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Sicotte R, D'Andrea G, Dumais A, Crocker AG, Villeneuve M, Brochu E, Abdel-Baki A. Aggressive behaviors in first-episode psychosis: Distinction between the premorbid phase and the onset of psychosis. Schizophr Res 2024; 271:283-291. [PMID: 39079405 DOI: 10.1016/j.schres.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND There is a well-established, although complex, association between aggression and psychosis, particularly in the early stages of illness. Some persons display aggressive behaviors even prior to psychosis onset. However, factors associated with aggressive behaviors prior to and at first-episode psychosis (FEP) onset remain underdocumented. AIMS The objective is two-fold: 1) to describe the prevalence of verbal and physical aggression occurring during the premorbid phase and at FEP onset; 2) distinguish the factors associated with aggressive behaviors during these two periods. METHOD Data on aggressive behaviors and factors potentially associated therewith were collected through research interviews and chart reviews among 567 persons with FEP admitted to two early intervention services in Montreal, Canada. Logistic regression analyses were conducted to identify factors associated with aggressive behaviors in both periods. RESULTS In the premorbid phase, 46.1 % (n = 257/558) of patients presented aggression (verbal: 35.9 %; towards objects: 24.2 %; against others: 27.9 %). At FEP, 18.1 % (n = 101/558) presented aggressive behaviors (verbal: 12.9 %; towards objects: 6.1 %; against others: 8.8 %). In the premorbid phase, lower education, prior justice involvement, cluster B personality traits/disorder and poorer functioning were associated with aggressive behaviors, while, at FEP, only prior homelessness was associated with aggression. CONCLUSIONS Aggressive behaviors are frequent in patients with FEP, prior onset and at FEP. Premorbid aggressive behaviors seem to be associated with premorbid difficulties. Early detection of youth with psychosis and those at high risk of psychosis, particularly homeless youth, is necessary to provide access to early specialized interventions and possibly prevent aggressive behaviors and their consequences.
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Affiliation(s)
- Roxanne Sicotte
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Giuseppe D'Andrea
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Douglas Mental Health University Institute, Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montréal, Québec, Canada; Community Mental Health Center of Sassuolo, Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Alexandre Dumais
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada; Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada; Institut National de Psychiatrie Légale Philippe-Pinel Research Center, Montréal, Québec, Canada
| | - Anne G Crocker
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada; Institut National de Psychiatrie Légale Philippe-Pinel Research Center, Montréal, Québec, Canada; School of Criminology, Université de Montréal, Montréal, Québec, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Edouard Brochu
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada.
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Roy L, Leclair M, Crocker AG, Abdel-Baki A, de Benedictis L, Bérubé FA, Thibeault E, Latimer E, Roy MA. Risk factors for homelessness and housing instability in the first episode of mental illness: Initial findings from the AMONT study. Early Interv Psychiatry 2024; 18:561-570. [PMID: 38353025 DOI: 10.1111/eip.13495] [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: 05/11/2023] [Accepted: 01/24/2024] [Indexed: 07/11/2024]
Abstract
AIM People living with mental illness are more likely than the general population to experience adverse housing outcomes, including homelessness. The aim of the current study is to examine residential status when participants have their first contact with mental health services, and the correlates of residential status at that moment. METHODS First-time mental health service users were recruited from seven clinical sites across Québec. Data on residential status at entry in the project, as well as demographic, clinical and social variables, were collected using self-report and interviewer-rated questionnaires. Participants were classified as 'Homeless', 'At risk of homelessness' and 'Stably Housed', and correlates of residential status were identified through multivariate logistic regression and unbiased recursive partitioning. RESULTS Among the 478 participants, 206 (43.1%) were in stable housing, 171 (35.8%) were at risk of homelessness and 101 (21.1%) were classified as homeless. Placement in a youth protection facility was strongly associated with adverse housing outcomes, while having a high school diploma and more social support were associated with more stable housing situations. CONCLUSIONS First-time mental health service users are likely to experience a range of adverse housing situations, indicating the potential for clinical sites to implement homelessness primary prevention strategies. Factors related to family, foster care and schooling seem to be particularly salient in understanding risk of homelessness in first-time mental health service users, calling for intersectoral action to prevent adverse psychosocial outcomes in this population.
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Affiliation(s)
- Laurence Roy
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Douglas Mental Health University Research Center (DMHURC), Montréal, Canada
- Centre de recherche de Montréal sur les inégalités sociales, les discriminations et les pratiques alternatives de citoyenneté (CREMIS), Montréal, Canada
| | - Marichelle Leclair
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, Canada
| | - Anne G Crocker
- Institut National de Psychiatrie Légale Philippe-Pinel, Montréal, Canada
| | - Amal Abdel-Baki
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | | | | | - Esther Thibeault
- Douglas Mental Health University Research Center (DMHURC), Montréal, Canada
| | - Eric Latimer
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Douglas Mental Health University Research Center (DMHURC), Montréal, Canada
| | - Marc-André Roy
- Université Laval, Québec, Canada
- Institut Universitaire en Santé Mentale de Québec, Québec, Canada
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Henriques-Calado J, Gama Marques J. Homeless people: a review of personality disorders. Front Psychiatry 2024; 15:1362723. [PMID: 38779545 PMCID: PMC11110170 DOI: 10.3389/fpsyt.2024.1362723] [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: 12/28/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Personality disorders in homeless people pose a challenge to the medical community and society, requiring specialized approaches for these super-difficult patients. The prevalence of personality disorders is higher in homeless populations than in the general population. However, there is a knowledge gap regarding personality disorders among people experiencing homelessness, and the implications of this lack of recognition are substantial. This paper provides a brief narrative review of personality disorders among homeless individuals. The primary importance and specificity of these disorders in this population remain unexplored. We searched PubMed and Web of Science databases in February and November 2023 using the keywords 'homeless' and 'personality disorder', and selected fifty-eight studies to be included in this literature review. The main themes of the results were personality disorders in homeless individuals and comorbid psychiatric disorders; risk factors and other psychological and behavioral data; clinical and intervention outcomes; and challenges linked to assessment, treatment, and intervention. The homeless population experiences significant diagnostic variability and the diagnosis of personality disorders is still evolving, contributing to difficulties in diagnosis, assessment, and treatment. A future challenge is to raise clinical awareness and optimize research knowledge, assessment, and intervention in personality disorders among homeless individuals with comorbid psychiatric disorders.
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Affiliation(s)
- Joana Henriques-Calado
- Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - João Gama Marques
- Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
- Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos (HJM), Unidade Local de Saúde São José (ULSSJ), Centro Clínico Académico de Lisboa (CCAL), Lisboa, Portugal
- Clínica Universitária de Psiquiatra e Psicologia Médica (CUPPM), Faculdade de Medicina, Universidade de Lisboa (FMUL), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa), Santé Mentale et Exclusion Sociale (SMES) Europa, Lisboa, Portugal
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Hird R, Radhakrishnan R, Tsai J. A systematic review of approaches to improve medication adherence in homeless adults with psychiatric disorders. Front Psychiatry 2024; 14:1339801. [PMID: 38260790 PMCID: PMC10800888 DOI: 10.3389/fpsyt.2023.1339801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Medication non-adherence is a significant problem among homeless individuals with psychiatric disorders in the United States. We conducted a systematic review to identify strategies to improve psychiatric medication adherence among homeless individuals with psychiatric disorders, including substance use disorders. Methods We searched seven databases (MEDLINE, Embase, PsychInfo, Scopus, Web of Science, CDSR, and CENTRAL) and screened 664 studies by title and abstract followed by full-text review. Our inclusion criteria were studies that: involved an intervention for homeless adults with psychiatric disorders, reported a quantitative outcome of medication adherence, and were published in English in a peer-reviewed journal. We rated the relative effectiveness of strategies described in each study using a self-designed scale. Results Eleven peer-reviewed studies met criteria for inclusion in this review. Within these studies, there were seven different approaches to improve medication adherence in this population. Three studies were randomized controlled trials (RCTs) and the remaining were observational studies. Outpatient interventions included Assertive Community Treatment, Cell Phone-Assisted Monitoring, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Homeless-Designated Pharmacy Clinics. Residential, shelter-based, and inpatient interventions included use of the Housing First model, Modified Therapeutic Communities, and Homeless-Designated Inpatient Care. The approaches described in four of the eleven studies were rated as scoring a 3 or higher on a 5-point scale of effectiveness in improving medication adherence; none received 5 points. Discussion The interventions with the strongest evidence for improving medication adherence in this population were Assertive Community Treatment, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Housing First. Overall, studies on this topic required more rigor and focus on medication adherence as an outcome in this population. This review highlights several promising strategies and the need for larger RCTs to determine effective and diverse ways to improve medication adherence among homeless adults with psychiatric disorders.
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Affiliation(s)
- Rachel Hird
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Rajiv Radhakrishnan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington, DC, United States
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Zentner KE, Shettell K, Abba-Aji A, Robles M. Supporting patients by family education in psychotic illness: a longitudinal pre-post study protocol. BMJ Open 2023; 13:e072881. [PMID: 37879701 PMCID: PMC10603450 DOI: 10.1136/bmjopen-2023-072881] [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: 02/18/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION A lack of education, resources and support for family carers of young adults with psychotic illnesses leaves them ill-equipped to support their loved one. By equipping families with skills and knowledge, public healthcare harnesses a powerful ally to support community stabilisation. AIMS The primary goal is to study the effect of a psychoeducation intervention for family carers supporting young adults with psychosis on family burden and stabilisation of service users. METHODS AND ANALYSIS A longitudinal quantitative study with a pre-post design will be used to assess the long-term effectiveness of the psychoeducation intervention for family carers supporting a young adult with psychosis. 111 family carers will be recruited for the intervention and measures will be taken from family carer participants and their matched young adult service users. Nine evidence and family peer-informed and expert-reviewed psychoeducation modules are administered in 2-hour sessions over 9 weeks to family carers. Functional index measures are administered preintervention, and at 6-month, 12-month and 24-month follow-up. Service utilisation will be measured during a 12-month period preintervention, a 12-month period postintervention and during a 12-24-month period post-intervention. ETHICS AND DISSEMINATION The study has been reviewed and approved by the University of Alberta Research Ethics Board (Pro00110691). This novel methodological approach to studying family psychoeducation interventions addresses unique methodological challenges and limitations and will be disseminated through peer-reviewed publications and academic and medical conferences. TRIAL REGISTRATION NUMBER NCT05500001; National Institutes of Health U.S. National Library of Medicine ClinicalTrials.gov.
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Affiliation(s)
- Kristen Emily Zentner
- Department of Psychology, Concordia University of Edmonton, Edmonton, Alberta, Canada
| | | | - Adam Abba-Aji
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Alberta Hospital Edmonton, Edmonton, Alberta, Canada
| | - Melanie Robles
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Passetti L, Smith Ramey J, Hunter B, Godley M. Predicting Response to Services for Homeless Adolescents and Transition Age Youth (TAY) with Substance Use And/Or Mental Health Disorders: Implications for Youth Treatment and Recovery. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:668-685. [PMID: 37461305 DOI: 10.1080/26408066.2023.2202663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE This paper examines patterns of response to a multi-disciplinary wrap-around program for homeless adolescents and transition-aged youth with substance use and/or mental health disorders. METHOD A cluster analysis of outcome data from 148 youth was conducted. RESULTS Cluster 1 (n = 67) demonstrated significant decreases in risky behavior (e.g., engaging in unprotected sex, crime, and substance use) and poor interpersonal relationships (e.g. more interaction with family and friends and lower rates of violence) but experienced relatively fewer interactions with family and friends. Cluster 2 (n = 57) demonstrated a significant decrease in poor life functioning (e.g., lower rates of employment/education, better quality of life, and less symptoms of internalizing disorders). Cluster 3 (n = 24) experienced significant increases in risky behavior, poor life functioning, and poor interpersonal relationships. DISCUSSION Clusters 1 and 2 improved over six months of care. Cluster 3 deteriorated despite receiving similar services and used more opioids and stimulants. CONCLUSIONS Peer engagement in programs for this population are important. Recommendations for cluster 3 include targeted outreach, medication assisted treatment, and additional research-supported treatments. Further research is needed to test these interventions over longer periods of time.
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Affiliation(s)
- Lora Passetti
- Lighthouse Institute, Chestnut Health Systems, Normal, Illinois, USA
| | - Jennifer Smith Ramey
- Substance Use/Co-Occurring Disorder Program, Horizon Behavioral Health, Lynchburg, Virginia, USA
| | - Brooke Hunter
- Lighthouse Institute, Chestnut Health Systems, Normal, Illinois, USA
| | - Mark Godley
- Lighthouse Institute, Chestnut Health Systems, Normal, Illinois, USA
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Nguyen MT, Sicotte R, Pires De Oliveira Padilha P, Abdel-Baki A. Community Treatment Orders use Among Persons With a First Episode of Psychosis in Quebec. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:119-129. [PMID: 36135936 PMCID: PMC9923137 DOI: 10.1177/07067437221125284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Specialized early intervention for psychosis can reduce the duration of untreated psychosis and improve clinical and functional outcomes. However, poor adherence to treatment is frequent. The literature on community treatment orders (CTOs) use in first-episode psychosis (FEP) as a means to improve treatment adherence is limited. In the context of early intervention for psychosis services (EIS), this study aims to describe (1) the frequency of CTOs utilisation, (2) the trend of CTOs use over time, (3) the timing and reasons for requesting CTOs and (4) the baseline characteristics of FEP patients on CTOs compared to those who were not. METHOD A 5-year prospective longitudinal study describing the use of CTOs among persons with FEP admitted to two urban EIS in Montreal, Quebec, from 2005 to 2013. At admission, and then annually for 5 years, CTOs data were collected through chart review. Baseline characteristics, assessed by patient interviews, standardized questionnaires and chart review, included socio-demographic data, illness severity, functioning and alcohol and substance use. Descriptive analyses were performed, and FEP patients on CTOs during follow-up and those who were not were compared using analyses of variance, chi-square test and multivariate logistic regression. RESULTS Among 567 FEP patients, 19.2% were placed on CTOs. The main reasons for requesting CTOs were to prevent further deterioration in mental state, social functioning, harmful behaviours to self and others and homelessness. FEP patients on CTOs had poorer premorbid and baseline functioning, more severe symptoms and social dysfunction at admission, including legal problems and homelessness. CONCLUSIONS CTOs can be a tool to improve adherence to treatment, which is crucial for relapse prevention in FEP. However, since it is a coercive method that limits a person's fundamental rights, further research is warranted to assess its impact on patients' lives, clinical and functional outcomes, as well as patients' and carers' perception.
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Affiliation(s)
- Minh Thi Nguyen
- Department of Psychiatry and Addiction, Faculty of Medicine, 5622University of Montréal, Montréal, Québec, Canada
| | - Roxanne Sicotte
- Department of Psychiatry and Addiction, Faculty of Medicine, 5622University of Montréal, Montréal, Québec, Canada
| | | | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, Faculty of Medicine, 5622University of Montréal, Montréal, Québec, Canada.,Neurosciences axis, 177460Research Center Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
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Lal S, Abdel-Baki A, Lee H. Telepsychiatry services during COVID-19: A cross-sectional survey on the experiences and perspectives of young adults with first-episode psychosis. Early Interv Psychiatry 2022; 17:368-377. [PMID: 35731034 PMCID: PMC9350121 DOI: 10.1111/eip.13332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/21/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Limited evidence exists on the implementation of telepsychiatry within the context of early intervention services for psychosis, the need for which has become even more relevant during the COVID-19 pandemic. To address this gap, we investigated the experiences and perspectives of young adults recovering from a first-episode psychosis (FEP) following their use of telepsychiatry services (i.e. use of video conferencing technology to deliver mental health services to patients in real time). METHODS A cross-sectional online survey study was implemented between November 19th , 2020 and March 9th , 2021 with young adults recruited from a specialized program for FEP located in an urban Canadian setting. Data were analysed using descriptive statistics, exploratory (Fisher's exact test), and content analysis. RESULTS Among 51 participants (mean age = 26.0, SD = 4.7; 56.9% female), the majority were satisfied with the service (91%, 46/51), perceived that the platform was easy to use (90%, 46/51) and felt secure in terms of confidentiality (82%, 42/51). Satisfaction was related to perceptions regarding ease of use, image quality, and employment/studying status. Several partially or totally agreed that the presence of a third party was essential to login during the first few sessions (35%, 18/51), and some needed technical support (24%, 12/51) throughout the sessions. CONCLUSIONS This study shows that telepsychiatry is feasible and acceptable to implement for patients in the early phase of psychosis recovery. It also highlights the importance of making technical support available, especially in the first few times of using the service, and addressing patient concerns regarding confidentiality, even when using secured health technologies.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Quebec, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, Quebec, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Centre Hospitalier Université de Montréal (CHUM), Montreal, Quebec, Canada.,Axe Neurosciences, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Hajin Lee
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Quebec, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, Quebec, Canada
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Haussleiter IS, Lehmann I, Ueberberg B, Heinz J, Zielasek J, Gouzoulis-Mayfrank E, Juckel G. Homelessness among psychiatric inpatients in North Rhine-Westphalia: a retrospective routine data analysis. BMC Psychiatry 2022; 22:132. [PMID: 35183140 PMCID: PMC8857834 DOI: 10.1186/s12888-022-03786-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within the last five years the number of homeless persons in Germany has more than doubled, with many suffering from mental illnesses that require treatment. Whether the mental illness itself led to losing shelter or whether the state of being homeless increased the likelihood of developing symptoms of a mental disorder remains unclear. The current study assessed the interaction of homelessness and mental illness from a care provider perspective. METHODS We conducted a retrospective analysis of inpatient routine data from 20 psychiatric hospitals in North Rhine-Westphalia (NRW), Germany, over a period of four years (N = 366,767 inpatient treatment cases). Patients were considered "homeless" if they had no fixed unique address. RESULTS About 2.4% of the analyzed cohort was classified as homeless, with increasing tendency over the study period (+14% from 2016 to 2019). The percentage of homeless patients varied broadly between the hospitals (0.2-6.3%). Homeless patients were more often male and on average eight years younger than patients with a fixed address. Homeless patients experienced more involuntary measures (admission and restraint), had a shorter course of treatment and were more often discharged within one day. Every second homeless case was diagnosed with a substance use disorder and every third homeless case with a psychotic disorder, whereas affective disorders were diagnosed less frequently in this group. Psychiatric comorbidity occurred more often in homeless patients whereas somatic diseases did not. CONCLUSIONS Multiple patient-related sociodemographic and local factors are associated with homelessness of psychiatric inpatients. In addition, clinical factors differ between homeless and non-homeless patients, pointing to more severe mental illness and treatment complications (e.g., coercive measures) in homeless persons. Thus, homelessness of psychiatric inpatients can imply special challenges that need to be considered by healthcare providers and politicians, with the goal of optimizing mental and social care and the mental health outcomes of homeless persons.
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Affiliation(s)
- Ida Sibylle Haussleiter
- LWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany. .,Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstrasse 1, 44791, Bochum, Germany.
| | - Isabell Lehmann
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Bianca Ueberberg
- grid.5570.70000 0004 0490 981XLWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Josephine Heinz
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,grid.411327.20000 0001 2176 9917Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,LVR Clinics Cologne, Cologne, Germany
| | - Georg Juckel
- grid.5570.70000 0004 0490 981XLWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstrasse 1, 44791 Bochum, Germany
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Relationship between cognition and age at onset of first-episode psychosis: comparative study between adolescents, young adults, and adults. Eur Child Adolesc Psychiatry 2021; 32:639-649. [PMID: 34714406 DOI: 10.1007/s00787-021-01901-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/24/2021] [Indexed: 12/13/2022]
Abstract
Psychotic disorders typically manifest from late adolescence to early adulthood, and an earlier onset might be associated with greater symptom severity and a worse long-term prognosis. This study aimed to compare the cognitive characteristics of patients with first-episode psychosis (FEP) by their age at onset. We included 298 patients diagnosed with FEP and classified them as having an early onset (EOS), youth onset (YOS), or adult onset (AOS) based on age limits of ≤ 18 years (N = 61), 19-24 years (N = 121), and ≥ 25 years (N = 116), respectively. Socio-demographic and clinical variables included age at baseline, gender, socio-economic status, antipsychotic medication, DSM-IV diagnoses assessed by clinical semi-structured interview, psychotic symptom severity, and age at onset. Neuropsychological assessment included six cognitive domains: premorbid intelligence, working memory, processing speed, verbal memory, sustained attention, and executive functioning. The EOS group had lower scores than the YOS or AOS groups in global cognition, executive functioning, and sustained attention. Although the scores in the YOS group were intermediate to those in the EOS and AOS groups for most cognitive factors, no statistically significant differences were detected between the YOS and AOS groups. Age at onset results in specific patterns of cognitive interference. Of note, impairment appears to be greater with EOS samples than with either YOS or AOS samples. A longitudinal study with a larger sample size is needed to confirm our findings.
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Lee R, Scodes J, van der Ven E, Alves-Bradford JM, Mascayano F, Smith S, Dixon L. Sociodemographic, clinical and help-seeking characteristics of homeless young people with recent onset of psychosis enrolled in specialized early intervention services. Early Interv Psychiatry 2021; 15:1044-1050. [PMID: 32875676 PMCID: PMC8237376 DOI: 10.1111/eip.13028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
AIM To examine differences in demographic, clinical, social, functional and help-seeking characteristics of homeless vs housed individuals enrolled in specialized early intervention teams in the United States. METHODS Participants comprised 1349 individuals enrolled across 21 teams. Teams report individual-level data including homelessness status at admission. Bivariate differences between homeless and housed participants were analysed using Wilcoxon-rank, chi-square, Fisher-exact and t tests, as appropriate. RESULTS Approximately 5% of participants were homeless at admission. Homeless participants were less likely to be enrolled in school and/or employed (12.2% vs 43.4%); to have more involvement in the legal system (23.0% vs 6.2%); and to have had a more restrictive pathway to care, than housed participants. CONCLUSIONS Homeless young people with recent-onset psychosis have a substantially greater need for a diversity of services for psychosocial needs. Homeless individuals may also have a more adverse pathway to care and directed outreach to engage this population may be needed.
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Affiliation(s)
- Rufina Lee
- Hunter College Silberman School of Social Work, City University of New York, New York, New York
| | | | - Els van der Ven
- Columbia University Mailman School of Public Health, New York, New York
| | | | | | - Stephen Smith
- New York State Psychiatric Institute, New York, New York
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, New York
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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Deschênes JM, Roy L, Girard N, Abdel-Baki A. Comment aider les jeunes atteints de psychose à éviter l’itinérance ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088183ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Gama Marques J, Bento A. Homeless, nameless and helpless: John Doe syndrome in treatment resistant schizophrenia. Schizophr Res 2020; 224:183-184. [PMID: 32933814 DOI: 10.1016/j.schres.2020.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- João Gama Marques
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Portugal; Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - António Bento
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Portugal
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The Impact of Treatment Orders for Residential Treatment of Comorbid Severe Substance Use Disorders for Youth Suffering from Early Psychosis: a Case Series. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00317-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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