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Andorko ND, Fitzgerald J, Roemer C, Solender E, Petti E, Rakhshan Rouhakhtar P, McNamara KE, Smith ME, Buchanan RW, Schiffman J, DeVylder J. Social work training to reduce duration of untreated psychosis: Methodology and considerations of a web-based training for community providers. Early Interv Psychiatry 2022; 16:393-401. [PMID: 34031987 PMCID: PMC8668167 DOI: 10.1111/eip.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 12/13/2020] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
AIM Outcomes for individuals with psychotic disorders can be improved through early intervention services; however, identification continues to be a major problem in connecting individuals with these services. Social workers form a vast majority of the human service and mental health workforce in the United States and therefore have the potential to play a unique role in identifying and referring those who may benefit from specialty early intervention services. METHODS The current article describes the methodological design, implementation, and participant recruitment procedures of a large-scale, web-based training program for social workers promoting identification and referral of individuals with emerging symptoms of a mental illness with psychosis in the context of a randomized clinical trial. RESULTS The web-based study enrolled 1384 individuals. More than half of study participants enrolled within the first 3 months of the 14-month recruitment period. Completion of all study components was achieved by 959 individuals (69% of total enrolled), and completion status did not vary significantly by gender, ethnicity, or facility at which the individual was employed. Completion rates varied by race, such that participants identifying as White were more likely to complete the study, while those identifying as Black were less likely. DISCUSSION The results suggest the feasibility of using a web-based training program to engage social workers in early psychosis identification practices. Challenges related to encouraging participants to complete the training and lessons learned during the study recruitment are discussed.
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Affiliation(s)
- Nicole D Andorko
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - John Fitzgerald
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA.,Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Caroline Roemer
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Eric Solender
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Emily Petti
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | | | - Karen E McNamara
- The Systems Evaluation Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa E Smith
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA.,Department of Psychological Science, University of California, Irvine, California, USA
| | - Jordan DeVylder
- Department of Psychological Science, University of California, Irvine, California, USA.,Graduate School of Social Service, Fordham University, New York, New York, USA
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Thompson EC, Andorko ND, Rouhakhtar PR, Millman ZB, Sagun K, Han SC, Chibani D, Reeves GM, Herman B, Schiffman J. Psychosis-Spectrum Screening and Assessment Within a College Counseling Center: A Pilot Study Exploring Feasibility and Clinical Need. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2022; 36:201-222. [PMID: 35694629 PMCID: PMC9175646 DOI: 10.1080/87568225.2020.1797604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Evidence supports the use of brief psychosis-spectrum screening tools for identifying individuals at an increased risk of developing a psychotic disorder. Screening has not been well studied in general mental health settings that serve young adults in the age range associated with highest risk for psychosis. This study explored the feasibility of psychosis-risk screening and assessment among help-seeking students at a university counseling center. The PRIME Screen-Revised was administered to students at clinic intake. Participants who screened positively were offered a follow-up assessment using the Structured Interview for Psychosis-risk Syndromes (SIPS). At intake, 510 students completed the PRIME Screen-Revised, with 132 (25.9%) screening positive. Comprehensive psychosis-spectrum evaluations were completed with 38 participants, and 22 met criteria for a psychosis-spectrum disorder, representing 57.9% of this subsample. Findings suggest that psychosis-risk screening in a college clinic is a promising approach to identifying those at high risk for or in the early stages of psychosis.
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Affiliation(s)
- Elizabeth C. Thompson
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Nicole D. Andorko
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | | | - Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Kristin Sagun
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Susan C. Han
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Doha Chibani
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Gloria M. Reeves
- Child and Adolescent Psychiatry, University of Maryland Medical Center, Baltimore, MD, 21201
| | - Bruce Herman
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
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Santos MESB, Roza DL, Barros REM, Santos JLF, Razzouk D, Azevedo-Marques JM, Menezes PR, Del-Ben CM. Patient needs four years after first psychiatric hospitalization in a Brazilian cohort. ACTA ACUST UNITED AC 2021; 54:e11447. [PMID: 34320123 PMCID: PMC8302140 DOI: 10.1590/1414-431x2021e11447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.
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Affiliation(s)
- M E S B Santos
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D L Roza
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R E M Barros
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J L F Santos
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D Razzouk
- Centro de Economia da Saúde Mental, Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - J M Azevedo-Marques
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P R Menezes
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.,Núcleo de Pesquisa em Saúde Mental Populacional, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C M Del-Ben
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.,Núcleo de Pesquisa em Saúde Mental Populacional, Universidade de São Paulo, São Paulo, SP, Brasil
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García-Mieres H, De Jesús-Romero R, Ochoa S, Feixas G. Beyond the cognitive insight paradox: Self-reflectivity moderates the relationship between depressive symptoms and general psychological distress in psychosis. Schizophr Res 2020; 222:297-303. [PMID: 32518005 DOI: 10.1016/j.schres.2020.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND People with psychosis experience significant emotional burden and distress associated with the symptomatic consequences of their mental disorder, thus difficulting their recovery. Several studies have found self-reflectivity, a dimension of cognitive insight, to be associated with effects which taken together may seem paradoxical, by predicting less psychotic symptom severity but more depression. To elucidate this issue, we examined the influence of psychotic symptoms, depressive symptoms, and self-reflectivity, on psychological distress. Further, we tested whether self-reflectivity moderated the relationship between depressive symptoms and psychological distress. METHODS Seventy-six outpatients with psychotic-spectrum disorders were assessed using measures of psychotic symptoms, depressive symptoms, cognitive insight (i.e., self-reflectivity, self-certainty) and psychological distress. RESULTS A regression model revealed that depressive, positive symptoms and the interaction between depressive symptoms and self-reflectivity had a significant effect on psychological distress. The moderation analysis showed that higher levels of self-reflectivity were related to less psychological distress associated with depressive mood. CONCLUSIONS The role of self-reflectivity on depression and distress may be more complex than a direct effect. Interventions targeted to improve metacognition by enhancing self-reflectivity might be important for lowering the psychological distress associated with depressive symptoms in people with psychosis.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
| | - Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 47405, IN, United States
| | | | - Susana Ochoa
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain
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'What people diagnosed with bipolar disorder experience as distressing': A meta-synthesis of qualitative research. J Affect Disord 2019; 248:108-130. [PMID: 30731279 DOI: 10.1016/j.jad.2019.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is considered to have a significantly negative impact on functioning and prognosis is considered poor. Current treatments are modestly effective and predominantly focus on reducing extreme mood fluctuations and symptoms, yet less is known about what patients themselves describe as distressing. Therefore we aimed to assess this through a systematic review. METHODS A comprehensive literature search was conducted in four major bibliographic databases in August 2017, updated in July 2018. Qualitative studies exploring BD were included if they contained themes related to distress. First person accounts from people with BD discussing what they experience as distressing were extracted and synthesised using thematic synthesis. Author interpretations were also extracted to support the synthesis. RESULTS Twenty-four studies were included. Five main analytical themes were developed: 1) diagnosis, 2) loss, 3) uncertainty, 4) threat and 5) relationships. Two further crosscutting themes were identified as 1) stigma and 2) fear of relapse. Implications for interventions to focus on these causes of distress also emerged. LIMITATIONS The included studies did not adequately examine the authors' potential own biases and influences within their interpretations of the data. One author predominantly undertook data extraction and coding for the current review, although research team discussions led to an agreed consensus on themes. CONCLUSIONS This was the first qualitative study to specifically explore distress in BD. The meta-synthesis highlights important areas that people with BD experience as distressing. Adaptations to current interventions, to focus on what people find distressing could seek to improve treatment outcomes.
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Griffiths R, Mansell W, Edge D, Tai S. Sources of Distress in First-Episode Psychosis: A Systematic Review and Qualitative Metasynthesis. QUALITATIVE HEALTH RESEARCH 2019; 29:107-123. [PMID: 30066602 DOI: 10.1177/1049732318790544] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this study, we aim to increase our understanding of the self-reported sources of distress among people who have experienced first-episode psychosis. Following a systematic literature search, 33 relevant studies containing first-person accounts of first-episode psychosis were identified, which were synthesized using thematic analysis. Two interrelated superordinate themes were identified: intrapersonal distress and interpersonal distress. Participants reported multiple, diverse, and multifaceted sources of distress across both themes. These were substantially different from those routinely recognized and targeted in clinical practice. This review suggests that practitioners who maintain a stance of genuine curiosity about the potential sources of distress for this population will be perceived as more helpful. The findings also highlight the importance of being service user-led when planning and delivering mental health care. Additional clinical and research implications are discussed.
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Affiliation(s)
- Robert Griffiths
- 1 Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Warren Mansell
- 2 The University of Manchester, Manchester, United Kingdom
| | - Dawn Edge
- 2 The University of Manchester, Manchester, United Kingdom
| | - Sara Tai
- 2 The University of Manchester, Manchester, United Kingdom
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Andrade MCR, Slade M, Bandeira M, Evans-Lacko S, Martin D, Andreoli SB. Need for information in a representative sample of outpatients with schizophrenia disorders. Int J Soc Psychiatry 2018; 64:476-481. [PMID: 29783875 DOI: 10.1177/0020764018776350] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Providing adequate information and involving patients in treatment have become an essential component of mental health care. Despite this, research regarding the extent to which this need has been met in clinical services is still scarce. AIMS To investigate the need for information about psychiatric condition and treatment among outpatients with schizophrenia disorders and how this need is associated with service use, adjusting for sociodemographic and clinical characteristics. METHODS Need for information about condition and treatment, using the corresponding domain in the Camberwell Assessment of Need (CAN), in a representative sample of 401 schizophrenia outpatients in Santos, Brazil was assessed. Hierarchical logistic regression was used to investigate the association of information as a reported need and as an unmet need with service use variables, adjusting for sociodemographic and clinical characteristics. RESULTS Need for information was reported by 214 (53.4%) patients, being met in 101 (25.2%) and unmet in 113 (28.2%). Hierarchical regression indicated a significant association of a reported need with higher age of onset, family monitoring medication use last year and lower education level, which was only associated with an unmet need. CONCLUSION Information was a commonly reported need and which was often unmet, showing no significant association with service use. Greater attention should be given by mental health services to information provision.
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Affiliation(s)
- Mário César Rezende Andrade
- 1 Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,2 Department of Psychology, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, Brazil
| | - Mike Slade
- 3 Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Marina Bandeira
- 2 Department of Psychology, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, Brazil
| | - Sara Evans-Lacko
- 4 Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Denise Martin
- 5 Department of Preventive Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,6 Universidade Católica de Santos (UNISANTOS), Santos, Brazil
| | - Sérgio Baxter Andreoli
- 1 Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,6 Universidade Católica de Santos (UNISANTOS), Santos, Brazil
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