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Engel L, Alvarez-Jimenez M, Cagliarini D, D’Alfonso S, Faller J, Valentine L, Koval P, Bendall S, O’Sullivan S, Rice S, Miles C, Penn DL, Phillips J, Russon P, Lederman R, Killackey E, Lal S, Maree Cotton S, Gonzalez-Blanch C, Herrman H, McGorry PD, Gleeson JFM, Mihalopoulos C. The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial. Schizophr Bull 2024; 50:427-436. [PMID: 37261464 PMCID: PMC10919787 DOI: 10.1093/schbul/sbad071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective. STUDY DESIGN A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted. STUDY RESULTS The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved. CONCLUSIONS The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.
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Affiliation(s)
- Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon D’Alfonso
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Jan Faller
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lee Valentine
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shaunagh O’Sullivan
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Chris Miles
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Jess Phillips
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Penni Russon
- School of Communication, University of Technology Sydney, Sydney, NWS, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sue Maree Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cesar Gonzalez-Blanch
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- University Hospital Marques de Valdecilla-IDIVAL, Santander, Spain
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - John F M Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Deakin Health Economics, Deakin University, Burwood, VIC, Australia
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2
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Cowman M, Godfrey E, Walsh T, Frawley E, Fowler D, Alvarez-Jimenez M, O’Connor K, Wykes T, Birchwood M, Donohoe G. Measures of Social and Occupational Function in Early Psychosis: A Systematic Review and Meta-analysis. Schizophr Bull 2024; 50:266-285. [PMID: 37173277 PMCID: PMC10919778 DOI: 10.1093/schbul/sbad062] [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: 05/15/2023]
Abstract
Deficits in social and occupational function are widely reported in psychosis, yet no one measure of function is currently agreed upon as a gold standard in psychosis research. The aim of this study was to carry out a systematic review and meta-analysis of functioning measures to determine what measures were associated with largest effect sizes when measuring between-group differences, changes over time, or response to treatment. Literature searches were conducted based on PsycINFO and PubMed to identify studies for inclusion. Cross-sectional and longitudinal observational and intervention studies of early psychosis (≤5 years since diagnosis) that included social and occupational functioning as an outcome measure were considered. A series of meta-analyses were conducted to determine effect size differences for between-group differences, changes over time, or response to treatment. Subgroup analyses and meta-regression were carried out to account for variability in study and participant characteristics. One hundred and sixteen studies were included, 46 studies provided data (N = 13 261) relevant to our meta-analysis. Smallest effect sizes for changes in function over time and in response to treatment were observed for global measures, while more specific measures of social and occupational function showed the largest effect sizes. Differences in effect sizes between functioning measures remained significant after variability in study and participant characteristics were accounted for. Findings suggest that more specific measures of social function are better able to detect changes in function over time and in response to treatment.
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Affiliation(s)
- Megan Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emmet Godfrey
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Talissa Walsh
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emma Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - David Fowler
- School of Psychology, University of Sussex, Falmer, UK
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Karen O’Connor
- RISE Early Intervention in Psychosis Service, South Lee Mental Health Service, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Til Wykes
- School of Mental Health & Psychological Sciences, King’s College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
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3
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Au-Yeung C, Bowie CR, Montreuil T, Baer LH, Lecomte T, Joober R, Abdel-Baki A, Jarvis GE, Margolese HC, De Benedictis L, Schmitz N, Thai H, Malla AK, Lepage M. Predictors of treatment attrition of cognitive health interventions in first episode psychosis. Early Interv Psychiatry 2023; 17:984-991. [PMID: 36653167 DOI: 10.1111/eip.13391] [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: 09/02/2022] [Revised: 11/16/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023]
Abstract
AIM Dropping out of psychological interventions is estimated to occur in up to a third of individuals with psychosis. Given the high degree of attrition in this population, identifying predictors of attrition is important to develop strategies to retain individuals in treatment. We observed a particularly high degree of attrition (48%) in a recent randomized controlled study assessing cognitive health interventions for first-episode psychosis participants with comorbid social anxiety. Due to the importance of developing interventions for social anxiety in first episode psychosis, the aim of the present study was to identify putative predictors of attrition through a secondary analysis of data. METHODS Participants (n = 96) with first episode psychosis and comorbid social anxiety were randomized to receive cognitive behavioural therapy for social anxiety or cognitive remediation. Differences between completers and non-completers (<50% intervention completed) were compared using t-tests or chi-square analyses; statistically significant variables were entered into a multivariate logistic regression model. RESULTS Non-completers tended to be younger, had fewer years of education and had lower levels of social anxiety compared to completers. Lower baseline social anxiety and younger age were statistically significant predictors of non-completion in the logistic regression model. CONCLUSIONS Age and social anxiety were predictors of attrition in cognitive health interventions in first episode psychosis populations with comorbid social anxiety. In the ongoing development of social anxiety interventions for this population, future studies should investigate specific engagement strategies, intervention formats and outcome monitoring to improve participant retention in treatment.
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Affiliation(s)
- Christy Au-Yeung
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Christopher R Bowie
- Department of Psychology, Department of Psychiatry, Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Tina Montreuil
- Departments of Educational & Counselling Psychology and Psychiatry, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Child Health and Human Development, Montreal, Quebec, Canada
| | - Larry H Baer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Tania Lecomte
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- Clinique JAP-Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, Montréal, Québec, Canada
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - G Eric Jarvis
- First Episode Psychosis Program, Jewish General Hospital, and Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychoses, McGill University Health Centre, Montreal, Quebec, Canada
| | - Luigi De Benedictis
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Connec-T Clinic (First Psychotic Episode and Early Intervention Program), Institut universitaire en santé mentale de Montréal, Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Helen Thai
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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4
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Donati FL, Mayeli A, Sharma K, Janssen SA, Lagoy AD, Casali AG, Ferrarelli F. Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study. Brain Sci 2023; 13:brainsci13040534. [PMID: 37190501 DOI: 10.3390/brainsci13040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023] Open
Abstract
Despite the heavy burden of schizophrenia, research on biomarkers associated with its early course is still ongoing. Single-pulse Transcranial Magnetic Stimulation coupled with electroencephalography (TMS-EEG) has revealed that the main oscillatory frequency (or "natural frequency") is reduced in several frontal brain areas, including the premotor cortex, of chronic patients with schizophrenia. However, no study has explored the natural frequency at the beginning of illness. Here, we used TMS-EEG to probe the intrinsic oscillatory properties of the left premotor cortex in early-course schizophrenia patients (<2 years from onset) and age/gender-matched healthy comparison subjects (HCs). State-of-the-art real-time monitoring of EEG responses to TMS and noise-masking procedures were employed to ensure data quality. We found that the natural frequency of the premotor cortex was significantly reduced in early-course schizophrenia compared to HCs. No correlation was found between the natural frequency and age, clinical symptom severity, or dose of antipsychotic medications at the time of TMS-EEG. This finding extends to early-course schizophrenia previous evidence in chronic patients and supports the hypothesis of a deficit in frontal cortical synchronization as a core mechanism underlying this disorder. Future work should further explore the putative role of frontal natural frequencies as early pathophysiological biomarkers for schizophrenia.
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Affiliation(s)
- Francesco L Donati
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Suite 456, Pittsburgh, PA 15213, USA
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Ahmad Mayeli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Suite 456, Pittsburgh, PA 15213, USA
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Kamakashi Sharma
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Sabine A Janssen
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Alice D Lagoy
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Suite 456, Pittsburgh, PA 15213, USA
| | - Adenauer G Casali
- Institute of Science and Technology, Federal University of São Paulo, São José dos Campos 12231-280, Brazil
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Suite 456, Pittsburgh, PA 15213, USA
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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5
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Allen KL, Mountford VA, Elwyn R, Flynn M, Fursland A, Obeid N, Partida G, Richards K, Schmidt U, Serpell L, Silverstein S, Wade T. A framework for conceptualising early intervention for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:320-334. [PMID: 36426567 PMCID: PMC10100476 DOI: 10.1002/erv.2959] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. METHOD AND RESULTS Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these. CONCLUSIONS We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.
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Affiliation(s)
- Karina L Allen
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Victoria A Mountford
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,LightHouse Arabia, Dubai, United Arab Emirates
| | - Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Gubbi Gubbi Country, Queensland, Australia
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Georgina Partida
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Katie Richards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Eating Disorder Service, North East London NHS Foundation Trust, Essex, UK
| | | | - Tracey Wade
- Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
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6
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Hyatt AS, Hasler V, Wilner EK. What happens after early intervention in first-episode psychosis? Limitations of existing service models and an agenda for the future. Curr Opin Psychiatry 2022; 35:165-170. [PMID: 35579870 DOI: 10.1097/yco.0000000000000785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Early intervention in first-episode psychosis (FEP) improves symptomatic and functional outcomes while programs last. However, these gains may not be sustained over time and not all individuals benefit equally from such programs. This review examines the efficacy of FEP programs, as well as step-down practices and long-term outcomes to identify ways to extend the gains made in FEP programs. RECENT FINDINGS FEP programs improve outcomes while services last, but effects diminish over time. Step-down and discharge practices vary widely with little randomized evidence guiding practice. Extending the duration of FEP programs for all does not consistently improve outcomes, but there is some encouraging evidence that targeted psychosocial interventions after program end may extend symptomatic and functional benefits. Members of marginalized groups and individuals with poorer outcomes during the FEP period may benefit from further specialized intervention after FEP. SUMMARY Step down practices from FEP programs should be structured and tailored to individual needs, and benefit from sustained connections to community resources. Psychosocial interventions like social skills training, peer support, and supported education and employment may help extend the benefit of FEP programs after more intensive services end.
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Affiliation(s)
- Andrew S Hyatt
- Department of Psychiatry, Cambridge Health Alliance, Cambridge
- Department of Psychiatry, Harvard Medical School, Boston, Massachu-setts, USA
| | - Victoria Hasler
- Department of Psychiatry, Cambridge Health Alliance, Cambridge
- Department of Psychiatry, Harvard Medical School, Boston, Massachu-setts, USA
| | - Emily K Wilner
- Department of Psychiatry, Cambridge Health Alliance, Cambridge
- Department of Psychiatry, Harvard Medical School, Boston, Massachu-setts, USA
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7
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Alvarez-Jimenez M, Koval P, Schmaal L, Bendall S, O'Sullivan S, Cagliarini D, D'Alfonso S, Rice S, Valentine L, Penn DL, Miles C, Russon P, Phillips J, McEnery C, Lederman R, Killackey E, Mihalopoulos C, Gonzalez-Blanch C, Gilbertson T, Lal S, Cotton SM, Herrman H, McGorry PD, Gleeson JFM. The Horyzons project: a randomized controlled trial of a novel online social therapy to maintain treatment effects from specialist first-episode psychosis services. World Psychiatry 2021; 20:233-243. [PMID: 34002511 PMCID: PMC8129860 DOI: 10.1002/wps.20858] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study aimed to determine whether, following two years of specialized support for first-episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single-blind randomized controlled trial. Participants were people with first-episode psychosis (N=170), aged 16-27 years, in clinical remission and nearing discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N=86) or TAU alone (N=84) between October 2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty-seven participants (55.5%) in the Horyzons plus TAU group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18-month follow-up, with no evidence of significant between-group differences (PSP mean difference: -0.29, 95% CI: -4.20 to 3.63, p=0.77). Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in TAU (odds ratio, OR=5.55, 95% CI: 1.09-28.23, p=0.04), with evidence of a dose-response effect. Moreover, participants in TAU were twice as likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR=0.31, 95% CI: 0.11-0.86, p=0.03, number needed to treat, NNT=5). There was a non-significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR=0.36, 95% CI: 0.11-1.08, p=0.07, NNT=7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key aim of specialized first-episode psychosis services. Horyzons holds significant promise as an engaging and sustainable intervention to provide effective vocational and relapse prevention support for young people with first-episode psychosis beyond specialist services.
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Affiliation(s)
- Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shaunagh O'Sullivan
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon D'Alfonso
- Orygen, Parkville, VIC, Australia
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lee Valentine
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Chris Miles
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Penni Russon
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jessica Phillips
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Carla McEnery
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin Health Economics, Deakin University, Geelong, VIC, Australia
| | - Cesar Gonzalez-Blanch
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- University Hospital Marques de Valdecilla-IDIVAL, Santander, Spain
| | - Tamsyn Gilbertson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sue Maree Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - John F M Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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8
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Malla A, Roy MA, Abdel-Baki A, Conus P, McGorry P. Intervention précoce pour les premiers épisodes psychotiques d’hier à demain : comment relever les défis liés à son déploiement pour en maximiser les bénéfices ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088190ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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9
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McCay E, Tibbo P, Conrad G, Crocker C, Langley J, Kirwan N, Aiello A, Danaher A, Sheasgreen C. Prepared for transition? A cross-sectional descriptive study of the gains attained in early psychosis programs. Early Interv Psychiatry 2020; 14:636-640. [PMID: 31943787 DOI: 10.1111/eip.12916] [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: 12/20/2018] [Revised: 10/24/2019] [Accepted: 12/14/2019] [Indexed: 11/28/2022]
Abstract
AIM To examine the degree to which youth identified as ready for discharge from three Canadian early psychosis intervention (EPI) programs had achieved optimal outcomes (ie, symptom remission, quality of life, self-esteem and functioning). METHODS This cross-sectional descriptive study is part of a larger study assessing the effectiveness of an evidence-based intervention to sustain the gains acquired in EPI programs in two Canadian provinces (Ontario and Nova Scotia), as youth transition from EPI services to community-based care. Baseline data collected from 39 participants receiving usual treatment in these three EPI programs comprised the comparison group. Participants completed measures to assess symptoms, quality of life, self-esteem and functional level just prior to discharge. RESULTS Participants demonstrated lower levels of symptoms, greater quality of life, greater self-esteem and greater levels of functioning, following EPI treatment when compared to similar youth described in the literature. These findings suggest that study participants had achieved optimal outcomes following EPI treatment. CONCLUSION The study findings have laid the ground work for the current Canadian Institutes of Health Research partnership study in which our research group is assessing the effectiveness of an evidence-based transitional intervention in order to address critical psychosocial issues of identity, stigma, effective relationships and meaningful life goals, along with the development of an individualized 'passport for transition'. It is anticipated that implementing an evidence-based transitional intervention will support participants to maintain the gains made in EPI programs once they transition to community-based care and will inform future research addressing this challenging issue.
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Affiliation(s)
- Elizabeth McCay
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Philip Tibbo
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Gretchen Conrad
- Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, Ottawa, Ontario, Canada
| | - Candice Crocker
- Department of Psychiatry, Nova Scotia Psychosis Research Unit, Dalhousie University, Nova Scotia Early Psychosis Program, Halifax, Nova Scotia, Canada
| | - John Langley
- Department of Psychiatry, St. Michael's Hospital, Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kirwan
- Mental Health and Addictions Service, Community Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andria Aiello
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Audrey Danaher
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Clare Sheasgreen
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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10
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Chan SKW, Pang HH, Yan KK, Hui CLM, Suen YN, Chang WC, Lee EHM, Sham P, Chen EYH. Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services. Br J Psychiatry 2020; 217:491-497. [PMID: 31284883 DOI: 10.1192/bjp.2019.161] [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] [Indexed: 01/27/2023]
Abstract
BACKGROUND Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services. AIMS We compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored. METHOD Patients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups. RESULTS There were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1-5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group. CONCLUSIONS Results suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.
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Affiliation(s)
- Sherry Kit Wa Chan
- Clinical Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Herbert H Pang
- Assistant Professor, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kang K Yan
- PhD student, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yi Nam Suen
- Research Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Clinical Associate Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Clinical Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Pak Sham
- Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Clinical Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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11
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Valentine L, McEnery C, Bell I, O'Sullivan S, Pryor I, Gleeson J, Bendall S, Alvarez-Jimenez M. Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study. JMIR Ment Health 2020; 7:e18990. [PMID: 32720904 PMCID: PMC7420518 DOI: 10.2196/18990] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A small number of studies have found that digital mental health interventions can be feasible and acceptable for young people experiencing first-episode psychosis; however, little research has examined how they might be blended with face-to-face approaches in order to enhance care. Blended treatment refers to the integration of digital and face-to-face mental health care. It has the potential to capitalize on the evidence-based features of both individual modalities, while also exceeding the sum of its parts. This integration could bridge the online-offline treatment divide and better reflect the interconnected, and often complementary, ways young people navigate their everyday digital and physical lives. OBJECTIVE This study aimed to gain young people's perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment. METHODS This qualitative study was underpinned by an end-user development framework and was based on semistructured interviews with 10 participants aged 19 to 28 (mean 23.4, SD 2.62). A thematic analysis was used to analyze the data. RESULTS Three superordinate themes emerged relating to young people's perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment: (1) blended features, (2) cautions, and (3) therapeutic alliance. CONCLUSIONS We found that young people were very enthusiastic about the prospect of blended models of mental health care, in so far as it was used to enhance their experience of traditional face-to-face treatment but not to replace it overall. Aspects of blended treatment that could enhance clinical care were readily identified by young people as increasing accessibility, continuity, and consolidation; accessing posttherapy support; strengthening the relationship between young person and clinician; and tracking personal data that could be used to better inform clinical decision making. Future research is needed to investigate the efficacy of blended models of care by evaluating its impact on the therapeutic alliance, clinical and social outcomes, cost-effectiveness, and engagement.
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Affiliation(s)
- Lee Valentine
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Carla McEnery
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Imogen Bell
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Shaunagh O'Sullivan
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Ingrid Pryor
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.,Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
| | - Sarah Bendall
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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12
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Women and Stigma: A Protocol for Understanding Intersections of Experience through Body Mapping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155432. [PMID: 32731565 PMCID: PMC7432432 DOI: 10.3390/ijerph17155432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/02/2022]
Abstract
This paper outlines a research and dissemination protocol to be undertaken with specific groups of marginalised women in Australia. Women impacted by significant mental distress, disability, or refugee status are among society’s most vulnerable and disenfranchised groups. They can experience significant social exclusion, marginalisation and stigma, associated with reduced help seeking, deprivation of dignity and human rights, and threats to health, well-being and quality of life. Previous research has assessed the experiences of discrete groups of women but has to date failed to consider mental health–refugee–disability intersections and overlaps in experience. Using body mapping, this research applies an intersectional approach to identify how women impacted by significant mental distress, disability, and refugee status negotiate stigma and marginalisation. Findings on strategies to cope with, negotiate and resist stigmatised identities will inform health policy and yield targeted interventions informed by much-needed insights on women’s embodied experience of stigma. The women’s body maps will be exhibited publicly as part of an integrated knowledge translation strategy. The aim is to promote and increase sensitivity and empathy among practitioners and policy makers, strengthening the basis for social policy deliberation.
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13
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Wright A, Browne J, Mueser KT, Cather C. Evidence-Based Psychosocial Treatment for Individuals with Early Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:211-223. [PMID: 31708048 DOI: 10.1016/j.chc.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coordinated specialty care (CSC) first-episode models are an evidence-based practice in the treatment of first-episode psychosis. Group, individual, and family therapies in CSC aim to help the client and family understand and cope with the experience of psychosis, promote symptomatic and functional recovery and improve quality of life, and support the pursuit of personally meaningful goals of the client. Common elements to these interventions include building a therapeutic alliance, recovery orientation, education, and skills training, which can be directed to a range of targets, including problem-solving, communication, social skills, and social cognition.
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Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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14
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Lavoie S, Polari AR, Goldstone S, Nelson B, McGorry PD. Staging model in psychiatry: Review of the evolution of electroencephalography abnormalities in major psychiatric disorders. Early Interv Psychiatry 2019; 13:1319-1328. [PMID: 30688016 DOI: 10.1111/eip.12792] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/03/2018] [Accepted: 12/29/2018] [Indexed: 12/29/2022]
Abstract
AIM Clinical staging in psychiatry aims to classify patients according to the severity of their symptoms, from stage 0 (increased risk, asymptomatic) to stage 4 (severe illness), enabling adapted treatment at each stage of the illness. The staging model would gain specificity if one or more quantifiable biological markers could be identified. Several biomarkers reflecting possible causal mechanisms and/or consequences of the pathophysiology are candidates for integration into the clinical staging model of psychiatric illnesses. METHODS This review covers the evolution (from stage 0 to stage 4) of the most important brain functioning impairments as measured with electroencephalography (EEG), in psychosis spectrum and in severe mood disorders. RESULTS The present review of the literature demonstrates that it is currently not possible to draw any conclusion with regard to the state or trait character of any of the EEG impairments in both major depressive disorder and bipolar disorder. As for schizophrenia, the most promising markers of the stage of the illness are the pitch mismatch negativity as well as the p300 event-related potentials, as these components seem to deteriorate with increasing severity of the illness. CONCLUSIONS Given the complexity of major psychiatric disorders, and that not a single impairment can be observed in all patients, future research should most likely consider combinations of markers in the quest for a better identification of the stages of the psychiatric illnesses.
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Affiliation(s)
- Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea R Polari
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Sherilyn Goldstone
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Lieberman JA, Small SA, Girgis RR. Early Detection and Preventive Intervention in Schizophrenia: From Fantasy to Reality. Am J Psychiatry 2019; 176:794-810. [PMID: 31569988 DOI: 10.1176/appi.ajp.2019.19080865] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Scientific progress in understanding human disease can be measured by the effectiveness of its treatment. Antipsychotic drugs have been proven to alleviate acute psychotic symptoms and prevent their recurrence in schizophrenia, but the outcomes of most patients historically have been suboptimal. However, a series of findings in studies of first-episode schizophrenia patients transformed the psychiatric field's thinking about the pathophysiology, course, and potential for disease-modifying effects of treatment. These include the relationship between the duration of untreated psychotic symptoms and outcome; the superior responses of first-episode patients to antipsychotics compared with patients with chronic illness, and the reduction in brain gray matter volume over the course of the illness. Studies of the effectiveness of early detection and intervention models of care have provided encouraging but inconclusive results in limiting the morbidity and modifying the course of illness. Nevertheless, first-episode psychosis studies have established an evidentiary basis for considering a team-based, coordinated specialty approach as the standard of care for treating early psychosis, which has led to their global proliferation. In contrast, while clinical high-risk research has developed an evidence-based care model for decreasing the burden of attenuated symptoms, no treatment has been shown to reduce risk or prevent the transition to syndromal psychosis. Moreover, the current diagnostic criteria for clinical high risk lack adequate specificity for clinical application. What limits our ability to realize the potential of early detection and intervention models of care are the lack of sensitive and specific diagnostic criteria for pre-syndromal schizophrenia, validated biomarkers, and proven therapeutic strategies. Future research requires methodologically rigorous studies in large patient samples, across multiple sites, that ideally are guided by scientifically credible pathophysiological theories for which there is compelling evidence. These caveats notwithstanding, we can reasonably expect future studies to build on the research of the past four decades to advance our knowledge and enable this game-changing model of care to become a reality.
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Affiliation(s)
- Jeffrey A Lieberman
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Scott A Small
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Ragy R Girgis
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
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16
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Chan SKW, Chan HYV, Devlin J, Bastiampillai T, Mohan T, Hui CLM, Chang WC, Lee EHM, Chen EYH. A systematic review of long-term outcomes of patients with psychosis who received early intervention services. Int Rev Psychiatry 2019; 31:425-440. [PMID: 31353981 DOI: 10.1080/09540261.2019.1643704] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite convincing evidence of short-term symptom control and functional recovery of patients with psychosis after receiving early intervention (EI) services, little is known about the long-term outcomes of EI for these patients. This review aims to evaluate the effectiveness of EI services in improving long-term outcomes of patients with psychosis. A systematic literature search was conducted on PubMed, PsycINFO, Scopus, Medline, CINAHL, BIOSIS, and EMBASE electronic databases to identify studies that evaluated long-term outcomes of patients with psychosis measured 5 years or beyond after entering the EI service. Of 13,005 articles returned from the search, 14 eligible articles reporting study cohorts from nine EI services in seven countries and regions were identified. Data on study design, patient characteristics, intervention components, and outcomes were extracted and reviewed. Only a few studies reported better longitudinal outcomes for negative symptoms, mortality, employment, and hospitalization in patients received EI services. However, results from cross-sectional measurements provided little evidence for long-term impacts of EI services on clinical and functional outcomes. A dilution effect of benefits over time was also demonstrated in several studies. This review highlights the gap in current EI service provision and suggests possible future directions for service improvement and further research.
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Affiliation(s)
- Sherry K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong
| | - Hei Y V Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Jillian Devlin
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Tarun Bastiampillai
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University , Adelaide , South Australia
| | - Titus Mohan
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University , Adelaide , South Australia
| | - Christy L M Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Wing C Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong
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17
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Niendam TA, Sardo A, Savill M, Patel P, Xing G, Loewy RL, Dewa CS, Melnikow J. The Rise of Early Psychosis Care in California: An Overview of Community and University-Based Services. Psychiatr Serv 2019; 70:480-487. [PMID: 30890048 DOI: 10.1176/appi.ps.201800394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE California's Mental Health Services Act Prevention and Early Intervention funds provide a unique opportunity for counties to initiate programs focused on early intervention in mental health, including early psychosis. To explain the configuration of early psychosis programs and plan for a statewide evaluation, this report provides an overview of California's early psychosis programming, including service composition, funding sources, inclusion criteria, and data collection practices. METHODS Following a comprehensive identification process, early psychosis program representatives were contacted to complete the California Early Psychosis Assessment Survey (CEPAS). RESULTS The response rate to the CEPAS was excellent (97%, 29 of 30 active programs across 24 of 58 counties). Most programs (N=27, 93%) serve individuals with first-episode psychosis between the ages of 12 and 25. Twenty-two programs (79%) provide more than half of the standard components of early psychosis care outlined in the First-Episode Psychosis Service Fidelity Scale. Sixty-four percent of programs collect client-level data at intake and follow up on five or more relevant outcome domains; however, these varied significantly across sites. CONCLUSIONS Substantial variability in services, inclusion criteria, and data recorded was evident across programs. Prior to conducting any large-scale evaluation, these findings highlight the significant challenges in retrospectively evaluating program effectiveness, need to harmonize program data collection methods, and importance of assessing the impact of program variability on outcomes.
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Affiliation(s)
- Tara A Niendam
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
| | - Angela Sardo
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
| | - Mark Savill
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
| | - Pooja Patel
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
| | - Guibo Xing
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
| | - Rachel L Loewy
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
| | - Carolyn S Dewa
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
| | - Joy Melnikow
- Department of Psychiatry (Niendam, Sardo, Patel, Dewa), Center for Healthcare Policy and Research (Xing, Dewa, Melnikow), and Department of Family and Community Medicine (Melnikow), University of California, Davis, Sacramento; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Savill, Loewy)
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18
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Thomson A, Griffiths H, Fisher R, McCabe R, Abbott-Smith S, Schwannauer M. Treatment outcomes and associations in an adolescent-specific early intervention for psychosis service. Early Interv Psychiatry 2019; 13:707-714. [PMID: 30690896 DOI: 10.1111/eip.12778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/20/2018] [Accepted: 12/26/2018] [Indexed: 01/17/2023]
Abstract
AIM Compared with adult onset psychosis, adolescent psychosis has been associated with poorer outcomes in terms of social and cognitive functioning and negative symptoms. Young people experiencing first episode psychosis have developmental needs that frequently pre-date and are compounded by psychosis onset (a previous study). There is a lack of published studies of adolescent onset psychosis and further information is needed so that developmentally appropriate interventions can be developed. We report an observational naturalistic cohort study of an adolescent specific service, the Early Psychosis Support service (EPSS). METHOD We examined baseline demographic and clinical variables, treatments outcomes and predictors of outcome for this population. RESULTS The mean age of our sample was 16.3 years. Median duration of untreated illness (DUI) was 88 weeks, and median duration of untreated psychosis (DUP) was 16 weeks. We found significant improvements in positive symptoms, negative symptoms, disorganization, excitement, emotional distress and depression from 0 to 12 months. We found that baseline positive symptoms and DUI significantly predicted positive symptoms at 12 months and only negative symptoms at baseline predicted 12-month negative symptoms. CONCLUSION Our finding that specialist early intervention for adolescents experiencing psychosis is effective suggests that such treatment should be routinely offered in line with existing clinical guidelines. Our finding that DUI is predictive of poorer outcome at 12 months suggests that even earlier intervention from a specialist team may further improve treatment outcomes.
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Affiliation(s)
- Alice Thomson
- CAMHS, NHS Lothian, Edinburgh, UK.,Section of Clinical, Health Psychology, University of Edinburgh, Edinburgh, UK
| | - Helen Griffiths
- CAMHS, NHS Lothian, Edinburgh, UK.,Section of Clinical, Health Psychology, University of Edinburgh, Edinburgh, UK
| | - Rebecca Fisher
- CAMHS, NHS Lothian, Edinburgh, UK.,Central and North West London, NHS Foundation Trust, London, UK
| | | | | | - Matthias Schwannauer
- CAMHS, NHS Lothian, Edinburgh, UK.,Section of Clinical, Health Psychology, University of Edinburgh, Edinburgh, UK
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19
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Alvarez-Jimenez M, Bendall S, Koval P, Rice S, Cagliarini D, Valentine L, D’Alfonso S, Miles C, Russon P, Penn DL, Phillips J, Lederman R, Wadley G, Killackey E, Santesteban-Echarri O, Mihalopoulos C, Herrman H, Gonzalez-Blanch C, Gilbertson T, Lal S, Chambers R, Daglas-Georgiou R, Latorre C, Cotton SM, McGorry PD, Gleeson JF. HORYZONS trial: protocol for a randomised controlled trial of a moderated online social therapy to maintain treatment effects from first-episode psychosis services. BMJ Open 2019; 9:e024104. [PMID: 30782893 PMCID: PMC6368148 DOI: 10.1136/bmjopen-2018-024104] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Specialised early intervention services have demonstrated improved outcomes in first-episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many patients with FEP remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has developed a moderated online social media therapy (HORYZONS) designed to enhance social functioning and maintain clinical gains from specialist FEP services. HORYZONS merges: (1) peer-to-peer social networking; (2) tailored therapeutic interventions; (3) expert and peer-moderation; and (4) new models of psychological therapy (strengths and mindfulness-based interventions) targeting social functioning. The aim of this trial is to determine whether following 2 years of specialised support and 18-month online social media-based intervention (HORYZONS) is superior to 18 months of regular care. METHODS AND ANALYSIS This study is a single-blind randomised controlled trial. The treatment conditions include HORYZONS plus treatment as usual (TAU) or TAU alone. We recruited 170 young people with FEP, aged 16-27 years, in clinical remission and nearing discharge from Early Psychosis Prevention and Intervention Centre, Melbourne. The study includes four assessment time points, namely, baseline, 6-month, 12-month and 18-month follow-up. The study is due for completion in July 2018 and included a 40-month recruitment period and an 18-month treatment phase. The primary outcome is social functioning at 18 months. Secondary outcome measures include rate of hospital admissions, cost-effectiveness, vocational status, depression, social support, loneliness, self-esteem, self-efficacy, anxiety, psychological well-being, satisfaction with life, quality of life, positive and negative psychotic symptoms and substance use. Social functioning will be also assessed in real time through our Smartphone Ecological Momentary Assessment tool. ETHICS AND DISSEMINATION Melbourne Health Human Research Ethics Committee (2013.146) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. TRIAL REGISTRATION NUMBER ACTRN12614000009617; Pre-results.
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Affiliation(s)
- Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniela Cagliarini
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Lee Valentine
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Simon D’Alfonso
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher Miles
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Penni Russon
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Penn
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
- Department of Psychology, University of North Carolina Chapel Hill, NC, United Stated
| | - Jess Phillips
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Olga Santesteban-Echarri
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Calgary, Alberta, Canada
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Tamsyn Gilbertson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- University of Montreal Hospital Research Center, Health Innovation and Evaluation Hub, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | - Rothanthi Daglas-Georgiou
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John F Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
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Lutgens D, Joober R, Iyer S, Lepage M, Norman R, Schmitz N, Mustafa S, Abadi S, Malla A. Progress of negative symptoms over the initial 5 years of a first episode of psychosis. Psychol Med 2019; 49:66-74. [PMID: 29534765 DOI: 10.1017/s003329171800048x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Specialized early intervention (EI) following a first episode of psychosis (FEP) are effective at reducing negative symptoms, although its trajectory warrants systematic assessment. However, findings are equivocal as to whether extended gains are made post 2 years of EI and whether there is additional benefit of extending EI for an additional 3 years. METHODS Data on 178 FEP patients, from a randomized controlled trial of a 3-year extension of EI service v. transfer to regular care following 2 years of EI service, were used for this report. Repeated measures analysis of variance were conducted separately for the initial 2 years of treatment in an EI service, and for the 3-year post-randomization to examine trajectories of negative symptoms over the two periods in the two arms of the study. RESULTS There were significant improvements in total negative symptoms over the first 2 years of EI F(4.612, 797.905) = 25.263, p < 0.001 and in domains of 'expressivity' and 'motivation'. In the following 3 years, there were further significant improvements in negative symptoms F(4.318, 759.908) = 4.182, p = 0.002 with no difference between groups F(4.318, 759.908) = 1.073, p = 0.371. Changes in negative symptoms over the extension period were driven by expressivity F(4.01, 674.73) = 7.19, p < 0.01, but not motivation F(6.58, 1112.18) = 0.95, p = 0.46. CONCLUSION Negative symptoms improve significantly over the first 2 years of EI. Subsequent amelioration was largely the result of expressivity. Motivation deficits remained stable. Extended EI offered no advantage over regular care post-randomization.
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Affiliation(s)
- Danyael Lutgens
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Ridha Joober
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Srividya Iyer
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Martin Lepage
- McGill University,Douglas Hospital Research Centre,Montreal,QC,Canada
| | - Ross Norman
- Department of Psychiatry,Western University; Prevention and Early Intervention Program for Psychosis (PEPP-London) London,Ontario,Canada
| | - Norbert Schmitz
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Sally Mustafa
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Sherezad Abadi
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Ashok Malla
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
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Nielsen RE, Hessellund KB, Valentin JB, Licht RW. Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia. Schizophr Res 2018; 202:234-240. [PMID: 30005935 DOI: 10.1016/j.schres.2018.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Investigate the associations of long-acting injectable (LAI) second generation antipsychotic drugs with number of relapses, psychiatric admissions, days hospitalized, intentional self-harm events, and costs linked to hospitalizations in incident patients diagnosed with schizophrenia. METHOD A nationwide, population-based, retrospective study utilizing mirror-image models before and after initiation of LAI SGA. RESULTS 10,509 patients were included as study population, with analyses being conducted on 2223 patients in a six-month period, 1383 in a 12-month period, 713 in a 24-month period. After initiation of LAI antipsychotics, patients experienced a reduction in number of relapses with an incidence rate ratio (IRR) of 0.60 for the first six months, IRR 0.64 for the first 12 months and IRR 0.64 for the first 24 months following initiation of LAI, all P < 0.001. The number of psychiatric admissions was reduced in a similar manner with respective IRR of 0.59, 0.60 and 0.64, all P < 0.001. Psychiatric bed-days were reduced with 58, 100 and 164 days for the respective periods after LAI initiation, all P < 0.001. In a Cox regression model in patients initiated on LAI, higher age at diagnosis, hazard rate ratio (HR) 0.99, 95%CI(0.98-0.99), P < 0.001, and a later calendar year of diagnosis, HR 0.99, 95%CI(0.98-1.00), P < 0.05, were associated with a lower risk of relapse, whereas mainly psychiatric comorbidity, HR 1.07, 95% CI (1.04-1.11), P < 0.001, and cardiovascular disease, HR 1.12, 95%CI(1.01-1.26), P < 0.05, were associated with relapse. CONCLUSION Even though the design does not allow inferences regarding causality, these population-based findings support the use of second generation LAI antipsychotics.
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Affiliation(s)
- René Ernst Nielsen
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | | | | | - Rasmus W Licht
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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22
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Norman RMG, Anderson KK, MacDougall A, Manchanda R, Harricharan R, Subramanian P, Richard J, Northcott S. Stability of outcomes after 5 years of treatment in an early intervention programme. Early Interv Psychiatry 2018. [PMID: 28627097 DOI: 10.1111/eip.12450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM It has been hypothesized that the first 5 years are critical in determining long-term recovery from psychotic disorders. We examine stability in recovery indices after 5 years for 56 patients treated in an early intervention programme for psychosis. METHODS Assessments of symptom remission and functional recovery were carried out 5 and 10 years after initiation of treatment. RESULTS Although overall rates of recovery were comparable at both times, there were significant changes for individuals reflecting both improvement and deterioration. CONCLUSIONS Evidence concerning the critical period hypothesis should examine stability in individuals rather than relying on cumulative indices.
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Affiliation(s)
- Ross M G Norman
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Arlene MacDougall
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Rahul Manchanda
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada
| | - Raj Harricharan
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada
| | - Priya Subramanian
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada
| | - Julie Richard
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada
| | - Sandra Northcott
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
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23
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Correll CU, Galling B, Pawar A, Krivko A, Bonetto C, Ruggeri M, Craig TJ, Nordentoft M, Srihari VH, Guloksuz S, Hui CLM, Chen EYH, Valencia M, Juarez F, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA, Marcy P, Addington J, Estroff SE, Robinson J, Penn D, Severe JB, Kane JM. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry 2018; 75:555-565. [PMID: 29800949 PMCID: PMC6137532 DOI: 10.1001/jamapsychiatry.2018.0623] [Citation(s) in RCA: 441] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal. OBJECTIVE To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis. DATA SOURCES Systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017. STUDY SELECTION Randomized trials comparing EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders. DATA EXTRACTION AND SYNTHESIS This systematic review was conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup and meta-regression analyses. MAIN OUTCOMES AND MEASURES The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric hospitalization during the treatment period. RESULTS Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24 months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13; 95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom severity at 18-24 months). CONCLUSIONS AND RELEVANCE In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.
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Affiliation(s)
- Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Britta Galling
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Aditya Pawar
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Anastasia Krivko
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Chiara Bonetto
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Thomas J. Craig
- Institute of Psychiatry, King’s College London, London, England
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
| | - Vinod H. Srihari
- Department of Psychiatry, Yale University, New Haven, Connecticut,Specialized Treatment Early in Psychosis (STEP) Program, Connecticut Mental Health Center, New Haven
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University, New Haven, Connecticut,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Eric Y. H. Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China,State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong, China
| | - Marcelo Valencia
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
| | - Francisco Juarez
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
| | - Delbert G. Robinson
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Nina R. Schooler
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry, SUNY Downstate Medical Center, New York, New York
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire,Bureau of Behavioral Health, College of Health and Human Services (CHHS), Dartmouth, New Hampshire
| | - Kim T. Mueser
- Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts,Department of Psychiatry, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts,Department of Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
| | - Robert A. Rosenheck
- Department of Psychiatry, Yale University, New Haven, Connecticut,Department of Epidemiology, Yale University, New Haven, Connecticut,Department of Public Health, Yale University, New Haven, Connecticut
| | - Patricia Marcy
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Jean Addington
- The Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Sue E. Estroff
- Department of Social Medicine, The University of North Carolina at Chapel Hill
| | | | - David Penn
- Department of Psychology, The University of North Carolina at Chapel Hill
| | | | - John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York
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Dixon LB, Goldman HH, Srihari VH, Kane JM. Transforming the Treatment of Schizophrenia in the United States: The RAISE Initiative. Annu Rev Clin Psychol 2018; 14:237-258. [PMID: 29328779 PMCID: PMC8990328 DOI: 10.1146/annurev-clinpsy-050817-084934] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
The schizophrenia spectrum disorders are neurodevelopmental illnesses with a lifetime prevalence near 1%, producing extensive functional impairment and low expectations for recovery. Until recently, treatment in the United States has largely attempted to stabilize individuals with chronic schizophrenia. The identification and promotion of evidence-based practices for schizophrenia via the Patient Outcomes Research Team, combined with international studies supporting the value of early intervention, provided the foundation for the Recovery After an Initial Schizophrenia Episode (RAISE) project. The RAISE studies further supported the value of reducing the duration of untreated psychosis and providing a multi-element treatment called coordinated specialty care (CSC) to improve outcomes for patients in usual treatment settings. Although CSC programs have proliferated rapidly in the United States, many challenges remain in the treatment and recovery of individuals with schizophrenia in the aftermath of RAISE.
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Affiliation(s)
- Lisa B Dixon
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032, USA;
| | - Howard H Goldman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA
| | - John M Kane
- Zucker Hillside Hospital and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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25
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Norman RMG, MacDougall A, Manchanda R, Harricharan R. An examination of components of recovery after five years of treatment in an early intervention program for psychosis. Schizophr Res 2018; 195:469-474. [PMID: 28888360 DOI: 10.1016/j.schres.2017.08.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
Recovery from psychotic disorders includes both symptomatic and functional components. Progress in understanding recovery requires careful replication and extension of findings using comparable measures. In the current paper, we present a study of five year recovery rates in an early intervention program in London, Canada with the same operational criteria as those used in a previous report from the OPUS cohort in Denmark. Our analysis extends the OPUS reports by including additional potential predictors of overall recovery, such as cognitive functioning, adherence to medication and early social support, and examining rates and predictors of individual components of recovery at five year follow-up. Consistent with reports from OPUS, we found younger age of onset and lower initial severity of negative symptoms to predict greater likelihood of overall recovery. Different patterns of predictors emerge when we examine individual components of recovery. Adherence to medication during the first year was the sole independent predictor of remission of positive symptoms, while early social adjustment and social support were more likely to predict negative symptom and functional aspects of recovery at five years. Cognitive functioning, as represented by IQ, did not predict any aspects of recovery. Our findings suggest the importance of examining the predictors of individual components in the quest to improve overall recovery.
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Affiliation(s)
- Ross M G Norman
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada; Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada.
| | - Arlene MacDougall
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada; Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada
| | - Rahul Manchanda
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada; Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada
| | - Raj Harricharan
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada; Prevention and Early Intervention for Psychoses Program, London Health Sciences Centre, London, Ontario, Canada
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26
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Rosen A, Killaspy H, Harvey C. Specialisation and marginalisation: how the assertive community treatment debate affects individuals with complex mental health needs. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.113.044537] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThe growth of specialism in a field can be considered a healthy response to emerging evidence, technology and skills, yet it risks creating unhelpful barriers to collaborative working and fragmented patient pathways. Mental health services in England have experienced this tension in recent years through the national implementation of local specialist community teams that aim to reduce the need for in-patient admission through a focus on crisis resolution, early intervention and assertive community treatment (ACT). In response to the results of studies assessing its effectiveness, there has been disinvestment in ACT. This risks marginalising people with severe and complex mental health problems by depriving them and their families of the intensive support they need for successful community living, as well as discouraging researchers from undertaking further high-quality studies that can inform the intelligent evolution of the ACT model within different contexts.
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27
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Early Intervention in Psychosis: Health of the Nation Outcome Scales (HoNOS) Outcomes From a Five-Year Prospective Study. Arch Psychiatr Nurs 2017; 31:553-560. [PMID: 29179820 DOI: 10.1016/j.apnu.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/09/2017] [Accepted: 07/15/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Over the last two decades, mental health services internationally have shifted towards intervening early in psychosis. The critical period for intervention is estimated to be five-years and many specialised programs target early psychosis. AIM/QUESTION This prospective cohort study aimed to evaluate five-year outcomes from an early psychosis program (EPP) that adopted an integrated model, providing nursing and multidisciplinary community mental healthcare to clients aged 16-65years, beyond the typical age range of 16-25years. METHOD We examined one routine outcome measure, the Health of the Nation Outcome Scales (HoNOS) across episodes of care for clients receiving EPP over a 5year period (n=239), comparing these results with HoNOS outcomes in an Australian national dataset for all public mental health clients. RESULTS HoNOS improvements were highly significant from intake to discharge and from review to discharge for EPP clients, and these compared well with national outcome performance. CONCLUSION There is potential for mental health nurses and other clinicians to significantly improve client symptoms and functioning, in a model of early psychosis treatment beyond a youth focus.
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Malla A, Joober R, Iyer S, Norman R, Schmitz N, Brown T, Lutgens D, Jarvis E, Margolese HC, Casacalenda N, Abdel‐Baki A, Latimer E, Mustafa S, Abadi S. Comparing three-year extension of early intervention service to regular care following two years of early intervention service in first-episode psychosis: a randomized single blind clinical trial. World Psychiatry 2017; 16:278-286. [PMID: 28941098 PMCID: PMC5608831 DOI: 10.1002/wps.20456] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This study aimed to determine if, following two years of early intervention service for first-episode psychosis, three-year extension of that service was superior to three years of regular care. We conducted a randomized single blind clinical trial using an urn randomization balanced for gender and substance abuse. Participants were recruited from early intervention service clinics in Montreal. Patients (N=220), 18-35 years old, were randomized to an extension of early intervention service (EEIS; N=110) or to regular care (N=110). EEIS included case management, family intervention, cognitive behaviour therapy and crisis intervention, while regular care involved transfer to primary (community health and social services and family physicians) or secondary care (psychiatric outpatient clinics). Cumulative length of positive and negative symptom remission was the primary outcome measure. EEIS patients had a significantly longer mean length of remission of positive symptoms (92.5 vs. 63.6 weeks, t=4.47, p<0.001), negative symptoms (73.4 vs. 59.6 weeks, t=2.84, p=0.005) and both positive and negative symptoms (66.5 vs. 56.7 weeks, t=2.25, p=0.03) compared to regular care patients. EEIS patients stayed in treatment longer than regular care patients (mean 131.7 vs. 105.3 weeks, t=3.98, p<0.001 through contact with physicians; 134.8 ± 37.7 vs. 89.8 ± 55.2, t=6.45, p<0.0001 through contact with other health care providers) and received more units of treatment (mean 74.9 vs. 39.9, t=4.21, p<0.001 from physicians, and 57.3 vs. 28.2, t=4.08, p<0.001 from other health care professionals). Length of treatment had an independent effect on the length of remission of positive symptoms (t=2.62, p=0.009), while number of units of treatment by any health care provider had an effect on length of remission of negative symptoms (t=-2.70, p=0.008) as well as total symptoms (t=-2.40, p=0.02). Post-hoc analysis showed that patients randomized to primary care, based on their better clinical profile at randomization, maintained their better outcome, especially as to remission of negative symptoms, at the end of the study. These data suggest that extending early intervention service for three additional years has a positive impact on length of remission of positive and negative symptoms compared to regular care. This may have policy implications for extending early intervention services beyond the current two years.
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Affiliation(s)
- Ashok Malla
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Mental Health University InstituteMontrealQCCanada
| | - Ridha Joober
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Mental Health University InstituteMontrealQCCanada
| | - Srividya Iyer
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Mental Health University InstituteMontrealQCCanada
| | - Ross Norman
- Departments of Psychiatry and Epidemiology and BiostatisticsUniversity of Western Ontario, and London Health Sciences CentreLondonONCanada
| | - Norbert Schmitz
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Hospital Research CentreMontrealQCCanada
| | - Thomas Brown
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Hospital Research CentreMontrealQCCanada
| | - Danyael Lutgens
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Mental Health University InstituteMontrealQCCanada
| | - Eric Jarvis
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Jewish General HospitalMontrealQCCanada
| | - Howard C. Margolese
- Department of PsychiatryMcGill UniversityMontrealQCCanada,McGill University Health CentreMontrealQCCanada
| | - Nicola Casacalenda
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Jewish General HospitalMontrealQCCanada
| | | | - Eric Latimer
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Hospital Research CentreMontrealQCCanada
| | - Sally Mustafa
- Douglas Mental Health University InstituteMontrealQCCanada
| | - Sherezad Abadi
- Douglas Mental Health University InstituteMontrealQCCanada
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Ouellet-Plamondon C, Abdel-Baki A, Salvat É, Potvin S. Specific impact of stimulant, alcohol and cannabis use disorders on first-episode psychosis: 2-year functional and symptomatic outcomes. Psychol Med 2017; 47:2461-2471. [PMID: 28424105 DOI: 10.1017/s0033291717000976] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many studies have concluded that cannabis use disorder (CUD) negatively influences outcomes in first-episode psychosis (FEP). However, few have taken into account the impact of concurrent misuse of other substances. METHODS This 2-year, prospective, longitudinal study of FEP patients, aged between 18 and 30 years, admitted to early intervention programs in Montreal, Quebec, Canada, examined the specific influence of different substance use disorders (SUD) (alcohol, cannabis, cocaine, amphetamines) on service utilization, symptomatic and functional outcomes in FEP. RESULTS Drugs and alcohol were associated with lower functioning, but drugs had a greater negative impact on most measures at 2-year follow-up. Half of CUD patients and more than 65% of cocaine or amphetamine abusers presented polysubstance use disorder (poly-SUD). The only group that deteriorated from years 1 to 2 (symptoms and functioning) were patients with persistent CUD alone. Outcome was worse in CUD than in the no-SUD group at 2 years. Cocaine, amphetamines and poly-SUD were associated with worse symptomatic and functional outcomes from the 1st year of treatment, persisting over time with higher service utilization (hospitalization). CONCLUSION The negative impact attributed to CUD in previous studies could be partly attributed to methodological flaws, like including polysubstance abusers among cannabis misusers. However, our investigation confirmed the negative effect of CUD on outcome. Attention should be paid to persistent cannabis misusers, since their condition seems to worsen over time, and to cocaine and amphetamine misusers, in view of their poorer outcome early during follow-up and high service utilization.
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Affiliation(s)
- C Ouellet-Plamondon
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - A Abdel-Baki
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - É Salvat
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - S Potvin
- Department of Psychiatry, Faculty of Medicine,Université de Montréal,Montreal, Quebec,Canada
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Conus P, Cotton S, Schimmelmann BG, McGorry PD, Lambert M. Rates and predictors of 18-months remission in an epidemiological cohort of 661 patients with first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1089-1099. [PMID: 28477070 DOI: 10.1007/s00127-017-1388-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/01/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Most first episode psychosis (FEP) outcome studies are based on patient samples enrolled through an informed consent procedure, which may induce important biases. Our aim was to study the 18-month outcome of FEP in an epidemiological sample of patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC). METHODS The files of 661 FEP patients treated for up to 18 months between 1998 and 2000 were assessed. Symptomatic remission was defined as receiving a score ≤3 on the Clinical Global Impressions (CGI) scales, and functional remission as concurrent fulfillment of occupation/employment and independent living. Predictors were analyzed using stepwise logistic regression models. RESULTS At endpoint, 63% of FEP patients had reached symptomatic remission and 44% functional remission. Duration of untreated psychosis, baseline symptom intensity, time in service and decrease or remission of substance use, predicted both symptomatic and functional outcome. A history of suicide attempt or non-adherence to medication was linked to lower likelihood to reach symptomatic remission while pre-morbid GAF and employment at baseline were linked to functional outcome. CONCLUSIONS The development of early intervention strategies should be pursued, in order both to provide treatment before symptoms reach a high intensity and to maintain social integration. Specific strategies need to promote engagement, facilitate adherence to medication and to create a framework where key issues such as substance abuse co-morbidity can be addressed.
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Affiliation(s)
- Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008, Prilly, Switzerland. .,Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.
| | - Sue Cotton
- Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.,Centre for Youth Mental Health University of Melbourne, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia
| | - Benno G Schimmelmann
- Department of Child- and Adolescent Psychiatry, University of Bern, Bern, Switzerland.,Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia.,Centre for Youth Mental Health University of Melbourne, 35 Poplar Road, Parkville Victoria, Melbourne, 3052, Australia
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chang WC, Kwong VWY, Lau ESK, So HC, Wong CSM, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Sustainability of treatment effect of a 3-year early intervention programme for first-episode psychosis. Br J Psychiatry 2017; 211:37-44. [PMID: 28385705 DOI: 10.1192/bjp.bp.117.198929] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 01/16/2023]
Abstract
BackgroundEvidence indicates that the positive effects of 2-year early intervention services for psychosis are not maintained after service withdrawal. Optimal duration of early intervention in sustaining initial improved outcomes remains to be determined.AimsTo examine the sustainability of the positive effects of an extended, 3-year, early intervention programme for patients with first-episode psychosis (FEP) after transition to standard care.MethodA total of 160 patients, who had received a 2-year early intervention programme for FEP, were enrolled to a 12-month randomised-controlled trial (ClinicalTrials.gov: NCT01202357) comparing a 1-year extension of the early intervention (3-year specialised treatment) with step-down care (2-year specialised treatment). Participants were followed up and reassessed 2 and 3 years after inclusion to the trial.ResultsThere were no significant differences between the treatment groups in outcomes on functioning, symptom severity and service use during the post-trial follow-up period.ConclusionsThe therapeutic benefits achieved by the extended, 3-year early intervention were not sustainable after termination of the specialised service.
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Affiliation(s)
- Wing Chung Chang
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Vivian Wing Yan Kwong
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Emily Sin Kei Lau
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Hon Cheong So
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Gloria Hoi Kei Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Olivia Tsz Ting Jim
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Sherry Kit Wa Chan
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Wing Chung Chang, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong; Vivian Wing Yan Kwong, MPsyMed, Emily Sin Kei Lau, MSocSc(CP), Department of Psychiatry, Queen Mary Hospital, Hong Kong; Hon Cheong So, MBBS, PhD, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong; Corine Sau Man Wong MsocSc, Gloria Hoi Kei Chan, MSSc(CP), Olivia Tsz Ting Jim, BSocSc, Christy Lai Ming Hui, PhD, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Sherry Kit Wa Chan, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong Hong Kong; Edwin Ho Ming Lee, MRCPsych, FHKCPsych, Department of Psychiatry, Queen Mary Hospital, Hong Kong; Eric Yu Hai Chen, MD, Department of Psychiatry, Queen Mary Hospital and State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
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Waiting time variation in Early Intervention Psychosis services: longitudinal evidence from the SEPEA naturalistic cohort study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:563-574. [PMID: 28213813 PMCID: PMC5423995 DOI: 10.1007/s00127-017-1343-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Early Intervention Psychosis [EIP] services have gained traction internationally, but are currently undergoing various forms of reconfiguration. In England, such services are now mandated to ensure 50% of accepted referrals commence care within 14 days, but no empirical evidence exists. We sought to estimate waiting times to EIP services in a large, representative epidemiological cohort in England, and investigate possible reasons for any variation. METHODS We estimated median waiting time from referral to acceptance by EIP services and investigated whether this varied by clinical, demographic or neighbourhood-level factors, amongst 798 participants, 16-35 years old, presenting to six EIP services over 3.5 years in a defined catchment area serving 2.5 million people. We used parametric survival analysis to inspect variation in waiting times (in days). RESULTS Median waiting time was 15 days (interquartile range 7-30), although this varied across services (p < 0.01). Waiting times increased over the case ascertainment period by an average of 4.3 days (95% CI 1.3, 6.2; p < 0.01). Longer waiting times were associated with greater diagnostic uncertainty, indexed by an organic presentation (+ 9.1 days; 95% CI 1.9, 16.6; p < 0.01), polysubstance abuse (+ 2.6; 0.6, 3.9; p < 0.01), absence of psychotic disorder (+1.8; -0.1, 3.0; p = 0.05) and insidious onset (+1.8; -0.1, 3.0; p = 0.06). Waiting times did not vary by most demographic or neighbourhood-level characteristics. CONCLUSIONS EIP services operate close to new waiting time standards in England, with little systematic variation by sociodemographic position. However, waiting times increased over the study period, coinciding with substantial service reorganisation. Longer waiting times associated with greater diagnostic uncertainty highlight opportunities to reduce delays in certain clinical groups at initial referral.
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Abstract
Background
In the last decade, an increasing number of publications have examined the precursors of bipolar disorders (BD) and attempted to clarify the early origins and illness trajectory. This is a complex task as the evolution of BD often shows greater heterogeneity than psychosis, and the first onset episode of BD may be dominated by depressive or manic features or both. To date, most of the published reviews have not clarified whether they are focused on prodromes, risk syndromes or addressing both phenomena.
To assist in the interpretation of the findings from previous reviews and independent studies, this paper examines two concepts deemed critical to understanding the pre-onset phase of any mental disorder: prodromes and risk syndromes. The utility of these concepts to studies of the evolution of bipolar disorder (BD) is explored. Findings The term “prodrome” is commonly used to describe the symptoms and signs that precede episode onset. If strictly defined, the term should only be applied retrospectively as it refers to cohorts of cases that all progress to meet diagnostic criteria for a specific disorder and gives insights into equifinality. Whilst prodromes may reliably predict individual relapses, the findings cannot necessarily be extrapolated to identify prospectively who will develop a first episode of a specific disorder from within a given population. In contrast, ‘risk syndrome’ is a term that encompasses sub-threshold symptom clusters, but has often been extended to include other putative risk factors such as family history, or other variables expressed continuously in the population, such as personality traits. Only a minority of individuals ‘at risk’ make the transition to a specific mental disorder. By prospectively observing those cases where the risk syndrome does not progress to severe disorder or progress to a non-BD condition, we gain insights into the discriminant validity of different pre-BD characteristics, pluripotentiality of outcomes, and protective factors and resilience. Conclusion We emphasize the clinical and research utility of prodromes and risk syndromes, examine examples of the conflation of the concepts, and highlight the rationale for regarding them as discrete entities.
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Affiliation(s)
- Pierre Alexis Geoffroy
- U1144, Inserm, 75006, Paris, France.,Pôle de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, 75475, Paris, France
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Wolfson Unit, Newcastle University, Newcastle upon Tyne, UK.
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Personality traits and psychotic symptoms in recent onset of psychosis patients. Compr Psychiatry 2017; 74:109-117. [PMID: 28147290 DOI: 10.1016/j.comppsych.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/29/2016] [Accepted: 01/10/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Personality in patients with psychosis, and particularly its relation to psychotic symptoms in recent onset of psychosis (ROP) patients, is understudied. The aims of this research were to study the relation between dimensional and categorical clinical personality traits and symptoms, as well as the effects that symptoms, sex and age have on clinically significant personality traits. METHODS Data for these analyses were obtained from 94 ROP patients. The Millon Clinical Multiaxial Inventory and the Positive and Negative Syndrome Scale were used to assess personality and symptoms. Correlational Analysis, Mann-Whitney test, and, finally, logistic regression were carried out. RESULTS The negative dimension was higher in patients with schizoid traits. The excited dimension was lower for those with avoidant and depressive traits. The anxiety and depression dimension was higher for patients with dependent traits. The positive dimension was lower for patients with histrionic and higher for patients with compulsive traits. Logistic regression demonstrated that gender and the positive and negative dimensions explained 35.9% of the variance of the schizoid trait. The excited dimension explained 9.1% of the variance of avoidant trait. The anxiety and depression dimension and age explained 31.3% of the dependent trait. Gender explained 11.6% of the histrionic trait, 14.5% of the narcissistic trait and 11.6% of the paranoid trait. Finally gender and positive dimension explained 16.1% of the compulsive trait. CONCLUSIONS The study highlights the importance of studying personality in patients with psychosis as it broadens understating of the patients themselves and the symptoms suffered.
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Shinn AK, Bolton KW, Karmacharya R, Lewandowski KE, Yuksel C, Baker JT, Chouinard VA, Pingali SM, Bye H, Cederbaum K, Öngür D. McLean OnTrack: a transdiagnostic program for early intervention in first-episode psychosis. Early Interv Psychiatry 2017; 11:83-90. [PMID: 26616380 PMCID: PMC4884661 DOI: 10.1111/eip.12299] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/22/2015] [Indexed: 12/25/2022]
Abstract
AIMS Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all comers with first-episode psychosis. METHODS We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare with current diagnoses, calculating the proportion of diagnostic changes. RESULTS At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder not otherwise specified (NOS) who do not meet full criteria for either category and two (2.2%) individuals with no psychosis. Although patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients. CONCLUSIONS Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a transdiagnostic approach to early intervention in first-episode psychosis, treating patients who share many but not all characteristics.
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Affiliation(s)
- Ann K Shinn
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kirsten W Bolton
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA
| | - Rakesh Karmacharya
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kathryn E Lewandowski
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cagri Yuksel
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Justin T Baker
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Virginie-Anne Chouinard
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Samira M Pingali
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA
| | - Hilary Bye
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA
| | - Katherine Cederbaum
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA
| | - Dost Öngür
- McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Albert N, Melau M, Jensen H, Emborg C, Jepsen JRM, Fagerlund B, Gluud C, Mors O, Hjorthøj C, Nordentoft M. Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II). BMJ 2017; 356:i6681. [PMID: 28082379 PMCID: PMC5228538 DOI: 10.1136/bmj.i6681] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the effects of five years of specialised early intervention (SEI) treatment for first episode schizophrenia spectrum disorder with the standard two years of SEI plus three years of treatment as usual. DESIGN Randomised, superiority, parallel group trial with blinded outcome assessment. Randomisation was centralised and computerised with concealed randomisation sequence carried out at an external site. SETTING Participants were recruited from six OPUS teams in Denmark between 2009 and 2012. OPUS teams provide SEI treatment to all patients diagnosed with a schizophrenia spectrum disorder in Denmark. PARTICIPANTS 400 participants (51% women) with a mean age of 25.6 (standard deviation 4.3) were randomised to five years of SEI (experimental intervention; n=197) or to two years of SEI plus three years of treatment as usual (control; n=203). INTERVENTIONS OPUS treatment consists of three core elements-modified assertive community treatment, family involvement, and social skill training-with a patient-case manager ratio of no more than 12:1. For participants randomised to five years of OPUS treatment, the treatment was largely unchanged. Participants randomised to the control group were mostly referred to community health centres after two years of SEI treatment. MAIN OUTCOMES Follow-up assessments were conducted five years after start of OPUS treatment. Primary outcome was negative symptoms measured on the scale for assessment of negative symptoms (avolition-apathy, anhedonia, alogia, and affective blunting). Secondary outcomes were remission of both negative and psychotic symptoms, psychotic symptoms, suicidal ideation, substance abuse, compliance with medical treatment, adherence with treatment, client satisfaction, days in hospital care, and labour market affiliation. RESULTS Levels of negative symptoms did not differ between the intervention group and control group (1.72 v 1.81 points; estimated mean difference -0.10 (95% confidence interval -0.33 to 0.13), P=0.39). Participants receiving five years of OPUS treatment were more likely to remain in contact with specialised mental health services (90.4% v 55.6%, P<0.001), had higher client satisfaction (estimated mean difference 2.57 points (95% confidence interval 1.36 to 3.79), P<0.001), and had a stronger working alliance (estimated mean difference 5.56 points (95% confidence interval 2.30 to 8.82), P=0.001) than the control group. CONCLUSIONS This trial tests SEI treatment for up to five years for patients with first episode schizophrenia spectrum disorder; previous trials have found treatment effects for programmes lasting from one to three years. The prolonged SEI treatment had few effects, which could be due to the high level of treatment provided to control participants and the late start of specialised treatment.Trial registration Clinicaltrial.gov NCT00914238.
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Affiliation(s)
- Nikolai Albert
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Hellerup, Denmark
| | - Marianne Melau
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Hellerup, Denmark
| | - Heidi Jensen
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Hellerup, Denmark
| | - Charlotte Emborg
- Psychosis Ward, Section P, Aarhus University Hospital, Risskov, Denmark
| | | | - Birgitte Fagerlund
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Glostrup, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Risskov, Denmark
| | - Carsten Hjorthøj
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Hellerup, Denmark
| | - Merete Nordentoft
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Hellerup, Denmark
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Keating D, McWilliams S, Schneider I, Hynes C, Cousins G, Strawbridge J, Clarke M. Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode. BMJ Open 2017; 7:e013881. [PMID: 28062471 PMCID: PMC5223704 DOI: 10.1136/bmjopen-2016-013881] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Clinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode schizophrenia; assess the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument; and compare recommendations in relation to the key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia. METHODS A multidisciplinary group identified key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia. The MEDLINE and EMBASE databases, websites of professional organisations and international guideline repositories, were searched for CPGs that met the inclusion criteria. The AGREE II instrument was applied by three raters and data were extracted from the guidelines in relation to the key health questions. RESULTS In total, 3299 records were screened. 10 guidelines met the inclusion criteria. 3 guidelines scored well across all domains. Recommendations varied in specificity. Side effect concerns, rather than comparative efficacy benefits, were a key consideration in antipsychotic choice. Antipsychotic medication is recommended for maintenance of remission following a first episode of schizophrenia but there is a paucity of evidence to guide duration of treatment. Clozapine is universally regarded as the medication of choice for treatment resistance. There is less evidence to guide care for those who do not respond to clozapine. CONCLUSIONS An individual's experience of using antipsychotic medication for the initial treatment of first-episode schizophrenia may have implications for future engagement, adherence and outcome. While guidelines of good quality exist to assist in medicines optimisation, the evidence base required to answer key health questions relevant to the pharmacological treatment of first-episode schizophrenia is limited.
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Affiliation(s)
- Dolores Keating
- Pharmacy Department, Saint John of God Hospital, Co Dublin, Ireland
| | | | - Ian Schneider
- Department of Old Age Psychiatry, Saint James's Hospital, Dublin, Ireland
| | - Caroline Hynes
- Pharmacy Department, Saint John of God Hospital, Co Dublin, Ireland
| | - Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Judith Strawbridge
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Blackrock, Co Dublin, Ireland
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Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program. Psychiatry Res 2017; 247:113-119. [PMID: 27888680 DOI: 10.1016/j.psychres.2016.11.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/12/2016] [Accepted: 11/05/2016] [Indexed: 11/23/2022]
Abstract
Substance use disorders (SUD) in first-episode psychosis (FEP) are highly prevalent and linked with poor outcomes. However, most longitudinal studies investigating their impacts in FEP have not reported proportions of patients who ceased SUD. Our aim was to examine the influence of SUD course on functional and symptomatic outcomes as well as service use in FEP. We performed a 2-year longitudinal study of 212 FEP patients, aged between 18 and 30 years, admitted to 2 early psychosis services in Montréal, Québec, Canada. We observed that cannabis was the first substance abused (42.9% at baseline), followed by alcohol (19.3%). The SUD rate decreased by approximately 30% during the first year. Patients with persistent SUD had worse functional outcomes (Quality of Life Scale, Social and Occupational Functioning Assessment Scale, employment), more symptoms (Positive and Negative Symptoms Scale) and heavier service use (emergency and hospitalization). SUD persistence was associated with illness severity, homelessness and cluster-B personality. Those living with their parents and financially supported by them were more likely to cease SUD. Our results indicate that SUD course was more significant than having SUD at admission; persistent SUD was associated with worse outcomes. SUD decreased during a general early psychosis intervention program (with no specialized SUD treatment). An integrated, specialized approach targeting FEP patients with predictive factors of SUD persistence during the first years of treatment might increase SUD cessation and possibly improve outcomes.
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Csillag C, Nordentoft M, Mizuno M, Jones PB, Killackey E, Taylor M, Chen E, Kane J, McDaid D. Early intervention services in psychosis: from evidence to wide implementation. Early Interv Psychiatry 2016; 10:540-546. [PMID: 26362703 DOI: 10.1111/eip.12279] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
AIM Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme fidelity, challenges for its widespread dissemination and economic perspectives related to it. METHODS This paper is a narrative review about the evidence supporting EI and the challenges to its widespread dissemination. RESULTS In spite of evidence of a wide range of benefits, widespread dissemination has been slow, and even currently implemented programmes might be threatened. This reflects in part the shortcomings of mental health care in general, such as low priority for funding, stigma and structural problems. Successful examples of advocacy, mobilization and destigmatization campaigns have overcome these difficulties. CONCLUSIONS Funding for mental health in general and for EI services appears low relative to need. One key argument for better funding for EI can be found in its favourable cost-effectiveness, but not all stakeholders beyond mental health administrators are aware of this. Positive impacts of EI programmes on excess unemployment and tax forgone suggest that social affairs and labour ministries - and not only health ministries - could be more involved in governance of mental health issues; ministries of justice and education are other sector stakeholders than can benefit. Wider dissemination of EI services will probably benefit from better integration of potential funders, promotion of joint targets and shared financial or budgetary incentives.
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Affiliation(s)
- Claudio Csillag
- Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark.
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - John Kane
- Department of Psychiatry, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York, USA
| | - David McDaid
- Health and Social Care, London School of Economics and Political Science, London, UK
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Durbin J, Selick A, Hierlihy D, Moss S, Cheng C. A first step in system improvement: a survey of Early Psychosis Intervention Programmes in Ontario. Early Interv Psychiatry 2016; 10:485-493. [PMID: 25366518 DOI: 10.1111/eip.12201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 09/24/2014] [Indexed: 11/30/2022]
Abstract
AIM Ontario, Canada is a large province with a geographically dispersed population. Early psychosis intervention (EPI) programmes are available province-wide, with delivery approaches adapted to context. This study examined EPI programme delivery in relation to recently released provincial EPI Program Standards, and variations based on geographic context. METHODS The data source was a province-wide key informant survey of early psychosis programmes conducted after release of the Standards. Chi-squared tests compared large- and small-area programmes on selected programme structural features and perceived adherence to 19 service components. RESULTS Responses were obtained from 52 programme sites, including 21 small-area programmes with 1 to 2 staff. In general, frequency of EPI delivery was highest for individual assessment and treatment components, and moderate for social supports and family support. Implementation was lowest for public education, early detection and recovery planning. Small-area programmes reported lower implementation for over half of the components, with differences statistically significant for psychiatric assessment and physical health monitoring. CONCLUSION Since the release of the Standards, the Ontario Ministry of Health has partnered with a provincial network of EPI stakeholders to support practice improvement. This survey identified components where more implementation support is needed, overall and for rural area delivery. Ultimately, systematic monitoring of programme fidelity and measuring client outcomes are key to advancing the quality of EPI programme delivery.
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Affiliation(s)
- Janet Durbin
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Avra Selick
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Sarah Moss
- Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Chiachen Cheng
- First Place, Canadian Mental Health Association - Thunder Bay Branch, Thunder Bay, Ontario, Canada
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Malla A, Ota A, Nagamizu K, Perry P, Weiller E, Baker RA. The effect of brexpiprazole in adult outpatients with early-episode schizophrenia: an exploratory study. Int Clin Psychopharmacol 2016; 31:307-14. [PMID: 27571460 PMCID: PMC5049948 DOI: 10.1097/yic.0000000000000140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this study was to evaluate flexibly dosed brexpiprazole for early-episode schizophrenia through the assessment of efficacy, social functioning, and tolerability. This was an exploratory, 16-week, open-label, flexible-dose (1, 2, 3, or 4 mg/day; target dose 3 mg/day) study in outpatients with early-episode schizophrenia (18-35 years old, ≤5 years' duration of illness). Efficacy was assessed by the Positive and Negative Syndrome Scale score (PANSS) and social functioning was assessed by changes from baseline in PANSS modified prosocial subscale, personal and social performance (PSP), and specific levels of functioning (SLOF) scales. Safety and tolerability were also evaluated. Overall, 25/49 patients completed the study. Symptoms of schizophrenia improved over the entire treatment period, as evidenced by reductions in PANSS total score from baseline (least squares mean change at week 16: -10.2). Improvements in social functioning were shown by least squares mean changes from baseline at week 16 in the PANSS prosocial subscale (-2.0), PSP (6.6), and SLOF (13.1). Brexpiprazole was generally well tolerated; the most common adverse events were insomnia (7/49 patients), somnolence (4/49), sedation, weight increase, and nausea (each 3/49). Brexpiprazole may represent a novel and effective treatment strategy for patients with early-episode schizophrenia and may be effective for improving social function.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ai Ota
- Otsuka Pharmaceutical Co., Tokyo, Japan
| | | | - Pamela Perry
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
| | | | - Ross A. Baker
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
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Tsiachristas A, Thomas T, Leal J, Lennox BR. Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England. BMJ Open 2016; 6:e012611. [PMID: 27798015 PMCID: PMC5073534 DOI: 10.1136/bmjopen-2016-012611] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To demonstrate the costs, outcomes and economic impact of early intervention in psychosis (EIP) services. DESIGN Longitudinal retrospective observational study of service usage and outcome data from mental health and acute care services for all those with a diagnosis of psychosis in contact with mental health services over a 3-year period (April 2010-March 2013). SETTING Thames Valley and South Midlands region in England (region covered by Oxford Academic Health Science Network). PARTICIPANTS 3674 people with psychosis, aged 16-35 years. INTERVENTIONS EIP team or other community mental health teams. MAIN OUTCOME MEASURES Change in housing status, change in employment status and improvement on each of the four domains of the Health of the Nation Outcome Scale (HONOS) questionnaire. Costs of mental and acute health inpatient, outpatient and community service use were also included in the study. RESULTS Patients in EIP services were 116% more likely (95% CI 1.263 to 3.708) to gain employment, 52% more likely to become accommodated in a mainstream house (95% CI 0.988 to 2.326) and 17% more likely to have an improvement in the emotional well-being domain of the HONOS questionnaire (95% CI 1.067 to 1.285), as compared to those in non-EIP services. Annual National Health Service (NHS) costs were also significantly lower for patients using EIP services compared to non-users. The mean annual NHS cost savings associated with EIP were £4031 (95% CI £1281 to £6780). These mostly came from lower mental health inpatient costs (£4075, 95% CI £1164 to £6986), lower acute hospital outpatient costs (£59, 95% CI £9 to £109), lower accident and emergency costs (£31, 95% CI £12 to £51), and higher mental health community costs (£648, 95% CI £122 to £1175). If all people with a first-episode psychosis across England were to be treated by EIP services, the savings in societal costs would be an estimated £63.3 million per year, of which £33.5 million would be in NHS costs. CONCLUSIONS Treatment within an EIP service is associated with better health and social outcomes, and reduced costs.
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Affiliation(s)
- Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tony Thomas
- Janssen Healthcare Innovation, Johnson & Johnson, High Wycombe, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Belinda R Lennox
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Lee C, Marandola G, Malla A, Iyer S. Challenges in and recommendations for working with international students with first-episode psychosis: a descriptive case series. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2016. [DOI: 10.1108/ijmhsc-07-2015-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to present a series of cases of international students being treated in a specialized early intervention service for first-episode psychosis (FEP), describing the particular challenges that arise in this process, and to provide recommendations addressing these challenges.
Design/methodology/approach
Two researchers independently reviewed the charts of seven international students and discussed them with their treating clinicians. Recurring themes were identified through an iterative process of discussion and consensus.
Findings
Four themes were identified which demonstrated specific challenges faced by international students being treated for FEP: difficulty maintaining student visa status, limited social and family support, financial and health insurance issues, and service disengagement.
Originality/value
The study suggests that international students with FEP may present with numerous and unique challenges, thereby requiring special attention in their treatment. Although these are preliminary findings based on a small case series, the findings can inform recommendations for mental health services in cities with a sizeable international student population and guide future research on this topic.
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Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 502] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
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Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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The course of negative symptoms over the first five years of treatment: Data from an early intervention program for psychosis. Schizophr Res 2015; 169:412-417. [PMID: 26431791 DOI: 10.1016/j.schres.2015.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/03/2015] [Accepted: 09/06/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cross-sectional studies suggest that negative symptoms are constituted by separable domains of reduced expressiveness and reduced motivation, but there is little data on the longitudinal course of these symptoms. We examined evidence for differences in the course and correlates of these two domains in a prospective study of patients presenting with a first episode of psychosis. METHODS Of 132 patients who were followed up for five years, it was possible to monitor reduced expressiveness and motivation on a weekly basis for 127. Information on treatment delay, premorbid adjustment, intellectual functioning, anxiety, depression and psychosocial functioning were also collected. RESULTS Over the five year follow-up, symptoms of reduced motivation occurred in 95.3% of patients and reduced expressiveness in 68.5%; and deficits in motivation were more likely to be unremitting (15.7%) than expressive deficits (5.5%). There were differences in the correlates of the proportion of time each patient experienced symptoms of each domain. Depression, weeks of full time occupation and weeks on a disability pension were associated with both domains. Anxiety was associated only with diminished motivation. Lower performance IQ; extrapyramidal symptoms (EPS) and dysrhythmic EEG were associated only with proportion of time showing reduced expressiveness. CONCLUSIONS The prospective data support previous cross-sectional findings that, while these domains of negative symptoms are correlated, they do show differences in prevalence over time and in their correlates.
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Azrin ST, Goldstein AB, Heinssen RK. Early Intervention for Psychosis: The Recovery After an Initial Schizophrenia Episode Project. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
High-quality services for people with psychosis are essential. However, in this debate David Castle questions whether separate early intervention services are the best option and argues instead for an integrated approach. Swaran Singh responds, robustly defending the value of early intervention services.
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Affiliation(s)
- David J Castle
- For: David J. Castle, MD, FRCPsych, FRANZCP, St Vincent's Mental Health Service and The University of Melbourne, PO Box 2900, Fitzroy, Victoria, Australia 3065. ; Against: Swaran P. Singh, MBBS, MD, FRCPsych, DM, Mental Health and Wellbeing, Warwick Medical School University of Warwick, Coventry, and Birmingham and Solihull Mental Health. Foundation Trust, Birmingham, and Equality and Human Rights Commission.
| | - Swaran P Singh
- For: David J. Castle, MD, FRCPsych, FRANZCP, St Vincent's Mental Health Service and The University of Melbourne, PO Box 2900, Fitzroy, Victoria, Australia 3065. ; Against: Swaran P. Singh, MBBS, MD, FRCPsych, DM, Mental Health and Wellbeing, Warwick Medical School University of Warwick, Coventry, and Birmingham and Solihull Mental Health. Foundation Trust, Birmingham, and Equality and Human Rights Commission.
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Tindall R, Francey S, Hamilton B. Factors influencing engagement with case managers: Perspectives of young people with a diagnosis of first episode psychosis. Int J Ment Health Nurs 2015; 24:295-303. [PMID: 25976922 DOI: 10.1111/inm.12133] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Holistic treatment during a first episode psychosis (FEP) can significantly impact the longevity and chronicity of the illness, as well as reduce the risk of premature death by suicide. However, treatment can only be effective if the young person participates. Given that 19-40% of young people disengage from early intervention services for FEP, this qualitative study aimed to understand how young people experienced engagement with case managers at an early intervention service. Semistructured interviews were conducted with seven young people and themes were identified using interpretive phenomenological analysis. Young people detailed how engagement with a service could be viewed as a process, following different stages between initial referral and discharge. Throughout this process, a number of factors influenced young people's decision to engage with, or disengage from, their case manager. This created a push-pull dynamic with periods of good engagement and poor engagement. Discussion of this dynamic adds nuance to established scholarship about engagement, including shifts over time in the importance of client empowerment and valued features of therapeutic relationships. Awareness and understanding of these concepts may guide changes to early intervention services and address the core issue of engagement.
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Affiliation(s)
- Rachel Tindall
- Department of Nursing, Orygen Youth Health, Melbourne, Victoria, Australia
| | - Shona Francey
- Department of Nursing, Orygen Youth Health, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
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Nilsen L, Norheim I, Frich JC, Friis S, Røssberg JI. Challenges for group leaders working with families dealing with early psychosis: a qualitative study. BMC Psychiatry 2015; 15:141. [PMID: 26134829 PMCID: PMC4488981 DOI: 10.1186/s12888-015-0540-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/23/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Family work is one of the best researched psychosocial interventions for patients with chronic psychosis. However, family work is less studied for patients with a first episode psychosis and the studies have revealed contradicting results. To our knowledge, no previous studies have examined qualitatively group leaders' experiences with family work. In the present study we wanted to explore challenges faced by mental health professionals working as group leaders for family interventions with first episode psychosis patients. METHOD A qualitative exploratory study was carried out based on digitally recorded in-depth interviews and a focus group interview with nine experienced mental health professionals. The interviews were transcribed in a slightly modified verbatim mode and analysed by systematic text condensation. RESULTS Challenges faced by group leaders was classified into six categories: (1) Motivating patients to participate, encouraging potential participants was demanding and time-consuming; (2) Selecting participants by identifying those who can form a functional group and benefit from the intervention; (3) Choosing group format to determine whether a single or multi-family group is best for the participants; (4) Preserving patient independence, while also encouraging them to participate in the intervention; (5) Adherence to the protocol, while customizing adjustments as needed; (6) Fostering good problem-solving by creating a fertile learning environment and choosing the most appropriate problem to solve. CONCLUSIONS Group leaders face challenges related to recruitment and selection of participants for family work, as well as in conducting sessions. Awareness of these challenges could help health professionals more specifically to tailor the intervention to the specific needs of patients and their families.
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Affiliation(s)
- Liv Nilsen
- Centre of Competence for Early Intervention in Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Irene Norheim
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.
| | - Jan C. Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Jan Ivar Røssberg
- Centre of Competence for Early Intervention in Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Mueser KT, Penn DL, Addington J, Brunette MF, Gingerich S, Glynn SM, Lynde DW, Gottlieb JD, Meyer-Kalos P, McGurk SR, Cather C, Saade S, Robinson DG, Schooler NR, Rosenheck RA, Kane JM. The NAVIGATE Program for First-Episode Psychosis: Rationale, Overview, and Description of Psychosocial Components. Psychiatr Serv 2015; 66:680-90. [PMID: 25772766 PMCID: PMC4490051 DOI: 10.1176/appi.ps.201400413] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project-known as the NAVIGATE program-with a particular focus on its psychosocial components. NAVIGATE is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services provided in the NAVIGATE program include the family education program (FEP), individual resiliency training (IRT), supported employment and education (SEE), and individualized medication treatment. NAVIGATE embraces a shared decision-making approach with a focus on strengths and resiliency and on collaboration with clients and family members in treatment planning and reviews. The NAVIGATE program has the potential to fill an important gap in the U.S. health care system by providing a comprehensive intervention specially designed to meet the unique treatment needs of persons recovering from a first episode of psychosis. A cluster-randomized controlled trial comparing NAVIGATE with usual community care has recently been completed.
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Affiliation(s)
- Kim T Mueser
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - David L Penn
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jean Addington
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Mary F Brunette
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan Gingerich
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Shirley M Glynn
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - David W Lynde
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jennifer D Gottlieb
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Piper Meyer-Kalos
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan R McGurk
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Corinne Cather
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Sylvia Saade
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Delbert G Robinson
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Nina R Schooler
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Robert A Rosenheck
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - John M Kane
- Dr. Mueser, Dr. Gottlieb, and Dr. McGurk are with the Center for Psychiatric Rehabilitation and the Department of Occupational Therapy, Sargent College, Boston University, Boston (e-mail: ). Dr. Penn and Dr. Saade are with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Addington is with the Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Brunette is with the Department of Psychiatry, Geisel School of Medicine, Lebanon, New Hampshire. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Dr. Glynn is with the Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Mr. Lynde is an independent consultant and trainer in Concord, New Hampshire. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Cather is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Robinson and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, New Haven, Connecticut, and with the MIRECC, VA New England Healthcare System, West Haven, Connecticut. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
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