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Sprüngli-Toffel E, Studerus E, Curtis L, Conchon C, Alameda L, Bailey B, Caron C, Haase C, Gros J, Herbrecht E, Huber CG, Riecher-Rössler A, Conus P, Solida A, Armando M, Kapsaridi A, Ducommun MM, Klauser P, Plessen KJ, Urben S, Edan A, Nanzer N, Navarro AL, Schneider M, Genoud D, Michel C, Kindler J, Kaess M, Oliver D, Fusar-Poli P, Borgwardt S, Andreou C. Individualized pretest risk estimates to guide treatment decisions in patients with clinical high risk for psychotic disorders. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024:S2950-2853(24)00052-8. [PMID: 39303874 DOI: 10.1016/j.sjpmh.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/30/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Clinical high risk for psychosis (CHR) states are associated with an increased risk of transition to psychosis. However, the predictive value of CHR screening interviews is dependent on pretest risk enrichment in referred patients. This poses a major obstacle to CHR outreach campaigns since they invariably lead to risk dilution through enhanced awareness. A potential compensatory strategy is to use estimates of individual pretest risk as a 'gatekeeper' for specialized assessment. We aimed to test a risk stratification model previously developed in London, UK (OASIS) and to train a new predictive model for the Swiss population. METHOD The sample was composed of 513 individuals referred for CHR assessment from six Swiss early psychosis detection services. Sociodemographic variables available at referral were used as predictors whereas the outcome variable was transition to psychosis. RESULTS Replication of the risk stratification model developed in OASIS resulted in poor performance (Harrel's c=0.51). Retraining resulted in moderate discrimination (Harrel's c=0.67) which significantly differentiated between different risk groups. The lowest risk group had a cumulative transition incidence of 6.4% (CI: 0-23.1%) over two years. CONCLUSION Failure to replicate the OASIS risk stratification model might reflect differences in the public health care systems and referral structures between Switzerland and London. Retraining resulted in a model with adequate discrimination performance. The developed model in combination with CHR assessment result, might be useful for identifying individuals with high pretest risk, who might benefit most from specialized intervention.
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Affiliation(s)
- Elodie Sprüngli-Toffel
- General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
| | - Erich Studerus
- Institute for Information Systems, University of Applied Sciences and Arts Northwestern Switzerland, Basel, Switzerland
| | - Logos Curtis
- Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Adult Psychiatry, Department of Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Caroline Conchon
- General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Luis Alameda
- General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; King's College of London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; Centro Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Departamento de Psiquiatria, Universidad de Sevilla, Sevilla, Spain
| | - Barbara Bailey
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Camille Caron
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Carmina Haase
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Julia Gros
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Evelyn Herbrecht
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | | | - Philippe Conus
- General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Alessandra Solida
- General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Center of Psychiatry of Neuchâtel (CNP), Neuchâtel, Switzerland
| | - Marco Armando
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Afroditi Kapsaridi
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Mathieu Mercapide Ducommun
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Paul Klauser
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Center for Psychiatric Neuroscience, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Urben
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Anne Edan
- Child and Adolescent Psychiatric Service, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Nathalie Nanzer
- Child and Adolescent Psychiatric Service, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | | | - Maude Schneider
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Davina Genoud
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Dominic Oliver
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Paolo Fusar-Poli
- King's College of London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
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Tempelaar W, Kozloff N, Mallia E, Voineskos A, Kurdyak P. Mental Health Service Use Before First Diagnosis of a Psychotic Disorder. JAMA Psychiatry 2024; 81:928-935. [PMID: 38888908 PMCID: PMC11195598 DOI: 10.1001/jamapsychiatry.2024.1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/05/2024] [Indexed: 06/20/2024]
Abstract
Importance Characterizing mental health service use trajectories preceding diagnosis of a psychotic disorder may help identify individuals at highest risk and in which settings they are at highest risk. Objective To examine mental health service use and diagnostic trajectories before first diagnosis of psychotic disorder and identify utilization and diagnostic patterns. Design, Setting, and Participants This population-based, retrospective cohort study used linked provincial health administrative data. The sample included individuals aged 15 to 29 years diagnosed with a psychotic disorder in Ontario, Canada, between April 1, 2012, and March 31, 2018. These individuals were matched to individuals with a diagnosis of a mood disorder. Data were analyzed from November 2018 to November 2019. Main Outcomes and Measures The main outcomes were rates, timing, and setting of mental health-related service use and associated diagnoses in the 3 years before the index disorder among individuals first diagnosed with a psychotic disorder compared with those first diagnosed with a mood disorder. Results A total of 10 501 individuals with a first diagnosis of psychotic disorder were identified (mean [SD] age, 21.55 [3.83] years; 72.1% male). A total of 72.2% of individuals had at least 1 mental health service visit during the 3 years before their first psychotic disorder diagnosis, which was significantly more than matched controls with a first mood disorder diagnosis (66.8%) (odds ratio [OR], 1.34; 95% CI, 1.26-1.42). Compared with individuals diagnosed with a mood disorder, individuals diagnosed with a psychotic disorder were significantly more likely to have had mental health-related hospital admissions (OR, 3.98; 95% CI, 3.43-4.62) and emergency department visits (OR, 2.27; 95% CI, 2.12-2.43) in the preceding 3 years. Those with psychotic disorders were more likely to have had prior diagnoses of substance use disorders (OR, 2.57; 95% CI, 2.35-2.81), other disorders (personality disorders, developmental disorders) (OR, 1.75; 95% CI, 1.61-1.90), and self-harm (OR, 1.64; 95% CI, 1.36-1.98) in the past 3 years compared with those diagnosed with mood disorders. Conclusions and Relevance This study found that in the 3 years prior to an index diagnosis, individuals with a first diagnosis of psychotic disorder had higher rates of mental health service use, particularly emergency department visits and hospitalizations, compared with individuals with a first diagnosis of a mood disorder. Individuals with psychotic disorders also had a greater number of premorbid diagnoses. Differences in health service utilization patterns between those with a first psychotic disorder diagnosis vs a first mood disorder diagnosis suggest distinct premorbid trajectories that could be useful for next steps in prediction and prevention research.
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Affiliation(s)
- Wanda Tempelaar
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Emilie Mallia
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy, Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Aristotle Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy, Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Centre of Excellence, Ontario Health, Toronto, Ontario, Canada
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Lasalvia A, Patuzzo S, Braun E, Henderson C. Advance statements in mental healthcare: time to close the evidence to practice gap. Epidemiol Psychiatr Sci 2023; 32:e68. [PMID: 38053411 PMCID: PMC10803188 DOI: 10.1017/s2045796023000835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023] Open
Abstract
This article discusses advance statements in mental health care, which allow individuals with mental disorders to express their preferences for treatment during mental health crises. Despite the evidence supporting their effectiveness, their implementation in clinical practice remains limited. This article explores variations among advance statements, such as psychiatric advance directives (PADs), joint crisis plans (JCPs) and self-binding directives (SBDs), highlighting their content, development process and legal status. We outline the benefits of advance statements, including empowerment, early intervention, improved therapeutic relationships and reduced compulsory admissions. We then draw attention to the challenges that may contribute to their lack of implementation, including legal complexities, communication issues, cultural factors, potential inequities, healthcare provider knowledge, changing preferences, resource constraints, crisis responses, data privacy, family involvement, and long-term evaluation. In conclusion, advance statements offer significant benefits but require addressing these critical aspects to ensure ethical and effective use. Bridging the evidence-to-practice gap is essential, with a focus on implementation science. Integrating these tools into routine clinical practice can significantly benefit individuals with severe mental disorders and mental health systems.
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Affiliation(s)
- Antonio Lasalvia
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Patuzzo
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Esther Braun
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
- Department of Philosophy, University of Oxford, Oxford, UK
| | - Claire Henderson
- Health Service and Population Research Department P029, David Goldberg Centre, King’s College London Institute of Psychiatry, London, UK
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Babatunde A, Ruck Keene A, Simpson A, Gilbert S, Stephenson L, Chua KC, Owen G, Simpson AJ, Smith S, Henderson C. Advance Statements for Black African and Caribbean people (AdStAC): protocol for an implementation study. BMC Psychiatry 2023; 23:344. [PMID: 37198589 DOI: 10.1186/s12888-023-04825-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND The UK government committed to legislating for Advance Choice Documents/Advance Statements (ACD/AS) following their recommendation by the Independent Review of the MHA (2018). ACDs/AS are yet to be implemented in routine practice despite evidence and high demand; they are associated with improved therapeutic relationships and a reduction (25%, RR 0.75, CI 0.61-0.93) in compulsory psychiatric admission. Barriers to their implementation are well documented, ranging from low knowledge levels to logistical challenges in accessing the content during episodes of acute care. In the UK this is an issue for Black people, who experience detention rates disproportionately (over three times) higher than those of White British people and have poorer care experiences and outcomes. ACDs/AS allow for Black people to have their concerns heard by mental health professionals in a care system where they often feel their views are ignored. AdStAC aims to improve Black service users' experiences in mental health services in South London by co-producing and testing an ACD/AS implementation resource with Black service users, mental health professionals and carers/supporters of Black service users. METHODS/DESIGN The study will take place in South London, England over three phases: 1) formative work through stakeholder workshops; 2) co-production of resources through a consensus development exercise and working groups; and 3) testing of the resources using quality improvement (QI) methods. A lived experience advisory group, staff advisory group and project steering committee will support the study throughout. The implementation resources will comprise: advance choice document/advance statement (ACD/AS) documentation, stakeholder trainings, a manual for mental health professionals to facilitate the processes of creating and revising advance statements, and informatics development. DISCUSSION The implementation resources will help increase the likelihood of the new mental health legislation in England being implemented effectively; through aligning evidence-based medicine, policy and law to effectively provide positive clinical, social and financial outcomes for Black people, the National Health Service (NHS) and wider society. This study will likely benefit a wider group of people with severe mental illness, as when marginalised groups who are least engaged, can be supported with these strategies, then the strategies are likely to work for others.
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Affiliation(s)
- Abigail Babatunde
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Alex Ruck Keene
- Institute of Psychiatry, Psychology and Neuroscience, 39 Essex Chambers, London, UK
| | - Alan Simpson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Steven Gilbert
- Steve Gilbert Consulting, Blackthorn House, St Pauls Square, Birmingham, BC 1RL, UK
| | - Lucy Stephenson
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF , UK
| | - Kia-Chong Chua
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Gareth Owen
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF , UK
| | - Adelabu Jonathan Simpson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | | | - Claire Henderson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Shah JL, Jones N, van Os J, McGorry PD, Gülöksüz S. Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis. Lancet Psychiatry 2022; 9:413-422. [PMID: 35430004 DOI: 10.1016/s2215-0366(21)00467-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/29/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022]
Abstract
Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.
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Affiliation(s)
- Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP)-Montreal, Montreal, QC, Canada; ACCESS Open Minds, Douglas Hospital Research Centre, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sinan Gülöksüz
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Misra S, Etkins OS, Yang LH, Williams DR. Structural Racism and Inequities in Incidence, Course of Illness, and Treatment of Psychotic Disorders Among Black Americans. Am J Public Health 2022; 112:624-632. [PMID: 35319958 PMCID: PMC8961835 DOI: 10.2105/ajph.2021.306631] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Abstract
Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).
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Affiliation(s)
- Supriya Misra
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Onisha S Etkins
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Lawrence H Yang
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - David R Williams
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
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Graham CD, McCracken LM, Harrison A, Walburn J, Weinman J. Outlining an Acceptance and Commitment Therapy approach to treatment non-adherence. Br J Health Psychol 2021; 27:1-12. [PMID: 34897907 DOI: 10.1111/bjhp.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/23/2021] [Indexed: 01/22/2023]
Affiliation(s)
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Sweden
| | - Anthony Harrison
- Department of Clinical and Health Psychology, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Jess Walburn
- School of Cancer & Pharmaceutical Sciences, King's College London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, UK
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Moore D, Castagnini E, Mifsud N, Geros H, Sizer H, Addington J, van der Gaag M, Nelson B, McGorry P, O'Donoghue B. The associations between migrant status and ethnicity and the identification of individuals at ultra-high risk for psychosis and transition to psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1923-1941. [PMID: 33641006 DOI: 10.1007/s00127-021-02047-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Migrant and ethnic minority populations exhibit a higher incidence of psychotic disorders. The Ultra-High Risk for psychosis (UHR) paradigm provides an opportunity to explore the stage at which such factors influence the development of psychosis. In this systematic review, we collate and appraise the literature on the association between ethnicity and migrant status and the rate of identification of individuals at UHR, as well as their rate of transition to psychosis. METHODS We conducted a systematic review in the Ovid Medline, PsychINFO, Pubmed, CINAHL and EMBASE databases according to PRISMA guidelines. We included studies written in English that included an UHR cohort, provided a measure of ethnicity or migrant status, and examined the incidence, rate, or risk of UHR identification or transition to psychosis. RESULTS Of 2182 unique articles identified, seven fulfilled the criteria. One study found overrepresentation of UHR individuals from black ethnic groups, while another found underrepresentation. Two studies found increased rates of transition among certain ethnic groups and a further two found no association. Regarding migrant status, one study found that first-generation migrants were underrepresented in an UHR sample. Lastly, a lower transition rate in migrant populations was identified in one study, while two found no association. CONCLUSION Rates of UHR identification and transition according to ethnic and migrant status were inconsistent and insufficient to conclusively explain higher incidences of psychotic disorders among these groups. We discuss the clinical implications and avenues for future research, which is required to clarify the nature of the associations.
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Affiliation(s)
- Danielle Moore
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Emily Castagnini
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nathan Mifsud
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Hellen Geros
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Holly Sizer
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mark van der Gaag
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barnaby Nelson
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick McGorry
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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Murray RM, David AS, Ajnakina O. Prevention of psychosis: moving on from the at-risk mental state to universal primary prevention. Psychol Med 2021; 51:223-227. [PMID: 32892760 PMCID: PMC7893507 DOI: 10.1017/s003329172000313x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/09/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022]
Abstract
The value of services for those with the 'At Risk Mental State for Psychosis' (ARMS) continues to be disputed. ARMS services have provided a valuable stimulus to academic research into the transition into psychosis. Furthermore, there is currently a welcome trend to transform such clinics into youth mental health services catering for the broader clientele of young people suffering from anxiety and depression, who already constitute the bulk of those seen at ARMS clinics. However, such services are never likely to make major inroads into preventing psychosis because they only reach a small proportion of those at risk. Evidence from medicine shows that avoiding exposure to factors which increase the risk of disease (e.g. poor nutrition, transmission of infection, tobacco smoking), produces greater public benefit than focussing efforts on individuals with, or about to develop, disease. We consider that the most productive approach for psychosis prevention is avoiding exposure to risk-increasing factors. The best-established risk factors for psychosis are obstetric events, childhood abuse, migration, city living, adverse life events and cannabis use. Some as city living, are likely proxies for an unknown causal factor(s) while preventing others such as childhood abuse is currently beyond our powers. The risk factor for psychosis which is most readily open to this approach is the use of cannabis. Therefore, as an initial step towards a strategy for universal primary prevention, we advocate public health campaigns to educate young people about the harms of regular use of high potency cannabis.
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Affiliation(s)
- Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Anthony S. David
- Institute of Mental Health, University College London, London, UK
| | - Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, University of London, London, UK
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10
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Yung AR, Wood SJ, Malla A, Nelson B, McGorry P, Shah J. The reality of at risk mental state services: a response to recent criticisms. Psychol Med 2021; 51:212-218. [PMID: 31657288 PMCID: PMC7893503 DOI: 10.1017/s003329171900299x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 09/27/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate. METHODS In this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers. RESULTS Many of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring. CONCLUSIONS ARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.
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Affiliation(s)
- Alison R. Yung
- School of Health Sciences, The University of Manchester, Manchester, UK
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, The National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Stephen J. Wood
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, The National Centre for Excellence in Youth Mental Health, Melbourne, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Ashok Malla
- Department of Psychiatry, Douglas Research Centre, McGill University, Montreal, Canada
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, The National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, The National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Jai Shah
- Department of Psychiatry, Douglas Research Centre, McGill University, Montreal, Canada
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11
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Geros H, Sizer H, Mifsud N, Reynolds S, Kim DJ, Eaton S, McGorry P, Nelson B, O'Donoghue B. Migrant status and identification as ultra-high risk for psychosis and transitioning to a psychotic disorder. Acta Psychiatr Scand 2020; 141:52-59. [PMID: 31520527 DOI: 10.1111/acps.13099] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Certain migrant groups are more likely to develop a psychotic disorder compared to the native-born populations, and a younger age at migration is associated with greater risk. However, it is not known at which stage migration has an effect on the development of psychotic disorders. We examined whether migrants were more likely to be identified as ultra-high risk for psychosis (UHR) compared to native-born young people and whether migrant status was associated with the risk of transition to a full-threshold psychotic disorder. METHODS The cohort included all young people aged 15-24 who were identified as UHR at a specialist clinic over a five-year period (2012-16). Australian census data were used to obtain the at-risk population. Poisson regression was used to calculate rate ratios and Cox regression analysis determined hazard ratios. RESULTS 467 young people were identified as UHR, of which 13.5% (n = 63) were born overseas. First-generation migrants were 2.6-fold less likely to be identified as UHR compared to Australian-born young people (IRR = 0.39, 95% CI [0.30, 0.51], P < 0.001). There was no difference between migrant and native-born young people in their risk of transitioning to a psychotic disorder (HR = 0.90, 95% CI [0.39, 2.08], P = 0.81). CONCLUSIONS UHR first-generation migrants may be under-accessing mental health services.
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Affiliation(s)
- H Geros
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - H Sizer
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - N Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Reynolds
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - D J Kim
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - P McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Orygen Youth Health, Parkville, Vic., Australia
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Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations. Epidemiol Psychiatr Sci 2019; 29:e67. [PMID: 31739812 PMCID: PMC8061208 DOI: 10.1017/s2045796019000635] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS). METHODS Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods. RESULTS One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor. CONCLUSIONS BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies.
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