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Halsall L, Ushakova A, Jones S, Chowdhury S, Goodwin L. Substance Use Within Trials of Psychological Interventions for Psychosis: Sample Inclusion, Secondary Measures, and Intervention Effectiveness. Schizophr Bull 2024:sbae073. [PMID: 38777384 DOI: 10.1093/schbul/sbae073] [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: 05/25/2024]
Abstract
INTRODUCTION Current clinical guidelines recommend that patients with co-occurring psychosis and alcohol or substance use disorders (A/SUD) receive evidenced-based treatment for both disorders, including psychological intervention for psychosis. However, the efficacy of such treatments for individuals with co-occurring psychosis and A/SUD is unclear. STUDY DESIGN Randomized controlled trials (RCTs) of psychological interventions for psychosis were systematically reviewed, to investigate how alcohol and substance use has been accounted for across sample inclusion and secondary measures. Findings from trials including individuals with co-occurring alcohol or substance use issues were then narratively summarized using the Synthesis Without Meta-Analysis guidelines, to indicate the overall efficacy of psychological interventions for psychosis, for this comorbid population. STUDY RESULTS Across the 131 trials identified, 60.3% of trials excluded individuals with alcohol or substance use issues. Additionally, only 6.1% measured alcohol or substance use at baseline, while only 2.3% measured alcohol or substance use as a secondary outcome. Across trials explicitly including individuals with alcohol or substance use issues, insufficient evidence was available to conclude the efficacy of any individual psychological intervention. However, preliminary findings suggest that psychoeducation (PE) and metacognitive therapy (MCT) may be proposed for further investigation. CONCLUSION Overall, co-occurring alcohol and substance use issues have been largely neglected across the recent RCTs of psychological interventions for psychosis; highlighting the challenges of making treatment decisions for these individuals using the current evidence base.
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Affiliation(s)
- Lauren Halsall
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, England
| | - Anastasia Ushakova
- Faculty of Health and Medicine, Centre for Health Informatics, Computing and Statistics, Lancaster University, Lancaster, England
| | - Steven Jones
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, England
| | - Samin Chowdhury
- Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, England
| | - Laura Goodwin
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, England
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Hansen HG, Gjøde ICT, Starzer M, Ranning A, Hjorthøj C, Albert N, Nordentoft M, Thorup AAE. Clinical illness course and family-related outcomes among parents with a first episode of schizophrenia spectrum disorder: a 20-year follow-up of the OPUS trial. Psychol Med 2024:1-10. [PMID: 38563286 DOI: 10.1017/s0033291724000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Studies investigating parenthood and how it affects long-term outcomes are lacking among individuals with schizophrenia spectrum disorders. This study aimed to examine the life of participants 20 years after their first diagnosis with a special focus on parenthood, clinical illness course, and family-related outcomes. METHODS Among 578 individuals diagnosed with first-episode schizophrenia spectrum disorder between 1998 and 2000, a sample of 174 participants was reassessed at the 20-year follow-up. We compared symptom severity, remission, clinical recovery, and global functioning between 75 parents and 99 non-parents. Also, family functioning scored on the family assessment device, and the children's mental health was reported. We collected longitudinal data on psychiatric admission, supported housing, and work status via the Danish registers. RESULTS Participants with offspring had significantly lower psychotic (mean (s.d.) of 0.89 (1.46) v. 1.37 (1.44), p = 0.031) negative (mean [s.d.] of 1.13 [1.16] v. 1.91 [1.07], p < 0.001) and disorganized symptom scores (mean [s.d.] of 0.46 [0.80] v. 0.85 [0.95], p = 0.005) and more were in remission (59.5% v. 22.4%, p < 0.001) and in clinical recovery (29.7% v. 11.1%, p = 0.002) compared to non-parents. When investigating global functioning over 20 years, individuals becoming parents after their first diagnosis scored higher than individuals becoming parents before their first diagnosis and non-parents. Regarding family-related outcomes, 28.6% reported unhealthy family functioning, and 10% of the children experienced daily life difficulties. CONCLUSIONS Overall, parents have more favorable long-term outcomes than non-parents. Still, parents experience possible challenges regarding family functioning, and a minority of their children face difficulties in daily life.
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Affiliation(s)
- Helene Gjervig Hansen
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Christine Tholstrup Gjøde
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Research Unit - Child and Adolescent Mental Health Centre, The Capital Region, Copenhagen, Denmark
| | - Marie Starzer
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Ranning
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Amager, Copenhagen University Hospital, Digevej 110, 2300 Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Research Unit - Child and Adolescent Mental Health Centre, The Capital Region, Copenhagen, Denmark
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Jonas KG, Cannon TD, Docherty AR, Dwyer D, Gur RC, Gur RE, Nelson B, Reininghaus U, Kotov R. Psychosis superspectrum I: Nosology, etiology, and lifespan development. Mol Psychiatry 2024; 29:1005-1019. [PMID: 38200290 DOI: 10.1038/s41380-023-02388-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
This review describes the Hierarchical Taxonomy of Psychopathology (HiTOP) model of psychosis-related psychopathology, the psychosis superspectrum. The HiTOP psychosis superspectrum was developed to address shortcomings of traditional diagnoses for psychotic disorders and related conditions including low reliability, arbitrary boundaries between psychopathology and normality, high symptom co-occurrence, and heterogeneity within diagnostic categories. The psychosis superspectrum is a transdiagnostic dimensional model comprising two spectra-psychoticism and detachment-which are in turn broken down into fourteen narrow components, and two auxiliary domains-cognition and functional impairment. The structure of the spectra and their components are shown to parallel the genetic structure of psychosis and related traits. Psychoticism and detachment have distinct patterns of association with urbanicity, migrant and ethnic minority status, childhood adversity, and cannabis use. The superspectrum also provides a useful model for describing the emergence and course of psychosis, as components of the superspectrum are relatively stable over time. Changes in psychoticism predict the onset of psychosis-related psychopathology, whereas changes in detachment and cognition define later course. Implications of the superspectrum for genetic, socio-environmental, and longitudinal research are discussed. A companion review focuses on neurobiology, treatment response, and clinical utility of the superspectrum, and future research directions.
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Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA.
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Anna R Docherty
- Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ruben C Gur
- Brain Behavior Laboratory, Department of Psychiatry and the Penn-CHOP Lifespan Brain Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Raquel E Gur
- Brain Behavior Laboratory, Department of Psychiatry and the Penn-CHOP Lifespan Brain Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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Mølgaard SN, Nielsen MØ, Roed K, Nielsen J. Clinical experiences of guided tapering of antipsychotics for patients with schizophrenia- a case series. BMC Psychiatry 2024; 24:240. [PMID: 38553687 PMCID: PMC10981298 DOI: 10.1186/s12888-024-05699-y] [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: 01/15/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND 80% of patients value information on treatment options as an important part of recovery, further patients with a history of psychotic episodes feel excluded from decision making about their antipsychotic treatment, and on top of that, mental health staff is prone to be reluctant to support shared decision making and medication tapering for patients with schizophrenia. This case series aims to demonstrate the tapering of antipsychotic medication and how guided tapering affects the patient's feeling of autonomy and psychiatric rehabilitation. CASE PRESENTATION We present six patients diagnosed with schizophrenia (International Classification of Mental and Behavioral Disorders- 10th Edition codes F20.0-5, F20.7-9) who underwent professionally guided tapering in our clinic. The clinic aims to guide the patients to identify the lowest possible dose of antipsychotic medication in a safe setting to minimise the risk of severe relapse. Two patients completely discontinued their antipsychotic medication, two suffered a relapse during tapering, one chose to stop the tapering at a low dose, and one patient with treatment resistant schizophrenia, which is still tapering down. CONCLUSIONS Reducing the antipsychotic dose increased emotional awareness in some patients (n = 4) helping them to develop better strategies to handle stress and increased feelings of recovery. Patients felt a greater sense of autonomy and empowerment during the tapering process, even when discontinuation was not possible. Increased awareness in patients and early intervention during relapse may prevent severe relapse. IMPACT AND IMPLICATIONS Some patients with schizophrenia might be over medicated, leading to unwanted side effects and the wish to reduce their medication. The patients in our study illustrate how guided tapering of antipsychotic medication done jointly with the patient can lead to improved emotional awareness and the development of effective symptom management strategies. This may in turn lead to a greater sense of empowerment and identity and give life more meaning, supporting the experience of personal recovery.
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Affiliation(s)
- Sofie Norlin Mølgaard
- Mental Health Center Glostrup, Copenhagen University Hospital, Unit for complicated schizophrenia, Glostrup, Denmark.
| | - Mette Ødegaard Nielsen
- Mental Health Center Glostrup, Copenhagen University Hospital, Unit for complicated schizophrenia, Glostrup, Denmark
| | - Kickan Roed
- Mental Health Centre Glostrup, Copenhagen University Hospital- Mental Health Services CPH, Centre for Applied Research in Mental Health Care, Glostrup, Denmark
| | - Jimmi Nielsen
- Mental Health Center Glostrup, Copenhagen University Hospital, Unit for complicated schizophrenia, Glostrup, Denmark
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Castle D, Copolov D, Singh B, Bastiampillai T. Seven decades of antipsychotic drugs: Why is the life of Australians with schizophrenia still so suboptimal? Aust N Z J Psychiatry 2024; 58:201-206. [PMID: 38130026 DOI: 10.1177/00048674231209840] [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: 12/23/2023]
Abstract
The advent of dopamine (D2) receptor-blocking medications over 70 years ago, ushered in a new era of biological treatment for schizophrenia. However, we argue that little subsequent progress has been made in translating this into fulfilled and fulfilling lives for people with schizophrenia. This Viewpoint asks why this is the case, and suggests ways forward for capitalising on extant and emerging new treatments for psychotic disorders, to the betterment of the lives of people living with schizophrenia.
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Affiliation(s)
- David Castle
- Department of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - David Copolov
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Bruce Singh
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Richmond, VIC, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Hyatt A, Mullin B, Hasler V, Madore D, Progovac AM, Cook BL, DeLisi LE. Predictors of relapse and engagement in care one year after ending services in an urban safety net coordinated specialty care program for first episode psychosis. Schizophr Res 2024; 264:140-146. [PMID: 38128345 PMCID: PMC10983670 DOI: 10.1016/j.schres.2023.12.022] [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: 06/23/2023] [Revised: 11/08/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aimed to identify risk factors for relapse (psychiatric emergency department visits or hospitalization) and lack of follow-up with outpatient psychiatric care in the 12 months after ending services in an urban safety net coordinated specialty care (CSC) program for first episode psychosis (FEP). METHODS The study population (n = 143) were individuals with FEP who had any CSC care between 2014 and 2021. To identify risk factors for relapse and follow up after exit, multivariable logistic regression was performed using data from electronic health records and linked insurance claims data. RESULTS Individuals with any emergency department visit or hospitalization 12 months prior to ending CSC (aOR = 4.69, 95 % CI 1.78-12.34) and those who were using cannabis at last CSC contact (aOR = 4.06, 95 % CI 1.56-10.56) had a higher risk of relapse after ending CSC services. Cannabis use at last contact was also associated with lower rates of outpatient psychiatric follow-up (aOR = 0.32, 95 % CI 0.12-0.94), while CSC duration in months had a small positive association with post-CSC psychiatric follow-up. There were no differences in relapse or follow-up by race or ethnicity, primary diagnosis, or medication usage. CONCLUSIONS Prior relapse during CSC predicted relapse in the 12 months after ending CSC services, but not outpatient follow up. Cannabis use predicted both a higher rate of relapse and a lower rate of follow up after ending services. There were no differences by race or ethnicity in our sample, suggesting that once individuals engaged in FEP care there were no evident disparities in the observed outcomes.
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Affiliation(s)
- Andrew Hyatt
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States.
| | - Brian Mullin
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States
| | - Victoria Hasler
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Drew Madore
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Ana M Progovac
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Benjamin Lê Cook
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
| | - Lynn E DeLisi
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge Street, Cambridge 02139, MA, United States; Harvard Medical School, Department of Psychiatry, 25 Shattuck Street, Boston 02115, MA, United States
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Rühl F, Lambert M, Rohenkohl A, Kraft V, Daubmann A, Schneider BC, Luedecke D, Karow A, Gallinat J, Leicht G, Schöttle D. Remission with or without comorbid substance use disorders in early psychosis: long-term outcome in integrated care (ACCESS III study). Front Psychol 2023; 14:1237718. [PMID: 38187418 PMCID: PMC10768197 DOI: 10.3389/fpsyg.2023.1237718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Schizophrenia-Spectrum-Disorders are associated with poor long-term outcome as well as disability and often severely affect the lives of patients and their families often from symptom onset. Up to 70% of first episode psychosis (FEP) patients suffer from comorbid substance use disorders (SUD). We aimed at studying the course of illness in FEP patients within evidence-based care, with and without comorbid SUD, to examine how decreased, remitted or persistent substance use impacted rates of a combined symptomatic and functional long-term recovery compared with patients without SUD. Methods ACCESS III is an integrated care model for FEP or patients in the early phase of non-affective and affective psychotic disorders. Treatment trajectories of patients, who had been in ACCESS care for 1 year, with and without SUD were compared with regard to the course of illness and quality of life using Mixed Model Repeated Measures (MMRM) and recovery rates were compared using binary logistic regression. Change in substance use was coded as either persistent, decreased/remitted or no use. Results ACCESS III was a prospective 1-year study (N = 120) in patients aged 12-29 years. Of these, 74 (61.6%) had a comorbid SUD at admission. There were no group differences regarding the course of illness between patients with or without comorbid SUD or between patients with a substance abuse or substance dependence. The only outcome parameter that was affected by SUD was quality of life, with larger improvement found in the group without substance use (p = 0.05) compared to persistent and remitted users. Using LOCF, 44 patients (48.9%) fulfilled recovery criteria at the endpoint; recovery did not differ based on substance use status. Discussion SUD and especially substance dependence are common in psychotic disorders even in FEP patients. Evidence-based integrated care led to long-term improvement in patients with comorbid SUD and rate of recovery did not differ for patients with substance use.
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Affiliation(s)
- Friederike Rühl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Brooke C. Schneider
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Jones N, Pagdon S, Ebuenyi I, Goldman H, Dixon L. Recovering the Vocational Self?: Service User Accounts of Barriers to Work and School and the Role of Early Psychosis Services in Supporting Career Development. Community Ment Health J 2023; 59:1452-1464. [PMID: 37278733 DOI: 10.1007/s10597-023-01149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
Vocational recovery is frequently identified as a primary goal of specialized early intervention in psychosis services (EIS). However, few studies have investigated the multi-level impacts of psychosis and its social sequelae on emerging vocational identities and mechanisms by which EIS may contribute to longer-term career development. The goal of this study was to deepen our understanding of the experiences of young adults with early psychosis during and following discharge from EIS as they relate to vocational derailment, identity and career development. We conducted in-depth interviews with 25 former EIS recipients and five family members (N = 30). Interviews were analyzed using modified grounded theory, with an orientation to generating a rich, theory informed understanding young people's experiences. Approximately half of the participants in our sample were not in employment, education, or training (NEET) and had applied for or were receiving disability benefits (SSI/SSDI). Among those participants who were working, the majority reported short-term, low-wage work. Thematic findings elucidate factors underlying the erosion of vocational identity, as well as ways in which both participant-reported vocational service characteristics and socioeconomic background shape different pathways to college, work and/or disability benefits both during and following discharge from EIS. Findings underscore the need for additional research on vocational identity among youth and young adults with early psychosis and the development and evaluation of interventions designed to support career development, address social and structural barriers to education and training, and foster long-term socioeconomic mobility.
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Affiliation(s)
- Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Shannon Pagdon
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Ikenna Ebuenyi
- School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard Goldman
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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Cheng C, Nadin S, Bohonis H, Katt M, Dewa CS. NorthBEAT: exploring the service needs of youth experiencing early psychosis in Northern Ontario. FRONTIERS IN HEALTH SERVICES 2023; 3:1163452. [PMID: 38028941 PMCID: PMC10646171 DOI: 10.3389/frhs.2023.1163452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
Introduction Early Psychosis Intervention (EPI) is critical for best outcomes. Among 369 diseases, psychosis is among those causing the greatest disability. Evidence-based interventions for youth in early stages of psychosis (EPI programs) have prevented chronic disability. Yet, EPI is frequently inaccessible for youth living in rural communities. Moreover, Indigenous youth often face more precipitous situations given inadequate staffing, and culturally unsafe care. The NorthBEAT (Barriers to Early Assessment and Treatment) project sought to understand the service needs of youth with psychosis in Northern Ontario. The goals were: (1) to describe the mental health of a subset of adolescents receiving EPI care; (2) examine Indigenous youth as a significant and vulnerable population; (3) to understand the barriers and facilitators for Indigenous and non-Indigenous youth receiving EPI. Methods Mixed methods (structured and narrative interviews) included: psychometric scales interviews with youth, and narrative interviews with youth, their family, and service providers Data validation workshops were held with participants. Results Structured interviews with 26 youth (M = 17 years) found the participants functioning moderately well with duration of untreated psychosis ranging from 1 to 96 months (M = 26 months). No significant differences were found in functioning or duration of psychosis between Indigenous and non-Indigenous youth. Narrative interviews were conducted with 18 youth, 11 family members, and 14 service providers. Identified barriers were a lack of knowledge about psychosis among service providers, a disconnected system leading to delays in treatment, help not wanted by youth, expansive geographical context. Service needs were: finding the right point of access, support for families, pre-crisis intervention, reduced stigma for youth and their families, and an EPI approach to care. Discussion Rural and northern youth face similar barriers to accessing EPI as urban youth. However, northern youth face additional unique challenges due to expansive geographical context, limited resources and lack of knowledge about services.
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Affiliation(s)
- Chiachen Cheng
- Addictions and Mental Health, St. Joseph’s Care Group, Thunder Bay, ON, Canada
- Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
- Clinical Sciences Division, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - Shevaun Nadin
- Addictions and Mental Health, St. Joseph’s Care Group, Thunder Bay, ON, Canada
- Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
| | - Hafsa Bohonis
- Dr. Gilles Arcand Centre for Health Equity, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - Mae Katt
- Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States
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Morales-Pillado C, Fernández-Castilla B, Sánchez-Gutiérrez T, González-Fraile E, Barbeito S, Calvo A. Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis. Psychol Med 2023; 53:6304-6315. [PMID: 36472150 PMCID: PMC10520607 DOI: 10.1017/s0033291722003610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/26/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. METHODS Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. RESULTS Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. CONCLUSIONS TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.
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Affiliation(s)
- Carla Morales-Pillado
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Belén Fernández-Castilla
- Department of Methodology of Behavioral and Health Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | | | | | - Sara Barbeito
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Starzer M, Hansen HG, Hjorthøj C, Albert N, Nordentoft M, Madsen T. 20-year trajectories of positive and negative symptoms after the first psychotic episode in patients with schizophrenia spectrum disorder: results from the OPUS study. World Psychiatry 2023; 22:424-432. [PMID: 37713547 PMCID: PMC10503930 DOI: 10.1002/wps.21121] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
This study aimed to identify the 20-year trajectories of positive and negative symptoms after the first psychotic episode in a sample of patients with an ICD-10 diagnosis of schizophrenia spectrum disorder, and to investigate the baseline characteristics and long-term outcomes associated with these trajectories. A total of 373 participants in the OPUS trial were included in the study. Symptoms were assessed at baseline and after 1, 2, 5, 10 and 20 years using the Scales for the Assessment of Positive and Negative Symptoms. We used latent class growth mixture modelling to identify trajectories, and multinominal regression analyses to investigate predictors of membership to identified trajectories. Five trajectories of positive symptoms were identified: early continuous remission (50.9% of the sample), stable improvement (18.0%), intermittent symptoms (10.2%), relapse with moderate symptoms (11.9%), and continuous severe symptoms (9.1%). Substance use disorder (odds ratio, OR: 2.83, 95% CI: 1.09-7.38, p=0.033), longer duration of untreated psychosis (OR: 1.02, 95% CI: 1.00-1.03, p=0.007) and higher level of negative symptoms (OR: 1.60, 95% CI: 1.07-2.39, p=0.021) were predictors of the relapse with moderate symptoms trajectory, while only longer duration of untreated psychosis (OR: 1.01, 95% CI: 1.00-1.02, p=0.030) predicted membership to the continuous severe symptoms trajectory. Two trajectories of negative symptoms were identified: symptom remission (51.0%) and continuous symptoms (49.0%). Predictors of the continuous symptoms trajectory were male sex (OR: 3.03, 95% CI: 1.48-6.02, p=0.002) and longer duration of untreated psychosis (OR: 1.01, 95% CI: 1.00-1.02, p=0.034). Trajectories displaying continuous positive and negative symptoms were linked to lower neurocognition, as measured by the Brief Assessment of Cognition in Schizophrenia (BACS) (z-score: -0.78, CI: -1.39 to -0.17, for continuous positive symptoms; z-score: -0.33, CI: -0.53 to -0.13, for continuous negative symptoms). The same trajectories were also linked to higher use of antipsychotic medication at 20-year follow-up (continuous positive symptoms: 78%; continuous negative symptoms: 67%). These findings suggest that the majority of patients with first-episode schizophrenia spectrum disorder have a trajectory with early stable remission of positive symptoms. Long duration of untreated psychosis and comorbid substance abuse are modifiable predictors of poor trajectories for positive symptoms in these patients. In about half of patients, negative symptoms do not improve over time. These symptoms, in addition to being associated with poor social and neurocognitive functioning, may prevent patients from seeking help.
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Affiliation(s)
- Marie Starzer
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helene Gjervig Hansen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Mental Health Centre Amager, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Madsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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12
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Andersen MF, Roed K, Riis A, Rafn BS, Ebdrup BH, Midtgaard J. Perspectives of professional experts in relation to the development of community-based exercise for young adults with schizophrenia: a qualitative study. BMJ Open Sport Exerc Med 2023; 9:e001658. [PMID: 37780132 PMCID: PMC10533806 DOI: 10.1136/bmjsem-2023-001658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Physical activity is a key modifiable factor in protecting physical and mental health in people with severe mental illness including schizophrenia. Therefore, early promotion of physical activity is recommended and programmes supporting long-term maintenance of physically active behaviour are warranted. This study aimed to explore the perspectives of professional experts in relation to the development of a sustainable community-based exercise programme tailored to young adults with schizophrenia and intended to promote change and adoption of physical activity. We conducted 9 semistructured interviews with 11 clinical and professional experts. Qualitative content analysis, as described by Graneheim and Lundman, was applied to analyse data. We identified four categories: (1) living a physical active life with schizophrenia, (2) exercise as promotor of personal recovery, (3) prescribing safe and relevant exercise and (4) instructors' qualifications and formation. When developing sustainable community-based exercise programmes tailored to young adults with schizophrenia, developers should ensure instructors' qualifications and provide an exercise protocol. In addition, developers should consider providing an inclusive and recovery-oriented exercise environment.
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Affiliation(s)
- Martin Færch Andersen
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Kickan Roed
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Allan Riis
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Bolette Skjødt Rafn
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Oncology, Rigshospitalet Department of Oncology, Copenhagen, Denmark
| | - Bjørn Hylsebeck Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Gutiérrez G, Goicoa T, Ugarte MD, Aranguren L, Corrales A, Gil-Berrozpe G, Librero J, Sánchez-Torres AM, Peralta V, García de Jalon E, Cuesta MJ, Martínez M, Otero M, Azcarate L, Pereda N, Monclús F, Moreno L, Fernández A, Ariz MC, Sabaté A, Aquerreta A, Aguirre I, Lizarbe T, Begué MJ. Small area variations in non-affective first-episode psychosis: the role of socioeconomic and environmental factors. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01665-z. [PMID: 37612449 DOI: 10.1007/s00406-023-01665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND There is strong evidence supporting the association between environmental factors and increased risk of non-affective psychotic disorders. However, the use of sound statistical methods to account for spatial variations associated with environmental risk factors, such as urbanicity, migration, or deprivation, is scarce in the literature. METHODS We studied the geographical distribution of non-affective first-episode psychosis (NA-FEP) in a northern region of Spain (Navarra) during a 54-month period considering area-level socioeconomic indicators as putative explanatory variables. We used several Bayesian hierarchical Poisson models to smooth the standardized incidence ratios (SIR). We included neighborhood-level variables in the spatial models as covariates. RESULTS We identified 430 NA-FEP cases over a 54-month period for a population at risk of 365,213 inhabitants per year. NA-FEP incidence risks showed spatial patterning and a significant ecological association with the migrant population, unemployment, and consumption of anxiolytics and antidepressants. The high-risk areas corresponded mostly to peripheral urban regions; very few basic health sectors of rural areas emerged as high-risk areas in the spatial models with covariates. DISCUSSION Increased rates of unemployment, the migrant population, and consumption of anxiolytics and antidepressants showed significant associations linked to the spatial-geographic incidence of NA-FEP. These results may allow targeting geographical areas to provide preventive interventions that potentially address modifiable environmental risk factors for NA-FEP. Further investigation is needed to understand the mechanisms underlying the associations between environmental risk factors and the incidence of NA-FEP.
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Affiliation(s)
- Gerardo Gutiérrez
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Tomas Goicoa
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Statistics, Computer Science and Mathematics, Public University of Navarra, Pamplona, Spain
- Institute for Advanced Material and Mathematics, INAMAT2, Public University of Navarra, Pamplona, Spain
| | - María Dolores Ugarte
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Statistics, Computer Science and Mathematics, Public University of Navarra, Pamplona, Spain
- Institute for Advanced Material and Mathematics, INAMAT2, Public University of Navarra, Pamplona, Spain
| | - Lidia Aranguren
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Asier Corrales
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Gustavo Gil-Berrozpe
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Navarrabiomed, Navarra University Hospital, Public University of Navarra, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elena García de Jalon
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain.
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain.
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14
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Paulson OB, Schousboe A, Hultborn H. The history of Danish neuroscience. Eur J Neurosci 2023; 58:2893-2960. [PMID: 37477973 DOI: 10.1111/ejn.16062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 07/22/2023]
Abstract
The history of Danish neuroscience starts with an account of impressive contributions made at the 17th century. Thomas Bartholin was the first Danish neuroscientist, and his disciple Nicolaus Steno became internationally one of the most prominent neuroscientists in this period. From the start, Danish neuroscience was linked to clinical disciplines. This continued in the 19th and first half of the 20th centuries with new initiatives linking basic neuroscience to clinical neurology and psychiatry in the same scientific environment. Subsequently, from the middle of the 20th century, basic neuroscience was developing rapidly within the preclinical university sector. Clinical neuroscience continued and was even reinforced during this period with important translational research and a close co-operation between basic and clinical neuroscience. To distinguish 'history' from 'present time' is not easy, as many historical events continue in present time. Therefore, we decided to consider 'History' as new major scientific developments in Denmark, which were launched before the end of the 20th century. With this aim, scientists mentioned will have been born, with a few exceptions, no later than the early 1960s. However, we often refer to more recent publications in documenting the developments of initiatives launched before the end of the last century. In addition, several scientists have moved to Denmark after the beginning of the present century, and they certainly are contributing to the present status of Danish neuroscience-but, again, this is not the History of Danish neuroscience.
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Affiliation(s)
- Olaf B Paulson
- Neurobiology Research Unit, Department of Neurology, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Arne Schousboe
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Hultborn
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Krause KR, Tay J, Douglas WA, Sammy A, Baba A, Goren K, Thombs BD, Howie AH, Oskoui M, Frøbert O, Trakadis Y, Little J, Potter BK, Butcher NJ, Offringa M. Paper II: thematic framework analysis of registry-based randomized controlled trials provided insights for designing trial ready registries. J Clin Epidemiol 2023; 159:330-343. [PMID: 37146660 DOI: 10.1016/j.jclinepi.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Registry-based randomized controlled trials (RRCTs) are increasingly used, promising to address challenges associated with traditional randomized controlled trials. We identified strengths and limitations reported in planned and completed RRCTs to inform future RRCTs. STUDY DESIGN AND SETTING We conducted an environmental scan of literature discussing conceptual or methodological strengths and limitations of using registries for trial design and conduct (n = 12), followed by an analysis of RRCT protocols (n = 13) and reports (n = 77) identified from a scoping review. Using framework analysis, we developed and refined a conceptual framework of RRCT-specific strengths and limitations. We mapped and interpreted strengths and limitations discussed by authors of RRCT articles using framework codes and quantified the frequencies at which these were mentioned. RESULTS Our conceptual framework identified six main RRCT strengths and four main RRCT limitations. Considering implications for RRCT conduct and design, we formulated ten recommendations for registry designers, administrators, and trialists planning future RRCTs. CONCLUSION Consideration and application of empirically underpinned recommendations for future registry design and trial conduct may help trialists utilize registries and RRCTs to their full potential.
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Affiliation(s)
- Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 1000 Queen Street W, Toronto, Ontario, Canada M6J 1H4
| | - Joanne Tay
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - William A Douglas
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Adrian Sammy
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Katherine Goren
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chem. de la Côte-Sainte-Catherine, Montréal, Quebec, Canada H3T 1E2; Departments of Psychiatry; Epidemiology, Biostatistics, and Occupational Health; Medicine; Psychology; and Biomedical Ethics Unit, McGill University, 845 Sherbrooke St W, Montreal, Quebec, Canada H3A 0G4
| | - Alison H Howie
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Maryam Oskoui
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montréal, Quebec, Canada H3G 2M1
| | - Ole Frøbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Yannis Trakadis
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada H3G 1A4
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Nancy J Butcher
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 1000 Queen Street W, Toronto, Ontario, Canada M6J 1H4; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada M5T 1R8
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, Ontario, Canada M5T 3M6; Division of Neonatology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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16
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Kohler CG, Wolf DH, Abi-Dargham A, Anticevic A, Cho YT, Fonteneau C, Gil R, Girgis RR, Gray DL, Grinband J, Javitch JA, Kantrowitz JT, Krystal JH, Lieberman JA, Murray JD, Ranganathan M, Santamauro N, Van Snellenberg JX, Tamayo Z, Gur RC, Gur RE, Calkins ME. Illness Phase as a Key Assessment and Intervention Window for Psychosis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:340-350. [PMID: 37519466 PMCID: PMC10382701 DOI: 10.1016/j.bpsgos.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
The phenotype of schizophrenia, regardless of etiology, represents the most studied psychotic disorder with respect to neurobiology and distinct phases of illness. The early phase of illness represents a unique opportunity to provide effective and individualized interventions that can alter illness trajectories. Developmental age and illness stage, including temporal variation in neurobiology, can be targeted to develop phase-specific clinical assessment, biomarkers, and interventions. We review an earlier model whereby an initial glutamate signaling deficit progresses through different phases of allostatic adaptation, moving from potentially reversible functional abnormalities associated with early psychosis and working memory dysfunction, and ending with difficult-to-reverse structural changes after chronic illness. We integrate this model with evidence of dopaminergic abnormalities, including cortical D1 dysfunction, which develop during adolescence. We discuss how this model and a focus on a potential critical window of intervention in the early stages of schizophrenia impact the approach to research design and clinical care. This impact includes stage-specific considerations for symptom assessment as well as genetic, cognitive, and neurophysiological biomarkers. We examine how phase-specific biomarkers of illness phase and brain development can be incorporated into current strategies for large-scale research and clinical programs implementing coordinated specialty care. We highlight working memory and D1 dysfunction as early treatment targets that can substantially affect functional outcome.
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Affiliation(s)
- Christian G. Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel H. Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Alan Anticevic
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Youngsun T. Cho
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Clara Fonteneau
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Roberto Gil
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Ragy R. Girgis
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - David L. Gray
- Cerevel Therapeutics Research and Development, East Cambridge, Massachusetts
| | - Jack Grinband
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Jonathan A. Javitch
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Molecular Pharmacology and Therapeutics, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York
| | - Joshua T. Kantrowitz
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- New York State Psychiatric Institute, New York
- Nathan Kline Institute, Orangeburg, New York
| | - John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey A. Lieberman
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - John D. Murray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mohini Ranganathan
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Nicole Santamauro
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jared X. Van Snellenberg
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Zailyn Tamayo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Hansen HG, Starzer M, Nilsson SF, Hjorthøj C, Albert N, Nordentoft M. Clinical Recovery and Long-Term Association of Specialized Early Intervention Services vs Treatment as Usual Among Individuals With First-Episode Schizophrenia Spectrum Disorder: 20-Year Follow-up of the OPUS Trial. JAMA Psychiatry 2023; 80:371-379. [PMID: 36811902 PMCID: PMC9947803 DOI: 10.1001/jamapsychiatry.2022.5164] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
Importance The OPUS 20-year follow-up is the longest follow-up of a randomized clinical trial testing early intervention services (EIS) among individuals with first-episode schizophrenia spectrum disorder. Objective To report on long-term associations of EIS compared with treatment as usual (TAU) for first-episode schizophrenia spectrum disorder. Design, Setting, and Participants A total of 547 individuals were included in this Danish multicenter randomized clinical trial between January 1998 and December 2000 and allocated to early intervention program group (OPUS) or TAU. Raters who were blinded to the original treatment performed the 20-year follow-up. A population-based sample aged 18 to 45 years with first-episode schizophrenia spectrum disorder were included. Individuals were excluded if they were treated with antipsychotics (>12 weeks prior to randomization), had substance-induced psychosis, had mental disability, or had organic mental disorders. Analysis took place between December 2021 and August 2022. Interventions EIS (OPUS) consisted of 2 years of assertive community treatment including social skill training, psychoeducation, and family involvement by a multidisciplinary team. TAU consisted of the available community mental health treatment. Main Outcomes and Measures Psychopathological and functional outcomes, mortality, days of psychiatric hospitalizations, number of psychiatric outpatient contacts, use of supported housing/homeless shelters, symptom remission, and clinical recovery. Results Of 547 participants, 164 (30%) were interviewed at 20-year follow-up (mean [SD] age, 45.9 [5.6] years; 85 [51.8%] female). No significant differences were found between the OPUS group compared with the TAU group on global functional levels (estimated mean difference, -3.72 [95% CI, -7.67 to 0.22]; P = .06), psychotic symptom dimensions (estimated mean difference, 0.14 [95% CI, -0.25 to 0.52]; P = .48), and negative symptom dimensions (estimated mean difference, 0.13 [95% CI, -0.18 to 0.44]; P = .41). The mortality rate was 13.1% (n = 36) in the OPUS group and 15.1% (n = 41) in the TAU group. Likewise, no differences were found 10 to 20 years after randomization between the OPUS and TAU groups on days of psychiatric hospitalizations (incidence rate ratio, 1.20 [95% CI, 0.73-1.20]; P = .46) or number of outpatient contacts (incidence rate ratio, 1.20 [95% CI, 0.89-1.61]; P = .24). Of the entire sample, 53 participants (40%) were in symptom remission and 23 (18%) were in clinical recovery. Conclusions and Relevance In this follow-up study of a randomized clinical trial, no differences between 2 years of EIS vs TAU among individuals with diagnosed schizophrenia spectrum disorders at 20 years were found. New initiatives are needed to maintain the positive outcomes achieved after 2 years of EIS and furthermore improve very long-term outcomes. While registry data was without attrition, interpretation of clinical assessments are limited by high attrition rate. However, this attrition bias most likely confirms the lack of an observed long-term association of OPUS with outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT00157313.
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Affiliation(s)
- Helene Gjervig Hansen
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department for Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Starzer
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department for Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Feodor Nilsson
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Mental Health Center Amager, Mental Health Services in the Capital Region, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department for Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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18
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Miley K, Meyer-Kalos P, Ma S, Bond DJ, Kummerfeld E, Vinogradov S. Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs. Psychol Med 2023; 53:2041-2049. [PMID: 37310333 PMCID: PMC10106305 DOI: 10.1017/s0033291721003780] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. METHODS Demographic, clinical, and psychosocial measures were obtained for 276 participants from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) trial at baseline and 6-months, along with measures of social and occupational functioning from the Quality of Life Scale. The Greedy Fast Causal Inference algorithm was used to learn a partial ancestral graph modeling causal relationships across baseline variables and 6-month functioning. Effect sizes were estimated using a structural equation model. Results were validated in an independent dataset (N = 187). RESULTS In the data-generated model, greater baseline socio-affective capacity was a cause of greater baseline motivation [Effect size (ES) = 0.77], and motivation was a cause of greater baseline social and occupational functioning (ES = 1.5 and 0.96, respectively), which in turn were causes of their own 6-month outcomes. Six-month motivation was also identified as a cause of occupational functioning (ES = 0.92). Cognitive impairment and duration of untreated psychosis were not direct causes of functioning at either timepoint. The graph for the validation dataset was less determinate, but otherwise supported the findings. CONCLUSIONS In our data-generated model, baseline socio-affective capacity and motivation are the most direct causes of occupational and social functioning 6 months after entering treatment in early schizophrenia. These findings indicate that socio-affective abilities and motivation are specific high-impact treatment needs that must be addressed in order to promote optimal social and occupational recovery.
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Affiliation(s)
- Kathleen Miley
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Piper Meyer-Kalos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Sisi Ma
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - David J. Bond
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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19
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Suen YN, Pang SWT, Cheung C, Wong TY, Hui LMC, Lee HME, Chang WC, Chen YHE, Chan SKW. Impact of early negative symptom patterns on the long-term outcomes of patients with first-episode schizophrenia-spectrum disorders: A 12-year follow up study. Psychiatry Res 2023; 323:115180. [PMID: 36989910 DOI: 10.1016/j.psychres.2023.115180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
Given the strong prognostic value of early negative symptoms (NS), understanding their associations with long-term outcomes of schizophrenia is essential. The study examined early NS patterns in trajectory, severity and variability and their association with 12-year outcomes. NS in the first 36 months after onset and the symptomatology, cognitive function, and functioning at 12 years were examined in 330 patients with first-episode schizophrenia spectrum disorders. The relationships and pathways between the outcomes at 12 years and the trajectory, severity, and variability of early NS were examined. We found that the prediction of trajectory of early NS to long-term outcomes was limited, whereas variability was negatively associated with the patient's long-term executive function, and severity was positively associated with long-term symptomatology and negatively associated with long-term functioning. Path modelling revealed that the severity and variability of early NS influenced patients' long-term functioning via cognitive function and/or clinical symptom pathways. Our findings support the notion that severity of early NS influences the prognosis of schizophrenia and the closer examination revealed that the severity and variability of early NS are differentially associated with long-term clinical symptoms, executive function, and functional outcomes via distinct pathways.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | | | - Charlton Cheung
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Ting Yat Wong
- Department of Psychiatry, University of Pennsylvania, United States of America
| | | | - Ho Ming Edwin Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Yu Hai Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China.
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20
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Hansen HG, Speyer H, Starzer M, Albert N, Hjorthøj C, Eplov LF, Nordentoft M. Clinical Recovery Among Individuals With a First-Episode Schizophrenia an Updated Systematic Review and Meta-Analysis. Schizophr Bull 2023; 49:297-308. [PMID: 36029094 PMCID: PMC10016416 DOI: 10.1093/schbul/sbac103] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Through decades the clinical recovery outcomes among individuals diagnosed with schizophrenia have been highly inconsistent ranging from 13.5% to 57%. The primary objective of this updated examination was to report the pooled estimate and explore various moderators to improve the understanding of the course of schizophrenia. STUDY DESIGN A systematic literature search was set up on PubMed, PsycInfo, and EMBASE until January 13th, 2022. Both observational and interventional studies among cohorts of individuals with the first episode of schizophrenia reporting on clinical recovery were included. The PRISMA 2020 statement was used and data was extracted for a random-effects meta-analysis, meta-regression, and sensitivity analyses. Risk of bias was assessed using The Newcastle-Ottawa Scale. STUDY RESULTS A 20.8% (95% CI = 17.3 to 24.8) recovery rate was found among 26 unique study samples (mean trial duration, 9.5 years) including 3877 individuals (mean age, 26.4 years). In meta-regression none of the following study characteristics could uncover the diverse reported recovery rates; age at inclusion (P = .84), year of inclusion (P = .93), follow-up time (P = .99), drop-out rate (P = .07), or strictness of the recovery criteria (P = .35). Furthermore, no differences in recovery were found between early intervention services (EIS; 19.5%; 95% CI = 15.0 to 24.8) compared to other interventions (21%; 95% CI = 16.9 to 25.8), P = .65. CONCLUSIONS A clinical recovery rate of approximately 21% was found with minimum impact from various moderators. The rate was not different comparing EIS with other interventions implying that new initiatives are needed to improve the rate of recovery.
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Affiliation(s)
- Helene Gjervig Hansen
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Helene Speyer
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Starzer
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Center of Psychiatry Amager, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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21
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Albert N, Hansen HG, Starzer M, Nordentoft M, Hjorthøj C. Functioning pre- and post-treatment in schizophrenia; further investigations into lead time bias and duration of untreated psychosis. Schizophr Res 2023; 252:287-293. [PMID: 36706472 DOI: 10.1016/j.schres.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The association between duration of untreated psychosis (DUP) and later outcome is not fully understood. Jonas et al. in their 20-year follow-up found that the association could be explained by lead-time bias. In this study we aimed to analyze the relationship between DUP, time since onset of psychosis and functional outcome using a similar statistical approach as the Jonas study. METHOD Using data from 496 participants with first-episode schizophrenia, DUP was assessed using the IRAOS and functioning at the baseline assessment and the subsequent follow-ups (1, 2, 5 and 10 years) was assessed using the GAF-F. For premorbid functioning, the Premorbid Assessment of Functioning Scale was used and rescaled to correspond to the GAF. RESULTS The model with the best fit of data included both a slope and a level change. This model of level of function over time had the inflection point at the time of first treatment. This model indicated a slow decline per year until first treatment, at which point there was a sharp decrease in functioning, and after which functioning gradually improved again. Both in this model and in models accounting for potential lead-time bias, however, longer DUP was associated with a decrease in function for each additional week of DUP. This is in contrast with the Jonas et al. study. CONCLUSION In this study, we did not find evidence of a lead-time bias, but rather found that onset of treatment occurs at the time when participants level of functioning was most impaired, and consequently was not at random.
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Affiliation(s)
- Nikolai Albert
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark; Mental Health Centre Amager, Copenhagen University Hospital, Digevej 110, 2300 Copenhagen, Denmark.
| | - Helene Gjervig Hansen
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
| | - Marie Starzer
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health, CORE, Dept. of Clinical Medicine, University of Copenhagen, Gentofte hospitalsvej 15, 4 sal, 2900 Hellerup, Denmark
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22
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Pokowitz EL, Stiles BJ, Thomas R, Bullard K, Ludwig KA, Gleeson JF, Alvarez-Jimenez M, Perkins DO, Penn DL. User experiences of an American-adapted moderated online social media platform for first-episode psychosis: Qualitative analysis. Digit Health 2023; 9:20552076231176700. [PMID: 37252256 PMCID: PMC10214093 DOI: 10.1177/20552076231176700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives The current study sought to qualitatively characterize the experiences of American users in a recent open trial of the Horyzons digital platform. Methods In total, 20 users on Horyzons USA completed semistructured interviews 12 weeks after their orientation to the platform and addressed questions related to (1) the platform, (2) their online therapist, and (3) the peer workers and community space. A hybrid inductive-deductive coding strategy was used to conduct a thematic analysis of the data (NCT04673851). Results The authors identified seven prominent themes that mapped onto the three components of self-determination theory. Features of the platform itself as well as inter- and intra-personal factors supported the autonomous use of Horyzons. Users also reflected that their perceived competence in social settings and in managing mental health was increased by the familiarity, privacy, and perceived safety of the platform and an emphasis on personalized therapeutic content. The behaviors or traits of online therapists as perceived by users and regular contact with peers and peer support specialists satisfied users' need for relatedness and promoted confidence in social settings. Users also described aspects of Horyzons USA that challenged their satisfaction of autonomy, competence, and relatedness, highlighting potential areas for future iterations of the platform's content and interface. Conclusions Horyzons USA is a promising digital tool that provides young adults with psychosis with the means to access tailored therapy material on demand and a supportive digital community to aid in the recovery process.
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Affiliation(s)
- Elena L Pokowitz
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Bryan J Stiles
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Riya Thomas
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Katherine Bullard
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Kelsey A Ludwig
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - John F Gleeson
- School of Behavioural and Health
Sciences, Australian Catholic
University, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health,
University of Melbourne, Melbourne, VIC, Australia
| | - Diana O Perkins
- Department of Psychiatry, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L Penn
- Department of Psychology and
Neuroscience, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
- School of Behavioural and Health
Sciences, Australian Catholic
University, Melbourne, VIC, Australia
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23
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Basaraba CN, Scodes JM, Dambreville R, Radigan M, Dachepally P, Gu G, Wang R, Dixon LB, Wall MM. Prediction Tool for Individual Outcome Trajectories Across the Next Year in First-Episode Psychosis in Coordinated Specialty Care. JAMA Psychiatry 2023; 80:49-56. [PMID: 36322062 PMCID: PMC9631229 DOI: 10.1001/jamapsychiatry.2022.3571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
Importance In coordinated specialty care (CSC) settings for people with a first episode of psychosis, the development of reliable, validated individual-level prediction tools for key outcomes may be informative for shared clinician and client decision-making. Objective To develop an individual-level prediction tool using machine-learning methods that predicts a trajectory of education/work status or psychiatric hospitalization outcomes over a client's next year of quarterly follow-up assessments. Additionally, to visualize these predictions in a way that is informative to clinicians and clients. Design, Setting, and Participants Individual-level data were collected for all patients enrolled in the OnTrackNY program at enrollment and at quarterly follow-ups using standardized forms. The OnTrackNY program, a network of CSC sites in New York State, provides person-centered, recovery-oriented, and evidence-based psychosocial and pharmaceutical interventions to individuals aged 16 to 30 years with recent-onset (<2 years) nonaffective psychosis. Although data collection is ongoing, data for this study were collected from October 2013 to December 2018, and the time frame for analysis was July 2020 to May 2021. Data were separated into a training/cross-validation set to perform internally validated model development and a separate holdout test set (~20% of the sample) for external validation. Random probability forest models were developed to predict individual-level trajectories of outcomes. Exposures Forty-three individual-level demographic and clinical features collected at enrollment in OnTrackNY, 25 of which were time-varying and updated at quarterly follow-up assessments, and 13 site-level demographic and economic census variables. Main Outcomes and Measures Individual-level education and/or employment status and psychiatric hospitalization trajectories at quarterly follow-up periods across the first 2 years of CSC. Results The total study sample consists of 1298 individuals aged 16 to 30 years and included 341 women (26.3%), 949 men (73.1%), and 8 (<1%) with another gender. Prediction models performed well for 1-year trajectories of education/work across all validation sets, with areas under the receiver operating characteristic curve (AUCs) ranging from 0.68 (95% CI, 0.63-0.74) to 0.88 (95% CI, 0.81-0.96). Predictive accuracy for psychiatric hospitalization 3 months ahead reached AUC above 0.70; moreover, predictions of future psychiatric hospitalizations at 6 months and beyond were consistently poor, with AUCs below 0.60. Given the good externally validated performance for predicting education/work, a prototype interactive visualization tool displaying individual-level education/work trajectories and related features was developed. Conclusions and Relevance This study suggests that accurate prediction tools can be developed for outcomes in people with first-episode psychosis, which may help inform shared clinician/client decision-making. Future work should study the effectiveness of its deployment, including proper communication to inform shared clinician/client decision-making in the context of a learning health care system. At present, more work is needed to develop better performing prediction models for future psychiatric hospitalizations before any tool is recommended for this outcome.
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Affiliation(s)
- Cale N. Basaraba
- Area Mental Health Data Science, New York State Psychiatric Institute, New York
| | - Jennifer M. Scodes
- Area Mental Health Data Science, New York State Psychiatric Institute, New York
| | - Renald Dambreville
- Area Mental Health Data Science, New York State Psychiatric Institute, New York
| | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Pranith Dachepally
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Gyojeong Gu
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Melanie M. Wall
- Area Mental Health Data Science, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
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24
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Farhang S, Shirzadi M, Alikhani R, Alizadeh BZ, Bruggeman R, Veling W. ARAS recent onset acute phase psychosis survey, a prospective observational cohort of first episode psychosis in Iran-the cohort profile. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:101. [PMID: 36402780 PMCID: PMC9675807 DOI: 10.1038/s41537-022-00295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
The Middle East is underrepresented in psychosis research. The ARAS recent onset acute phase psychosis survey (ARAS) is a longitudinal cohort across multiple centers in Iran, established to investigate characteristics, determinants and early course of psychosis in a non-Western, Middle East context. Here, baseline characteristics of the ARAS cohort are reported. The ARAS cohort enrolled patients with recent onset psychosis from September 2018 to September 2021 in East Azerbaijan, Kermanshah and Tehran, including Iranian patients from different sociocultural contexts. The baseline assessment included demographics, socioeconomic status, clinical (positive, negative, depressive symptoms) and psychosocial (religiosity, social support, self-stigma) characteristics, cognitive functioning, metabolic profile, substance use and medication use measured by validated questionnaires. These assessments will be followed up after one and five years. A total of 500 patients with a first episode of psychosis were enrolled from three provinces in Iran. With 74.1% being male, the mean age (SD) of patients was 32.3 (9.7) years. Nearly a quarter of patients was diagnosed with schizophrenia and 36.8% with substance induced psychotic disorder. Amphetamine (24%) and opium (12%) use were common, cannabis use was not (5%). Only 6.1% of patients lived alone while 29% of patients was married and had children. The majority of them had achieved secondary educational level and 34% had a paid job. The most common antipsychotic treatment was risperidone. There was a wide range for scores of PANSS, with 9.4% having dominant negative symptoms. The most common prescribed medication was risperidone. Near to 40% of patients had noticeable signs of depression and prevalence of metabolic syndrome was 13.4%. The majority of patients (57.2%) had moderate and 5.4% reported to have severe disability. More than 30% reported to be highly religious. Patients had the highest satisfaction with people living with, and the lowest for finance and job.
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Affiliation(s)
- Sara Farhang
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Maryam Shirzadi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rosa Alikhani
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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25
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Morgan C, Dazzan P, Lappin J, Heslin M, Donoghue K, Fearon P, Jones PB, Murray RM, Doody GA, Reininghaus U. Rethinking the course of psychotic disorders: modelling long-term symptom trajectories. Psychol Med 2022; 52:2641-2650. [PMID: 33536092 PMCID: PMC9647538 DOI: 10.1017/s0033291720004705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The clinical course of psychotic disorders is highly variable. Typically, researchers have captured different course types using broad pre-defined categories. However, whether these adequately capture symptom trajectories of psychotic disorders has not been fully assessed. Using data from AESOP-10, we sought to identify classes of individuals with specific symptom trajectories over a 10-year follow-up using a data-driven approach. METHOD AESOP-10 is a follow-up, at 10 years, of 532 incident cases with a first episode of psychosis initially identified in south-east London and Nottingham, UK. Using extensive information on fluctuations in the presence of psychotic symptoms, we fitted growth mixture models to identify latent trajectory classes that accounted for heterogeneity in the patterns of change in psychotic symptoms over time. RESULTS We had sufficient data on psychotic symptoms during the follow-up on 326 incident patients. A four-class quadratic growth mixture model identified four trajectories of psychotic symptoms: (1) remitting-improving (58.5%); (2) late decline (5.6%); (3) late improvement (5.4%); (4) persistent (30.6%). A persistent trajectory, compared with remitting-improving, was associated with gender (more men), black Caribbean ethnicity, low baseline education and high disadvantage, low premorbid IQ, a baseline diagnosis of non-affective psychosis and long DUP. Numbers were small, but there were indications that those with a late decline trajectory more closely resembled those with a persistent trajectory. CONCLUSION Our current approach to categorising the course of psychotic disorders may misclassify patients. This may confound efforts to elucidate the predictors of long-term course and related biomarkers.
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Affiliation(s)
- Craig Morgan
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paola Dazzan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Julia Lappin
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Heslin
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Kim Donoghue
- Addictions Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Robin M Murray
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Psychosis Studies Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Gillian A Doody
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Ulrich Reininghaus
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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26
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Sediqzadah S, Portnoy A, Kim JJ, Keshavan M, Pandya A. Cost-Effectiveness of Early Intervention in Psychosis: A Modeling Study. Psychiatr Serv 2022; 73:970-977. [PMID: 35193372 DOI: 10.1176/appi.ps.202100161] [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 Programs for early intervention in psychosis have shown clinical efficacy. The authors aimed to evaluate the cost-effectiveness of early intervention programs compared with standard care for the treatment of first-episode psychosis in the United States. METHODS A decision-analytic model integrating published data on clinical efficacy, costs, and health utilities was developed to evaluate early intervention versus standard care over the lifetime of patients after their first psychotic episode. Model input data were derived from meta-analyses, clinical trials, and U.S. national data. The main outcomes included hospitalizations, employment rate, quality-adjusted life years (QALYs), lifetime health care costs, and incremental cost-effectiveness ratios (ICERs). RESULTS Compared with patients receiving standard care, patients in the early intervention strategy had 3.2 fewer hospitalizations and 2.7 more years of employment over the course of their remaining life expectancy. From a health care perspective, early intervention had an ICER of approximately $51,600 per QALY. From a societal perspective, early intervention saved costs (i.e., yielded greater health benefits and had lower costs compared with standard care). Results were sensitive to the effect of early intervention on suicide, cost of standard care, cost of early intervention, and the effect (relative risk) of early intervention on employment. A scenario analysis that excluded the effect (i.e., hazard ratio) of early intervention on suicide yielded an ICER of approximately $197,000 per QALY. CONCLUSIONS These results suggest that it is economically beneficial to fund early intervention in psychosis programs in the United States. The findings indicate that early intervention in psychosis saves costs (from the societal perspective) and is cost-effective (health care sector perspective).
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Affiliation(s)
- Saadia Sediqzadah
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Allison Portnoy
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Jane J Kim
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Matcheri Keshavan
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Ankur Pandya
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
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27
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Robinson DG, Schooler NR, Marcy P, Gibbons RD, Hendricks Brown C, John M, Mueser KT, Penn DL, Rosenheck RA, Addington J, Brunette MF, Correll CU, Estroff SE, Mayer-Kalos PS, Gottlieb JD, Glynn SM, Lynde DW, Gingerich S, Pipes R, Miller AL, Severe JB, Kane JM. Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial. Schizophr Bull 2022; 48:1021-1031. [PMID: 35689478 PMCID: PMC9434430 DOI: 10.1093/schbul/sbac053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To examine long-term effects of early intervention services (EIS) for first-episode psychosis, we compared Heinrichs-Carpenter Quality of Life (QLS) and Positive and Negative Syndrome Scale (PANSS) scores and inpatient hospitalization days over 5 years with data from the site-randomized RAISE-ETP trial that compared the EIS NAVIGATE (17 sites; 223 participants) and community care (CC) (17 sites; 181 participants). Inclusion criteria were: age 15-40 years; DSM-IV diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychotic disorder not otherwise specified; first psychotic episode; antipsychotic medication taken for ≤6 months. NAVIGATE-randomized participants could receive NAVIGATE from their study entry date until NAVIGATE ended when the last-enrolled NAVIGATE participant completed 2 years of treatment. Assessments occurred every 6 months. 61% of participants had assessments conducted ≥2 years; 31% at 5 years. Median follow-up length was CC 30 months and NAVIGATE 38 months. Primary analyses assumed data were not-missing-at-random (NMAR); sensitivity analyses assumed data were missing-at-random (MAR). MAR analyses found no significant treatment-by-time interactions for QLS or PANSS. NMAR analyses revealed that NAVIGATE was associated with a 13.14 (95%CI:6.92,19.37) unit QLS and 7.73 (95%CI:2.98,12.47) unit PANSS better improvement and 2.53 (95%CI:0.59,4.47) fewer inpatient days than CC (all comparisons significant). QLS and PANSS effect sizes were 0.856 and 0.70. NAVIGATE opportunity length (mean 33.8 (SD = 5.1) months) was not associated (P = .72) with QLS outcome; duration of untreated psychosis did not moderate (P = .32) differential QLS outcome. While conclusions are limited by the low rate of five-year follow-up, the data support long-term benefit of NAVIGATE compared to community care.
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Affiliation(s)
- Delbert G Robinson
- To whom correspondence should be addressed; The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA; tel: 718 470-8195, fax: 718 343-1659, e-mail:
| | - Nina R Schooler
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Robert D Gibbons
- Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - C Hendricks Brown
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Majnu John
- The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- Department of Mathematics, Hofstra University, Hempstead, NY, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - David L Penn
- Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Christoph U Correll
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
- Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin, Berlin, Germany
| | - Sue E Estroff
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Piper S Mayer-Kalos
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jennifer D Gottlieb
- Division of Population Behavioral Health Innovation and Harvard Medical School, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Shirley M Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - David W Lynde
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Susan Gingerich
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ronny Pipes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexander L Miller
- Department of Psychiatry and Behavioral Sciences San Antonio, UT Health San Antonio, TX, USA
| | - Joanne B Severe
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - John M Kane
- Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
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28
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Abdel-Baki A, Poulin É, Medrano S, Pires de Oliveira Padilha P, Stip E, Potvin S. Impact of early use of long-acting injectable antipsychotics on functional outcome in first episode psychosis: a 3-year longitudinal study. Int J Psychiatry Clin Pract 2022; 27:25-34. [PMID: 35654421 DOI: 10.1080/13651501.2022.2079531] [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: 10/18/2022]
Abstract
OBJECTIVES To describe, in a naturalistic setting, the impact of the early use of LAI-AP on functional outcomes of early psychosis patients as compared to oral antipsychotics (OAP). METHODS Longitudinal prospective 3-year naturalistic study of all consecutive admissions (n = 416) to two Early intervention services (EIS) for psychosis comparing baseline characteristics and the evolution of global functioning, occupation (work and studies), and living arrangements autonomy according to the route of administration of the antipsychotic medication. The cohort was divided into four groups: LAI-AP first (started on LAI-AP and later received OAP), OAP first, LAI-AP only, and OAP only. RESULTS Global assessment of functioning (GAF) improved in all groups, but our mixed-effect model did not show any significant association between the route of administration and the GAF outcome. The LAI-AP only group was significantly less likely to have extreme residential instability at 3 years than the other groups despite its highest proportion of homeless youth and their poor prognostic factors at baseline. CONCLUSIONS Our naturalistic study suggests a significant protective effect of LAI-AP on extreme residential instability for the most vulnerable patients, but no impact of the first AP administration route on other functional outcomes was observed at 3 years of follow-up. Key pointsLong-acting injectable antipsychotics seem promising to avoid extreme residential instability in early psychosis.Global assessment of functioning (GAF) improved in all groups.There was no significant association between the first route of administration and global functionning.
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Affiliation(s)
- Amal Abdel-Baki
- Clinique JAP, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,CHUM Research Centre, Montreal, Canada
| | - Émile Poulin
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
| | | | | | - Emmanuel Stip
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,CHUM Research Centre, Montreal, Canada.,Department of Psychiatry and Behavioral Sciences, College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Centre de Recherche Fernand-Séguin, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
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29
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Hyatt AS, Hasler V, Wilner EK. What happens after early intervention in first-episode psychosis? Limitations of existing service models and an agenda for the future. Curr Opin Psychiatry 2022; 35:165-170. [PMID: 35579870 DOI: 10.1097/yco.0000000000000785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Early intervention in first-episode psychosis (FEP) improves symptomatic and functional outcomes while programs last. However, these gains may not be sustained over time and not all individuals benefit equally from such programs. This review examines the efficacy of FEP programs, as well as step-down practices and long-term outcomes to identify ways to extend the gains made in FEP programs. RECENT FINDINGS FEP programs improve outcomes while services last, but effects diminish over time. Step-down and discharge practices vary widely with little randomized evidence guiding practice. Extending the duration of FEP programs for all does not consistently improve outcomes, but there is some encouraging evidence that targeted psychosocial interventions after program end may extend symptomatic and functional benefits. Members of marginalized groups and individuals with poorer outcomes during the FEP period may benefit from further specialized intervention after FEP. SUMMARY Step down practices from FEP programs should be structured and tailored to individual needs, and benefit from sustained connections to community resources. Psychosocial interventions like social skills training, peer support, and supported education and employment may help extend the benefit of FEP programs after more intensive services end.
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Affiliation(s)
- Andrew S Hyatt
- Department of Psychiatry, Cambridge Health Alliance, Cambridge
- Department of Psychiatry, Harvard Medical School, Boston, Massachu-setts, USA
| | - Victoria Hasler
- Department of Psychiatry, Cambridge Health Alliance, Cambridge
- Department of Psychiatry, Harvard Medical School, Boston, Massachu-setts, USA
| | - Emily K Wilner
- Department of Psychiatry, Cambridge Health Alliance, Cambridge
- Department of Psychiatry, Harvard Medical School, Boston, Massachu-setts, USA
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30
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O'Keeffe D, Kinsella A, Waddington JL, Clarke M. 20-Year Prospective, Sequential Follow-Up Study of Heterogeneity in Associations of Duration of Untreated Psychosis With Symptoms, Functioning, and Quality of Life Following First-Episode Psychosis. Am J Psychiatry 2022; 179:288-297. [PMID: 35360921 DOI: 10.1176/appi.ajp.2021.20111658] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Determining the extent to which relationships between duration of untreated psychosis (DUP) and outcome endure longitudinally across the lifetime course of psychotic illness requires prospective, systematic studies of epidemiologically representative incidence cohorts across decades. Transience, persistence, or heterogeneity in associations between DUP and distinct outcome domains are yet to be investigated over such time frames. METHODS Prospective, sequential follow-up studies of an epidemiologically representative first-episode psychosis incidence cohort in Ireland were conducted at 6 months and 4, 8, 12, and 20 years (N=171). Linear mixed-model analyses were applied to determine whether prospective associations of DUP with symptoms, functioning, and quality of life were consistent or varied across psychotic illness trajectory over a 20-year period. Evaluations included time, DUP quartile, and DUP quartile-by-time interaction effects. RESULTS Prospective, sequential follow-ups showed positive and negative symptoms, function, and quality of life to exhibit distinct trajectories of improvement in relation to shorter DUP. Despite heterogeneity in course and relationship to premorbid features, associations between shorter DUP and greater improvement were still evident 20 years after the first psychotic episode. Across the long-term course of psychotic illness, trajectories of association between shorter DUP and better outcome differed between domains of psychopathology, functionality, and quality of life. Nevertheless, such associations with shorter DUP were sustained for at least 20 years. CONCLUSIONS These profiles indicate that while associations between DUP and long-term outcome can vary according to the domain of outcome, they are sustained across decades in a manner that could not be fully accounted for in terms of premorbid features or lead-time bias.
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Affiliation(s)
- Donal O'Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
| | - Anthony Kinsella
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
| | - John L Waddington
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin (O'Keeffe, Clarke); School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (Kinsella, Waddington); Jiangsu Key Laboratory of Translational Research and Therapy for Neuropsychiatric Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China (Waddington); School of Medicine, University College Dublin (Clarke)
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31
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Peebo K, Saluveer E, Küünarpuu H, Orgse T, Harro J. First-episode psychosis integrative treatment: Estonian experience. Nord J Psychiatry 2022; 76:207-214. [PMID: 34275409 DOI: 10.1080/08039488.2021.1946139] [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: 10/20/2022]
Abstract
PURPOSE Research on first-episode psychosis early intervention has shown significant positive effects on psychopathological, functional and quality-of-life outcome measures. The effects reported have however been short-term and there is still only limited information about the long-term effects. This article will present the short-term results of an effectiveness study in a Baltic country and the first results of a registry-based long-term follow-up. METHODS One hundred and ninety-nine first-episode psychosis patients were included in the early intervention effectiveness study in 2004-2008, and 107 were available for a follow-up after two years. Registry-based ten-year follow-up (n = 116) was conducted with a retrospectively formed control group (n = 114). RESULTS Patients who received early intervention had substantial symptomatic improvement (BPRS score reduction > 50%) after 6 months of treatment, the Global Assessment of Functioning (GAF) scores were significantly improved after 6 months, and the quality of life after 12 months was significantly higher than at the beginning of treatment. After 2 years employment increased by 14% (43.9-57.9%). Long-term follow-up revealed that significantly fewer patients in the intervention group had been in supported housing compared to the control group. Patients in the intervention group had spent more time working during the follow-up period and had almost two times larger incomes, suggestive of higher employment/salary level. CONCLUSIONS Early intervention with flexible duration has positive long-term effects on the functioning of patients.
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Affiliation(s)
- Karola Peebo
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Erika Saluveer
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia
| | - Harri Küünarpuu
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia
| | - Teele Orgse
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia
| | - Jaanus Harro
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia.,Chair of Neuropsychopharmacology, Institute of Chemistry, Faculty of Science and Technology, University of Tartu, Tartumaa, Estonia
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32
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Keshavan MS, Ongur D, Srihari VH. Toward an expanded and personalized approach to coordinated specialty care in early course psychoses. Schizophr Res 2022; 241:119-121. [PMID: 35121436 DOI: 10.1016/j.schres.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Matcheri S Keshavan
- Stanley Cobb Professor of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, 75, Fenwood Road, Boston, MA, United States of America.
| | - Dost Ongur
- William P. and Henry B. Test Professor of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Vinod H Srihari
- Professor of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
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33
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McDonagh MS, Dana T, Kopelovich SL, Monroe-DeVita M, Blazina I, Bougatsos C, Grusing S, Selph SS. Psychosocial Interventions for Adults With Schizophrenia: An Overview and Update of Systematic Reviews. Psychiatr Serv 2022; 73:299-312. [PMID: 34384230 DOI: 10.1176/appi.ps.202000649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors of this systematic review (SR) sought to provide evidence for effects of commonly used psychosocial interventions on several outcomes among adults with schizophrenia. METHODS MEDLINE, the Cochrane Library, and PsycINFO databases were searched through July 2020. Eligible studies were SRs and trials of at least 12 weeks duration and with ≥50 participants that compared psychosocial interventions with treatment as usual among adults with schizophrenia. Study design, year, setting, country, sample size, eligibility criteria, population, clinical and intervention characteristics, results, and funding source were extracted, along with quality criteria. The evidence was evaluated on quality and strength of evidence stratified by intervention area and outcome, according to the Evidence-Based Practice Centers Methods Guide of the Agency for Healthcare Research and Quality. RESULTS Nine SRs and 30 trials (N=23,921 patients) in 11 intervention areas were included. Trials were mostly of fair quality and had low-to-moderate strength of evidence. Compared with treatment as usual, most psychosocial interventions were more effective in improving intervention-targeted outcomes, including core illness symptoms. Compared with treatment as usual, assertive community treatment, cognitive-behavioral therapy (CBT), family interventions, psychoeducation, social skills training, supported employment, and early interventions for first-episode psychosis (FEP) improved various functional outcomes. CBT and early interventions for FEP improved quality of life. Family interventions, psychoeducation, illness self-management, and early interventions for FEP reduced relapse. CONCLUSIONS Compared with treatment as usual, most psychosocial interventions improved functional outcomes, quality of life, and core illness symptoms, and several reduced relapse frequency among adults with schizophrenia.
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Affiliation(s)
- Marian S McDonagh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Tracy Dana
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sarah L Kopelovich
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Maria Monroe-DeVita
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Ian Blazina
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Christina Bougatsos
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sara Grusing
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Shelley S Selph
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
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34
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Diaz E, Estric C, Schandrin A, Lopez-Castroman J. Neurocognitive functioning and impulsivity in first-episode psychosis with suicidal ideation and behavior: A systematic review. Schizophr Res 2022; 241:130-139. [PMID: 35123335 DOI: 10.1016/j.schres.2022.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/26/2021] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prevalence of suicidal ideation (SI) and behavior (SB) among people suffering from psychotic disorders is a public health issue. Most suicide attempts (SAs) occur before or during the early phases of first-episode psychosis (FEP). Improving knowledge about the suicide risk in the early stages is essential to develop therapeutic and prevention strategies. We conducted a systematic review to investigate an association between neurocognitive impairments or a history of impulsive behavior and SI or SB among patients with FEP. METHOD PRISMA guidelines were followed. Ten databases were searched using MeSH terms or key-words related to FEP, impulsivity or cognitive functioning measures and SI or SB, without restrictions for study design or length of follow-up. Included studies evaluated at least one cognitive function with neuropsychological tests or validated questionnaires, or provided records of impulsive behavior. RESULTS Twenty one research papers were included from databases, bibliographic references or expert opinions. Among patients with FEP, seven studies showed more pronounced neuropsychological impairments, especially regarding attention, processing speed, executive functioning and theory of mind in patients that had attempted suicide. No association was found between cognitive impairments on neuropsychological tests and SI. Previous non-suicidal impulsive behaviors were associated with SAs and suicide. CONCLUSION Our review suggests an association between neurocognitive impairments and SAs among patients with FEP. Records of impulsive behavior are also associated with SB in that population. Further research on the neuropsychology of FEP is necessary to identify how these impairments facilitate SB and evaluate their potential utility as therapeutic targets.
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Affiliation(s)
- Emmanuel Diaz
- Department of Adult Psychiatry, CHU Nimes, University Montpellier, Nimes, France
| | - Clémentine Estric
- Department of Adult Psychiatry, CHU Nimes, University Montpellier, Nimes, France.
| | - Aurélie Schandrin
- Department of Adult Psychiatry, CHU Nimes, University Montpellier, Nimes, France.
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, CHU Nimes, University Montpellier, Nimes, France; University of Montpellier and INSERM, Montpellier, France; CIBERSAM, Spain.
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35
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A multimodal study of a first episode psychosis cohort: potential markers of antipsychotic treatment resistance. Mol Psychiatry 2022; 27:1184-1191. [PMID: 34642460 PMCID: PMC9001745 DOI: 10.1038/s41380-021-01331-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022]
Abstract
Treatment resistant (TR) psychosis is considered to be a significant cause of disability and functional impairment. Numerous efforts have been made to identify the clinical predictors of TR. However, the exploration of molecular and biological markers is still at an early stage. To understand the TR condition and identify potential molecular and biological markers, we analyzed demographic information, clinical data, structural brain imaging data, and molecular brain imaging data in 7 Tesla magnetic resonance spectroscopy from a first episode psychosis cohort that includes 136 patients. Age, gender, race, smoking status, duration of illness, and antipsychotic dosages were controlled in the analyses. We found that TR patients had a younger age at onset, more hospitalizations, more severe negative symptoms, a reduction in the volumes of the hippocampus (HP) and superior frontal gyrus (SFG), and a reduction in glutathione (GSH) levels in the anterior cingulate cortex (ACC), when compared to non-TR patients. The combination of multiple markers provided a better classification between TR and non-TR patients compared to any individual marker. Our study shows that ACC-GSH, HP and SFG volumes, and age at onset, could potentially be biomarkers for TR diagnosis, while hospitalization and negative symptoms could be used to evaluate the progression of the disease. Multimodal cohorts are essential in obtaining a comprehensive understanding of brain disorders.
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36
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Box-Steffensmeier JM, Burgess J, Corbetta M, Crawford K, Duflo E, Fogarty L, Gopnik A, Hanafi S, Herrero M, Hong YY, Kameyama Y, Lee TMC, Leung GM, Nagin DS, Nobre AC, Nordentoft M, Okbay A, Perfors A, Rival LM, Sugimoto CR, Tungodden B, Wagner C. The future of human behaviour research. Nat Hum Behav 2022; 6:15-24. [PMID: 35087189 DOI: 10.1038/s41562-021-01275-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Jean Burgess
- School of Communication and Digital Media Research Centre (DMRC), Queensland University of Technology, Brisbane, Queensland, Australia. .,Australian Research Council Centre of Excellence for Automated Decision-Making and Society (ADM+S), Melbourne, Victoria, Australia.
| | - Maurizio Corbetta
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy. .,Venetian Institute of Molecular Medicine (VIMM), Padova, Italy.
| | - Kate Crawford
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, USA. .,Microsoft Research New York, New York, NY, USA. .,École Normale Supérieure, Paris, France.
| | - Esther Duflo
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Laurel Fogarty
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany.
| | - Alison Gopnik
- Department of Psychology, University of California at Berkeley, Berkeley, CA, USA.
| | - Sari Hanafi
- American University of Beirut, Beirut, Lebanon.
| | - Mario Herrero
- Department of Global Development, College of Agriculture and Life Sciences and Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, USA.
| | - Ying-Yi Hong
- Department of Management, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China.
| | - Yasuko Kameyama
- Center for Social and Environmental Systems Research, Social Systems Division, National Institute for Environmental Studies, Tsukuba, Japan.
| | - Tatia M C Lee
- State Key Laboratory of Brain and Cognitive Sciences and Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China.
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China. .,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong, Hong Kong Special Administrative Region, China.
| | - Daniel S Nagin
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Anna C Nobre
- Department of Experimental Psychology, University of Oxford, Oxford, UK. .,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Merete Nordentoft
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Aysu Okbay
- Department of Economics, School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Andrew Perfors
- Complex Human Data Hub, University of Melbourne, Melbourne, Victoria, Australia.
| | | | - Cassidy R Sugimoto
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Bertil Tungodden
- Centre of Excellence FAIR, NHH Norwegian School of Economics, Bergen, Norway.
| | - Claudia Wagner
- GESIS - Leibniz Institute for the Social Sciences, Köln, Germany. .,RWTH Aachen University, Aachen, Germany. .,Complexity Science Hub Vienna, Vienna, Austria.
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37
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Engen MJ, Vaskinn A, Melle I, Færden A, Lyngstad SH, Flaaten CB, Widing LH, Wold KF, Åsbø G, Haatveit B, Simonsen C, Ueland T. Cognitive and Global Functioning in Patients With First-Episode Psychosis Stratified by Level of Negative Symptoms. A 10-Year Follow-Up Study. Front Psychiatry 2022; 13:841057. [PMID: 35401286 PMCID: PMC8990888 DOI: 10.3389/fpsyt.2022.841057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Negative and cognitive symptoms are core features of schizophrenia that are correlated in cross-sectional designs. To further explore the relationship between these critical symptom dimensions we use a method for stratifying participants based on level and persistence of negative symptoms from absent to sustained levels over a 10-year follow-up period. We investigate associations with cognitive performance and level of global functioning. First-episode psychosis (FEP) participants (n = 102) and healthy controls (n = 116) were assessed at baseline and follow-up. A cognitive battery consisting of 14 tests derived into four domains and a composite score were used in the analyses. FEP participants were stratified based on negative symptom items from the Positive and Negative Syndrome Scale (PANSS-R) into four groups with either no, mild, transitory or sustained symptoms over the 10-year follow-up period. Global functioning was measured with Global Assessment of Functioning Scale-Split version. Multivariate and univariate analyses of variance were used to explore between-group differences in level and course of cognitive performance as global functioning. A multivariate analysis with four cognitive domains as dependent variables, showed significant group differences in performance when including healthy controls and the negative symptom groups. The groups with no and mild negative symptoms outperformed the group with sustained levels of negative symptoms on verbal learning and memory. The group with no negative symptoms also outperformed the group with sustained negative symptoms on the cognitive composite score. Significant improvements on verbal learning and memory, executive functioning and the cognitive composite were detected for the entire sample. No differences in cognitive course were detected. There was a significant improvement in global functioning as measured by the GAF-F over the follow-up period (p < 0.001), without any time x group interactions (p = 0.25). Participants with sustained negative symptoms had a significantly lower level of global functioning at 10-year follow-up with an additional independent effect of the cognitive composite score, compared to all other groups. Individuals with an early illness course characterized by absence of negative symptoms form a group with better cognitive and functional outcomes than the impairments typically associated with schizophrenia. Individuals with sustained levels of negative symptoms on the other hand may require a combined focus on both negative and cognitive symptoms.
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Affiliation(s)
- Magnus Johan Engen
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Anja Vaskinn
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Ann Færden
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Siv Hege Lyngstad
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway
| | - Camilla Bärthel Flaaten
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Line Hustad Widing
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Kristin Fjelnseth Wold
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gina Åsbø
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Beathe Haatveit
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Carmen Simonsen
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
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Gallagher K, Ferrara M, Pollard J, Yoviene Sykes L, Li F, Imetovski S, Cahill J, Mathis W, Srihari VH. Taking the next step: Improving care transitions from a first-episode psychosis service. Early Interv Psychiatry 2022; 16:91-96. [PMID: 35029048 DOI: 10.1111/eip.13127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 12/01/2022]
Abstract
AIMS First-episode services (FES) improve outcomes in recent onset psychosis, but there is growing concern about how patients fare after discharge from these time-limited services. METHODS A quality improvement approach (QI) was used to improve patient engagement in the discharge planning process (disposition), and successful engagement in care 3 months after discharge from the FES (transfer). Data from 144 consecutive discharges over 62 months are presented. A planning phase was followed by recurrent Plan-Do-Study-Act cycles (PDSA) that included the introduction of proactive efforts targeting disposition planning (with patients and families) and follow-up to facilitate transfer after discharge. Fisher's exact test was used to compare disposition and transfer outcomes across the QI phases. RESULTS This QI approach was sustained through a three-fold escalation in discharge volume. Transfer status at 3 months was significantly different between the pre- and post PDSA phases (p = .02). A greater proportion were confirmed transfers post-PDSA (54.3 vs. 37%), but of those with known status at 3 months, similar proportions were successfully transferred (76, 73%). Patients discharged post-PDSA were less likely to have unknown treatment status (26 vs. 51%). Disposition outcomes were also significantly improved post-PDSA (p = .03). Patients were more likely to engage with discharge planning (69.7 vs. 48.6%) and less likely to be lost to follow-up (13.8 vs. 25.7%), or to refuse assistance (11.0 vs. 20.0%). CONCLUSION This QI approach offers a feasible way to improve disposition and transfer after FES and can be built upon in efforts to sustain functional gains in onward pathways.
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Affiliation(s)
- Keith Gallagher
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Maria Ferrara
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Jessica Pollard
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Laura Yoviene Sykes
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences (YCAS), New Haven, Connecticut, USA
| | - Shannon Imetovski
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - John Cahill
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Walter Mathis
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
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39
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Yen K, Liu CC, Lin YT, Chien YL, Hsieh MH, Liu CM, Hwang TJ, Liao WH, Hwu HG. Discontinuing Antipsychotic Medication After Remission from First-Episode Psychosis: A Survey of Psychiatrists' Attitudes in Taiwan. Neuropsychiatr Dis Treat 2022; 18:465-475. [PMID: 35261544 PMCID: PMC8898187 DOI: 10.2147/ndt.s339866] [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: 09/28/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients in remission after first-episode psychosis are inclined to discontinue antipsychotic treatment, which may lead to higher risk of relapse and unfavorable outcomes. Paradoxically, also there are evidences suggesting that certain patients may stay well in drug-free condition. Psychiatrists' views towards this dilemma might affect their approaches to these patients, and discrepant attitudes are noted between Western and Asian clinicians. This study aimed to examine psychiatrists' attitudes about discontinuing antipsychotic medications after remission from first-episode psychosis. METHODS Psychiatrists were recruited for this study using convenience sampling. A cross-sectional survey was conducted using a set of questionnaires comprising nine items for attitudes toward medication discontinuation, six vignettes for probing psychiatrists' practice in designated clinical scenarios, and a list of criteria that may affect their responses. RESULTS Responses were provided by 118 psychiatrists, two-thirds men, mean age 39.8 ± 10.1 years and mean experience 12.7 ± 9.7 years. Half of the participants endorsed that fewer than 20% of the remitted patients should stop medication completely; the majority advised that an observation period of 1 year or longer is necessary while discontinuing medication. The majority would not initiate discussion with patients about discontinuing medication. Responding to two case vignettes, those who endorsed that more patients could stop antipsychotics were also more inclined to discuss it with patients, but not consistently in response to the other four case vignettes. Taiwan psychiatrists expressed a wide range of decision-making considerations for discontinuing antipsychotics. CONCLUSION The majority of Taiwan psychiatrists thought it was not feasible to stop medications completely but were willing to consider this option. Once being presented with actual clinical scenarios, many participants hesitated to discontinue antipsychotic medications for various reasons. The proactive attitude of psychiatrists towards conducting clinical trials to test the feasibility of medication discontinuation may help to provide better reference for this clinical dilemma.
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Affiliation(s)
- Ko Yen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Hsiang Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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40
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Tortorella A. We Should Improve Personalization of Management in Patients with a Diagnosis of Schizophrenia. J Clin Med 2021; 11:jcm11010184. [PMID: 35011925 PMCID: PMC8745754 DOI: 10.3390/jcm11010184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 12/23/2022] Open
Abstract
The current management of patients with schizophrenia is marked by a lack of personalization. After the diagnosis is made, a second-generation antipsychotic is usually prescribed based on the current clinician’s preferences, sometimes accompanied by a psychosocial intervention which is typically not evidence-based and not targeted to the specific needs of the individual patient. In this opinion paper, some steps are outlined that could be taken in order to address this lack of personalization. A special emphasis is laid on the clinical characterization of the patient who has received a diagnosis of schizophrenia. Considerations are put forward concerning the assessment of the negative dimension in ordinary clinical practice, which is often neglected; the evaluation of cognitive functioning using a simple test battery which requires limited professional training and takes no more than 15 min to administer; the evaluation of social functioning using a validated instrument focusing on personal care skills, interpersonal relationships, social acceptability, activities, and work skills; and the assessment of the unmet needs of the person (including practical, social, and emotional needs, and existential or personal recovery). The implications of the assessment of these domains for the formulation of the management plan are discussed.
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41
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Humensky JL, Nossel I, Bello I, Malinovsky I, Radigan M, Gu G, Wang R, Wall MM, Jones N, Dixon LB. Rates of Inpatient and Emergency Room Use Before and After Discharge Among Medicaid Enrollees in OnTrackNY. Psychiatr Serv 2021; 72:1328-1331. [PMID: 34106739 PMCID: PMC8570971 DOI: 10.1176/appi.ps.202000791] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined hospital and emergency room (ER) use among Medicaid enrollees before and after discharge from OnTrackNY, a coordinated specialty care program for recent-onset psychosis. METHODS Medicaid claims data were linked to program data. Inpatient hospitalization, inpatient days, and ER visits were assessed in the 6 months prior to OnTrackNY enrollment and 6 months prior to and after discharge. The sample consisted of 138 participants with continuous Medicaid enrollment during the study. RESULTS Inpatient visits significantly declined from the pre-OnTrackNY enrollment period to the predischarge period (β=-1.23, standard error [SE]=0.22, p<0.001), did not significantly change in the first 6 months after discharge (β=0.19, SE=0.26, p=0.48), and remained significantly lower than before OnTrackNY enrollment (β=-1.05, SE=0.20, p<0.001). Similar patterns were observed for inpatient days and ER use. CONCLUSIONS ER and hospital use declined during OnTrackNY participation and did not significantly change in the first 6 months after discharge.
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Affiliation(s)
- Jennifer L Humensky
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Ilana Nossel
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Iruma Bello
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Igor Malinovsky
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Marleen Radigan
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Gyojeong Gu
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Rui Wang
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Melanie M Wall
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Nev Jones
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Lisa B Dixon
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
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42
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Cannon TD. Do the Benefits of Early Intervention Services for Psychosis Generalize and Persist in the Real World? Am J Psychiatry 2021; 178:890-892. [PMID: 34592842 DOI: 10.1176/appi.ajp.2021.21080792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, Conn
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43
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Roe D, Mashiach-Eizenberg M, Garber Epstein P, Yamin A, Hoter Ishay G, Zisman-Ilani Y. Implementation of NAVIGATE for first episode psychosis in Israel: Clients' characteristics, program utilization and ratings of change. Early Interv Psychiatry 2021; 15:1343-1348. [PMID: 33034108 DOI: 10.1111/eip.13055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/02/2020] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE NAVIGATE is a comprehensive treatment program for first episode psychosis developed and implemented in the US that has been found to be effective. The purpose of the present study was to describe the first initiative of NAVIGATE's implementation outside the US, and to present data collected in Israel from the first two clinics focusing on NAVIGATE clients' characteristics, components utilization and retrospective clinician ratings of change. METHODS Administrative data for 61 NAVIGATE clients in Israel and retrospective ratings of NAVIGATE clinicians were analysed. RESULTS The duration of untreated psychosis was 4.4 months (SD = 6.8). Clients were mostly referred to NAVIGATE from psychiatric hospitals (n = 29, 50.9%) and community mental health agencies (n = 20, 35.1%). The individualized resiliency training (IRT) component had the highest client utilization rate (n = 53, 98.1%) with a monthly average of M = 2.32 sessions (SD = 2.75). Clinicians' retrospective ratings indicated that 66% of the clients (n = 33) had improved in at least one life domain, with the most common improvement in employment (n = 28, 56%), recovery (n = 24, 50%), and symptoms severity (n = 23, 47%). CONCLUSIONS Our findings reveal that NAVIGATE can be implemented outside the US within a different social and cultural context and different mental health system. The utilization rates of the program components and clinicians' retrospective ratings indicated positive change among most of NAVIGATE clients, pointing to the potential value of NAVIGATE above and beyond different countries and health systems.
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Affiliation(s)
- David Roe
- Faculty of Social Welfare and Health Sciences, Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | | | - Amit Yamin
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Gili Hoter Ishay
- Faculty of Social Welfare and Health Sciences, Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Yaara Zisman-Ilani
- Department of Social and Behavioural Science, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
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44
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Posselt CM, Albert N, Nordentoft M, Hjorthøj C. The Danish OPUS Early Intervention Services for First-Episode Psychosis: A Phase 4 Prospective Cohort Study With Comparison of Randomized Trial and Real-World Data. Am J Psychiatry 2021; 178:941-951. [PMID: 34315283 DOI: 10.1176/appi.ajp.2021.20111596] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The Danish OPUS trial showed significant efficacy of early intervention services for first-episode schizophrenia spectrum disorders compared with standard treatment, leading to implementation of the OPUS intervention in clinical practice. The authors sought to determine whether the effectiveness of OPUS treatment in real-world clinical practice is comparable to the efficacy seen in the trial. METHODS The study compared patients who received OPUS treatment as part of the original randomized trial to those who received standard treatment in the trial (the control group) and those who received OPUS treatment after it was implemented in Denmark. The authors investigated whether the three groups differed on register-based outcomes, such as use of secondary health care, functional outcomes, and death. Analyses were adjusted for relevant confounders. RESULTS Compared with trial study participants, patients who received OPUS treatment after implementation (N=3,328) had a tendency toward lower mortality (hazard ratio=0.60, 95% CI=0.33, 1.09), fewer and shorter psychiatric admissions, and possibly fewer filled prescriptions of antipsychotics and other psycholeptics after 4 or 5 years. While at first less likely to be working or studying, patients who received postimplementation OPUS treatment eventually had higher odds of working than did those in the OPUS trial (after 5 years, odds ratio=1.49, 95% CI=1.07, 2.09). The odds of being in a couple relationship were also higher among patients in the postimplementation group than those in the trial. Other outcomes showed less clear associations with treatment group. Generally, the control group in the trial fared worse than both of the OPUS treatment groups. CONCLUSIONS Not only did OPUS treatment maintain its efficacy after it was implemented as a standard treatment, it paralleled or surpassed many of the effects observed when the OPUS intervention was delivered in a randomized trial. The study results provide further evidence in support of implementation and funding of early intervention services worldwide.
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Affiliation(s)
- Christine Merrild Posselt
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Psykiatri Øst, Region Sjællands Psykiatri, Roskilde (Albert); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Psykiatri Øst, Region Sjællands Psykiatri, Roskilde (Albert); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Psykiatri Øst, Region Sjællands Psykiatri, Roskilde (Albert); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Psykiatri Øst, Region Sjællands Psykiatri, Roskilde (Albert); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
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Reduced cortical thickness of the paracentral lobule in at-risk mental state individuals with poor 1-year functional outcomes. Transl Psychiatry 2021; 11:396. [PMID: 34282119 PMCID: PMC8289863 DOI: 10.1038/s41398-021-01516-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023] Open
Abstract
Although widespread cortical thinning centered on the fronto-temporal regions in schizophrenia has been reported, the findings in at-risk mental state (ARMS) patients have been inconsistent. In addition, it remains unclear whether abnormalities of cortical thickness (CT) in ARMS individuals, if present, are related to their functional decline irrespective of future psychosis onset. In this multicenter study in Japan, T1-weighted magnetic resonance imaging was performed at baseline in 107 individuals with ARMS, who were subdivided into resilient (77, good functional outcome) and non-resilient (13, poor functional outcome) groups based on the change in Global Assessment of Functioning scores during 1-year follow-up, and 104 age- and sex-matched healthy controls recruited at four scanning sites. We measured the CT of the entire cortex and performed group comparisons using FreeSurfer software. The relationship between the CT and cognitive functioning was examined in an ARMS subsample (n = 70). ARMS individuals as a whole relative to healthy controls exhibited a significantly reduced CT, predominantly in the fronto-temporal regions, which was partly associated with cognitive impairments, and an increased CT in the left parietal and right occipital regions. Compared with resilient ARMS individuals, non-resilient ARMS individuals exhibited a significantly reduced CT of the right paracentral lobule. These findings suggest that ARMS individuals partly share CT abnormalities with patients with overt schizophrenia, potentially representing general vulnerability to psychopathology, and also support the role of cortical thinning in the paracentral lobule as a predictive biomarker for short-term functional decline in the ARMS population.
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A Multicentre, Randomised, Controlled Trial of a Combined Clinical Treatment for First-Episode Psychosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147239. [PMID: 34299697 PMCID: PMC8304114 DOI: 10.3390/ijerph18147239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Abstract
Introduction: There is evidence that early intervention contributes to improving the prognosis and course of first-episode psychosis (FEP). However, further randomised treatment clinical trials are needed. Objectives: The aim of this study was to compare the efficacy of a combined clinical treatment involving Cognitive Behavioural Therapy (CBT) as an adjunctive to treatment-as-usual (TAU) (CBT+TAU) versus TAU alone for FEP. Patients and methods: In this multicentre, single-blind, randomised controlled trial, 177 participants were randomly allocated to either CBT+TAU or TAU. The primary outcome was post-treatment patient functioning. Results: The CBT+TAU group showed a greater improvement in functioning, which was measured using the Global Assessment Functioning (GAF) and Functioning Assessment Short Test (FAST), compared to the TAU group post-treatment. The CBT+TAU participants exhibited a greater decline in depressive, negative, and general psychotic symptoms; a better awareness of the disease and treatment adherence; and a greater increase in brain-derived neurotrophic factor levels than TAU participants. Conclusions: Early intervention based on a combined clinical treatment involving CBT as an adjunctive to standard treatment may improve clinical and functional outcomes in FEP.
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Lim J, McCombe G, Harrold A, Brown K, Clarke M, Hanlon D, Hennessy L, O'Brien S, Lyne J, Corcoran C, McGorry P, Cullen W. The role of key workers in improving physical health in first episode psychosis: A scoping review. Early Interv Psychiatry 2021; 15:16-33. [PMID: 32134195 DOI: 10.1111/eip.12937] [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: 05/20/2019] [Revised: 10/01/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
AIM Studies have demonstrated that a majority of the decline in health status and functioning emerges during the first few years following the onset of psychosis. This knowledge led to the development of specialized early intervention services (EIS) targeting patients experiencing their first episode of psychosis (FEP). The central component of EIS is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. The aim of this scoping review was to examine how key workers can enhance the physical health outcomes in people with FEP by addressing the factors associated with increased mortality in this population. METHODS The scoping review framework comprised a five-stage process developed by Arksey and O'Malley. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS A total of 27 studies conducted across 10 countries were analysed. These studies discussed the various ways in which key workers can mediate enhancements in the various factors contributing to the increased mortality rates in FEP patients. CONCLUSIONS A broad range of key worker-mediated outcomes was identified, which were broadly classified into three themes: influences on lifestyle, influences on effects of psychosis and influences on organizational barriers. Our findings suggest that key workers primarily mediated the amelioration of psychosis-induced effects and the reduction of organizational barriers. Further trials of key worker interventions to enhance physical health outcomes in this cohort are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | - John Lyne
- Royal College of Surgeons in Ireland, Dublin, Ireland.,North Dublin Mental Health Services, Dublin, Ireland
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Jabar LSA, Sørensen HJ, Nordentoft M, Hjorthøj C, Albert N. Associations between duration of untreated psychosis and domains of positive and negative symptoms persist after 10 years of follow-up: A secondary analysis from the OPUS trial. Schizophr Res 2021; 228:575-580. [PMID: 33272767 DOI: 10.1016/j.schres.2020.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/10/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Long duration of untreated psychosis (DUP) has been linked with more severe psychotic and negative symptoms. However, it is uncertain which specific psychotic and negative domains that are affected over time and if these are stable over the course of illness. OBJECTIVE To examine whether DUP is associated with psychotic and negative symptoms measured longitudinally up to 10 years after initial assessment. METHOD Psychopathology of participants from the OPUS I trial, aged 18-45 years with a baseline ICD-10 schizophrenia spectrum diagnosis, excluding schizotypal disorder (468 participants left), was assessed at baseline and 2, 5 and 10 years after initial assessment. The associations between DUP and domains of positive and negative symptoms were calculated using linear regression analysis. RESULTS Longer DUP was significantly associated with the severity of hallucinations, delusions and anhedonia-asociality at baseline. Longer DUP remained significantly associated with hallucinations, delusions and anhedonia-asociality after 2 years. DUP was significantly associated with hallucinations, delusions, avolition-apathy and anhedonia-asociality after 5 years. Longer DUP was still significantly associated with hallucinations and delusions but not with any of the negative symptom subdomains after 10 years. Results were not substantially changed after adjusting for treatment with antipsychotic medication at each point in time. CONCLUSION We demonstrated associations between DUP and the severity of hallucinations and delusions which persist after at least 10 years of follow-up and an association between longer DUP and anhedonia-asociality which persist until 5 years of follow-up. Further, DUP was associated with avolition-apathy after 5 years.
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Affiliation(s)
- Lana Saad Abdul Jabar
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark.
| | - Holger Jelling Sørensen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Denmark
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
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Ayesa-Arriola R, Ortíz-García de la Foz V, Martínez-García O, Setién-Suero E, Ramírez ML, Suárez-Pinilla P, Mayoral-van Son J, Vázquez-Bourgon J, Juncal-Ruiz M, Gómez-Revuelta M, Tordesillas-Gutiérrez D, Crespo-Facorro B. Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort. Psychol Med 2021; 51:264-277. [PMID: 31736458 DOI: 10.1017/s0033291719003179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of the current study was to examine the heterogeneity of functional outcomes in first episode psychosis (FEP) patients and related clinical, neurocognitive and sociodemographic factors using a cluster analytic approach. METHOD A large sample of FEP patients (N = 209) was functionally reassessed 10 years after the first contact with an early intervention service. Multiple baseline, 3-year and 10-year follow-up variables were explored. RESULTS The cluster analysis emphasized the existence of six independent clusters of functioning: one cluster was normal overall (42.16%), two clusters showed moderate interpersonal (9.63%) or instrumental (12.65%) deficits, two clusters showed more severe interpersonal (12.05%) or interpersonal and instrumental (13.85%) deficits and there was a significantly overall impaired cluster (9.63%). Cluster comparisons showed that several baseline and follow-up factors were differentially involved in functional outcomes. CONCLUSIONS The current study demonstrated that distinct clusters of functioning in FEP patients can be identified. The fact that a variety of profiles was observed contributes to a better understanding of the nature of the heterogeneity characterizing FEP patients and has clinical implications for developing individualized treatment plans.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Víctor Ortíz-García de la Foz
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Obdulia Martínez-García
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Esther Setién-Suero
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - María Luz Ramírez
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Paula Suárez-Pinilla
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Jacqueline Mayoral-van Son
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Sierrallana Hospital, Torrelavega, Cantabria, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - María Juncal-Ruiz
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Sierrallana Hospital, Torrelavega, Cantabria, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Diana Tordesillas-Gutiérrez
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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Strålin P, Skott M, Cullberg J. Early predictors for late hospitalizations up to 14 years after first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1371-1380. [PMID: 33263822 PMCID: PMC8316245 DOI: 10.1007/s00127-020-01991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE New hospitalizations after first episode psychosis (FEP) may be viewed as an indicator of instability in a psychotic disorder. In the current study we wanted to analyse long term risk for psychosis hospitalizations after FEP. We also wanted to analyse predictors for late hospitalizations, with focus on early antipsychotic medication. METHODS First episode psychosis cases were recruited to the Swedish Parachute project in 1996-1997. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion. Longitudinal data from population registers on psychiatric hospitalizations up to 14 years after inclusion were analysed. One hundred and sixty-one cases were included of the original 175 in the project. Associations with possible early predictive factors from the original project data were analysed with COX regression. RESULTS A majority of the cases (67%) had hospitalizations in the first year after inclusion in the study. The cohort then diverged into a group (46%) with new hospitalizations for psychosis after the first year, most of them multiple times, and another group (54%) without new hospitalizations for psychosis, many without any late antipsychotic medication. Forty-two percentage of the cases had antipsychotic medication by month 12, and it was significantly associated with later psychosis hospitalizations (HR = 2.5, p value < 0.001). CONCLUSIONS The study demonstrates that a large part of FEP cases have a good outcome as measured by absence of new hospitalizations for psychosis, and that many cases may terminate antipsychotic medication within a year of FEP onset without later relapses needing hospitalizations.
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Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maria Skott
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Johan Cullberg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
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