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Tramazzo S, Lian W, Ajnakina O, Carlson G, Bromet E, Kotov R, Jonas K. Long-Term Course of Remission and Recovery in Psychotic Disorders. Am J Psychiatry 2024; 181:532-540. [PMID: 38745457 DOI: 10.1176/appi.ajp.20230189] [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] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Understanding prognosis is critical to anticipating public health needs and providing care to individuals with psychotic disorders. However, the long-term course of remission and recovery remains unclear. In this study, the most common trajectories of illness course are described for a cohort of individuals followed for 25 years since first admission for psychosis. METHODS Participants are from the Suffolk County Mental Health Project, an epidemiological study of first-admission psychosis. Data for the present study was collected from six follow-ups, with 311 individuals assessed at the 25-year follow-up. Common patterns of remission and recovery were assessed in the baseline cohort of 591 individuals and the subsample from the 25-year follow up. RESULTS In the baseline cohort and the 25-year subsample, the most common trajectory for individuals with schizophrenia spectrum disorders was no remission and no recovery. Among individuals with other psychotic disorders, in both the baseline and 25-year cohorts, the modal pattern was one of intermittent remission and recovery. Individuals with other psychotic disorders were more likely to experience stable remission (15.1%) and stable recovery (21.1%), outcomes that were rare among individuals with schizophrenia spectrum disorders (0% and 0.6%, respectively). CONCLUSIONS The modal longitudinal pattern for individuals with other psychoses is one of multiple transitions into and out of symptomatic and functional recovery. Engagement in a long-term health care plan may help individuals detect and respond to these changes. Sustained remission and recovery are rare among people with schizophrenia spectrum disorders. Efforts should be directed toward developing more effective treatments for this population.
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Affiliation(s)
- Sara Tramazzo
- Departments of Psychiatry (Tramazzo, Bromet, Kotov, Jonas), Applied Mathematics and Statistics (Lian), and Child Psychiatry (Carlson), Stony Brook University, Stony Brook, N.Y.; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (Ajnakina)
| | - Wenxuan Lian
- Departments of Psychiatry (Tramazzo, Bromet, Kotov, Jonas), Applied Mathematics and Statistics (Lian), and Child Psychiatry (Carlson), Stony Brook University, Stony Brook, N.Y.; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (Ajnakina)
| | - Olesya Ajnakina
- Departments of Psychiatry (Tramazzo, Bromet, Kotov, Jonas), Applied Mathematics and Statistics (Lian), and Child Psychiatry (Carlson), Stony Brook University, Stony Brook, N.Y.; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (Ajnakina)
| | - Gabrielle Carlson
- Departments of Psychiatry (Tramazzo, Bromet, Kotov, Jonas), Applied Mathematics and Statistics (Lian), and Child Psychiatry (Carlson), Stony Brook University, Stony Brook, N.Y.; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (Ajnakina)
| | - Evelyn Bromet
- Departments of Psychiatry (Tramazzo, Bromet, Kotov, Jonas), Applied Mathematics and Statistics (Lian), and Child Psychiatry (Carlson), Stony Brook University, Stony Brook, N.Y.; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (Ajnakina)
| | - Roman Kotov
- Departments of Psychiatry (Tramazzo, Bromet, Kotov, Jonas), Applied Mathematics and Statistics (Lian), and Child Psychiatry (Carlson), Stony Brook University, Stony Brook, N.Y.; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (Ajnakina)
| | - Katherine Jonas
- Departments of Psychiatry (Tramazzo, Bromet, Kotov, Jonas), Applied Mathematics and Statistics (Lian), and Child Psychiatry (Carlson), Stony Brook University, Stony Brook, N.Y.; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (Ajnakina)
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Hode Y, Padovani R, Hikmat W, Guillard-Bouhet N, Attal J, Bralet MC, Biotteau M, Chereau Boudet I, Canceil O, Montagne Larmurier A, Roussel C, Lemestré S, Willard D. Family psychoeducation in schizophrenia and schizophrenia related disorder, treatment compliance, and suicidal risk reduction: questions about their relationship from a naturalistic observation. Front Psychiatry 2024; 15:1370566. [PMID: 38638418 PMCID: PMC11024790 DOI: 10.3389/fpsyt.2024.1370566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The Profamille V3.2 multi-family psycho-educational program directed at caregivers of relatives with schizophrenia or schizophrenia related disorder has been shown to decrease the annual prevalence of suicide attempts. It has been reported that psychoeducation of families can sometimes improve compliance with treatment. This study investigates whether the Profamille program improves compliance and thus reduces the risk of suicide among patients. Method This is a retrospective study of 179 groups of family caregivers, encompassing 1946 participants enrolled in Module 1 of the Profamille program and followed up one year after completion of the module. Evaluations were conducted using questionnaires filled out by family caregivers at three distinct times: prior to beginning the program, upon its completion, and again one year following its conclusion. The annual prevalence of suicide attempts was measured both before the program began and one year after its conclusion, while compliance to treatment was evaluated at the start and end of the program. Result After the Profamille program, the annual prevalence of suicide attempts fell by a factor of 2 (p-value = 0.00002) and patient compliance improved (p-value <0.000001). This reduction in suicide attempts was observed independently of improved compliance. Compliance seems to have an additional effect, but only after participation in the program. Conclusion The Profamille program reduces patients' risk of suicide even when patients are not taking the treatment. When family psychoeducation is not proposed in schizophrenia or schizophrenia related disorder, this can represent a loss of chance for patients.
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Affiliation(s)
- Yann Hode
- Association Psychoeducation PROFAMILLE, Chatenois, France
| | | | - Wydad Hikmat
- Psychiatric Hospital of Kelaa Sraghna, Ministry of Health, Morocco, Kelâa des Sraghna, Morocco
| | - Nathalie Guillard-Bouhet
- CREATIV Centre de REhabilitation et d'Activités Thérapeutiques Intersectoriel de la Vienne, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Jérome Attal
- La Colombière, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Marie-Cecile Bralet
- CRISALID-HDF (Department Support of cognitive remediation and psychosocial rehabilitation- South Hauts de France area), Etablissement Public de Santé Mentale Oise, Clermont de l Oise, France
- INSERM Unit Research 1247 GRAP, Picardie Jules Vernes University, Amiens, France
- GDR 3557 Research network, Addiction and Psychiatry, Paris, France
- Centre Hospitalier Isarien, Clermont de l’Oise, France
| | | | - Isabelle Chereau Boudet
- Centre Expert Schizophrenie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont Ferrand, France
| | - Olivier Canceil
- Fondation Santé des Etudiants de France, Paris, France
- Sante Mentale France, Paris, France
| | | | - Céline Roussel
- Centre Hospitalier Annecy Genevois (CH Annecy), Metz-Tessy, France
| | - Stéphanie Lemestré
- Association de psychoéducation des Familles Profamille Liège Belgique, Liège, Belgium
| | - Dominique Willard
- Pôle PEPIT (Pôle Hospitalo-Universitaire d’Evaluation Prévention et Innovation Thérapeutique), Groupe Hospitalier Universitaire Paris psychiatrie et neurosciences, Paris, France
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Pescosolido BA, Green HD. Who has mental health problems? Comparing individual, social and psychiatric constructions of mental health. Soc Psychiatry Psychiatr Epidemiol 2024; 59:443-453. [PMID: 37069339 PMCID: PMC10108793 DOI: 10.1007/s00127-023-02474-4] [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: 09/22/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The persistent gap between population indicators of poor mental health and the uptake of services raises questions about similarities and differences between social and medical/psychiatric constructions. Rarely do studies have assessments from different perspectives to examine whether and how lay individuals and professionals diverge. METHODS Data from the Person-to-Person Health Interview Study (P2P), a representative U.S. state sample (N ~ 2700) are used to examine the overlap and correlates of three diverse perspectives-self-reported mental health, a self/other problem recognition, and the CAT-MH™ a validated, computer adaptive test for psychopathology screening. Descriptive and multinominal logit analyses compare the presence of mental health problems across stakeholders and their association with respondents' sociodemographic characteristics. RESULTS Analyses reveal a set of socially constructed patterns. Two convergent patterns indicate whether there is (6.9%, The "Sick") or is not (64.6%, The "Well") a problem. The "Unmet Needers" (8.7%) indicates that neither respondents nor those around them recognize a problem identified by the screener. Two patterns indicate clinical need where either respondents (The "Self Deniers", 2.9%) or others (The "Network Deniers", 6.0%) do not. Patterns where the diagnostic indicator does not suggest a problem include The "Worried Well" (4.9%) where only the respondent does, The "Network Coerced" (4.6%) where only others do, and The "Prodromal" (1.4%) where both self and others do. Education, gender, race, and age are associated with social constructions of mental health problems. CONCLUSIONS The implications of these results hold the potential to improve our understanding of unmet need, mental health literacy, stigma, and treatment resistance.
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Affiliation(s)
- Bernice A Pescosolido
- Department of Sociology, College of Arts & Sciences and the Irsay Institute, Indiana University, IN, Bloomington, USA.
| | - Harold D Green
- Department of Applied Health, School of Public Health and the Irsay Institute, Indiana University, IN, Bloomington, USA
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Ranchoff BL, Jeung C, Zeber JE, Simon GE, Ericson KM, Qian J, Geissler KH. Transitions in health insurance among continuously insured patients with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:25. [PMID: 38409218 PMCID: PMC10897200 DOI: 10.1038/s41537-024-00446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 02/28/2024]
Abstract
Changes in health insurance coverage may disrupt access to and continuity of care, even for those who remain insured. Continuity of care is especially important in schizophrenia, which requires ongoing medical and pharmaceutical treatment. However, little is known about continuity of insurance coverage among those with schizophrenia. The objective was to examine the probability of insurance transitions for individuals with schizophrenia who were continuously insured and whether this varied across insurance types. The Massachusetts All-Payer Claims Database identified individuals with schizophrenia aged 18-64 who were continuously insured during a two-year period between 2014 and 2018. A logistic regression estimated the association of having an insurance transition - defined as having a change in insurance type - with insurance type at the start of the period, adjusting for age, sex, ZIP code in the lowest quartile of median income, and ZIP code with concentrated poverty. Overall, 15.1% had at least one insurance transition across a 24-month period. Insurance transitions were most frequent among those with plans from the Marketplace. In regression adjusted results, individuals covered by the traditional Medicaid program were 20.2 percentage points [pp] (95% confidence interval [CI]: 24.6 pp, 15.9 pp) less likely to have an insurance transition than those who were insured by a Marketplace plan. Insurance transitions among individuals with schizophrenia were common, with more than one in six people having at least one transition in insurance type during a two-year period. Given that even continuously insured individuals with schizophrenia commonly experience insurance transitions, attention to insurance transitions as a barrier to care access and continuity is warranted.
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Affiliation(s)
- Brittany L Ranchoff
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
| | - Chanup Jeung
- School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - John E Zeber
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Keith M Ericson
- National Bureau for Economic Research, Cambridge, MA, USA
- Boston University Questrom School of Business, Boston, MA, USA
| | - Jing Qian
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Kimberley H Geissler
- Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School-Baystate, Springfield, MA, USA
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Moon KJ, Stephenson S, Hasenstab KA, Sridhar S, Seiber EE, Breitborde NJK, Nawaz S. Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State. J Behav Health Serv Res 2024; 51:132-145. [PMID: 38017296 DOI: 10.1007/s11414-023-09865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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McDonald A, Still M, Sommer J, Coniglio F. Riding the tides: Directions in mental health rehabilitation in NSW. Australas Psychiatry 2023; 31:791-794. [PMID: 37907834 DOI: 10.1177/10398562231205129] [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] [Indexed: 11/02/2023]
Abstract
OBJECTIVE This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. CONCLUSION The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses.
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Affiliation(s)
- Andrew McDonald
- Mental Health Services, Sydney Local Health District, Concord, NSW, Australia
| | - Megan Still
- Mental Health Services, Sydney Local Health District, Concord, NSW, Australia
| | - Joanne Sommer
- New South Wales Ministry of Health, Sydney, NSW, Australia
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Oh E, Gang M. [Effect of Digital Health Interventions on Psychotic Symptoms among Persons with Severe Mental Illness in Community: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2023; 53:69-86. [PMID: 36898686 DOI: 10.4040/jkan.22121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/28/2022] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE This study aimed to evaluate the effects of digital health interventions on the psychotic symptoms among people with severe mental illness in the community. METHODS A systematic review and meta-analysis were conducted in accordance with the Cochrane Intervention Research Systematic Review Manual and PRISMA. A literature search was conducted of published randomized controlled trials (RCTs) for digital health interventions from January 2022 to April 2022. RevMan software 5.3 was used for quality assessment and meta-analysis. RESULTS A total 14 studies out of 9,864 studies were included in the review, and 13 were included in meta-analysis. The overall effect size of digital health interventions on psychotic symptoms was -0.21 (95% CI = -0.32 to -0.10). Sub-analysis showed that the reduction of the psychotic symptoms was effective in the schizophrenia spectrum group (SMD = -.0.22; 95% CI = -.0.36 to -0.09), web (SMD = -0.41; 95% CI = -0.82 to 0.01), virtual reality (SMD = -0.33; 95% CI = -0.56 to -0.10), mobile (SMD = -0.15; 95% CI = -0.28 to -0.03), intervention period of less than 3 months (SMD = -0.23; 95% CI = -0.35 to -0.11), and non-treatment group (SMD = -0.23; 95% CI = -0.36 to -0.11). CONCLUSION These findings suggest that digital health interventions alleviate psychotic symptoms in patients with severe mental illnesses. However, well-designed digital health studies should be conducted in the future.
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Affiliation(s)
- Eunjin Oh
- Department of Nursing, Songwon University, Gwangju, Korea
| | - Moonhee Gang
- College of Nursing, Chungnam National University, Daejeon, Korea.
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Tauscher JS, Lybarger K, Ding X, Chander A, Hudenko WJ, Cohen T, Ben-Zeev D. Automated Detection of Cognitive Distortions in Text Exchanges Between Clinicians and People With Serious Mental Illness. Psychiatr Serv 2022; 74:407-410. [PMID: 36164769 DOI: 10.1176/appi.ps.202100692] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors tested whether natural language processing (NLP) methods can detect and classify cognitive distortions in text messages between clinicians and people with serious mental illness as effectively as clinically trained human raters. METHODS Text messages (N=7,354) were collected from 39 clients in a randomized controlled trial of a 12-week texting intervention. Clinical annotators labeled messages for common cognitive distortions: mental filtering, jumping to conclusions, catastrophizing, "should" statements, and overgeneralizing. Multiple NLP classification methods were applied to the same messages, and performance was compared. RESULTS A tuned model that used bidirectional encoder representations from transformers (F1=0.62) achieved performance comparable to that of clinical raters in classifying texts with any distortion (F1=0.63) and superior to that of other models. CONCLUSIONS NLP methods can be used to effectively detect and classify cognitive distortions in text exchanges, and they have the potential to inform scalable automated tools for clinical support during message-based care for people with serious mental illness.
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Affiliation(s)
- Justin S Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences (Tauscher, Chander, Cohen, Ben-Zeev), and Department of Biomedical Informatics and Medical Education (Lybarger, Ding, Cohen), University of Washington, Seattle; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire (Hudenko)
| | - Kevin Lybarger
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences (Tauscher, Chander, Cohen, Ben-Zeev), and Department of Biomedical Informatics and Medical Education (Lybarger, Ding, Cohen), University of Washington, Seattle; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire (Hudenko)
| | - Xiruo Ding
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences (Tauscher, Chander, Cohen, Ben-Zeev), and Department of Biomedical Informatics and Medical Education (Lybarger, Ding, Cohen), University of Washington, Seattle; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire (Hudenko)
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences (Tauscher, Chander, Cohen, Ben-Zeev), and Department of Biomedical Informatics and Medical Education (Lybarger, Ding, Cohen), University of Washington, Seattle; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire (Hudenko)
| | - William J Hudenko
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences (Tauscher, Chander, Cohen, Ben-Zeev), and Department of Biomedical Informatics and Medical Education (Lybarger, Ding, Cohen), University of Washington, Seattle; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire (Hudenko)
| | - Trevor Cohen
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences (Tauscher, Chander, Cohen, Ben-Zeev), and Department of Biomedical Informatics and Medical Education (Lybarger, Ding, Cohen), University of Washington, Seattle; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire (Hudenko)
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences (Tauscher, Chander, Cohen, Ben-Zeev), and Department of Biomedical Informatics and Medical Education (Lybarger, Ding, Cohen), University of Washington, Seattle; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire (Hudenko)
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Valencia M, Medina R, Calixto E, Rodríguez N. Cerebral, Psychosocial, Family Functioning and Disability of Persons with Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:2069-2082. [PMID: 36133029 PMCID: PMC9484561 DOI: 10.2147/ndt.s370449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/30/2022] [Indexed: 11/23/2022] Open
Abstract
The human brain is the most cognitively capable of mammalian brains, endowed as it is with an overdeveloped cerebral cortex that, in parallel, renders it vulnerable to mental disorders. Schizophrenia is the expression of the dysregulation of the neuronal activity of cortical and subcortical regions due to modifications in the levels of the various neurotransmitters, especially of dopamine, with a reciprocal, intimate relationship among genes with environmental and psychosocial factors. If the dopaminergic system increases the function prefrontal cortex will be reduced: this is the main reason of social, occupational and familiar disruption. The present article describes the function of the brain in schizophrenia and its relation with anatomical, physiological, and genetic changes, in addition to identifying, psychosocial and family factors that can be determinant in the functionality of the patient. A review of national and international bibliography was conducted bearing in mind the following variables: functioning at the cerebral level; psychosocial functioning, familial functioning, disability, and functionality in persons with schizophrenia. Due to the variety of the issues included in this review, it can be concluded that schizophrenia is the product of a complex array of symptoms, deficits and disabilities. It was identified that there is a reciprocal confluence of diverse genetic, psychosocial, familial, environmental, educative, and social factors which affect the functionality of persons with this disorder. The latter makes it necessary to study the patient taking into consideration all of these components in an integral manner.
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Affiliation(s)
- Marcelo Valencia
- Department of Innovation and Global Health, Epidemiologic and Psychosocial Research Direction; National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Rafael Medina
- Institute Jaliscience of Mental Health, Guadalajara, Jalisco, Mexico
| | - Eduardo Calixto
- Neurobiology Department, Neurosciences Direction, National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico
| | - Noemí Rodríguez
- Institute Jaliscience of Mental Health, Guadalajara, Jalisco, Mexico
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Jovanović N, Russo M, Pemovska T, Francis JJ, Arenliu A, Bajraktarov S, Džubur Kulenović A, Injac Stevović L, Novotni A, Andrić Petrović S, Radojičić T, Ribić E, Konjufca J, Marić NP. Improving treatment of patients with psychosis in low-and-middle-income countries in Southeast Europe: Results from a hybrid effectiveness-implementation, pragmatic, cluster-randomized clinical trial (IMPULSE). Eur Psychiatry 2022; 65:e50. [PMID: 35946167 PMCID: PMC9491080 DOI: 10.1192/j.eurpsy.2022.2302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In Southeast Europe (SEE) standard treatment of patients with psychosis is largely based on pharmacotherapy with psychosocial interventions rarely available. DIALOG+ is a digital psychosocial intervention designed to make routine care therapeutically effective. This trial simultaneously examined effectiveness of DIALOG+ versus standard care on clinical and social outcomes (Aim 1) and explored intervention fidelity (Aim 2). Methods A hybrid type II effectiveness–implementation, cluster-randomized trial was conducted in five SEE countries: Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia, and Serbia. The intervention was offered to patients six times across 12 months instead of routine care. The outcomes were subjective quality of life (primary), clinical symptoms, satisfaction with services, and economic costs. Intervention fidelity was operationalized as adherence to the protocol in terms of frequency, duration, content, and coverage. Data were analyzed using multilevel regression. Results A total of 81 clinicians and 468 patients with psychosis were randomized to DIALOG+ or standard care. The intervention was delivered with high fidelity. The average number of delivered sessions was 5.5 (SD = 2.3) across 12 months. Patients in the intervention arm had better quality of life (MANSA) at 6 months (p = 0.03). No difference was found for other outcomes at 6 months. Due to disruptions caused by the COVID-19 pandemic, 12-month data were not interpretable. Conclusions DIALOG+ improved subjective quality of life of individuals with psychosis at 6 months (after four sessions), albeit with small effect size. The intervention has the potential to contribute to holistic care of patients with psychosis.
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Jongkind A, Hendriks M, Grootens K, Beekman ATF, van Meijel B. Evaluation of a collaborative care program for patients with treatment-resistant schizophrenia: Protocol for a multiple case-study. (Preprint). JMIR Res Protoc 2021; 11:e35336. [PMID: 35700002 PMCID: PMC9237776 DOI: 10.2196/35336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Approximately one-third of all patients with schizophrenia are treatment resistant. Worldwide, undertreatment with clozapine and other effective treatment options exist for people with treatment-resistant schizophrenia (TRS). In this respect, it appears that regular health care models do not optimally fit this patient group. The Collaborative Care (CC) model has proven to be effective for patients with severe mental illness, both in primary care and in specialized mental health care facilities. The key principles of the CC model are that both patients and informal caregivers are part of the treatment team, that a structured treatment plan is put in place with planned evaluations by the team, and that the treatment approach is multidisciplinary in nature and uses evidence-based interventions. We developed a tailored CC program for patients with TRS. Objective In this paper, we provide an overview of the research design for a potential study that seeks to gain insight into both the process of implementation and the preliminary effects of the CC program for patients with TRS. Moreover, we aim to gain insight into the experiences of professionals, patients, and informal caregivers with the program. Methods This study will be underpinned by a multiple case study design (N=20) that uses a mixed methods approach. These case studies will focus on an Early Psychosis Intervention Team and 2 Flexible Assertive Community treatment teams in the Netherlands. Data will be collected from patient records as well as through questionnaires, individual interviews, and focus groups. Patient recruitment commenced from October 2020. Results Recruitment of participants commenced from October 2020, with the aim of enrolling 20 patients over 2 years. Data collection will be completed by the end of 2023, and the results will be published once all data are available for reporting. Conclusions The research design, framed within the process of developing and testing innovative interventions, is discussed in line with the aims of the study. The limitations in clinical practice and specific consequences of this study are explained. International Registered Report Identifier (IRRID) DERR1-10.2196/35336
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Affiliation(s)
- Amy Jongkind
- Reinier van Arkel, 's-Hertogenbosch, Netherlands
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Koen Grootens
- Reinier van Arkel, 's-Hertogenbosch, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Aartjan T F Beekman
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Berno van Meijel
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Inholland University of Applied Sciences, Department of Health, Sports & Welfare, Cluster Nursing, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, Netherlands
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12
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Ben-Zeev D, Chander A, Tauscher J, Buck B, Nepal S, Campbell A, Doron G. A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE. J Med Internet Res 2021; 23:e29201. [PMID: 34766913 PMCID: PMC8663659 DOI: 10.2196/29201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/19/2021] [Accepted: 10/03/2021] [Indexed: 01/23/2023] Open
Abstract
Background People with serious mental illness (SMI) have significant unmet mental health needs. Development and testing of digital interventions that can alleviate the suffering of people with SMI is a public health priority. Objective The aim of this study is to conduct a fully remote randomized waitlist-controlled trial of CORE, a smartphone intervention that comprises daily exercises designed to promote reassessment of dysfunctional beliefs in multiple domains. Methods Individuals were recruited via the web using Google and Facebook advertisements. Enrolled participants were randomized into either active intervention or waitlist control groups. Participants completed the Beck Depression Inventory-Second Edition (BDI-II), Generalized Anxiety Disorder-7 (GAD-7), Hamilton Program for Schizophrenia Voices, Green Paranoid Thought Scale, Recovery Assessment Scale (RAS), Rosenberg Self-Esteem Scale (RSES), Friendship Scale, and Sheehan Disability Scale (SDS) at baseline (T1), 30-day (T2), and 60-day (T3) assessment points. Participants in the active group used CORE from T1 to T2, and participants in the waitlist group used CORE from T2 to T3. Both groups completed usability and accessibility measures after they concluded their intervention periods. Results Overall, 315 individuals from 45 states participated in this study. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Participants rated CORE as highly usable and acceptable. Intent-to-treat analyses showed significant treatment×time interactions for the BDI-II (F1,313=13.38; P<.001), GAD-7 (F1,313=5.87; P=.01), RAS (F1,313=23.42; P<.001), RSES (F1,313=19.28; P<.001), and SDS (F1,313=10.73; P=.001). Large effects were observed for the BDI-II (d=0.58), RAS (d=0.61), and RSES (d=0.64); a moderate effect size was observed for the SDS (d=0.44), and a small effect size was observed for the GAD-7 (d=0.20). Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3. Conclusions We successfully recruited, screened, randomized, treated, and assessed a geographically dispersed sample of participants with SMI entirely via the web, demonstrating that fully remote clinical trials are feasible in this population; however, study retention remains challenging. CORE showed promise as a usable, acceptable, and effective tool for reducing the severity of psychiatric symptoms and disability while improving recovery and self-esteem. Rapid adoption and real-world dissemination of evidence-based mobile health interventions such as CORE are needed if we are to shorten the science-to-service gap and address the significant unmet mental health needs of people with SMI during the COVID-19 pandemic and beyond. Trial Registration ClinicalTrials.gov NCT04068467; https://clinicaltrials.gov/ct2/show/NCT04068467
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Affiliation(s)
- Dror Ben-Zeev
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Justin Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Benjamin Buck
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Guy Doron
- School of Psychology, Interdisciplinary Center, Herzliya, Israel
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Golberstein E, Busch SH, Sint K, Rosenheck RA. Insurance Status and Continuity for Young Adults With First-Episode Psychosis. Psychiatr Serv 2021; 72:1160-1167. [PMID: 33971726 PMCID: PMC8488003 DOI: 10.1176/appi.ps.201900571] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Insurance status and continuity may affect access to and quality of care. The authors characterized patterns of and changes in insurance status over 1 year among people with first-episode psychosis (FEP), comparing insurance patterns with adults of similar age in the general population. METHODS Longitudinal data on insurance status and predictors of insurance status among adults with FEP were obtained from RAISE-ETP (Recovery After an Initial Schizophrenia Episode-Early Treatment Program) study participants with complete 1-year data (N=288). The frequencies of insurance status and transitions are presented. Bivariate comparisons were used to assess the impact of the comprehensive coordinated care intervention in RAISE-ETP on insurance changes. These data were compared with contemporaneous longitudinal data in the 2011 Medical Expenditures Panel Study. RESULTS The RAISE-ETP experimental intervention did not significantly change insurance status. At baseline, levels of uninsurance (47%) and public insurance (31%) were higher among RAISE-ETP participants than among a similar age group in the general public (29% and 13%, respectively). Insurance transitions were common among people with FEP, although 79% of those with public insurance at baseline also had public insurance at 1 year. Of studied RAISE-ETP participants, 60% had a period of uninsurance during the year studied. CONCLUSIONS Compared with a national sample, people with FEP were more likely to use public insurance but still had high persistence of 12-month uninsurance. That over half of the RAISE-ETP participants had a period of uninsurance suggests that more research is needed on whether these periods affect treatment continuity and medication adherence.
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Affiliation(s)
- Ezra Golberstein
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
| | - Susan H Busch
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
| | - Kyaw Sint
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
| | - Robert A Rosenheck
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
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He XY, Hou CL, Huang ZH, Huang YH, Zhang JJ, Wang ZL, Jia FJ. Individuals at ultra-high risk of psychosis and first-degree relatives of patients with schizophreniaexperience impaired family functionality and social support deficit in comparison to healthy controls. Compr Psychiatry 2021; 109:152263. [PMID: 34274881 DOI: 10.1016/j.comppsych.2021.152263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Abstract
AIM The present study was designed to assess the role of family function and social support in the context of different phases of schizophrenia. METHODS First-episode patients with experiences of schizophrenia (FEP), ultra-high risk for psychosis (UHR), first-degree relatives (FDR) of patients with experiences of schizophrenia, and healthy controls (HC) (40 per group) were subjected to in-person clinical interviews. The results of these interviews were then used to gauge social support and family function using the Perceived Social Support Scale (PSSS) and the Family Adaptability and Cohesion Scales (FACESII-CV). Data were analyzed through ANCOVA, correlation analysis and logistic regression analyses. RESULTS We found that family function and social support showed a approximately gradual downward trend through the HC, FDR, UHR, and FEP groups but no significant differences were found in the family function of the FDR, UHR and FDR group. Logistic regression analyses indicated that UHR group patients exhibited decreased family support and family cohesion relative to members of the HC group, but had greater perceived social support than did members of the FEP group. Results for members of the FDR group were in line with those of members of the UHR group. CONCLUSIONS These findings suggested that both UHR and FDR individuals experience impaired family functionality and social support which expanded the understanding of the psychological characteristics of the prodromal period of schizophrenia. Further explorations are warranted to develop optimal psychosocial interventions.
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Affiliation(s)
- Xiao-Yan He
- The Second School of Clinical Medicine, Southern Medical University, Guangdong Province, Guangzhou, China; Guangdong Provincial People's Hospital, Guangdong Academy of MedicalSciences, Guangdong Mental Health Center, Guangdong Province, China; Liuzhou Worker's Hospital, Liuzhou, Guangxi Province, China
| | - Cai-Lan Hou
- The Second School of Clinical Medicine, Southern Medical University, Guangdong Province, Guangzhou, China; Guangdong Provincial People's Hospital, Guangdong Academy of MedicalSciences, Guangdong Mental Health Center, Guangdong Province, China.
| | - Zhuo-Hui Huang
- Guangdong Provincial People's Hospital, Guangdong Academy of MedicalSciences, Guangdong Mental Health Center, Guangdong Province, China
| | - Ying-Hua Huang
- Guangdong Second People's Hospital, Guangzhou, Guangdong Province, China
| | - Ji-Jie Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangdong Province, Guangzhou, China; Guangdong Provincial People's Hospital, Guangdong Academy of MedicalSciences, Guangdong Mental Health Center, Guangdong Province, China
| | - Zhong-Lei Wang
- ShenzhenKangNing Hospital, Shenzhen, Guangdong Province, China
| | - Fu-Jun Jia
- The Second School of Clinical Medicine, Southern Medical University, Guangdong Province, Guangzhou, China; Guangdong Provincial People's Hospital, Guangdong Academy of MedicalSciences, Guangdong Mental Health Center, Guangdong Province, China.
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15
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Fulford D, Gard DE, Mueser KT, Mote J, Gill K, Leung L, Mow J. Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App. JMIR Ment Health 2021; 8:e27475. [PMID: 34128812 PMCID: PMC8277369 DOI: 10.2196/27475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/05/2021] [Accepted: 04/17/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND People with schizophrenia and other serious mental illnesses often lack access to evidence-based interventions, particularly interventions that target meaningful recovery outcomes such as social functioning and quality of life. Mobile technologies, including smartphone apps, have the potential to provide scalable support that places elements of evidence-based interventions at the palm of patients' hands. OBJECTIVE We aim to develop a smartphone app-called Motivation and Skills Support-to provide targeted social goal support (eg, making new friends and improving existing relationships) for people with schizophrenia enrolled in a stand-alone open trial. METHODS In this paper, we presented preliminary outcomes of 31 participants who used the Motivation and Skills Support app for 8 weeks, including social functioning pre- to postintervention, and momentary reports of treatment targets (eg, social motivation and appraisals) during the intervention. RESULTS The findings suggest that the intervention improved self-reported social functioning from baseline to treatment termination, particularly in female participants. Gains were not maintained at the 3-month follow-up. Furthermore, increased social functioning was predicted by momentary reports of social appraisals, including perceived social competence and the extent to which social interactions were worth the effort. CONCLUSIONS The implications of these findings and future directions for addressing social functioning in schizophrenia using mobile technology have been discussed. TRIAL REGISTRATION ClinicalTrials.gov NCT03404219; https://clinicaltrials.gov/ct2/show/NCT03404219.
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Affiliation(s)
- Daniel Fulford
- Department of Occupational Therapy, Boston University, Boston, MA, United States.,Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
| | - David E Gard
- Department of Psychology, San Francisco State University, San Francisco, CA, United States
| | - Kim T Mueser
- Department of Occupational Therapy, Boston University, Boston, MA, United States.,Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
| | - Jasmine Mote
- Department of Occupational Therapy, Tufts University, Somerville, MA, United States
| | - Kathryn Gill
- Department of Occupational Therapy, Boston University, Boston, MA, United States
| | - Lawrence Leung
- Department of Psychology, San Francisco State University, San Francisco, CA, United States
| | - Jessica Mow
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
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16
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Buck B, Chander A, Brian RM, Wang W, Campbell AT, Ben-Zeev D. Expanding the Reach of Research: Quantitative Evaluation of a Web-Based Approach for Remote Recruitment of People Who Hear Voices. JMIR Form Res 2021; 5:e23118. [PMID: 34081011 PMCID: PMC8212619 DOI: 10.2196/23118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/09/2020] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background Similar to other populations with highly stigmatized medical or psychiatric conditions, people who hear voices (ie, experience auditory verbal hallucinations [AVH]) are often difficult to identify and reach for research. Technology-assisted remote research strategies reduce barriers to research recruitment; however, few studies have reported on the efficiency and effectiveness of these approaches. Objective This study introduces and evaluates the efficacy of technology-assisted remote research designed for people who experience AVH. Methods Our group developed an integrated, automated and human complementary web-based recruitment and enrollment apparatus that incorporated Google Ads, web-based screening, identification verification, hybrid automation, and interaction with live staff. We examined the efficacy of that apparatus by examining the number of web-based advertisement impressions (ie, number of times the web-based advertisement was viewed); clicks on that advertisement; engagement with web-based research materials; and the extent to which it succeeded in representing a broad sample of individuals with AVH, assessed through the self-reported AVH symptom severity and demographic representativeness (relative to the US population) of the sample recruited. Results Over an 18-month period, our Google Ads advertisement was viewed 872,496 times and clicked on 11,183 times. A total amount of US $4429.25 was spent on Google Ads, resulting in 772 individuals who experience AVH providing consent to participate in an entirely remote research study (US $0.40 per click on the advertisement and US $5.73 per consented participant) after verifying their phone number, passing a competency screening questionnaire, and providing consent. These participants reported high levels of AVH frequency (666/756, 88.1% daily or more), distress (689/755, 91.3%), and functional interference (697/755, 92.4%). They also represented a broad sample of diversity that mirrored the US population demographics. Approximately one-third (264/756, 34.9%) of the participants had never received treatment for their AVH and, therefore, were unlikely to be identified via traditional clinic-based research recruitment strategies. Conclusions Web-based procedures allow for time saving, cost-efficient, and representative recruitment of individuals with AVH and can serve as a model for future studies focusing on hard-to-reach populations.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Rachel M Brian
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Weichen Wang
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Andrew T Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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17
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Mojtabai R. Estimating the prevalence of schizophrenia in the United States using the multiplier method. Schizophr Res 2021; 230:48-49. [PMID: 33667858 DOI: 10.1016/j.schres.2021.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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18
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Xiao S, Li T, Zhou W, Shen M, Yu Y. WeChat-based mHealth intention and preferences among people living with schizophrenia. PeerJ 2020; 8:e10550. [PMID: 33362979 PMCID: PMC7749651 DOI: 10.7717/peerj.10550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/20/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The past few decades have seen a rapid expansion of mHealth programs among people with serious mental illness, yet mHealth for schizophrenia is in a much earlier stage of development. This study examined the intention of WeChat-based mHealth programs among people living with schizophrenia (PLS) and evaluated correlates of the intention. METHODS A total of 400 PLS aged 18-77 completed a cross-sectional survey by face-to-face interviews. The survey included a general question asking about participants' willingness to attend WeChat-based mHealth programs, followed by preferences of three specific WeChat-based programs: psychoeducation, peer support, and professional support. PLS symptoms, functioning and disability were measured using the 18-item Brief Psychiatric Rating Scale (BPRS-18), the Global Assessment of Functioning (GAF), and the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), respectively. A multivariate logistic regression was used to determine correlates of program participation intention. RESULTS Over forty percent (43%, n = 172) of participants were willing to participate in WeChat-based mHealth programs, among whom preferences for each specific program were shown in descending order: psychoeducation (68.60%), professional support (60.47%), and peer support (52.33%). A multivariate analysis revealed that younger age (OR: 0.13-0.20, 95% CI [0.05-0.43]), higher education (OR: 3.48-6.84, 95% CI [1.69-18.21]), and lower disability (OR: 0.97, 95% CI [0.94-0.99]) were all independently associated with WeChat-based mHealth program participation intention. CONCLUSION The findings provide guidance for further development of WeChat-based mHealth programs among PLS in China, and targeted at those who are younger, well-educated and with lower disability.
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Affiliation(s)
- Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Tongxin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Wei Zhou
- School of Public Administration, Hunan University, Changsha, Hunan, China
| | - Minxue Shen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
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Jonas KG, Fochtmann LJ, Perlman G, Tian Y, Kane JM, Bromet EJ, Kotov R. Lead-Time Bias as a Potential Explanation for the Link Between Duration of Untreated Psychosis and Outcome: Response to Iyer et al. Am J Psychiatry 2020; 177:1181-1183. [PMID: 33256448 DOI: 10.1176/appi.ajp.2020.20030299r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Laura J Fochtmann
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Yuan Tian
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - John M Kane
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Evelyn J Bromet
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
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20
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Ben-Zeev D, Buck B, Meller S, Hudenko WJ, Hallgren KA. Augmenting Evidence-Based Care With a Texting Mobile Interventionist: A Pilot Randomized Controlled Trial. Psychiatr Serv 2020; 71:1218-1224. [PMID: 32631130 PMCID: PMC7708508 DOI: 10.1176/appi.ps.202000239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate the feasibility and clinical utility of training intensive psychiatric community care team members to serve as "mobile interventionists" who engage patients in recovery-oriented texting exchanges. METHODS A 3-month pilot randomized controlled trial was conducted to compare the mobile interventionist approach as an add-on to assertive community treatment (ACT) versus ACT alone. Participants were 49 individuals with serious mental illness (62% with schizophrenia/schizoaffective disorder, 24% with bipolar disorder, and 14% with depression). Clinical outcomes were evaluated at baseline, posttreatment, and 6-month follow-up, and satisfaction was evaluated posttreatment. RESULTS The intervention appeared feasible (95% of participants assigned to the mobile interventionist arm initiated the intervention, texting on 69% of possible days and averaging four messages per day), acceptable (91% reported satisfaction), and safe (no adverse events reported). Exploratory posttreatment clinical effect estimations suggested greater reductions in the severity of paranoid thoughts (Cohen's d=-0.61) and depression (d=-0.59) and improved illness management (d=0.31) and recovery (d=0.23) in the mobile interventionist group. CONCLUSIONS Augmentation of care with a texting mobile interventionist proved to be feasible, acceptable, safe, and clinically promising. The findings are encouraging given the relative ease of training practitioners to serve as mobile interventionists, the low burden placed on patients and practitioners, and the simplicity of the technology. The technical resources are widely accessible to patients and practitioners, boding well for potential intervention scalability. When pandemics such as COVID-19 block the possibility of in-person patient-provider contact, evidence-based texting interventions can serve a crucial role in supporting continuity of care.
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Affiliation(s)
- Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Suzanne Meller
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - William J Hudenko
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
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21
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Jonas KG, Fochtmann LJ, Perlman G, Tian Y, Kane JM, Bromet EJ, Kotov R. Lead-Time Bias Confounds Association Between Duration of Untreated Psychosis and Illness Course in Schizophrenia. Am J Psychiatry 2020; 177:327-334. [PMID: 32046533 PMCID: PMC10754034 DOI: 10.1176/appi.ajp.2019.19030324] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE At first hospitalization, a long duration of untreated psychosis (DUP) predicts illness severity and worse treatment outcomes. The mechanism of this association, however, remains unclear. It has been hypothesized that lengthy untreated psychosis is toxic or that it reflects a more severe form of schizophrenia. Alternatively, the association may be an artifact of lead-time bias. These hypotheses are tested in a longitudinal study of schizophrenia with 2,137 observations spanning from childhood to 20 years after first admission. METHODS Data were from the Suffolk County Mental Health Project. The cohort included 287 individuals with schizophrenia or schizoaffective disorder. DUP was defined as days from first psychotic symptom to first psychiatric hospitalization. Psychosocial function was assessed using the Premorbid Adjustment Scale and the Global Assessment of Functioning Scale. Psychosocial function trajectories were estimated using multilevel spline regression models adjusted for gender, occupational status, race, and antipsychotic medication. RESULTS Both long- and short-DUP patients experienced similar declines in psychosocial function, but declines occurred at different times relative to first admission. Long-DUP patients experienced most of these declines prior to first admission, while short-DUP patients experienced declines after first admission. When psychosocial function was analyzed relative to psychosis onset, DUP did not predict illness course. CONCLUSIONS The association between DUP and psychosocial function may be an artifact of early detection, creating the illusion that early intervention is associated with improved outcomes. In other words, DUP may be better understood as an indicator of illness stage than a predictor of course.
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Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Laura J Fochtmann
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Yuan Tian
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - John M Kane
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Evelyn J Bromet
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health (Jonas, Fochtmann, Perlman, Bromet, Kotov) and Department of Applied Mathematics and Statistics (Tian), Stony Brook University, Stony Brook, N.Y.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Feinstein Institute for Medical Research, Manhasset, New York (Kane)
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22
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Affiliation(s)
- Donald C Goff
- Department of Psychiatry (Goff), Department of Population Health, Division of Statistics (Li), and Department of Population Health, Division of Epidemiology (Thorpe), New York University Grossman School of Medicine, New York University Langone Health, New York; Nathan Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Goff)
| | - Chenxiang Li
- Department of Psychiatry (Goff), Department of Population Health, Division of Statistics (Li), and Department of Population Health, Division of Epidemiology (Thorpe), New York University Grossman School of Medicine, New York University Langone Health, New York; Nathan Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Goff)
| | - Lorna Thorpe
- Department of Psychiatry (Goff), Department of Population Health, Division of Statistics (Li), and Department of Population Health, Division of Epidemiology (Thorpe), New York University Grossman School of Medicine, New York University Langone Health, New York; Nathan Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Goff)
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23
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Schmit MK, Oller ML, Tapia‐Fuselier JL, Schmit EL. A Holistic Client Functioning Profile Comparison of People With Serious Mental Illness. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Marianna L. Oller
- Department of Counseling and Higher Education, University of North Texas
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24
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Lüdtke T, Platow-Kohlschein H, Rüegg N, Berger T, Moritz S, Westermann S. Mindfulness Mediates the Effect of a Psychological Online Intervention for Psychosis on Self-Reported Hallucinations: A Secondary Analysis of Voice Hearers From the EviBaS Trial. Front Psychiatry 2020; 11:228. [PMID: 32308631 PMCID: PMC7145894 DOI: 10.3389/fpsyt.2020.00228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychological online interventions (POIs) could represent a promising approach to narrow the treatment gap in psychosis but it remains unclear whether improving mindfulness functions as a mechanism of change in POIs. For the present study, we examined if mindfulness mediates the effect of a comprehensive POI on distressing (auditory) hallucinations. METHODS We conducted a secondary analysis on voice hearers (n = 55) from a randomized controlled trial evaluating a POI for psychosis (EviBaS; trial registration NCT02974400, clinicaltrials.gov). The POI includes a module on mindfulness and we only considered POI participants in our analyses who completed the mindfulness module (n = 16). RESULTS Participants who completed the mindfulness module reported higher mindfulness (p = 0.015) and lower hallucinations (p = 0.001) at post assessment, compared to controls, but there was no effect on distress by voices (p = 0.598). Mindfulness mediated the POI's effect on hallucinations (b = -1.618, LLCI = -3.747, ULCI = -0.054) but not on distress by voices (b = -0.057, LLCI = -0.640, ULCI = 0.915). LIMITATIONS AND DISCUSSION Completion of the mindfulness module was not randomized. Hence, we cannot draw causal inferences. Even if we assumed causality, it remains unclear which contents of the POI could have resulted in increased mindfulness and reduced hallucinations, as participants completed other modules as well. In addition, confounding variables could explain the mediation and the sample size was small. Nonetheless, the overall pattern of results indicates that the POI is likely to improve mindfulness, and that increased mindfulness could partially explain the POI's efficacy.
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Affiliation(s)
- Thies Lüdtke
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Platow-Kohlschein
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Ben-Zeev D, Buck B, Hallgren K, Drake RE. Effect of Mobile Health on In-person Service Use Among People With Serious Mental Illness. Psychiatr Serv 2019; 70:507-510. [PMID: 30947636 DOI: 10.1176/appi.ps.201800542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether mobile health (mHealth) affects the use of in-person services among people with serious mental illness. METHODS This randomized comparative effectiveness trial evaluated minutes of service use among 163 participants for 3 months before, during, and after exposure to mHealth or clinic-based care. RESULTS mHealth and clinic-based care participants used fewer services during the intervention (9% and 14%, respectively) and follow-up (2% and 12%) periods than during the preintervention phase. During treatment, mHealth treatment responders (participants who experienced recovery gains and maintained them at follow-up) reduced service use more than nonresponders (12% vs. 10%). Postintervention, service use by mHealth treatment responders continued to drop (an additional 11%), whereas service use by mHealth nonresponders increased by 8%. CONCLUSIONS mHealth and clinic-based illness management interventions may reduce the need for other in-person services among people with serious mental illness, particularly among mHealth users who experience sustained recovery.
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Affiliation(s)
- Dror Ben-Zeev
- BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Ben-Zeev, Buck, Hallgren); Health Services Research and Development, Puget Sound Veterans Affairs Healthcare System, Seattle (Buck); Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and Westat Inc., Rockville, Maryland (Drake)
| | - Benjamin Buck
- BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Ben-Zeev, Buck, Hallgren); Health Services Research and Development, Puget Sound Veterans Affairs Healthcare System, Seattle (Buck); Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and Westat Inc., Rockville, Maryland (Drake)
| | - Kevin Hallgren
- BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Ben-Zeev, Buck, Hallgren); Health Services Research and Development, Puget Sound Veterans Affairs Healthcare System, Seattle (Buck); Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and Westat Inc., Rockville, Maryland (Drake)
| | - Robert E Drake
- BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Ben-Zeev, Buck, Hallgren); Health Services Research and Development, Puget Sound Veterans Affairs Healthcare System, Seattle (Buck); Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and Westat Inc., Rockville, Maryland (Drake)
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26
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Sommerfeld DH, Granholm E, Holden J, Seijo C, Rapoport CS, Mueser KT, Naqvi JB, Aarons GA. Concept mapping study of stakeholder perceptions of implementation of cognitive-behavioral social skills training on assertive community treatment teams. Psychol Serv 2019; 18:33-41. [PMID: 30855157 DOI: 10.1037/ser0000335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aimed to identify factors associated with implementation of cognitive behavioral social skills training (CBSST) on assertive community treatment (ACT) teams in a large public sector behavioral health system. This study used concept mapping (a mixed-method approach) and involved a sample including diverse stakeholder participants including patients, ACT team members, team leaders, organization leaders, and system leaders. We identified 14 distinct issues related to implementing CBSST on ACT teams: (a) CBSST fit with ACT structure, (b) CBSST fit with ACT process, (c) provider perceptions about CBSST, (d) staff pressures/other demands; (e) CBSST and ACT synergy, (f) client characteristics, (g) benefits of CBSST, (h) coordination/interaction among ACT providers, (i) government/regulatory factors, (j) integration of CBSST into ACT, (k) training support, (l) training resources, (m) multilevel agency leadership, and (n) provider characteristics. Each of these dimensions were rated in regard to importance and changeability with the top 5 rated dimensions including effective training support; alignment of leadership across levels of the community-based organizations delivering services; perceived benefits of CBSST, CBSST and ACT synergy; and provider perceptions of CBSST. The most critical issues for CBSST implementation on ACT teams should be addressed in future studies. Implementation strategies that capitalize on enhancing leadership and organizational climate hold promise to address all of these issues. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego
| | - Chariz Seijo
- Department of Psychiatry, University of California, San Diego
| | | | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University
| | - Jeanean B Naqvi
- Department of Psychiatry, University of California, San Diego
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27
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Sommerfeld DH, Aarons GA, Naqvi JB, Holden J, Perivoliotis D, Mueser KT, Granholm E. Stakeholder Perspectives on Implementing Cognitive Behavioral Social Skills Training on Assertive Community Treatment Teams. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 46:188-199. [PMID: 30406858 DOI: 10.1007/s10488-018-0904-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined stakeholder perceptions of the "fit" between cognitive-behavioral social skills training (CBSST) and assertive community treatment (ACT) when implementing CBSST into existing community-based ACT teams. Focus group feedback was collected from a diverse set of stakeholders (i.e., clients, providers, supervisors, agency administrators, public sector representatives, and intervention developers). Results identified perceived client and provider benefits for integrating CBSST into ACT while highlighting the importance of purposeful adaptations, training, and implementation tools to facilitate structural and values fit between CBSST and ACT. Study findings will inform future endeavors to implement CBSST and other relevant EBPs into ACT. Trial Registry: ClinicalTrials.gov #NCT02254733.
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Affiliation(s)
- David H Sommerfeld
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA
| | - Jeanean B Naqvi
- Department of Psychology, Carnegie Mellon University, Pittsburgh, USA
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA.,Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0812, USA.,Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, USA
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28
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Hswen Y, Naslund JA, Brownstein JS, Hawkins JB. Online Communication about Depression and Anxiety among Twitter Users with Schizophrenia: Preliminary Findings to Inform a Digital Phenotype Using Social Media. Psychiatr Q 2018; 89:569-580. [PMID: 29327218 PMCID: PMC6043409 DOI: 10.1007/s11126-017-9559-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Digital technologies hold promise for supporting the detection and management of schizophrenia. This exploratory study aimed to generate an initial understanding of whether patterns of communication about depression and anxiety on popular social media among individuals with schizophrenia are consistent with offline representations of the illness. From January to July 2016, posts on Twitter were collected from a sample of Twitter users who self-identify as having a schizophrenia spectrum disorder (n = 203) and a randomly selected sample of control users (n = 173). Frequency and timing of communication about depression and anxiety were compared between groups. In total, the groups posted n = 1,544,122 tweets and users had similar characteristics. Twitter users with schizophrenia showed significantly greater odds of tweeting about depression compared with control users (OR = 2.69; 95% CI 1.76-4.10), and significantly greater odds of tweeting about anxiety compared with control users (OR = 1.81; 95% CI 1.20-2.73). This study offers preliminary insights that Twitter users with schizophrenia may express elevated symptoms of depression and anxiety in their online posts, which is consistent with clinical characteristics of schizophrenia observed in offline settings. Social media platforms could further our understanding of schizophrenia by informing a digital phenotype and may afford new opportunities to support early illness detection.
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Affiliation(s)
- Yulin Hswen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. .,Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, USA.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - John S Brownstein
- Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Jared B Hawkins
- Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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29
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Burden of Schizophrenia or Psychosis-Related Symptoms in Adults Undergoing Substance Abuse Evaluation. J Nerv Ment Dis 2018; 206:528-536. [PMID: 29905667 DOI: 10.1097/nmd.0000000000000835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study evaluated the biopsychosocial characteristics of adults undergoing substance abuse evaluation with potential schizophrenia/psychotic disorder, or possible schizophrenia/psychosis-like symptoms, compared with those with no schizophrenia/psychosis-like symptoms. A cross-sectional, observational study examined 170,201 adults, aged 18 to 30, who completed the Addiction Severity Index-Multimedia Version (ASI-MV). Approximately 10% were classified as having possible schizophrenia/psychosis-like symptoms or potential schizophrenia/psychotic disorder. These patients were more likely to exhibit moderate to extreme severity on employment, medical, legal, substance use, social, and psychiatric status than nonsymptomatic patients. The potential schizophrenia or psychotic disorder cohort was also more likely to have ever experienced physical abuse (odds ratio [OR] = 4.30, 95% confidence interval [CI] = 4.12-4.48) and/or sexual abuse (OR = 4.32, 95% CI = 4.15-4.51) versus the no schizophrenia/psychosis-like symptoms cohort. Findings support a recommendation for routine screening for mental health issues, particularly schizophrenia/psychosis-like symptoms, for adults entering substance use disorder treatment settings. This may increase the likelihood of appropriate and earlier intervention.
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30
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Rüegg N, Moritz S, Berger T, Lüdtke T, Westermann S. An internet-based intervention for people with psychosis (EviBaS): study protocol for a randomized controlled trial. BMC Psychiatry 2018; 18:102. [PMID: 29653532 PMCID: PMC5899332 DOI: 10.1186/s12888-018-1644-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/28/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence shows that internet-based self-help interventions are effective in reducing symptoms for a wide range of mental disorders. To date, online interventions treating psychotic disorders have been scarce, even though psychosis is among the most burdensome disorders worldwide. Furthermore, the implementation of cognitive-behavioral therapy (CBT) for psychosis in routine health care is challenging. Internet-based interventions could narrow this treatment gap. Thus, a comprehensive CBT-based online self-help intervention for people with psychosis has been developed. The aim of this study is the evaluation of the feasibility and efficacy of the intervention compared with a waiting list control group. METHODS The intervention includes modules on delusion, voice hearing, social competence, mindfulness, and seven other domains. Participants are guided through the program by a personal moderator. Usage can be amended by an optional smartphone app. In this randomized controlled trial, participants are allocated to a waiting list or an intervention of eight weeks. Change in positive psychotic symptoms of both groups will be compared (primary outcome) and predictors of treatment effects will be assessed. DISCUSSION To our knowledge, this project is one of the first large-scale investigations of an internet-based intervention for people with psychosis. It may thus be a further step to broaden treatment options for people suffering from this disorder. TRIAL REGISTRATION NCT02974400 (clinicaltrials.gov), date of registration: November 28th 2016.
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Affiliation(s)
- Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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31
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Roos E, Bjerkeset O, Svavarsdóttir MH, Steinsbekk A. Like a hotel, but boring: users' experience with short-time community-based residential aftercare. BMC Health Serv Res 2017; 17:832. [PMID: 29246222 PMCID: PMC5732432 DOI: 10.1186/s12913-017-2777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background The discharge process from hospital to home for patients with severe mental illness (SMI) is often complex, and most are in need of tailored and coordinated community services at home. One solution is to discharge patients to inpatient short-stay community residential aftercare (CRA). The aim of this study was to explore how patients with SMI experience a stay in CRA established in a City in Central Norway. Methods A descriptive qualitative study with individual interviews and a group interview with 13 persons. The CRA aims to improve the discharge process from hospital to independent supported living by facilitating the establishment of health and social services and preparing the patients. The philosophy is to help patients use community resources by e.g. not offering any organized in-house activities. The main question in the interviews was “How have you experienced the stay at the CRA?” The interviews were analyzed with a thematic approach using systematic text condensation. Results The participants experienced the stay at the CRA “Like a hotel” but also boring, due to the lack of organized in-house activities. The patients generally said they were not informed about the philosophy of the CRA before the stay. The participants had to come up with activities outside the CRA and said they got active help from the staff to do so; some experienced this as positive, whereas others wanted more organized in-house activities like they were used to from mental health hospital stays. Participants described the staff in the CRA to be helpful and forthcoming, but they did not notice the staff being active in organizing the aftercare. Conclusions The stay at the CRA was experienced as different from other services, with more freedom and focus on self-care, and lack of in-house activities. This led to increased self-activity among the patients, but some wanted more in-house activities. To prepare the patients better for the stay at the CRA, more information about the philosophy is needed in the pre-admission process. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2777-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway. .,, Municipality of Trondheim, Norway.
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Margrét Hrönn Svavarsdóttir
- Department of Health Sciences, Norwegian University of Sciences and Technology, Gjøvik, Norway.,School of Health Sciences, University of Akureyri, Akureyri, Iceland
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway
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Kotov R, Fochtmann L, Li K, Tanenberg-Karant M, Constantino EA, Rubinstein J, Perlman G, Velthorst E, Fett AKJ, Carlson G, Bromet EJ. Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project. Am J Psychiatry 2017; 174:1064-1074. [PMID: 28774193 PMCID: PMC5767161 DOI: 10.1176/appi.ajp.2017.16101191] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Kraepelin considered declining course a hallmark of schizophrenia, but others have suggested that outcomes usually stabilize or improve after treatment initiation. The authors investigated this question in an epidemiologically defined cohort with psychotic disorders followed for 20 years after first hospitalization. METHOD The Suffolk County Mental Health Project recruited first-admission patients with psychosis from all inpatient units of Suffolk County, New York (response rate, 72%). Participants were assessed in person six times over two decades; 373 completed the 20-year follow-up (68% of survivors); 175 had schizophrenia/schizoaffective disorder. Global Assessment of Functioning (GAF), psychotic symptoms, and mood symptoms were rated at each assessment. Month 6, when nearly all participants were discharged from the index hospitalization, was used as a reference. RESULTS In the schizophrenia group, mean GAF scores declined from 49 at month 6 to 36 at year 20. Negative and positive symptoms also worsened (Cohen's d values, 0.45-0.73). Among participants without schizophrenia, GAF scores were higher initially (a mean of approximately 64) but declined by 9 points over the follow-up period. Worsening began between years 5 and 8. Neither aging nor changes in antipsychotic treatment accounted for the declines. In all disorders, depression improved and manic symptoms remained low across the 20 years. CONCLUSIONS The authors found substantial symptom burden across disorders that increased with time and ultimately may undo initial treatment gains. Previous studies have suggested that better health care delivery models may preempt this decline. In the United States, these care needs are often not met, and addressing them is an urgent priority.
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Affiliation(s)
- Roman Kotov
- Department of Psychiatry, Stony Brook University
| | | | - Kaiqiao Li
- Department of Psychiatry, Stony Brook University
| | | | | | | | - Greg Perlman
- Department of Psychiatry, Stony Brook University
| | - Eva Velthorst
- Departments of Psychiatry and Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Anne-Kathrin J. Fett
- Department of Educational Neuroscience & Research Institute LEARN!, Faculty of Psychology and Education, VU University, Amsterdam, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
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A Model to Transform Psychosis Milieu Treatment Using CBT-Informed Interventions. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Frost BG, Tirupati S, Johnston S, Turrell M, Lewin TJ, Sly KA, Conrad AM. An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges. BMC Psychiatry 2017; 17:22. [PMID: 28095811 PMCID: PMC5240195 DOI: 10.1186/s12888-016-1164-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered. DISCUSSION This descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations. CONCLUSIONS Improved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.
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Affiliation(s)
- Barry G. Frost
- School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW 2308 Australia ,Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia
| | - Srinivasan Tirupati
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | | | - Megan Turrell
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia
| | - Terry J. Lewin
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Ketrina A. Sly
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Agatha M. Conrad
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
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Rotondi AJ, Spring MR, Hanusa BH, Eack SM, Haas GL. Designing eHealth Applications to Reduce Cognitive Effort for Persons With Severe Mental Illness: Page Complexity, Navigation Simplicity, and Comprehensibility. JMIR Hum Factors 2017; 4:e1. [PMID: 28057610 PMCID: PMC5247620 DOI: 10.2196/humanfactors.6221] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/23/2016] [Accepted: 10/14/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth technologies offer great potential for improving the use and effectiveness of treatments for those with severe mental illness (SMI), including schizophrenia and schizoaffective disorder. This potential can be muted by poor design. There is limited research on designing eHealth technologies for those with SMI, others with cognitive impairments, and those who are not technology savvy. We previously tested a design model, the Flat Explicit Design Model (FEDM), to create eHealth interventions for individuals with SMI. Subsequently, we developed the design concept page complexity, defined via the design variables we created of distinct topic areas, distinct navigation areas, and number of columns used to organize contents and the variables of text reading level, text reading ease (a newly added variable to the FEDM), and the number of hyperlinks and number of words on a page. OBJECTIVE The objective of our study was to report the influence that the 19 variables of the FEDM have on the ability of individuals with SMI to use a website, ratings of a website's ease of use, and performance on a novel usability task we created termed as content disclosure (a measure of the influence of a homepage's design on the understanding user's gain of a website). Finally, we assessed the performance of 3 groups or dimensions we developed that organize the 19 variables of the FEDM, termed as page complexity, navigational simplicity, and comprehensibility. METHODS We measured 4 website usability outcomes: ability to find information, time to find information, ease of use, and a user's ability to accurately judge a website's contents. A total of 38 persons with SMI (chart diagnosis of schizophrenia or schizoaffective disorder) and 5 mental health websites were used to evaluate the importance of the new design concepts, as well as the other variables in the FEDM. RESULTS We found that 11 of the FEDM's 19 variables were significantly associated with all 4 usability outcomes. Most other variables were significantly related to 2 or 3 of these usability outcomes. With the 5 tested websites, 7 of the 19 variables of the FEDM overlapped with other variables, resulting in 12 distinct variable groups. The 3 design dimensions had acceptable coefficient alphas. Both navigational simplicity and comprehensibility were significantly related to correctly identifying whether information was available on a website. Page complexity and navigational simplicity were significantly associated with the ability and time to find information and ease-of-use ratings. CONCLUSIONS The 19 variables and 3 dimensions (page complexity, navigational simplicity, and comprehensibility) of the FEDM offer evidence-based design guidance intended to reduce the cognitive effort required to effectively use eHealth applications, particularly for persons with SMI, and potentially others, including those with cognitive impairments and limited skills or experience with technology. The new variables we examined (topic areas, navigational areas, columns) offer additional and very simple ways to improve simplicity.
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Affiliation(s)
- Armando J Rotondi
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Department of Veterans Affairs, Pittsburgh, PA, United States.,School of Medicine, Center for Behavioral Health and Smart Technology, University of Pittsburgh, Pittsburgh, PA, United States.,School of Medicine, Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, United States.,School of Medicine, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Michael R Spring
- Information Science and Technology, School of Information Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Barbara H Hanusa
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Department of Veterans Affairs, Pittsburgh, PA, United States
| | - Shaun M Eack
- School of Medicine, Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, United States.,School of Social Work, University of Pittsburgh, Pittsburgh, PA, United States.,School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gretchen L Haas
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Department of Veterans Affairs, Pittsburgh, PA, United States.,School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Biagianti B, Schlosser D, Nahum M, Woolley J, Vinogradov S. Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders. JMIR Ment Health 2016; 3:e52. [PMID: 27965190 PMCID: PMC5192235 DOI: 10.2196/mental.6671] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/10/2016] [Accepted: 11/17/2016] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Numerous psychosocial interventions for individuals with chronic psychotic disorders (CPD) have shown positive effects on social cognitive and functional outcome measures. However, access to and engagement with these interventions remains limited. This is partly because these interventions require specially trained therapists, are not available in all clinical settings, and have a high scheduling burden for participants, usually requiring a commitment of several weeks. Delivering interventions remotely via mobile devices may facilitate access, improve scheduling flexibility, and decrease participant burden, thus improving adherence to intervention requirements. To address these needs, we designed the Creating Live Interactions to Mitigate Barriers (CLIMB) digital intervention, which aims to enhance social functioning in people with CPD. CLIMB consists of two treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy (ORGT). ORGT is an innovative treatment that combines remote group therapy with group texting (short message service, SMS). OBJECTIVES The objectives of this single-arm study were to investigate the feasibility of delivering 6 weeks of CLIMB to people with CPD and explore the initial effects on outcomes. METHODS Participants were recruited, screened and enrolled via the Internet, and delivered assessments and interventions remotely using provided tablets (iPads). Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. To assess feasibility, adherence to study procedures, attrition rates, engagement metrics, and acceptability of the intervention were evaluated. Changes on measures of social cognition, quality of life, and symptoms were also explored. RESULTS In total, 27 participants were enrolled over 12 months. Remote assessments were completed successfully on 96% (26/27) of the enrolled participants. Retention in the 6-week trial was 78% (21/27). Of all the iPads used, 95% (22/23) were returned undamaged at the end of the intervention. Participants on average attended 84% of the group therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P=.001), prosodic happiness intensity (P=.04), and facial anger (P=.04), with large within-group effect sizes (d=.60 to d=.86). Trend-level improvements were observed on aspects of quality of life (P values less than .09). No improvements were observed for symptoms. CONCLUSIONS It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with CPD using mobile devices. This approach may represent a scalable method to increase treatment access and adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies in larger samples should evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in CPD.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of Milan, Milano, Italy.,Posit Science, Inc., San Francisco, CA, United States
| | - Danielle Schlosser
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Mor Nahum
- Posit Science, Inc., San Francisco, CA, United States.,Hebrew University, Jerusalem, Israel
| | - Josh Woolley
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Sophia Vinogradov
- Department of Psychiatry, University Of Minnesota, Minneapolis, MN, United States
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Roux P, Passerieux C, Fleury MJ. Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders. Br J Psychiatry 2016; 209:511-516. [PMID: 27758837 DOI: 10.1192/bjp.bp.116.184010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Needs and service performance assessment are key components in improving recovery among individuals with mental disorders. AIMS To test the role of service performance as a mediating factor between severity of patients' needs and outcomes. METHOD A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling. RESULTS The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes. CONCLUSIONS Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life.
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Affiliation(s)
- Paul Roux
- Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada
| | - Christine Passerieux
- Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada
| | - Marie-Josée Fleury
- Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada
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de Jager A, Rhodes P, Beavan V, Holmes D, McCabe K, Thomas N, McCarthy-Jones S, Lampshire D, Hayward M. Investigating the Lived Experience of Recovery in People Who Hear Voices. QUALITATIVE HEALTH RESEARCH 2016; 26:1409-1423. [PMID: 25896792 DOI: 10.1177/1049732315581602] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although there is evidence of both clinical and personal recovery from distressing voices, the process of recovery over time is unclear. Narrative inquiry was used to investigate 11 voice-hearers' lived experience of recovery. After a period of despair/exhaustion, two recovery typologies emerged: (a) turning toward/empowerment, which involved developing a normalized account of voices, building voice-specific skills, integration of voices into daily life, and a transformation of identity, and (b) turning away/protective hibernation, which involved harnessing all available resources to survive the experience, with the importance of medication in recovery being emphasized. Results indicated the importance of services being sensitive and responsive to a person's recovery style at any given time and their readiness for change. Coming to hold a normalized account of voice-hearing and the self and witnessing of preferred narratives by others were essential in the more robust turning toward recovery typology.
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Affiliation(s)
| | - Paul Rhodes
- The University of Sydney, New South Wales, Australia
| | - Vanessa Beavan
- Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - Douglas Holmes
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Neil Thomas
- Swinburne University of Technology, Melbourne, Australia
| | | | | | - Mark Hayward
- The University of Sussex, Brighton, United Kingdom
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López Alvarez M, Laviana Cuetos M. La coordinación sociosanitaria en la atención a personas con trastornos mentales graves. ENFERMERIA CLINICA 2016; 26:61-7. [DOI: 10.1016/j.enfcli.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
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Lobban F, Barrowclough C. An Interpersonal CBT Framework for Involving Relatives in Interventions for Psychosis: Evidence Base and Clinical Implications. COGNITIVE THERAPY AND RESEARCH 2015; 40:198-215. [PMID: 27069287 PMCID: PMC4792366 DOI: 10.1007/s10608-015-9731-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Working with families in psychosis improves outcomes and is cost effective. However, implementation is poor, partly due to lack of a clear theoretical framework. This paper presents an interpersonal framework for extending the more familiar cognitive behavioral therapy model of psychosis to include the role of relatives' behavior in the process of recovery. A summary of the framework is presented, and the evidence to support each link is reviewed in detail. Limitations of the framework are discussed and further research opportunities highlighted. Clinical implications and a case example are described to show how the framework can be used flexibly to facilitate clinical practice. Our aim is to shift the focus of psychosocial interventions from an individualistic approach to treatment, towards greater involvement of relatives and recognition of the importance of the social environment on mental health.
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Affiliation(s)
- Fiona Lobban
- />Division of Health Research, Faculty of Health and Medicine, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, LA14YT UK
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Nkire N, Sardinha S, Nwosu B, McDonough CM, De Coteau PA, Duffy I, Waddington JL, Russell V. Evaluation of knowledge and attitudes among primary care physicians in Cavan-Monaghan as 'gatekeepers-in-waiting' for the introduction of Carepath for Overcoming Psychosis Early (COPE). Early Interv Psychiatry 2015; 9:141-50. [PMID: 23855315 DOI: 10.1111/eip.12069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/02/2013] [Indexed: 11/28/2022]
Abstract
AIM To investigate general practitioners' current knowledge of and attitudes towards psychosis and its management by Cavan-Monaghan Mental Health Service, Ireland, prior to their involvement in the introduction of an early intervention service. METHODS As part of a continuing medical education programme for psychosis, delivered to all 32 general practitioners practising in this region, participants were asked to complete a 29-item questionnaire designed to assess their baseline knowledge and attitudes. RESULTS All 32 general practitioners participated in the study. Although 17% had received no previous psychiatric training, 93% described their knowledge of psychiatric disorders as average or above average. However, only 53% could correctly identify all of a set of psychiatric symptoms related to psychosis. Only 50% felt comfortable initiating treatment for psychotic symptoms. Whereas only 40% had heard of the early intervention model, 89% believed it to be advantageous. Easy accessibility to services and rapid assessment of patients referred were most commonly reported as helpful. However, concerns were expressed about the potential for associated increases in workload. CONCLUSIONS As 'gatekeepers-in-waiting', these general practitioners will have a vital role in effective implementation of the early intervention service for psychosis. However, their knowledge needs improvement, through regular educational sessions, and this service must be responsive to their needs. In addition, general practitioners' concerns regarding the potential for increased workload must be adequately addressed in order to maintain enthusiasm and collaboration at the interface between primary care and mental health services, particularly in the context of early intervention.
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Affiliation(s)
- Nnamdi Nkire
- Cavan-Monaghan Mental Health Service, Dublin, Ireland; Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Affiliation(s)
- Craig Van Dyke
- a Department of Psychiatry and Global Health Sciences, University of California, San Francisco
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Technology-based interventions for psychiatric illnesses: improving care, one patient at a time. Epidemiol Psychiatr Sci 2014; 23:317-21. [PMID: 25046343 PMCID: PMC7192167 DOI: 10.1017/s2045796014000432] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Worldwide, individuals with severe psychiatric illnesses struggle to receive evidence-based care. While science has made remarkably slow progress in the development and implementation of effective psychiatric treatments, we have witnessed enormous progress in the emergence and global penetration of personal computing technology. The present paper examines how digital resources that are already widespread (e.g., smartphones, laptop computers), can be leveraged to support psychiatric care. These instruments and implementation strategies can increase patient access to evidenced-based care, help individuals overcome the barriers associated with the stigma of mental illness, and facilitate new treatment paradigms that harness wireless communication, sensors and the Internet, to enhance treatment potency. Innovative digital treatment programmes that have been used successfully with a range of conditions (i.e., schizophrenia, posttraumatic stress disorder and borderline personality disorder) are presented in the paper to demonstrate the utility and potential impact of technology-based interventions in the years ahead.
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Ben-Zeev D, Brenner CJ, Begale M, Duffecy J, Mohr DC, Mueser KT. Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophr Bull 2014; 40:1244-53. [PMID: 24609454 PMCID: PMC4193714 DOI: 10.1093/schbul/sbu033] [Citation(s) in RCA: 307] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The FOCUS smartphone intervention was developed to provide automated real-time/real-place illness management support to individuals with schizophrenia. The system was specifically designed to be usable by people with psychotic disorders who may have cognitive impairment, psychotic symptoms, negative symptoms, and/or low reading levels. FOCUS offers users both prescheduled and on-demand resources to facilitate symptom management, mood regulation, medication adherence, social functioning, and improved sleep. In this study, 33 individuals with schizophrenia or schizoaffective disorder used FOCUS over a 1-month period in their own environments. Participants were able to learn how to use the intervention independently, and all but one participant completed the trial successfully and returned the smartphones intact. Completers used the system on 86.5% of days they had the device, an average of 5.2 times a day. Approximately 62% of use of the FOCUS intervention was initiated by the participants, and 38% of use was in response to automated prompts. Baseline levels of cognitive functioning, negative symptoms, persecutory ideation, and reading level were not related to participants' use of the intervention. Approximately 90% of participants rated the intervention as highly acceptable and usable. Paired samples t tests found significant reductions in psychotic symptoms, depression, and general psychopathology, after 1 month of FOCUS use. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the FOCUS intervention for schizophrenia and introduces a new treatment model which has promise for extending the reach of evidence-based care beyond the confines of a physical clinic using widely available technologies.
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Affiliation(s)
- Dror Ben-Zeev
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH;
| | | | - Mark Begale
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Jennifer Duffecy
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Kim T. Mueser
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH;,Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
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Trend in rates for deaths with mention of schizophrenia on death certificates of US residents, 1999-2010. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1083-91. [PMID: 24562389 DOI: 10.1007/s00127-014-0846-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/03/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Trends in mortality rates for schizophrenia using multiple causes of death (including contributory causes) coded on death certificates in the US resident population apparently have not been reported. METHODS Age-standardized rates for deaths per 100,000 in 1999-2010 at age 15+ years (and for 15-64 and 65+ years) with mention of schizophrenia were examined for the US resident population, including variation by age, gender, race (blacks/African Americans and whites) and region. RESULTS Deaths at age 15+ years coded with schizophrenia as underlying cause were only 12 % of all deaths with mention of schizophrenia, for which the rate declined from 1.58 in 1999 (3,407 deaths) to 1.32 in 2010 (3,422 deaths) (percentage change or PC = -16 %). Declines were larger in females than males, in whites than blacks, and occurred in the Northeast, Midwest and South but not the West. The rate increased for age 15-64 years (PC = +28 %) (mainly in males), however, while declining for age 65+ years (PC = -35 %). For deaths at age 15-64 years with schizophrenia coded as other than the underlying cause, the largest continuous increase was for endocrine-metabolic diseases (predominantly diabetes mellitus) as underlying cause, with smaller increases in males for cardiovascular diseases, external causes and neoplasms. CONCLUSION Trends in the US rate for deaths with mention of schizophrenia varied among the sociodemographic groups examined. The lack of decline for age 15-64 years requires further study especially with regard to mediators (e.g., obesity) of excess mortality in schizophrenia identified from cohort studies.
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Affiliation(s)
- Eric B Elbogen
- Forensic Psychiatry Program and Clinic, Department of Psychiatry, University of North Carolina-Chapel Hill School of Medicine, CB #7167, Chapel Hill, NC 27599, USA.
| | - Sally C Johnson
- Forensic Psychiatry Program and Clinic, Department of Psychiatry, University of North Carolina-Chapel Hill School of Medicine, CB #7167, Chapel Hill, NC 27599, USA
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Manuel JI, Gandy ME, Rieker D. Trends in hospital discharges and dispositions for episodes of co-occurring severe mental illness and substance use disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 42:168-75. [PMID: 24509709 DOI: 10.1007/s10488-014-0540-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined trends in general hospital discharges and dispositions involving episodes of severe mental illness (SMI) with and without co-occurring substance use disorders. We analyzed data from the National Hospital Discharge Survey from 1979 through 2008. Discharges involving SMI and co-occurring substance use disorders (COD) were associated with shorter lengths of stay and had a greater likelihood of being discharged routinely or home and reduced likelihood of being transferred to a short- or long-term facility. Although COD discharges had a greater odds of leaving against medical advice than SMI discharges, this effect was not significant over time. A greater understanding of hospital discharge planning practices is needed to ensure that patients are linked to appropriate aftercare services.
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Affiliation(s)
- Jennifer I Manuel
- School of Social Work, Academic Learning Commons, Virginia Commonwealth University, 1000 Floyd Avenue, Richmond, VA, 23284, USA,
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Torres-González F, Ibanez-Casas I, Saldivia S, Ballester D, Grandón P, Moreno-Küstner B, Xavier M, Gómez-Beneyto M. Unmet needs in the management of schizophrenia. Neuropsychiatr Dis Treat 2014; 10:97-110. [PMID: 24476630 PMCID: PMC3897352 DOI: 10.2147/ndt.s41063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.
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Affiliation(s)
- Francisco Torres-González
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Inmaculada Ibanez-Casas
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Dinarte Ballester
- Sistema de Saúde Mãe de Deus, Escola Superior de Saúde, Universidade do Vale do Rio dos Sinos, Brazil ; Maristán Network, University of Granada, Granada, Spain
| | - Pamela Grandón
- Department of Psychology, Faculty of Social Sciences, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Berta Moreno-Küstner
- Andalusian Psychosocial Research Group and Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Malaga, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Miguel Xavier
- Department of Mental Health, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal ; Maristán Network, University of Granada, Granada, Spain
| | - Manuel Gómez-Beneyto
- Centro de Investigación Biomédica en Red de Salud Mental, University of Valencia, Spain ; Maristán Network, University of Granada, Granada, Spain
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Ben-Zeev D, Kaiser SM, Brenner CJ, Begale M, Duffecy J, Mohr DC. Development and Usability Testing of FOCUS: A Smartphone System for Self-Management of Schizophrenia. Psychiatr Rehabil J 2013; 36:289-296. [PMID: 24015913 PMCID: PMC4357360 DOI: 10.1037/prj0000019] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Mobile Health (mHealth) approaches can support the rehabilitation of individuals with psychiatric conditions. In the current article, we describe the development of a smartphone illness self-management system for people with schizophrenia. METHODS The research was conducted with consumers and practitioners at a community-based rehabilitation agency. Stage 1: 904 individuals with schizophrenia or schizoaffective disorder completed a survey reporting on their current use of mobile devices and interest in mHealth services. Eight practitioners completed a survey examining their attitudes and expectations from an mHealth intervention, and identified needs and potential obstacles. Stage 2: A multidisciplinary team incorporated consumer and practitioner input and employed design principles for the development of e-resources for people with schizophrenia to produce an mHealth intervention. Stage 3: 12 consumers participated in laboratory usability sessions. They performed tasks involved in operating the new system, and provided "think aloud" commentary and post-session usability ratings. RESULTS 570 (63%) of survey respondents reported owning a mobile device and many expressed interest in receiving mHealth services. Most practitioners believed that consumers could learn to use and would benefit from an mHealth intervention. In response, we developed a smartphone system that targets medication adherence, mood regulation, sleep, social functioning, and coping with symptoms. Usability testing revealed several design vulnerabilities, and the system was adapted to address consumer needs and preferences accordingly. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Through a comprehensive development process, we produced an mHealth illness self-management intervention that is likely to be used successfully, and is ready for deployment and systemic evaluation in real-world conditions.
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Gottlieb JD, Romeo KH, Penn DL, Mueser KT, Chiko BP. Web-based cognitive-behavioral therapy for auditory hallucinations in persons with psychosis: a pilot study. Schizophr Res 2013; 145:82-7. [PMID: 23410709 DOI: 10.1016/j.schres.2013.01.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/21/2012] [Accepted: 01/02/2013] [Indexed: 12/20/2022]
Abstract
CBT for Psychosis (CBTp) is an empirically-supported intervention for schizophrenia, but few people have access to it in the U.S. "Coping with Voices" is an interactive, computerized self-directed web-based CBTp program developed to increase access to CBTp with the objective of reducing the severity, distress, and functional impairment caused by auditory hallucinations. This open pilot study tested the feasibility and effects of this new intervention. Twenty-one individuals with schizophrenia spectrum disorders and auditory hallucinations were enrolled in the individual-based 10-session Coping with Voices program at one of 4 community mental health centers. High levels of participant satisfaction with the program were found, with most reporting that the program was engaging and helped them manage their symptoms. Seventeen participants (81%) completed more than 50% of the scheduled program sessions (i.e., 6 or more sessions), and were defined as "exposed" to the program. Exposed participants showed statistically significant reductions from baseline to post-treatment in several measures of auditory hallucinations, including overall severity and the perception of voices as an "outside entity" and intensity of "negative commentary," as well as reductions in other psychotic symptoms, and overall psychopathology. This study supports the feasibility of the web-based Coping with Voices program and its potential clinical benefits, and suggests that more rigorous research is warranted to evaluate its effects.
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Affiliation(s)
- Jennifer D Gottlieb
- Boston University, Center for Psychiatric Rehabilitation, 940 Commonwealth Ave. West, Boston, MA 02115, USA.
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