques, sleep restriction therapy, basic sleep hygiene education, and the provision of portable sleep trackers. Other treatments include antipsychotics in acute phases and melatonin. The early intervention in sleep disturbances may improve overall prognosis in emerging psychosis populations.
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Affiliation(s)
- Lorena Marin
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Armand Guàrdia
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - José Haba-Rubio
- Centre for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Mentxu Natividad
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Elena Bosch
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Noelia Domínguez
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - José Antonio Monreal
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
- Institut de Neurociències, UAB, CIBERSAM, 08221 Terrassa, Spain
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Barendse MEA, Lara GA, Guyer AE, Swartz JR, Taylor SL, Shirtcliff EA, Lamb ST, Miller C, Ng J, Yu G, Tully LM. Sex and pubertal influences on the neurodevelopmental underpinnings of schizophrenia: A case for longitudinal research on adolescents. Schizophr Res 2023; 252:231-241. [PMID: 36682313 PMCID: PMC10725041 DOI: 10.1016/j.schres.2022.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 11/08/2022] [Accepted: 12/10/2022] [Indexed: 01/21/2023]
Abstract
Sex is a significant source of heterogeneity in schizophrenia, with more negative symptoms in males and more affective symptoms and internalizing comorbidity in females. In this narrative review, we argue that there are likely sex differences in the pathophysiological mechanisms of schizophrenia-spectrum disorders (SZ) that originate during puberty and relate to the sex-specific impacts of pubertal maturation on brain development. Pubertal maturation might also trigger underlying (genetic or other) vulnerabilities in at-risk individuals, influencing brain development trajectories that contribute to the emergence of SZ. This review is the first to integrate links between pubertal development and neural development with cognitive neuroscience research in SZ to form and evaluate these hypotheses, with a focus on the frontal-striatal and frontal-limbic networks and their hypothesized contribution to negative and mood symptoms respectively. To test these hypotheses, longitudinal research with human adolescents is needed that examines the role of sex and pubertal development using large cohorts or high risk samples. We provide recommendations for such studies, which will integrate the fields of psychiatry, developmental cognitive neuroscience, and developmental endocrinology towards a more nuanced understanding of the role of pubertal factors in the hypothesized sex-specific pathophysiological mechanisms of schizophrenia.
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Affiliation(s)
- M E A Barendse
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - G A Lara
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - A E Guyer
- Department of Human Ecology, UC Davis, CA, USA; Center for Mind and Brain, UC Davis, CA, USA
| | - J R Swartz
- Center for Mind and Brain, UC Davis, CA, USA
| | - S L Taylor
- Division of Biostatistics, Department of Public Health Sciences, UC Davis, CA, USA
| | - E A Shirtcliff
- Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - S T Lamb
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - C Miller
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - J Ng
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - G Yu
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA
| | - L M Tully
- Department of Psychiatry and Behavioral Sciences, UC Davis, CA, USA.
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Allan S, O’Driscoll C, McLeod HJ, Gleeson J, Farhall J, Morton E, Bell I, Bradstreet S, Machin M, Gumley A. Fear of psychotic relapse: exploring dynamic relationships with common early warning signs of relapse using electronic once-a-day self-reports. PSYCHOSIS 2023. [DOI: 10.1080/17522439.2022.2162955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Stephanie Allan
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Ciarán O’Driscoll
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Hamish J. McLeod
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - John Farhall
- Department of Psychology and Counselling, LaTrobe University, Melbourne, Australia
| | - Emma Morton
- Department of Psychiatry, University of British Colombia, Vancouver, Canada
| | | | - Simon Bradstreet
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Mathew Machin
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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8
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Young AS, Choi A, Cannedy S, Hoffmann L, Levine L, Liang LJ, Medich M, Oberman R, Olmos-Ochoa TT. Passive Mobile Self-tracking of Mental Health by Veterans With Serious Mental Illness: Protocol for a User-Centered Design and Prospective Cohort Study. JMIR Res Protoc 2022; 11:e39010. [PMID: 35930336 PMCID: PMC9391975 DOI: 10.2196/39010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Serious mental illnesses (SMI) are common, disabling, and challenging to treat, requiring years of monitoring and treatment adjustments. Stress or reduced medication adherence can lead to rapid worsening of symptoms and behaviors. Illness exacerbations and relapses generally occur with little or no clinician awareness in real time, leaving limited opportunity to modify treatments. Previous research suggests that passive mobile sensing may be beneficial for individuals with SMI by helping them monitor mental health status and behaviors, and quickly detect worsening mental health for prompt assessment and intervention. However, there is too little research on its feasibility and acceptability and the extent to which passive data can predict changes in behaviors or symptoms. OBJECTIVE The aim of this research is to study the feasibility, acceptability, and safety of passive mobile sensing for tracking behaviors and symptoms of patients in treatment for SMI, as well as developing analytics that use passive data to predict changes in behaviors and symptoms. METHODS A mobile app monitors and transmits passive mobile sensor and phone utilization data, which is used to track activity, sociability, and sleep in patients with SMI. The study consists of a user-centered design phase and a mobile sensing phase. In the design phase, focus groups, interviews, and usability testing inform further app development. In the mobile sensing phase, passive mobile sensing occurs with participants engaging in weekly assessments for 9 months. Three- and nine-month interviews study the perceptions of passive mobile sensing and ease of app use. Clinician interviews before and after the mobile sensing phase study the usefulness and feasibility of app utilization in clinical care. Predictive analytic models are built, trained, and selected, and make use of machine learning methods. Models use sensor and phone utilization data to predict behavioral changes and symptoms. RESULTS The study started in October 2020. It has received institutional review board approval. The user-centered design phase, consisting of focus groups, usability testing, and preintervention clinician interviews, was completed in June 2021. Recruitment and enrollment for the mobile sensing phase began in October 2021. CONCLUSIONS Findings may inform the development of passive sensing apps and self-tracking in patients with SMI, and integration into care to improve assessment, treatment, and patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05023252; https://clinicaltrials.gov/ct2/show/NCT05023252. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39010.
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Affiliation(s)
- Alexander S Young
- Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Veterans Integrated Service Network-22 Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Healthcare System, Department of Veterans Affairs, Los Angeles, CA, United States
| | - Abigail Choi
- Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shay Cannedy
- Veterans Integrated Service Network-22 Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Healthcare System, Department of Veterans Affairs, Los Angeles, CA, United States
| | - Lauren Hoffmann
- Veterans Integrated Service Network-22 Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Healthcare System, Department of Veterans Affairs, Los Angeles, CA, United States
| | - Lionel Levine
- Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, United States
| | - Li-Jung Liang
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Melissa Medich
- Veterans Integrated Service Network-22 Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Healthcare System, Department of Veterans Affairs, Los Angeles, CA, United States
| | - Rebecca Oberman
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles Veterans Healthcare Center, Department of Veterans Affairs, Los Angeles, CA, United States
| | - Tanya T Olmos-Ochoa
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles Veterans Healthcare Center, Department of Veterans Affairs, Los Angeles, CA, United States
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9
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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10
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Aucott L, Birchwood M, Briggs A, Bucci S, Cotton SM, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung AR, Farhall J, Gleeson J. The EMPOWER blended digital intervention for relapse prevention in schizophrenia: a feasibility cluster randomised controlled trial in Scotland and Australia. Lancet Psychiatry 2022; 9:477-486. [PMID: 35569503 DOI: 10.1016/s2215-0366(22)00103-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early warning signs monitoring by service users with schizophrenia has shown promise in preventing relapse but the quality of evidence is low. We aimed to establish the feasibility of undertaking a definitive randomised controlled trial to determine the effectiveness of a blended digital intervention for relapse prevention in schizophrenia. METHODS This multicentre, feasibility, cluster randomised controlled trial aimed to compare Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) with treatment as usual in community mental health services (CMHS) in Glasgow and Melbourne. CMHS were the unit of randomisation, selected on the basis of those that probably had five or more care coordinators willing to participate. Participants were eligible if they were older than 16 years, had a schizophrenia or related diagnosis confirmed via case records, were able to provide informed consent, had contact with CMHS, and had had a relapse within the previous 2 years. Participants were randomised within stratified clusters to EMPOWER or to continue their usual approach to care. EMPOWER blended a smartphone for active monitoring of early warning signs with peer support to promote self-management and clinical triage to promote access to relapse prevention. Main outcomes were feasibility, acceptability, usability, and safety, which was assessed through face-to-face interviews. App usage was assessed via the smartphone and self-report. Primary end point was 12 months. Participants, research assistants and other team members involved in delivering the intervention were not masked to treatment conditions. Assessment of relapse was done by an independent adjudication panel masked to randomisation group. The study is registered at ISRCTN (99559262). FINDINGS We identified and randomised eight CMHS (six in Glasgow and two in Melbourne) comprising 47 care coordinators. We recruited 86 service users between Jan 19 and Aug 8, 2018; 73 were randomised (42 [58%] to EMPOWER and 31 [42%] to treatment as usual). There were 37 (51%) men and 36 (49%) women. At 12 months, main outcomes were collected for 32 (76%) of service users in the EMPOWER group and 30 (97%) of service users in the treatment as usual group. Of those randomised to EMPOWER, 30 (71%) met our a priori criterion of more than 33% adherence to daily monitoring that assumed feasibility. Median time to discontinuation of these participants was 31·5 weeks (SD 14·5). There were 29 adverse events in the EMPOWER group and 25 adverse events in the treatment as usual group. There were 13 app-related adverse events, affecting 11 people, one of which was serious. Fear of relapse was lower in the EMPOWER group than in the treatment as usual group at 12 months (mean difference -7·53 (95% CI -14·45 to 0·60; Cohen's d -0·53). INTERPRETATION A trial of digital technology to monitor early warning signs blended with peer support and clinical triage to detect and prevent relapse appears to be feasible, safe, and acceptable. A further main trial is merited. FUNDING UK National Institute for Health Research Health Technology Assessment programme and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Andrew I Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Simon Bradstreet
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Maximillian Birchwood
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue M Cotton
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul French
- Department of Psychiatry, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- The Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Swaran P Singh
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Suresh Sundram
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Mental Health Program, Monash Health, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Chris Williams
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia; NorthWestern Mental Health, The Royal Melbourne Hospital, Epping, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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11
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Nuzum E, Hammoud R, Spencer T, Akande I, Tognin S. No rest for the weary: Prevalence, impact and nature of sleep problems among young people at risk of psychosis. Early Interv Psychiatry 2022; 16:651-658. [PMID: 34461672 DOI: 10.1111/eip.13210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/09/2021] [Accepted: 08/15/2021] [Indexed: 12/15/2022]
Abstract
AIMS Sleep problems are common in people with a psychosis-spectrum diagnosis and are associated with worse psychotic symptoms and lower quality of life. Sleep problems are also frequent in individuals at a clinical high risk for psychosis (CHR-P) however, less is known about the prevalence and association with symptoms in this population. This study investigates the prevalence of sleep problems within CHR-P individuals and the associations with attenuated positive symptoms, transition to psychosis, time to transition to psychosis and functioning. METHODS The clinical records interactive search (CRIS) tool was used to carry out a retrospective study of 795 CHR-P individuals. Sleep problems, subsequent psychotic diagnoses, attenuated positive symptoms and Health of The Nation Outcome Scale scores were extracted. Regression models were used to examine the association between sleep problems and clinical outcomes. RESULTS 59.5% of CHR-P individuals experienced sleep problems. Perceptual abnormality severity (OR = 1.24, 95% CI = 1.05-1.48) and frequency (OR = 1.31, 95% CI = 1.08-1.58) as measured by the Comprehensive Assessment of At-Risk Mental State interview, predicted sleep problems. Sleep problems were not associated with transition to psychosis; however, they were significantly associated with a shorter time to transition in individuals who developed psychosis (HR = 1.4, 95% CI = 1.05-1.88) and higher follow-up Health of the Nation Outcome Scale scores (MD = 2.26, 95% CI = 0.55-3.96). CONCLUSIONS The high prevalence of sleep problems, along with the association with positive symptoms and worse functioning, highlights the need for effective sleep interventions in this population. Further research is needed to better understand the relationship between sleep problems and transition to psychosis.
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Affiliation(s)
- Eleanor Nuzum
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ryan Hammoud
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tom Spencer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Isaac Akande
- Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
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12
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Soto-Martin M, Foff EP, Devanand DP. Relapse in Dementia-related Psychosis and Clinical Decisions. Alzheimer Dis Assoc Disord 2022; 36:180-184. [PMID: 35137699 PMCID: PMC9132239 DOI: 10.1097/wad.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
Patients with dementia can experience hallucinations and delusions because of their underlying neurodegenerative condition, a syndrome known as dementia-related psychosis. Dementia-related psychosis contributes to morbidity and mortality among patients with dementia and increases the burden on caregivers and the health care system. With no pharmacological treatment currently approved in the United States for this condition, patients are often treated off-label with antipsychotics. Though typical and atypical antipsychotics have demonstrated variable to modest efficacy in dementia-related psychosis, serious safety concerns arise with their use. Accordingly, clinical and Centers for Medicare & Medicaid Services guidelines recommend trying antipsychotics only when other therapies have failed and encourage treatment discontinuation of antipsychotics after 4 months to assess whether ongoing therapy is needed. Discontinuation of effective antipsychotic treatment, however, may increase the risk for relapse of symptoms and the associated morbidities that accompany relapse. A randomized medication withdrawal clinical trial design allows assessment of relapse risk after discontinuation and can provide initial information on longer-term safety of therapy for dementia-related psychosis. Given the substantial unmet need in this condition, new, well-tolerated therapies that offer acute and sustained reduction of symptoms while also preventing recurrence of symptoms of psychosis are critically needed.
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Affiliation(s)
- Maria Soto-Martin
- Alzheimer Clinical and Research Centre, Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Erin P. Foff
- Acadia Pharmaceuticals Inc., Princeton, NJ at the time this work was completed
| | - Davangere P. Devanand
- Departments of Psychiatry and Neurology, Columbia University Medical Center, New York, NY
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13
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Ybarra ML, Rodriguez KM, Fehmie DA, Mojtabai R, Cullen B. Acceptability of Texting 4 Relapse Prevention, Text Messaging-Based Relapse Prevention Program for People With Schizophrenia and Schizoaffective Disorder. J Nerv Ment Dis 2022; 210:123-128. [PMID: 34570061 PMCID: PMC10069806 DOI: 10.1097/nmd.0000000000001421] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT We report process outcomes of the pilot randomized controlled trial of Texting 4 Relapse Prevention (T4RP), a text messaging-based relapse prevention program for people with schizophrenia or schizoaffective disorder (SAD). Forty people were randomized to either the intervention or treatment as usual control group at a 2:1 ratio. Process indicators were collected at 6 months post enrollment.Over 90% of patients agreed or strongly agreed that the text messages were easy to understand, easy to answer, positive, and helped them feel supported. Patient acceptability was positively associated with recovery (β = 0.29, p = <0.001) and patient-provider communication scores (β = 1.04, p < 0.001), and negatively associated with symptoms of the disorder (β = -0.27, p = 0.07). Acceptability was similar by diagnosis (β, SAD diagnosis = 0.40, p = 0.90) and age (β = 0.05, p = 0.67). Findings suggest that a text messaging intervention aimed at preventing relapse is feasible and perceived as beneficial in individuals with schizophrenia and SAD. Future research might include a targeted study of T4RP within the context of hospital discharge when people with schizophrenia/SAD are at highest risk of relapse.
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Affiliation(s)
- Michele L. Ybarra
- Center for Innovative Public Health Research, 555 N El Camino Real A347, San Clemente, CA 92672 USA
| | - Katrina M. Rodriguez
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21287 USA
| | - Desiree A. Fehmie
- Center for Innovative Public Health Research, 555 N El Camino Real A347, San Clemente, CA 92672 USA
| | - Ramin Mojtabai
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21287 USA
| | - Bernadette Cullen
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21287 USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland, 21287 USA
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14
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Lee DY, Kim C, Lee S, Son SJ, Cho SM, Cho YH, Lim J, Park RW. Psychosis Relapse Prediction Leveraging Electronic Health Records Data and Natural Language Processing Enrichment Methods. Front Psychiatry 2022; 13:844442. [PMID: 35479497 PMCID: PMC9037331 DOI: 10.3389/fpsyt.2022.844442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Identifying patients at a high risk of psychosis relapse is crucial for early interventions. A relevant psychiatric clinical context is often recorded in clinical notes; however, the utilization of unstructured data remains limited. This study aimed to develop psychosis-relapse prediction models using various types of clinical notes and structured data. METHODS Clinical data were extracted from the electronic health records of the Ajou University Medical Center in South Korea. The study population included patients with psychotic disorders, and outcome was psychosis relapse within 1 year. Using only structured data, we developed an initial prediction model, then three natural language processing (NLP)-enriched models using three types of clinical notes (psychological tests, admission notes, and initial nursing assessment) and one complete model. Latent Dirichlet Allocation was used to cluster the clinical context into similar topics. All models applied the least absolute shrinkage and selection operator logistic regression algorithm. We also performed an external validation using another hospital database. RESULTS A total of 330 patients were included, and 62 (18.8%) experienced psychosis relapse. Six predictors were used in the initial model and 10 additional topics from Latent Dirichlet Allocation processing were added in the enriched models. The model derived from all notes showed the highest value of the area under the receiver operating characteristic (AUROC = 0.946) in the internal validation, followed by models based on the psychological test notes, admission notes, initial nursing assessments, and structured data only (0.902, 0.855, 0.798, and 0.784, respectively). The external validation was performed using only the initial nursing assessment note, and the AUROC was 0.616. CONCLUSIONS We developed prediction models for psychosis relapse using the NLP-enrichment method. Models using clinical notes were more effective than models using only structured data, suggesting the importance of unstructured data in psychosis prediction.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Seongwon Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.,Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Sun-Mi Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Yong Hyuk Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Jaegyun Lim
- Department of Laboratory Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.,Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
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15
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Hui CLM, Lam BST, Wong AKH, Tao TJ, Ho ECN, Suen YN, Lee EHM, Chan SKW, Chang WC, Chong CSY, Siu CMW, Lo WTL, Chen EYH. ReMind, a smartphone application for psychotic relapse prediction: A longitudinal study protocol. Early Interv Psychiatry 2021; 15:1659-1666. [PMID: 33369162 DOI: 10.1111/eip.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/29/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychotic disorders are associated with a high rate of relapse. In addition to medication non-adherence, some psychosocial factors have been found to be predictive of relapse (e.g., poor premorbid adjustment, high expressed emotion and substance misuse). Impairments in cognitive functions including general memory functioning, set shifting, attention, processing speed and working memory have also been indicative of a subsequent psychotic episode. As clinical appointments do not always allow for timely or accurate detection of these early warning signs, the ReMind app is developed to explore potential relapse predictors and enhance the process of relapse monitoring. AIM The ReMind app aims (1) to assess whether verbal or visual working memory predicts psychotic relapse in 1 year and (2) to determine whether social factors such as stressful life events, level of expressed emotion and medication adherence also predict relapse in 1 year. METHODS This is a one-year prospective follow-up study involving 176 remitted patients diagnosed with schizophrenia or non-affective psychoses. Monthly relapse predictor assessments will be conducted via ReMind throughout the one-year study duration. These assessments include neurocognitive tasks and psychosocial questionnaires. RESULTS Recruitment began in August 2017 and is still ongoing. Preliminary user feedback suggested an overall positive experience with the app. CONCLUSION The ReMind app presents a step forward to the identification and sensitive detection of reliable psychosis relapse predictors. With its anticipated success, it may offer an alternative means of monitoring relapse for the Chinese-speaking population in the future.
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Affiliation(s)
| | | | | | | | | | - Yi-Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | - Sherry Kit-Wa Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Wing-Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | | | | | | | - Eric Yu-Hai 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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16
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da Silva AHS, de Freitas LA, Shuhama R, Del-Ben CM, Vedana KGG, Martin IDS, Zanetti ACG. Family environment and depressive episode are associated with relapse after first-episode psychosis. J Psychiatr Ment Health Nurs 2021; 28:1065-1078. [PMID: 33544947 DOI: 10.1111/jpm.12735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Relapse rates are high among patients who have experienced first-episode psychosis (FEP). Psychotic relapses are associated with worse quality of life and poorer functionality of the FEP patient. The use of psychoactive substances, non-adherence to drug treatment, and high expressed emotion (EE) are notable predictors of relapse after the FEP. Although some studies have suggested that psychotic relapse may be associated with a family environment with high levels of emotional over-involvement (EOI), this finding is still inconsistent across different cultures. EE specific components must be evaluated and interpreted according to the context of cultural norms. There is a scarcity of studies on the role of depression in the occurrence of relapses after the FEP, and the results remain uncertain. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study explored the predictors of psychotic relapses in Brazilian patients who experienced FEP. Our results indicate that 29.2% of the patients relapsed after the FEP. Patients diagnosed with depression and high-EOI in the family environment were predictors of psychotic relapses in this population. This study expands knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nursing professionals must consider the implications of the family environment and depression in the course of psychosis. Family interventions and the appropriate treatment of depression are important for improving the prognosis of FEP patients. ABSTRACT: Introduction Psychotic relapse may be associated with relatives' high emotional over-involvement (EOI) and with a diagnosis of major depressive episode (MDE) among first-episode psychosis (FEP) patients, but the results are still inconsistent across different cultures. Aim Evaluate the predictors of relapse in FEP patients. Method Prospective cohort study with 6-month follow-up conducted with 65 dyads of patients and relatives from an early intervention unit in Brazil. At the baseline interview, relatives answered to a sociodemographic data form and to the Family Questionnaire. Patients provided sociodemographic and clinical data and answered the Measurement of Treatment Adherence; the Alcohol, Smoking and Substance Involvement Screening Test; the Severity of Dependence Scale to assess cannabis dependence, and the MDE module of the Mini-International Neuropsychiatric Interview. Psychotic relapses were evaluated using items from the Brief Psychiatric Rating Scale. The data were analysed using multiple logistic regression. Results 29.2% of the patients presented at least one psychotic relapse. High-EOI and MDE were predictors of psychotic relapses. Discussion Our findings expand the knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. Implications for practice Family nursing interventions and the appropriate treatment of MDE must be considered in the care of FEP patients.
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Affiliation(s)
- Amanda Heloisa Santana da Silva
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Larissa Amorim de Freitas
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Rosana Shuhama
- Division of Psychiatry, Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Kelly Graziani Giacchero Vedana
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Isabela Dos Santos Martin
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
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The impact of patient-controlled hospital admissions among patients with severe mental disorders on health care cost: A nationwide register-based cohort study using quasi-experimental design. J Psychiatr Res 2021; 144:331-337. [PMID: 34737122 DOI: 10.1016/j.jpsychires.2021.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
To assess whether patient-controlled admissions (PCA) to psychiatric hospital wards have an effect on total health care costs in the short term and longer term compared with patients receiving treatment as usual (TAU). Based on Danish register data and using coarsened exact matching, patients who signed a contract for PCA during 2013-2016 were matched on observables with a control group of TAU patients identified from psychiatric registers. As primary outcome patients' expenditure was explored in 6-monthly intervals over the first 12 months, and as secondary outcome over the 12-24 month period after index month. To control for unobservable selection a quasi-experimental difference-in-difference design was applied on the matched population using the principle of intention to treat. 414 PCA patients (out of 423 available) were successfully matched with 7181 never exposed TAU patients (out of 67,331 available). Total healthcare costs for PCA patients were €8887 (95% CI 708-17,067) higher per month than unexposed TAU patients in the first six months after index. Monthly psychiatric costs were €8922 (95% CI 708-17,067) higher for PCA patients than for TAU patients. These differences persisted, in the next three six-monthly periods, albeit were not statistically significant, in the second six-monthly period after index. In conclusion, driven by the psychiatric costs, implementing PCA increased the total healthcare costs in the short term compared with TAU. More research of the impact on health care costs in a broader and long-term perspective is still needed.
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Measuring the effectiveness of psychoeducation on adherence, depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractDespite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.
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A Prospective Study for Prediction of Psychotic Relapse Using the Korean Early Signs Scale in Patients With Schizophrenia. J Clin Psychopharmacol 2021; 40:451-456. [PMID: 32701904 DOI: 10.1097/jcp.0000000000001263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A psychotic relapse of schizophrenia is commonly preceded by nonpsychotic behavioral symptoms and signs, and detection of these early signs may enable prevention of relapse of schizophrenia. This study aimed to test the predictive validity of a Korean version of Early Signs Scale (K-ESS) for psychotic relapse for detecting the early signs. MATERIALS AND METHODS In this multicenter noninterventional 52-week prospective study, outpatients diagnosed as having schizophrenia within 5 years were recruited. The K-ESS and Clinical Global Impression-Severity (CGI-S) scale were administered monthly until the end of the study or the relapse. The primary objective was to determine an optimal cutoff point of K-ESS score for prediction of psychotic relapse. The secondary objective was to assess the concurrent validity of the K-ESS using CGI-S scale. RESULTS Among the 162 included patients, 14 (8.6%) relapsed during the 52-week study period. The optimal cutoff score of K-ESS was 15 with a sensitivity of 71.43% and a specificity of 52.70%, indicating poor predictive accuracy of K-ESS. A lower cutoff K-ESS score of 3 and a higher cutoff score of 28 were found in the subgroups with milder (CGI-S = 1-2) and severer (CGI-S = 3-4) symptom severity, respectively, with fair to good predictive accuracy. The K-ESS showed acceptable concurrent validity with CGI-S and concordance rate between self-rated and informant-rated scores. DISCUSSION The predictive accuracy of K-ESS was limited by evaluation interval of a month. At least fortnightly follow-up would be needed for detection of early signs to prevent a psychotic relapse in schizophrenia.
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Sired R, Griffith E, Jamalamadaka T, Salkovskis P. Negative interpretations of ambiguous 'psychosis-like' and 'anxiety-like' experiences in recovery from psychosis or anxiety. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:463-485. [PMID: 33982800 DOI: 10.1111/bjc.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Fear of relapse (FOR) after experiencing psychosis has been found to predict actual relapse; however, potential mechanisms underlying this relationship have not been investigated. Negative appraisals of 'prodromal symptoms' are believed to play an important role in both psychosis and mental health anxiety (MHA). This study aimed to explore whether people in recovery from psychosis or anxiety disorders show an enduring tendency to negatively interpret ambiguous experiences both related and less related to their previous mental health difficulty relative to controls. DESIGN Cross-sectional between-groups questionnaire design. METHODS Participants self-reported as in recovery from psychosis (n = 33) or anxiety (n = 77) or without previous experience of mental health problems (n = 61) were recruited online or via NHS services. Interpretations of psychosis-like, anxiety-like, and external-control experiences were measured using the newly developed Experiences Interpretation Questionnaire (EIQ). MHA and FOR were measured using self-report questionnaires. RESULTS People in recovery from psychosis interpreted psychosis-like experiences significantly more negatively than the other groups. Negative interpretations of anxiety-like experiences were greater than controls but comparable between mental health groups. Contrary to predictions, FOR was not significantly different between the mental health groups. MHA and FOR did not significantly predict negative interpretations of psychosis-like items in the psychosis group, however, MHA predicted negative interpretations of anxiety-like items in the anxiety group. The EIQ subscales demonstrated good test-retest reliability. CONCLUSIONS People in self-defined recovery from psychosis or anxiety are more likely to negatively interpret ambiguous experiences relating to their previous mental health difficulties. Clinical and future research implications are outlined. PRACTITIONER POINTS People in recovery from psychosis or anxiety appraise possible symptoms of their previous difficulties negatively/catastrophically (as indicating relapse) relative to those without prior MH problems. Clinicians should consider attending to how people in recovery appraise possible symptoms when encouraging early signs monitoring as part of relapse prevention. This may be important to ensure that self-monitoring leads to helpful responses rather than being counterproductive, with catastrophic interpretations leading to anxiety and thus increasing the risk of relapse. Interventions drawing on CBT principles to address catastrophic interpretations of possible symptoms may potentially be a useful addition to relapse prevention work; in psychosis this may also include symptoms of anxiety.
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Affiliation(s)
- Rebecca Sired
- Avon and Wiltshire Partnership NHS Mental Health Trust, UK.,Department of Psychology, University of Bath, UK
| | - Emma Griffith
- Avon and Wiltshire Partnership NHS Mental Health Trust, UK.,Department of Psychology, University of Bath, UK
| | | | - Paul Salkovskis
- Department of Experimental Psychology, The Oxford Centre for Psychological Health, The Oxford Institute of Clinical Psychology, University of Oxford, Salisbury, UK
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Gao J, Wei Q, Pan R, Yi W, Xu Z, Duan J, Tang C, He Y, Liu X, Song S, Su H. Elevated environmental PM 2.5 increases risk of schizophrenia relapse: Mediation of inflammatory cytokines. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 753:142008. [PMID: 32892002 DOI: 10.1016/j.scitotenv.2020.142008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ecological epidemiology suggests that hospital admissions for schizophrenia are associated with an increased environmental PM2.5, but no prospective study has verified this result, and the physiological mechanism is not clear. METHODS We used a repeated-measures design to prospectively assess the association of environmental PM2.5 and the risk of relapse in schizophrenia, and used two linear mixed-effects models to explore possible mediating effects of immune cytokines on the premise of controlling confounders. RESULTS We import the data using EpiData software, and collate and analyze of the data using R software. The increase of PM2.5 at lag0 had the greatest impact on the relapse of schizophrenia (for each 10 μg/m3 increase in PM2.5, the relapse risk score increased by 1.504, that is to say, odds ratio (OR) = 4.500 (95% confidence interval (CI): 2.849-7.106,P < 0.001)), and cumulative effects lasted for four days with the maximum at the second day (for each 10 μg/m3 increase in PM2.5, the relapse risk score increased by 1.301, OR = 3.673 (95%CI: 1.962-6.876,P < 0.001)). PM2.5 exposure was statistically related to four symptom dimensions of early signs scale (ESS), and the symptoms most affected by the increased PM2.5 were depression/withdrawal (ESSN) (OR = 1.990, 95%CI: 1.701-2.328), anxiety/agitation (ESS-A) (OR = 1.537, 95%CI: 1.340-1.763), initial psychosis (ESS-IP) (OR = 1.398, 95%CI: 1.151-1.697), and disinhibition (ESS-D) (OR = 1.235, 95%CI: 1.133-1.347). Furthermore, there are three statistically significant pathways in intermediary analysis: of PM2.5 and relapse risk: "PM2.5 → IL-17 → ESS", "PM2.5 → IL-17 → ESS-A", and "PM2.5 → IL-17 → ESS-N", and the intermediary ratio of IL-17 was 11.66%, 16.37% and 22.55%, respectively. CONCLUSIONS Increased environmental PM2.5 is a risk factor for the relapse of schizophrenia. Early relapse identification and intervention based on clinical characteristics are of great significance for timely termination of relapse and slowing down of relapse.
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Affiliation(s)
- Jiaojiao Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Zihan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Jun Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Chao Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Yangyang He
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Xiangguo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Shasha Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China.
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Parmigiani G, Mandarelli G, Tarsitani L, Roselli V, Gaviano I, Buscajoni A, Biondi M, Girardi P, Ferracuti S. Perceived Stress and Life Events in Patients Affected by Schizophrenia and Schizoaffective and Bipolar Disorder: Is There a Role for Self-Reported Basic Symptoms? Psychopathology 2021; 54:136-143. [PMID: 33910198 DOI: 10.1159/000514926] [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: 03/10/2020] [Accepted: 01/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The stress-diathesis model of psychotic disorders describes, in vulnerable individuals, the role of psychosocial stress in the onset and exacerbation of psychotic symptoms. Another interesting approach to the study of vulnerability in the development of psychosis is represented by the basic symptoms concept. OBJECTIVE The present study aims at proposing an integration between these two models and investigating possible associations between psychotic symptoms, basic symptoms, perceived stress, and life events in a sample of patients affected by schizophrenia (SZ), schizoaffective (SA), and bipolar disorder with and without psychotic symptoms. METHODS 112 patients were recruited in two university hospitals. Severity of psychiatric symptoms (Positive and Negative Syndrome Scale, PANSS), basic symptoms (Frankfurt Complaint Questionnaire, FCQ), perceived stress (Stress-related Vulnerability Scale, SVS), and life events (Paykel's interview for recent life events) were assessed. RESULTS Patients affected by bipolar disorder (both with and without psychotic symptoms) showed a higher number of independent life events (p < 0.01) and tended to report more frequently at least 1 life event in the previous 6 months (p < 0.01) than patients affected by SZ or SA disorder. No differences emerged between the study groups in perceived stress nor in measures of basic symptoms. In the whole sample, a logistic regression analysis showed that the SVS total score (p < 0.05) and PANSS total score (p < 0.001) were associated with the presence of psychotic symptoms. CONCLUSIONS In the study sample, life events and basic symptoms did not play a major role in influencing psychotic symptoms, compared to the subjective perception of stress and the severity of psychopathology. Taken together, these results can be informative for rehabilitation therapies aimed at enhancing resilience and coping strategies in this vulnerable group of patients.
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Affiliation(s)
- Giovanna Parmigiani
- Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "Sapienza", Rome, Italy
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
| | - Valentina Roselli
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
| | - Ilaria Gaviano
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
| | - Andrea Buscajoni
- Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "Sapienza", Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "Sapienza", Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
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Drożdżowicz A. Increasing the Role of Phenomenology in Psychiatric Diagnosis-The Clinical Staging Approach. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2020; 45:683-702. [PMID: 33094808 PMCID: PMC7703742 DOI: 10.1093/jmp/jhaa022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits.
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Moncrieff J, Crellin NE, Long MA, Cooper RE, Stockmann T. Definitions of relapse in trials comparing antipsychotic maintenance with discontinuation or reduction for schizophrenia spectrum disorders: A systematic review. Schizophr Res 2020; 225:47-54. [PMID: 31604607 DOI: 10.1016/j.schres.2019.08.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/28/2019] [Accepted: 08/31/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Avoidance of relapse is the main aim of long-term antipsychotic treatment in schizophrenia, yet how 'relapse' is defined in trials is not well-known. METHODS We conducted a systematic review of definitions of relapse in trials of continuous antipsychotic treatment compared with discontinuation, intermittent treatment or dose reduction for people with schizophrenia spectrum disorders. Trials were identified from previous Cochrane reviews and a new search. The quality of relapse definitions was rated in terms of reliability and clinical relevance and associations between quality of definitions and trial characteristics and outcome were explored. RESULTS We identified 82 reports of 81 trials which employed 54 different definitions of relapse. There were 33 definitions in the 35 trials published since 1990, with recent trials employing complex definitions often involving alternative criteria. Only ten primary definitions of relapse required the presence of psychotic symptoms in all cases, and only three specified this in combination with a measure of overall severity or functional decline. Only two definitions specified a duration longer than two days. Relapse definitions were rated as showing good reliability in 37 trials, but only seven showed good clinical relevance. Six trials with definitions that were both reliable and clinically relevant were slightly longer, but did not differ from remaining trials in other characteristics or overall or relative risk of relapse. CONCLUSIONS Antipsychotic trials define relapse in numerous different ways, and few definitions consistently reflect suggested indications of a clinically significant relapse.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, Gower Street, London WC1E 6BT, UK.
| | - Nadia E Crellin
- Division of Psychiatry, University College London, Gower Street, London WC1E 6BT, UK
| | - Maria A Long
- Division of Psychiatry, University College London, Gower Street, London WC1E 6BT, UK
| | - Ruth E Cooper
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, London E13 8SP, UK
| | - Tom Stockmann
- Division of Psychiatry, University College London, Gower Street, London WC1E 6BT, UK
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Cullen BA, Rodriguez K, Eaton WW, Mojtabai R, Von Mach T, Ybarra ML. Clinical outcomes from the texting for relapse prevention (T4RP) in schizophrenia and schizoaffective disorder study. Psychiatry Res 2020; 292:113346. [PMID: 32750572 PMCID: PMC7530047 DOI: 10.1016/j.psychres.2020.113346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
This 6 month randomized control trial investigated whether a novel text-messaging program impacted targeted clinical outcomes in patients with schizophrenia and schizoaffective disorder (SAD). Forty patients were enrolled and completed baseline, 3-month and 6-month assessments. The intervention group received daily symptom check-in text messages, plus, a medication reminder or, inspirational quote text. The control group had treatment as usual. At 6 months the Positive and Negative Syndrome Scale mean positive score was significantly lower and injectable medication compliance was significantly higher in the intervention group. Recovery scores were significantly higher at 3 months. Results suggest that this program may benefit individuals with schizophrenia/SAD who use text messaging. Further investigation in a larger sample appears warranted.
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Affiliation(s)
- Bernadette A Cullen
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Katrina Rodriguez
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William W Eaton
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tara Von Mach
- Ann & Robert H. Lurie Children's Hospital of Chicago, USA
| | - Michele L Ybarra
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Center for Innovative Public Health Research, San Clemente, California, USA
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Gumley A, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Beattie L, Bell I, Birchwood M, Briggs A, Bucci S, Castagnini E, Clark A, Cotton SM, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, Matrunola C, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Smith L, Sundram S, Thomson D, Thompson A, Whitehill H, Wilson-Kay A, Williams C, Yung A, Farhall J, Gleeson J. Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technology Blended With Peer Support. JMIR Res Protoc 2020; 9:e15058. [PMID: 31917372 PMCID: PMC6996736 DOI: 10.2196/15058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
Background Relapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. Objective This study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. Methods We will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. Results Recruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. Conclusions The knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, sample size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 99559262; http://isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID) DERR1-10.2196/15058
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Affiliation(s)
- Andrew Gumley
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Simon Bradstreet
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - John Ainsworth
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Stephanie Allan
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Louise Beattie
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Imogen Bell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Max Birchwood
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Emily Castagnini
- La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne, Australia
| | - Andrea Clark
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Research Scotland Mental Health Network, Glasgow, United Kingdom
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | | | - Paul French
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
| | - Shon Lewis
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Machin
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Claire Matrunola
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Research Scotland Mental Health Network, Glasgow, United Kingdom
| | - Hamish McLeod
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Nicola McMeekin
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Emma Morton
- Australian Catholic University, Melbourne, Australia
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frank Reilly
- Scottish Recovery Network, Glasgow, United Kingdom
| | - Matthias Schwannauer
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Swaran P Singh
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Lesley Smith
- Scottish Recovery Network, Glasgow, United Kingdom
| | | | - David Thomson
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Helen Whitehill
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,Scottish Recovery Network, Glasgow, United Kingdom
| | - Alison Wilson-Kay
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Christopher Williams
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Farhall
- La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne, Australia
| | - John Gleeson
- Australian Catholic University, Melbourne, Australia
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Shimomura Y, Kikuchi Y, Suzuki T, Uchida H, Mimura M, Takeuchi H. Antipsychotic treatment in the maintenance phase of schizophrenia: An updated systematic review of the guidelines and algorithms. Schizophr Res 2020; 215:8-16. [PMID: 31784340 DOI: 10.1016/j.schres.2019.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/14/2019] [Accepted: 09/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND We updated our previous systematic review regarding clinical guidelines and algorithms on antipsychotic treatment in the maintenance phase of schizophrenia (doi: 10.1016/j.schres.2011.11.021) to incorporate and synthesize more recent findings to guide clinical practice. METHODS We conducted a systematic literature search to identify clinical guidelines and algorithms describing antipsychotic treatment in the maintenance phase of schizophrenia using MEDLINE and Embase. We assessed overall quality of the guidelines/algorithms according to the AGREE II instrument and extracted information on treatment recommendations. RESULTS We identified 20 guidelines/algorithms from various regions, including 11 updated or newly launched ones after the previous systematic review in 2012. All of the guidelines/algorithms satisfied a certain level of quality. Where mentioned, endorsements were sorted into "recommended", "partially recommended", or "not recommended". As for antipsychotic discontinuation strategy, a majority of guidelines/algorithms that mentioned this strategy did not recommend it for multiple-episode schizophrenia (N = 5/6). On the other hand, the guidelines/algorithms tended to shift from "not recommended" to "partially recommended" both for schizophrenia in general (N = 7/13, N = 7/8 for those published after 2013) and first-episode schizophrenia (N = 10/11, N = 7/7 for those published after 2013) regarding this strategy. All guidelines/algorithms (N = 9/9) converged to discourage antipsychotic intermittent/targeted strategy. Similar to antipsychotic discontinuation strategy, all of the updated or new guidelines/algorithms (N = 6/6) endorsed antipsychotic dose reduction/lower dose strategy. CONCLUSION Recent clinical guidelines and algorithms on antipsychotic maintenance treatment in schizophrenia shifted more toward a possibility of antipsychotic discontinuation and dose reduction/lower dose strategies. Nonetheless, clinicians need to contemplate on the risk-benefit balance of these strategies for individual patients.
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Affiliation(s)
- Yutaro Shimomura
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Yuhei Kikuchi
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Takefumi Suzuki
- University of Yamanashi Faculty of Medicine, Department of Neuropsychiatry, Yamanashi, Japan
| | - Hiroyuki Uchida
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan; Centre for Addiction and Mental Health, Geriatric Mental Health Program, Toronto, Ontario, Canada
| | - Masaru Mimura
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Hiroyoshi Takeuchi
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan; Centre for Addiction and Mental Health, Schizophrenia Program, Toronto, Ontario, Canada.
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28
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Predicting relapse with residual symptoms in schizophrenia: A secondary analysis of the PROACTIVE trial. Schizophr Res 2020; 215:173-180. [PMID: 31672387 DOI: 10.1016/j.schres.2019.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Little attention has been paid to the contribution of individual residual symptom to predict relapse in patients with schizophrenia receiving oral or long-acting injectable (LAI) antipsychotics. METHOD We used the data from the Preventing Relapse on Oral Antipsychotics Compared to Injectables - Evaluating Efficacy (PROACTIVE) study, in which 305 outpatients with schizophrenia were randomly allocated to either biweekly LAI-risperidone (LAI-R) or daily oral second-generation antipsychotics (SGA) and assessed for up to 30 months. Baseline individual symptoms that could predict subsequent relapse were identified, using a Cox proportional hazards model. Moreover, among those who relapsed during the study (n = 73), individual symptoms were compared between baseline and biweekly ratings 8 to 2 weeks before relapse, using the linear mixed model. RESULTS A greater score in grandiosity at baseline was significantly associated with subsequent relapse (adjusted HR = 1.24, p = 0.006). When the two treatment groups were separately analyzed, more severe grandiosity (adjusted HR = 1.43, p = 0.003) and less severe hallucinatory behavior (adjusted HR = 0.70, p = 0.013) at baseline were significantly associated with relapse in the oral SGA group, but none was identified in the LAI-R group. Emotional withdrawal was significantly worse 8 and 2 weeks before relapse compared to the baseline (p = 0.032 and p = 0.043, respectively). DISCUSSION More severe grandiosity and less hallucination may have led to more frequent relapses in patients with schizophrenia receiving oral antipsychotics, which was not a case in those receiving LAI-R. The exploratory analysis indicates an increase in emotional withdrawal before relapse may be a useful marker for earlier interventions to possibly avert relapse.
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29
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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30
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Mi WF, Chen XM, Fan TT, Tabarak S, Xiao JB, Cao YZ, Li XY, Bao YP, Han Y, Li LZ, Shi Y, Guo LH, Wang XZ, Liu YQ, Wang ZM, Chen JX, Wu FC, Ma WB, Li HF, Xiao WD, Liu FH, Xie W, Zhang HY, Lu L. Identifying Modifiable Risk Factors for Relapse in Patients With Schizophrenia in China. Front Psychiatry 2020; 11:574763. [PMID: 33061925 PMCID: PMC7518216 DOI: 10.3389/fpsyt.2020.574763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preventing relapse of schizophrenic patients is really a challenge. The present study sought to provide more explicit evidence and factors of different grades and weights by a series of step-by-step analysis through χ2 test, logistic regression analysis and decision-tree model. The results of this study may contribute to controlling relapse of schizophrenic patients. METHODS A total of 1,487 schizophrenia patients were included who were 18-65 years of age and discharged from 10 hospitals in China from January 2009 to August 2009 and from September 2011 to February 2012 with improvements or recovery of treatment effect. We used a questionnaire to collect information about relapse and correlative factors during one year after discharge by medical record collection and telephone interview. The χ2 test and logistic regression analysis were used to identify risk factors and high-risk factors firstly, and then a decision-tree model was used to find predictive factors. RESULTS The χ2 test found nine risk factors which were associated with relapse. Logistic regression analysis also showed four high-risk factors further (medication adherence, occupational status, ability of daily living, payment method of medical costs). At last, a decision-tree model revealed four predictors of relapse; it showed that medication adherence was the first grade and the most powerful predictor of relapse (relapse rate for adherence vs. nonadherence: 22.9 vs. 55.7%, χ2 = 116.36, p < 0.001). The second grade factor was occupational status (employment vs. unemployment: 19.7 vs. 42.7%, χ2 = 17.72, p < 0.001); the third grade factors were ability of daily living (normal vs. difficult: 28.4 vs. 54.3%, χ2 = 8.61, p = 0.010) and household income (household income ≥ 3000 RMB vs. <3000 RMB: 28.6 vs. 42.4%, χ2 = 6.30, p = 0.036). The overall positive predictive value (PPV) of the logistic regression was 0.740, and the decision-tree model was 0.726. Both models were reliable. CONCLUSIONS For schizophrenic patients discharged from hospital, who had good medication adherence, more higher household income, be employed and normal ability of daily living, would be less likely to relapse. Decision tree provides a new path for doctors to find the schizophrenic inpatient's relapse risk and give them reasonable treatment suggestions after discharge.
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Affiliation(s)
- Wei-Feng Mi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao-Min Chen
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei, China
| | - Teng-Teng Fan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Serik Tabarak
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jing-Bo Xiao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yong-Zhi Cao
- Key Laboratory of High Confidence Software Technologies (MOE), Department of Computer Science and Technology, Peking University, Beijing, China
| | - Xiao-Yu Li
- Key Laboratory of High Confidence Software Technologies (MOE), Department of Computer Science and Technology, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Ling-Zhi Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ying Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Li-Hua Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao-Zhi Wang
- Department of Psychiatry, The Fourth People's Hospital of Dalian Jinzhou District, Dalian, China
| | - Yong-Qiao Liu
- Department of Psychiatry, The Sixth People's Hospital of Hebei Province, Baoding, China
| | - Zhan-Min Wang
- Department of Psychiatry, Rongjun Hospital of Hebei Province, Baoding, China
| | - Jing-Xu Chen
- Department of Psychiatry, Beijing HuiLongGuan Hospital, Beijing, China
| | - Feng-Chun Wu
- Department of Psychiatry, Guangzhou Psychiatric Hospital, Guangzhou, China
| | - Wen-Bin Ma
- Department of Psychiatry, Jinzhou Kangning Hospital, Jinzhou, China
| | - Hua-Fang Li
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai, China
| | - Wei-Dong Xiao
- Department of Psychiatry, The People's Hospital of Hubei Province, Wuhan, China
| | - Fei-Hu Liu
- Department of Psychiatry, The Mental Health Center of Xi'an, Xi'an, China
| | - Wen Xie
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei, China
| | - Hong-Yan Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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31
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Allan S, Bradstreet S, McLeod HJ, Gleeson J, Farhall J, Lambrou M, Clark A, Gumley AI. Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation. BJPsych Open 2019; 6:e3. [PMID: 31826793 PMCID: PMC7001464 DOI: 10.1192/bjo.2019.88] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context. AIMS To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients. METHOD Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory. RESULTS All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking. CONCLUSIONS Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.
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Affiliation(s)
- Stephanie Allan
- Student, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Simon Bradstreet
- Trial Manager, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Hamish J McLeod
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - John Gleeson
- Professor, Australian Catholic University, Australia
| | - John Farhall
- Associate Professor, La Trobe University, Australia
| | - Maria Lambrou
- Research Assistant, Australian Catholic University, Australia
| | - Andrea Clark
- Research Assistant, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
| | - Andrew I Gumley
- Professor, Glasgow Institute of Health and Wellbeing, University of Glasgow, UK
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32
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Allan S, Mcleod H, Bradstreet S, Beedie S, Moir B, Gleeson J, Farhall J, Morton E, Gumley A. Understanding Implementation of a Digital Self-Monitoring Intervention for Relapse Prevention in Psychosis: Protocol for a Mixed Method Process Evaluation. JMIR Res Protoc 2019; 8:e15634. [PMID: 31821154 PMCID: PMC6930509 DOI: 10.2196/15634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background Relapse is common in people who experience psychosis and is associated with many negative consequences, both societal and personal. People who relapse often exhibit changes (early warning signs [EWS]) in the period before relapse. Successful identification of EWS offers an opportunity for relapse prevention. However, several known barriers impede the use of EWS monitoring approaches. Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) is a complex digital intervention that uses a mobile app to enhance the detection and management of self-reported changes in well-being. This is currently being tested in a pilot cluster randomized controlled trial. As digital interventions have not been widely used in relapse prevention, little is known about their implementation. Process evaluation studies run in parallel to clinical trials can provide valuable data on intervention feasibility. Objective This study aims to transparently describe the protocol for the process evaluation element of the EMPOWER trial. We will focus on the development of a process evaluation framework sensitive to the worldview of service users, mental health staff, and carers; the aims of the process evaluation itself; the proposed studies to address these aims; and a plan for integration of results from separate process evaluation studies into one overall report. Methods The overall process evaluation will utilize mixed methods across 6 substudies. Among them, 4 will use qualitative methodologies, 1 will use a mixed methods approach, and 1 will use quantitative methodologies. Results The results of all studies will be triangulated into an overall analysis and interpretation of key implementation lessons. EMPOWER was funded in 2016, recruitment finished in January 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in December 2019. Conclusions The findings from this study will help identify implementation facilitators and barriers to EMPOWER. These insights will inform both upscaling decisions and optimization of a definitive trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID) DERR1-10.2196/15634
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Affiliation(s)
- Stephanie Allan
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sara Beedie
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Bethany Moir
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Emma Morton
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrew Gumley
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Allan S, Bradstreet S, Mcleod H, Farhall J, Lambrou M, Gleeson J, Clark A, Gumley A. Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study. J Med Internet Res 2019; 21:e14366. [PMID: 31651400 PMCID: PMC6838692 DOI: 10.2196/14366] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation—both within trials and beyond. Objective Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262
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Affiliation(s)
- Stephanie Allan
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Maria Lambrou
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrea Clark
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Gumley
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Developing Texting for Relapse Prevention: A Scalable mHealth Program for People With Schizophrenia and Schizoaffective Disorder. J Nerv Ment Dis 2019; 207:854-862. [PMID: 31503175 PMCID: PMC7189625 DOI: 10.1097/nmd.0000000000001037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Symptom relapse in people with schizophrenia and schizoaffective disorder is common and has a negative impact on the course of illness. Here, we describe the development of Texting for Relapse Prevention, a scalable, cost-effective text messaging relapse prevention program that queries patients' "early warning signs" daily. Results of development focus groups and content advisory teams with 25 patients and 19 providers suggest that patients were enthusiastic about the program and thought that receiving daily messages about their symptoms would help them feel supported. Providers also were positive about the idea but worried that the program might interfere with patient-provider communication if patients thought that the messages were coming from providers. Patients found the content positive and actionable. The program was improved to address this feedback. This iterative development process that included multiple stakeholders ensured that the program is feasible and acceptable to both patients and providers.
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Taylor M, Jauhar S. Are we getting any better at staying better? The long view on relapse and recovery in first episode nonaffective psychosis and schizophrenia. Ther Adv Psychopharmacol 2019; 9:2045125319870033. [PMID: 31523418 PMCID: PMC6732843 DOI: 10.1177/2045125319870033] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/22/2019] [Indexed: 12/27/2022] Open
Abstract
Relapse in, and recovery from, schizophrenia has been acknowledged since the disease was first described. In this review the authors summarize the long-term (>100 years) data on relapse and recovery in schizophrenia by reviewing the extant older and modern relevant literature. The authors systematically question the utility of pharmacological and nonpharmacological interventions, with an emphasis on first episode nonaffective psychosis. The method used is a narrative review of earlier meta-analytic and systematic reviews. Antipsychotic medication discontinuation studies suggest a role for prophylactic maintenance treatment in the majority of people with schizophrenia, despite recent debate on this subject. The authors conclude that long-term outcomes, including relapse and recovery rates, have improved in the last 100 years, though prospectively identifying those people who do not require long-term antipsychotic treatment has not yet been possible. Data also suggests that interventions and outcomes during the first 5 years of the disease can influence the long-term schizophrenia trajectory.
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Affiliation(s)
- Mark Taylor
- Brisbane, and University of Queensland, 54
Jephson Street, Toowong, Queensland, 4066, Australia
| | - Sameer Jauhar
- Department of Psychological Medicine, IoPPN,
Kings College London, UK
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Fond G, Bulzacka E, Boucekine M, Schürhoff F, Berna F, Godin O, Aouizerate B, Capdevielle D, Chereau I, D'Amato T, Dubertret C, Dubreucq J, Faget C, Leignier S, Lançon C, Mallet J, Misdrahi D, Passerieux C, Rey R, Schandrin A, Urbach M, Vidailhet P, Leboyer M, Boyer L, Llorca PM. Machine learning for predicting psychotic relapse at 2 years in schizophrenia in the national FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:8-18. [PMID: 30552914 DOI: 10.1016/j.pnpbp.2018.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/27/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Predicting psychotic relapse is one of the major challenges in the daily care of schizophrenia. OBJECTIVES To determine the predictors of psychotic relapse and follow-up withdrawal in a non-selected national sample of stabilized community-dwelling SZ subjects with a machine learning approach. METHODS Participants were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia and received a thorough clinical and cognitive assessment, including recording of current treatment. Relapse was defined by at least one acute psychotic episode of at least 7 days, reported by the patient, her/his relatives or by the treating psychiatrist, within the 2-year follow-up. A classification and regression tree (CART) was used to construct a predictive decision tree of relapse and follow-up withdrawal. RESULTS Overall, 549 patients were evaluated in the expert centers at baseline and 315 (57.4%) (mean age = 32.6 years, 24% female gender) were followed-up at 2 years. On the 315 patients who received a visit at 2 years, 125(39.7%) patients had experienced psychotic relapse at least once within the 2 years of follow-up. High anger (Buss&Perry subscore), high physical aggressiveness (Buss&Perry scale subscore), high lifetime number of hospitalization in psychiatry, low education level, and high positive symptomatology at baseline (PANSS positive subscore) were found to be the best predictors of relapse at 2 years, with a percentage of correct prediction of 63.8%, sensitivity 71.0% and specificity 44.8%. High PANSS excited score, illness duration <2 years, low Buss&Perry hostility score, high CTQ score, low premorbid IQ and low medication adherence (BARS) score were found to be the best predictors of follow-up withdrawal with a percentage of correct prediction of 52.4%, sensitivity 62%, specificity 38.7%. CONCLUSION Machine learning can help constructing predictive score. In the present sample, aggressiveness appears to be a good early warning sign of psychotic relapse and follow-up withdrawal and should be systematically assessed in SZ subjects. The other above-mentioned clinical variables may help clinicians to improve the prediction of psychotic relapse at 2 years.
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Affiliation(s)
- G Fond
- Fondation FondaMental, Créteil, France; Faculté de Médecine - Secteur Timone, Aix-Marseille Univ, d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | - E Bulzacka
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - M Boucekine
- Faculté de Médecine - Secteur Timone, Aix-Marseille Univ, d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - F Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - O Godin
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; INRA, NutriNeuro, University of Bordeaux, U1286, Bordeaux F-33076, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Hôpital la Colombière, CHRU Montpellier, Service Universitaire de Psychiatrie Adulte, Université Montpellier 1, Montpellier 1061, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; Faculté de Médecine, Université d'Auvergne, CMP B, CHU, EA 7280, Clermont-Ferrand Cedex 69 63003, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France; Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, Bron Cedex 69678, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Faculté de médecine, Louis Mourier Hospital, Université Paris Diderot, Colombes U894, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, Alpes Isère, Grenoble, France
| | - C Faget
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - S Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, Alpes Isère, Grenoble, France
| | - C Lançon
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Faculté de médecine, Louis Mourier Hospital, Université Paris Diderot, Colombes U894, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; CNRS UMR 5287-INCIA, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - R Rey
- Fondation FondaMental, Créteil, France; Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, Bron Cedex 69678, France
| | - A Schandrin
- Fondation FondaMental, Créteil, France; Hôpital la Colombière, CHRU Montpellier, Service Universitaire de Psychiatrie Adulte, Université Montpellier 1, Montpellier 1061, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - P Vidailhet
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | | | - L Boyer
- Fondation FondaMental, Créteil, France; Faculté de Médecine - Secteur Timone, Aix-Marseille Univ, d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; Faculté de Médecine, Université d'Auvergne, CMP B, CHU, EA 7280, Clermont-Ferrand Cedex 69 63003, France
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Eisner E, Bucci S, Berry N, Emsley R, Barrowclough C, Drake RJ. Feasibility of using a smartphone app to assess early signs, basic symptoms and psychotic symptoms over six months: A preliminary report. Schizophr Res 2019; 208:105-113. [PMID: 30979665 PMCID: PMC6551369 DOI: 10.1016/j.schres.2019.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/06/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychosis relapses are common, have profound adverse consequences for patients, and are costly to health services. 'Early signs' have been used to predict relapse, in the hope of prevention or mitigation, with moderate sensitivity and specificity. We investigated the feasibility and validity of adding 'basic symptoms' to conventional early signs and monitoring these using a smartphone app. METHODS Individuals (n = 18) experiencing a relapse within the past year were asked to use a smartphone app ('ExPRESS') weekly for six months to report early signs, basic symptoms and psychotic symptoms. Above-threshold increases in app-reported psychotic symptoms prompted a telephone interview (PANSS positive items) to assess relapse. RESULTS Participants completed 65% app assessments and 58% telephone interviews. App items showed high concurrent validity with researcher-rated psychotic symptoms and basic symptoms over six months. There was excellent agreement between telephone call and face-to-face assessed psychotic symptoms. The primary relapse definition, based on telephone assessment and casenotes, compared well with a casenote-only definition but had better specificity. Mixed-effects models provided preliminary evidence of concurrent and predictive validity: early signs and basic symptoms were associated with most app-assessed psychotic symptom variables the same week and with a number of psychotic symptoms variables three weeks later; adding basic symptoms to early signs improved model fit in most of these cases. CONCLUSIONS This is the first study to test a smartphone app for monitoring early signs and basic symptoms as putative relapse predictors. It demonstrates that weekly app-based monitoring is feasible, valid and acceptable over six months.
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Affiliation(s)
- Emily Eisner
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom.
| | - Sandra Bucci
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester M25 3BL, United Kingdom.
| | - Natalie Berry
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom.
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom.
| | - Christine Barrowclough
- University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom.
| | - Richard James Drake
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester M25 3BL, United Kingdom; University of Manchester, Division of Psychology and Mental Health, Jean McFarlane Building (3(rd) Floor), Manchester M13 9L, United Kingdom.
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Hwang DK, Nam M, Lee YJG. The effect of cognitive behavioral therapy for insomnia in schizophrenia patients with sleep Disturbance: A non-randomized, assessor-blind trial. Psychiatry Res 2019; 274:182-188. [PMID: 30807969 DOI: 10.1016/j.psychres.2019.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/02/2023]
Abstract
This non-randomized, assessor blind study evaluated the effects of cognitive behavioral therapy for insomnia (CBT-I) delivered in a group format on insomnia symptoms as well as psychotic, depressive, and anxiety symptoms in schizophrenia patients (n = 63) recruited from residential or rehabilitative facilities in Seoul, South Korea. Thirty-one patients received four sessions of CBT-I in groups of 2-9 patients in addition to usual care, while the control group (n = 32) received no additional intervention. The Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI), Psychotic Symptoms Rating Scale (PSYRATS), Anxiety Sensitivity Index (ASI), and Beck Depression Inventory (BDI) were administered at baseline, week 4, and week 8. Both groups showed significant time-group interactions on the ISI and PSQI. Post hoc testing showed that, compared to the control group, the CBT-I group showed significant reductions in ISI and PSQI at both week 4 and week 8. For the PSYRATS, ASI, and BDI scores, the CBT-I and control groups showed significant time-group interactions, but post hoc testing revealed no significant group differences at either week 4 or week 8. Therefore, CBT-I was effective for reducing insomnia symptoms in patients with schizophrenia and the effect lasted for 4 weeks after the intervention.
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Affiliation(s)
- Dong-Ki Hwang
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Republic of Korea
| | - Min Nam
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Republic of Korea
| | - Yu-Jin G Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Republic of Korea.
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Eisner E, Drake RJ, Berry N, Barrowclough C, Emsley R, Machin M, Bucci S. Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse. JMIR Mhealth Uhealth 2019; 7:e11568. [PMID: 30924789 PMCID: PMC6460313 DOI: 10.2196/11568] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/25/2018] [Accepted: 12/10/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Schizophrenia relapses are common, have profound, adverse consequences for patients and are costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. Such interventions show promise but could be further developed. This study addresses 2 developments: adding basic symptoms to checklists of conventional early signs and using a mobile phone app ExPRESS to aid early signs monitoring. OBJECTIVE This study aimed to (1) design a pool of self-report items assessing basic symptoms (Basic Symptoms Checklist, BSC); (2) develop and beta test a mobile phone app (ExPRESS) for monitoring early signs, basic symptoms, and psychotic symptoms; and (3) evaluate the long-term acceptability of ExPRESS via qualitative feedback from participants in a 6-month feasibility study. METHODS The BSC items and ExPRESS were developed and then adjusted following feedback from beta testers (n=5) with a schizophrenia diagnosis. Individuals (n=18) experiencing a relapse of schizophrenia within the past year were asked to use ExPRESS for 6 months to answer weekly questions about experiences of early signs, basic symptoms, and psychotic symptoms. At the end of follow-up, face-to-face qualitative interviews (n=16; 2 were uncontactable) explored experiences of using ExPRESS. The topic guide sought participants' views on the following a priori themes regarding app acceptability: item content, layout, and wording; app appearance; length and frequency of assessments; worries about app use; how app use fitted with participants' routines; and the app's extra features. Interview transcripts were analyzed using the framework method, which allows examination of both a priori and a posteriori themes, enabling unanticipated aspects of app use experiences to be explored. RESULTS Participants' mean age was 38 years (range 22-57 years). Responses to a priori topics indicated that long-term use of ExPRESS was acceptable; small changes for future versions of ExPRESS were suggested. A posteriori themes gave further insight into individuals' experiences of using ExPRESS. Some reported finding it more accessible than visits from a clinician, as assessments were more frequent, more anonymous, and did not require the individual to explain their feelings in their own words. Nevertheless, barriers to app use (eg, unfamiliarity with smartphones) were also reported. Despite ExPRESS containing no overtly therapeutic components, some participants found that answering the weekly questions prompted self-reflection, which had therapeutic value for them. CONCLUSIONS This study suggests that apps are acceptable for long-term symptom monitoring by individuals with a schizophrenia diagnosis across a wide age range. If the potential benefits are understood, patients are generally willing and motivated to use a weekly symptom-monitoring app; most participants in this study were prepared to do so for more than 6 months. TRIAL REGISTRATION ClinicalTrials.gov NCT03558529; https://clinicaltrials.gov/ct2/show/NCT03558529 (Archived by WebCite at http://www.webcitation.org/70qvtRmZY).
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Affiliation(s)
- Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Richard James Drake
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
| | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Christine Barrowclough
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
| | - Matthew Machin
- Division of Informatics, Imaging & Data Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
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Winsky-Sommerer R, de Oliveira P, Loomis S, Wafford K, Dijk DJ, Gilmour G. Disturbances of sleep quality, timing and structure and their relationship with other neuropsychiatric symptoms in Alzheimer’s disease and schizophrenia: Insights from studies in patient populations and animal models. Neurosci Biobehav Rev 2019; 97:112-137. [DOI: 10.1016/j.neubiorev.2018.09.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/31/2018] [Accepted: 09/30/2018] [Indexed: 02/06/2023]
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Kim HK, Park HY, Seo E, Bang M, Song YY, Lee SY, Kim KR, Park JY, Kang JI, Lee E, An SK. Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis. Front Psychiatry 2019; 10:459. [PMID: 31293463 PMCID: PMC6606785 DOI: 10.3389/fpsyt.2019.00459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/11/2019] [Indexed: 01/31/2023] Open
Abstract
Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%-30% within 1-2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ2(1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31-0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.
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Affiliation(s)
- Hyun Kyu Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunchong Seo
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Yun Young Song
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Young Lee
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Park
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Graduate Program in Cognitive Science, Yonsei University, Seoul, South Korea
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Meyer N, Kerz M, Folarin A, Joyce DW, Jackson R, Karr C, Dobson R, MacCabe J. Capturing Rest-Activity Profiles in Schizophrenia Using Wearable and Mobile Technologies: Development, Implementation, Feasibility, and Acceptability of a Remote Monitoring Platform. JMIR Mhealth Uhealth 2018; 6:e188. [PMID: 30377146 PMCID: PMC6234334 DOI: 10.2196/mhealth.8292] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/19/2017] [Accepted: 06/21/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is growing interest in the potential for wearable and mobile devices to deliver clinically relevant information in real-world contexts. However, there is limited information on their acceptability and barriers to long-term use in people living with psychosis. OBJECTIVE This study aimed to describe the development, implementation, feasibility, acceptability, and user experiences of the Sleepsight platform, which harnesses consumer wearable devices and smartphones for the passive and unobtrusive capture of sleep and rest-activity profiles in people with schizophrenia living in their homes. METHODS A total of 15 outpatients with a diagnosis of schizophrenia used a consumer wrist-worn device and smartphone to continuously and remotely gather rest-activity profiles over 2 months. Once-daily sleep and self-rated symptom diaries were also collected via a smartphone app. Adherence with the devices and smartphone app, end-of-study user experiences, and agreement between subjective and objective sleep measures were analyzed. Thresholds for acceptability were set at a wear time or diary response rate of 70% or greater. RESULTS Overall, 14 out of 15 participants completed the study. In individuals with a mild to moderate symptom severity at baseline (mean total Positive and Negative Syndrome Scale score 58.4 [SD 14.4]), we demonstrated high rates of engagement with the wearable device (all participants meeting acceptability criteria), sleep diary, and symptom diary (93% and 86% meeting criteria, respectively), with negative symptoms being associated with lower diary completion rate. The end-of-study usability and acceptability questionnaire and qualitative analysis identified facilitators and barriers to long-term use, and paranoia with study devices was not a significant barrier to engagement. Comparison between sleep diary and wearable estimated sleep times showed good correspondence (ρ=0.50, P<.001). CONCLUSIONS Extended use of wearable and mobile technologies are acceptable to people with schizophrenia living in a community setting. In the future, these technologies may allow predictive, objective markers of clinical status, including early markers of impending relapse.
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Affiliation(s)
- Nicholas Meyer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Maximilian Kerz
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dan W Joyce
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Richard Jackson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Chris Karr
- Audacious Software, Chicago, IL, United States
- Center for Behavioural Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Richard Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
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Wang D, Gopal S, Baker S, Narayan VA. Trajectories and changes in individual items of positive and negative syndrome scale among schizophrenia patients prior to impending relapse. NPJ SCHIZOPHRENIA 2018; 4:10. [PMID: 29925851 PMCID: PMC6010453 DOI: 10.1038/s41537-018-0056-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 11/09/2022]
Abstract
Effective early detection of impending relapse may offer opportunities for early interventions to prevent full relapse in schizophrenia patients. Previously reported early warning signs were not consistently validated by prospective studies. It remains unclear which symptoms are most predictive of relapse. To prioritize the symptoms to be captured by periodic self-report in technology-enabled remote assessment solutions for monitoring symptoms and detecting relapse early, we analyzed data from three relapse-prevention studies to identify individual items of the Positive and Negative Syndrome Scale (PANSS) that changed the most prior to relapse and to understand exactly when these symptoms manifested. Relapse was defined by a composite endpoint: hospitalization, suicidal/homicidal ideation, violent behavior, a 25% increase in the PANSS total score, or a significant increase in at least one of several pre-specified PANSS items. Longitudinal mixed effect models were applied to model the trajectories of individual PANSS items before relapse. Among 267 relapsed patients, the PANSS items that increased the most at relapse from randomization did not differ much by different relapse reasons or medications. A subset of seven PANSS items, including delusions, suspiciousness, hallucinations, anxiety, excitement, tension, and conceptual disorganization, had on average > 1-point of increase at relapse. The trajectories of these items suggested these items started to increase 7-10 days before relapse and reached on average 1-point of increase 0.3 ~ 1.2 days before relapse. Our results indicated that a subset of PANSS items could be leveraged to develop remote assessment solutions for monitoring symptoms and detecting relapse early in schizophrenia patients.
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Affiliation(s)
- Dai Wang
- R&D Information Technology, Janssen Research & Development, LLC, Titusville, NJ, USA.
| | - Srihari Gopal
- Neuroscience Therapeutic Area, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Susan Baker
- Neuroscience Therapeutic Area, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Vaibhav A Narayan
- R&D Information Technology, Janssen Research & Development, LLC, Titusville, NJ, USA
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Eisner E, Drake R, Lobban F, Bucci S, Emsley R, Barrowclough C. Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice. Schizophr Res 2018; 192:124-130. [PMID: 28499766 PMCID: PMC5821684 DOI: 10.1016/j.schres.2017.04.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/22/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early signs interventions show promise but could be further developed. A recent review suggested that 'basic symptoms' should be added to conventional early signs to improve relapse prediction. This study builds on preliminary evidence that basic symptoms predict relapse and aimed to: 1. examine which phenomena participants report prior to relapse and how they describe them; 2. determine the best way of identifying pre-relapse basic symptoms; 3. assess current practice by comparing self- and casenote-reported pre-relapse experiences. METHODS Participants with non-affective psychosis were recruited from UK mental health services. In-depth interviews (n=23), verbal checklists of basic symptoms (n=23) and casenote extracts (n=208) were analysed using directed content analysis and non-parametric statistical tests. RESULTS Three-quarters of interviewees reported basic symptoms and all reported conventional early signs and 'other' pre-relapse experiences. Interviewees provided rich descriptions of basic symptoms. Verbal checklist interviews asking specifically about basic symptoms identified these experiences more readily than open questions during in-depth interviews. Only 5% of casenotes recorded basic symptoms; interviewees were 16 times more likely to report basic symptoms than their casenotes did. CONCLUSIONS The majority of interviewees self-reported pre-relapse basic symptoms when asked specifically about these experiences but very few casenotes reported these symptoms. Basic symptoms may be potent predictors of relapse that clinicians miss. A self-report measure would aid monitoring of basic symptoms in routine clinical practice and would facilitate a prospective investigation comparing basic symptoms and conventional early signs as predictors of relapse.
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Affiliation(s)
- Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK.
| | - Richard Drake
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Richard Emsley
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Christine Barrowclough
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
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Palacios-Ceña D, Martín-Tejedor EA, Elías-Elispuru A, Garate-Samaniego A, Pérez-Corrales J, García-García E. The impact of a short-term cohousing initiative among schizophrenia patients, high school students, and their social context: A qualitative case study. PLoS One 2018; 13:e0190895. [PMID: 29324773 PMCID: PMC5764336 DOI: 10.1371/journal.pone.0190895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background A number of programs have been developed to promote the contact between adolescents and mentally-ill patients, in order to break the stigma, improve understanding, promote mental health and prevent substance abuse. The aim of this study was to describe the experience of patients with schizophrenia, high school students, and their social context, participating in a short-term cohousing initiative. Methods A qualitative case-study approach was implemented. Patients with schizophrenia from the San Juan de Dios Psychiatric Hospital, female students from Almen High School, and participants from their social context (parents, hospital staff, and teachers) were included, using purposeful sampling. Data were collected from 51 participants (15 patients, nine students, 11 hospital staff, six teachers, 10 parents) via non-participant observation, focus groups, informal interviews, researchers’ field notes and patients’ personal diaries and letters. A thematic analysis was performed. Results The themes identified included a) learning to live together: students and patients participate and learn together; b) the perception of the illness and the mentally-ill: the barrier between health and disease is very slim, and society tends to avoid contact with those who are ill; c) change: a transformation takes place in students, in their self-perception, based on the real and intense nature of the experience; d) a trial and an opportunity: patients test their ability to live outside the hospital; e) discharge and readmission: discharge is experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as failures. Conclusions Our findings can help us to better understand schizophrenia and encourage a more positive approach towards both the illness and those who suffer from it. These results may be used for the development of cohousing programs in controlled environments.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- * E-mail:
| | | | - Ana Elías-Elispuru
- Hospital Psiquiátrico San Juan de Dios Arrasate-Mondragón, Hermanos de San Juan de Dios, Arrasate, Spain
| | - Amaia Garate-Samaniego
- Hospital Psiquiátrico San Juan de Dios Arrasate-Mondragón, Hermanos de San Juan de Dios, Arrasate, Spain
| | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Niendam TA, Tully LM, Iosif AM, Kumar D, Nye KE, Denton JC, Zakskorn LN, Fedechko TL, Pierce KM. Enhancing early psychosis treatment using smartphone technology: A longitudinal feasibility and validity study. J Psychiatr Res 2018; 96:239-246. [PMID: 29126059 DOI: 10.1016/j.jpsychires.2017.10.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/02/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
Abstract
Smartphone applications that promote symptom tracking and self-management may improve treatment of serious mental illness (SMI). Although feasibility has been established in chronic adult outpatient or inpatient SMI samples, no data exist regarding implementation of smartphone technology in adolescent and young adult populations as part of early psychosis (EP) outpatient care. We implemented a smartphone "app" plus clinician Dashboard as an add-on treatment tool in the University of California, Davis Early Psychosis Program. Participants completed daily and weekly surveys examining mood, symptoms, and treatment relevant factors via the app for up to 14 months. Clinicians discussed symptom ratings and surveys during regular treatment sessions using the Dashboard. We report methodological details of the study, feasibility metrics, and analyses of the validity of measuring symptoms via self-report using mobile health (mHealth) technology in comparison to gold-standard clinician-rated interviews based on a comprehensive longitudinal analysis of within-person data. Results demonstrate that integrating mHealth technology into EP care is feasible and self-report assessment of symptoms via smartphone provides symptom data comparable to that obtained via gold-standard clinician-rated assessments.
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Affiliation(s)
- Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Laura M Tully
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States.
| | - Ana-Maria Iosif
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, United States
| | - Divya Kumar
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Kathleen E Nye
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Jennifer C Denton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Lauren N Zakskorn
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Taylor L Fedechko
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
| | - Katherine M Pierce
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, United States
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Kilicaslan EE, Esen AT, Kasal MI, Ozelci E, Boysan M, Gulec M. Childhood trauma, depression, and sleep quality and their association with psychotic symptoms and suicidality in schizophrenia. Psychiatry Res 2017; 258:557-564. [PMID: 28916298 DOI: 10.1016/j.psychres.2017.08.081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/18/2017] [Accepted: 08/27/2017] [Indexed: 02/07/2023]
Abstract
This study involved the examination of the relationship between childhood trauma and both psychotic symptoms and suicidality in patients with schizophrenia after controlling for the possible confounding factors, such as clinical features, depression, and sleep quality. The Childhood Trauma Questionnaire-Short Form, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Pittsburgh Sleep Quality Index (PSQI), and the suicidality subscale of Mini-International Neuropsychiatric Interview (MINI) were administered to 199 patients with schizophrenia. We used sequential multiple stepwise regression analyses in which positive symptoms, negative symptoms, overall psychopathology, total symptoms of schizophrenia, and suicidality were dependent variables. Depressive symptomatology and childhood physical abuse significantly contributed to positive, negative, general psychopathology, and global schizophrenia symptomatology. Interestingly, general psychopathology scores were negatively associated with childhood physical neglect. Also, subjective sleep quality significantly contributed to positive schizophrenia symptoms. Although prior suicide attempts and depression were significant antecedents of suicidal ideation, no association between suicidality and both childhood trauma and sleep was found. Childhood physical abuse could have an impact on psychopathology in schizophrenia. In addition to childhood trauma, depression, sleep disturbances, and clinical features should be considered and inquired about in the course of clinical care of schizophrenia patients.
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Affiliation(s)
- Esin Evren Kilicaslan
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Izmir, Turkey.
| | - Asli Tugba Esen
- University of Health Sciences, Izmir Tepecik Education and Training Hospital, Psychiatry Department, Izmir, Turkey
| | - Meltem Izci Kasal
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Izmir, Turkey
| | - Erdal Ozelci
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Izmir, Turkey
| | - Murat Boysan
- Yuzuncu Yil University, Faculty of Literature, Psychology Department, Van, Turkey
| | - Mustafa Gulec
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Izmir, Turkey
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Sullivan S, Northstone K, Gadd C, Walker J, Margelyte R, Richards A, Whiting P. Models to predict relapse in psychosis: A systematic review. PLoS One 2017; 12:e0183998. [PMID: 28934214 PMCID: PMC5608199 DOI: 10.1371/journal.pone.0183998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background There is little evidence on the accuracy of psychosis relapse prediction models. Our objective was to undertake a systematic review of relapse prediction models in psychosis. Method We conducted a literature search including studies that developed and/or validated psychosis relapse prediction models, with or without external model validation. Models had to target people with psychosis and predict relapse. The key databases searched were; Embase, Medline, Medline In-Process Citations & Daily Update, PsychINFO, BIOSIS Citation Index, CINAHL, and Science Citation Index, from inception to September 2016. Prediction modelling studies were assessed for risk of bias and applicability using the PROBAST tool. Results There were two eligible studies, which included 33,088 participants. One developed a model using prodromal symptoms and illness-related variables, which explained 14% of relapse variance but was at high risk of bias. The second developed a model using administrative data which was moderately discriminative (C = 0.631) and associated with relapse (OR 1.11 95% CI 1.10, 1.12) and achieved moderately discriminative capacity when validated (C = 0.630). The risk of bias was low. Conclusions Due to a lack of high quality evidence it is not possible to make any specific recommendations about the predictors that should be included in a prognostic model for relapse. For instance, it is unclear whether prodromal symptoms are useful for predicting relapse. The use of routine data to develop prediction models may be a more promising approach, although we could not empirically compare the two included studies.
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Affiliation(s)
- Sarah Sullivan
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Kate Northstone
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Caroline Gadd
- Otsuka Pharmaceutical Europe Ltd, trading as Otsuka Health Solutions, Wexham Springs, Slough, United Kingdom
| | - Julian Walker
- Avon & Wiltshire Mental Health NHS Trust, Jenner House, Chippenham, Wilts, United Kingdom
| | - Ruta Margelyte
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Alison Richards
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Penny Whiting
- NIHR CLAHRC West, United Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Cragin CA, Straus MB, Blacker D, Tully LM, Niendam TA. Early Psychosis and Trauma-Related Disorders: Clinical Practice Guidelines and Future Directions. Front Psychiatry 2017; 8:33. [PMID: 28321193 PMCID: PMC5337515 DOI: 10.3389/fpsyt.2017.00033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
Abstract
Despite high rates of trauma-related disorders among individuals with early psychosis, no clinical practice guidelines for the treatment of comorbid early psychosis and trauma-related disorders exist to date. Indeed, the routine exclusion of individuals with past and current psychosis from participation in trauma research and practice has limited the accumulation of research that could support such clinical practice guidelines. While preliminary research evidence suggests that traditional, evidence-based treatments for trauma-related disorders can be safely and effectively employed to reduce symptoms of posttraumatic stress and chronic psychosis, it remains unclear whether such treatments are appropriate for individuals in the early stages of psychotic illness. Clinical experts (N = 118) representing 121 early psychosis programs across 28 states were surveyed using the expert consensus method. Forty-nine clinical experts responded and reached consensus on 46 of 49 expert consensus items related to the treatment of comorbid early psychosis and trauma-related disorders. Conjoint or family therapy and individual therapy were rated as treatment approaches of choice. Anxiety or stress management and psychoeducation were rated as treatment interventions of choice for addressing both trauma symptoms and psychotic symptoms. In addition, case management was rated as a treatment intervention of choice for addressing psychotic symptoms. No consensus was reached on expert consensus items regarding the appropriateness of a parallel treatment approach exposure interventions for addressing psychotic symptoms, or sensorimotor or movement interventions for addressing trauma symptoms. In areas where expert consensus exists and is supported by current research, preliminary clinical practice guidelines for the treatment of comorbid early psychosis and trauma-related disorders are offered. In areas where expert consensus does not exist, recommendations for future research are offered. The results of this study are intended to serve as a launching point for scientists and practitioners interested in advancing appropriate treatment for high-risk and underserved individuals with comorbid early psychosis and trauma-related disorders.
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Affiliation(s)
- Casey A Cragin
- Department of Clinical Psychology, Antioch University New England , Keene, NH , USA
| | - Martha B Straus
- Department of Clinical Psychology, Antioch University New England , Keene, NH , USA
| | - Dawn Blacker
- CAARE Diagnostic and Treatment Center, Department of Pediatrics, University of California , Davis, Sacramento , USA
| | - Laura M Tully
- UC Davis Imaging Research Center, Department of Psychiatry and Behavioral Sciences, University of California , Davis, Sacramento , USA
| | - Tara A Niendam
- UC Davis Imaging Research Center, Department of Psychiatry and Behavioral Sciences, University of California , Davis, Sacramento , USA
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Morrison AP, Law H, Barrowclough C, Bentall RP, Haddock G, Jones SH, Kilbride M, Pitt E, Shryane N, Tarrier N, Welford M, Dunn G. Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Heather Law
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Steven H Jones
- The Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK
| | - Martina Kilbride
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Pitt
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Nicholas Shryane
- School of Social Sciences, University of Manchester, Manchester, UK
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Mary Welford
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
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