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Cowman M, Godfrey E, Walsh T, Frawley E, Fowler D, Alvarez-Jimenez M, O’Connor K, Wykes T, Birchwood M, Donohoe G. Measures of Social and Occupational Function in Early Psychosis: A Systematic Review and Meta-analysis. Schizophr Bull 2024; 50:266-285. [PMID: 37173277 PMCID: PMC10919778 DOI: 10.1093/schbul/sbad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Deficits in social and occupational function are widely reported in psychosis, yet no one measure of function is currently agreed upon as a gold standard in psychosis research. The aim of this study was to carry out a systematic review and meta-analysis of functioning measures to determine what measures were associated with largest effect sizes when measuring between-group differences, changes over time, or response to treatment. Literature searches were conducted based on PsycINFO and PubMed to identify studies for inclusion. Cross-sectional and longitudinal observational and intervention studies of early psychosis (≤5 years since diagnosis) that included social and occupational functioning as an outcome measure were considered. A series of meta-analyses were conducted to determine effect size differences for between-group differences, changes over time, or response to treatment. Subgroup analyses and meta-regression were carried out to account for variability in study and participant characteristics. One hundred and sixteen studies were included, 46 studies provided data (N = 13 261) relevant to our meta-analysis. Smallest effect sizes for changes in function over time and in response to treatment were observed for global measures, while more specific measures of social and occupational function showed the largest effect sizes. Differences in effect sizes between functioning measures remained significant after variability in study and participant characteristics were accounted for. Findings suggest that more specific measures of social function are better able to detect changes in function over time and in response to treatment.
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Affiliation(s)
- Megan Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emmet Godfrey
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Talissa Walsh
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emma Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - David Fowler
- School of Psychology, University of Sussex, Falmer, UK
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Karen O’Connor
- RISE Early Intervention in Psychosis Service, South Lee Mental Health Service, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Til Wykes
- School of Mental Health & Psychological Sciences, King’s College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
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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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Palmer ER, Griffiths SL, Watkins B, Weetman T, Ottridge R, Patel S, Woolley R, Tearne S, Au P, Taylor E, Sadiq Z, Al-Janabi H, Major B, Marriott C, Husain N, Katshu MZUH, Giacco D, Barnes NM, Walters JTR, Barnes TRE, Birchwood M, Drake R, Upthegrove R. Antidepressants for the prevention of depression following first-episode psychosis (ADEPP): study protocol for a multi-centre, double-blind, randomised controlled trial. Trials 2023; 24:646. [PMID: 37803384 PMCID: PMC10557320 DOI: 10.1186/s13063-023-07499-3] [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: 04/14/2023] [Accepted: 07/06/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Depressive episodes are common after first-episode psychosis (FEP), affecting more than 40% of people, adding to individual burden, poor outcomes, and healthcare costs. If the risks of developing depression were lower, this could have a beneficial effect on morbidity and mortality, as well as improving outcomes. Sertraline is a selective serotonin reuptake inhibitor and a common first-line medication for the treatment of depression in adults. It has been shown to be safe when co-prescribed with antipsychotic medication, and there is evidence that it is an effective treatment for depression in established schizophrenia. We present a protocol for a multi-centre, double-blind, randomised, placebo-controlled clinical trial called ADEPP that aims to investigate the efficacy and cost-effectiveness of sertraline in preventing depression after FEP. METHODS The recruitment target is 452 participants between the ages of 18 and 65 years who are within 12 months of treatment initiation for FEP. Having provided informed consent, participants will be randomised to receive either 50 mg of sertraline daily or matched placebo for 6 months, in addition to treatment as usual. The primary outcome measure will be a comparison of the number of new cases of depression between the treatment and placebo arms over the 6-month intervention phase. Secondary outcomes include suicidal behaviour, anxiety, rates of relapse, functional outcome, quality of life, and resource use. DISCUSSION The ADEPP trial will test whether the addition of sertraline following FEP is a clinically useful, acceptable, and cost-effective way of improving outcomes following FEP. TRIAL REGISTRATION ISRCTN12682719 registration date 24/11/2020.
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Affiliation(s)
- Edward R Palmer
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Siân Lowri Griffiths
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Ben Watkins
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Tyler Weetman
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Ryan Ottridge
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Pui Au
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Eleanor Taylor
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Zara Sadiq
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Barnaby Major
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Charlotte Marriott
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, Division of Mental Health and Neurosciences University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare National Health Service Foundation Trust, Nottingham, UK
| | - Domenico Giacco
- Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Nicholas M Barnes
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James T R Walters
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | | | - Max Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK
| | - Richard Drake
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
- Early Intervention Service, Birmingham Women's and Children's NHS Trust, Birmingham, UK.
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Griffiths SL, Bogatsu T, Longhi M, Butler E, Alexander B, Bandawar M, Everard L, Jones PB, Fowler D, Hodgekins J, Amos T, Freemantle N, McCrone P, Singh SP, Birchwood M, Upthegrove R. Five-year illness trajectories across racial groups in the UK following a first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:569-579. [PMID: 36717434 PMCID: PMC10066114 DOI: 10.1007/s00127-023-02428-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Psychosis disproportionally affects ethnic minority groups in high-income countries, yet evidence of disparities in outcomes following intensive early intervention service (EIS) for First Episode Psychosis (FEP) is less conclusive. We investigated 5-year clinical and social outcomes of young people with FEP from different racial groups following EIS care. METHOD Data were analysed from the UK-wide NIHR SUPEREDEN study. The sample at baseline (n = 978) included White (n = 750), Black (n = 71), and Asian (n = 157) individuals, assessed during the 3 years of EIS, and up to 2 years post-discharge (n = 296; Black [n = 23]; Asian [n = 52] and White [n = 221]). Outcome trajectories were modelled for psychosis symptoms (positive, negative, and general), functioning, and depression, using linear mixed effect models (with random intercept and slopes), whilst controlling for social deprivation. Discharge service was also explored across racial groups, 2 years following EIS. RESULTS Variation in linear growth over time was accounted for by racial group status for psychosis symptoms-positive (95% CI [0.679, 1.235]), negative (95% CI [0.315, 0.783]), and general (95% CI [1.961, 3.428])-as well as for functioning (95% CI [11.212, 17.677]) and depressive symptoms (95% CI [0.261, 0.648]). Social deprivation contributed to this variance. Black individuals experienced greater levels of deprivation (p < 0.001, 95% CI [0.187, 0.624]). Finally, there was a greater likelihood for Asian (OR = 3.04; 95% CI [2.050, 4.498]) and Black individuals (OR = 2.47; 95% CI [1.354, 4.520]) to remain in secondary care by follow-up. CONCLUSION Findings suggest variations in long-term clinical and social outcomes following EIS across racial groups; social deprivation contributed to this variance. Black and Asian individuals appear to make less improvement in long-term recovery and are less likely to be discharged from mental health services. Replication is needed in large, complete data, to fully understand disparities and blind spots to care.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mia Longhi
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Emily Butler
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Beel Alexander
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mrunal Bandawar
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Linda Everard
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and CAMEO, Cambridge and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | | | - Tim Amos
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Paul McCrone
- Institute for Life Course Development, University of Greenwich, London, UK
| | - Swaran P Singh
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
| | - Max Birchwood
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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5
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Sánchez-Torres AM, Amoretti S, Enguita-Germán M, Mezquida G, Moreno-Izco L, Panadero-Gómez R, Rementería L, Toll A, Rodriguez-Jimenez R, Roldán A, Pomarol-Clotet E, Ibáñez Á, Usall J, Contreras F, Vieta E, López-Ilundain JM, Merchán-Naranjo J, González-Pinto A, Berrocoso E, Bernardo M, Cuesta MJ. Relapse, cognitive reserve, and their relationship with cognition in first episode schizophrenia: a 3-year follow-up study. Eur Neuropsychopharmacol 2023; 67:53-65. [PMID: 36495858 DOI: 10.1016/j.euroneuro.2022.11.011] [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: 07/06/2022] [Revised: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
Schizophrenia is frequently characterized by the presence of multiple relapses. Cognitive impairments are core features of schizophrenia. Cognitive reserve (CR) is the ability of the brain to compensate for damage caused by pathologies such as psychotic illness. As cognition is related to CR, the study of the relationship between relapse, cognition and CR may broaden our understanding of the course of the disease. We aimed to determine whether relapse was associated with cognitive impairment, controlling for the effects of CR. Ninety-nine patients with a remitted first episode of schizophrenia or schizophreniform disorder were administered a set of neuropsychological tests to assess premorbid IQ, attention, processing speed, working memory, verbal and visual memory, executive functions and social cognition. They were followed up for 3 years (n=53) or until they relapsed (n=46). Personal and familial CR was estimated from a principal component analysis of the premorbid information gathered. Linear mixed-effects models were applied to analyse the effect of time and relapse on cognitive function, with CR as covariate. Patients who relapsed and had higher personal CR showed less deterioration in attention, whereas those with higher CR (personal and familial CR) who did not relapse showed better performance in processing speed and visual memory. Taken together, CR seems to ameliorate the negative effects of relapse on attention performance and shows a positive effect on processing speed and visual memory in those patients who did not relapse. Our results add evidence for the protective effect of CR over the course of the illness.
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Affiliation(s)
- Ana M Sánchez-Torres
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR); Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Mónica Enguita-Germán
- Navarra Institute of Health Research (IdiSNA), Pamplona, Spain; Unidad de Metodología. Navarrabiomed-CHN -UPNA. Pamplona
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain
| | - Rocío Panadero-Gómez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Lide Rementería
- BIOARABA Health Research Institute. OSI Araba. University Hospital. University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Alba Toll
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM)
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12); Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Alexandra Roldán
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Edith Pomarol-Clotet
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ángela Ibáñez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat
| | - Fernando Contreras
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatric Department. Bellvitge Universitary Hospital. IDIBELL
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain
| | - Jessica Merchán-Naranjo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; BIOARABA Health Research Institute. OSI Araba. University Hospital. University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Esther Berrocoso
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychology, University of Cadiz, Spain, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute of Health Research (IdiSNA), Pamplona, Spain.
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Rapsey EHS, Pilcher NM. “The world is a beautiful place – I want to explore that a bit”: the experience of taking part in an adventure therapy sailing project by a group of individuals who have experienced psychosis. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2145347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ferrari M, Pawliuk N, Pope M, MacDonald K, Boruff J, Shah J, Malla A, Iyer SN. A Scoping Review of Measures Used in Early Intervention Services for Psychosis. Psychiatr Serv 2022; 74:523-533. [PMID: 36321318 DOI: 10.1176/appi.ps.202100506] [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: 11/06/2022]
Abstract
OBJECTIVE The early intervention service (EIS) model for psychosis has been implemented with increasing frequency; yet, improving outcomes across domains for all patients remains challenging. Measurement-based care can strengthen outcomes by optimizing interventions and promoting alignment with standards, but it is still not widely deployed in EIS. The authors conducted a scoping review by systematically identifying and synthesizing measures used in EIS related to purpose (i.e., to assess patients, families, and programs), domains (e.g., symptoms, quality of life), and reporting perspectives (of patients, families, and clinicians). METHODS EMBASE, MEDLINE, PsycINFO, CINAHL, and Cochrane Library databases were searched for pertinent literature published between 2000 and 2020. Two reviewers independently screened titles, abstracts, and full texts and extracted data. Measures were classified as clinician-reported outcome measures (CROMs), patient-reported outcome or experience measures (PROMs/PREMs), or family-reported outcome or experience measures (FROMs/FREMs). RESULTS In total, 172 measures of 27 domains were identified from 115 articles. Nineteen measures had been used to assess programs on fidelity, service engagement, and satisfaction; 136 to assess patients on duration of untreated psychosis, symptoms, functioning, quality of life, and others; and 17 to assess families on coping and burden, background, and others. Sixty percent were CROMs, 30% were PROMs/PREMs, and 10% were FROMs/FREMs. CONCLUSIONS Greater inclusion of PROMs and FROMs is needed because they align with the EIS philosophy of patient and family engagement and may improve shared decision making and outcomes. A comprehensive, meaningfully synthesized archive of measures can advance measurement-based care, services research, and data harmonization in early psychosis.
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Affiliation(s)
- Manuela Ferrari
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
| | - Nicole Pawliuk
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
| | - Megan Pope
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
| | - Kevin MacDonald
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
| | - Jill Boruff
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal (Ferrari, Pawliuk, Pope, MacDonald, Shah, Malla, Iyer); Department of Psychiatry (Ferrari, Shah, Malla, Iyer) and Schulich Library of Physical Sciences, Life Sciences, and Engineering (Boruff), McGill University, Montreal
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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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9
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Gehue LJ, Crouse JJ, Battisti RA, Yim M, Carpenter JS, Scott EM, Hickie IB. Piloting the 'Youth Early-intervention Study' ('YES'): Preliminary functional outcomes of a randomized controlled trial targeting social participation and physical well-being in young people with emerging mental disorders. J Affect Disord 2021; 280:180-188. [PMID: 33217700 DOI: 10.1016/j.jad.2020.10.070] [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: 03/26/2020] [Revised: 09/07/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Young people with mental disorders present with diverse social, vocational, physical, and developmental needs. However, multifaceted interventions are rare. We examine the effectiveness of a clinical trial targeting social participation and physical well-being in young people accessing clinical services. METHODS The 'Youth Early-intervention Study' ('YES') was an unblinded, two-phase, pilot randomized controlled trial offered as an adjunct to standard clinical care, consisting of group activities. Mixed effects models were used to examine functional outcomes over time measured by the 'Social and Occupational Functioning Assessment Scale', 'Functioning Assessment Short Test', and 'Brief Disability Questionnaire' (items 7 and 8). RESULTS 133 participants aged 14-25 were recruited. 87 participants completed both arms and 83 participants completed a 12-month post-trial assessment. Functioning improved across all outcomes. While diagnoses differed in functioning at baseline (lower functioning in psychotic and bipolar disorders compared to depression), they did not differ in the rate of improvement across any measure. Randomization groups did not differ in baseline functioning or the rate of improvement, suggesting a non-specific impact of the intervention. Engagement with education increased from 11% at baseline to 51% at 12-months post-trial and full-time employment increased from 8% at baseline to 20% at 12-months post-trial. LIMITATIONS Small sample, no control group, and unmeasured potential moderators (e.g. neurocognitive impairment). CONCLUSIONS 'YES' was effective and preliminary positive outcomes were observed across all functional outcomes. Future studies should compare the 'YES' intervention to a treatment-as-usual control condition and conduct a multi-centre trial across early intervention service sites.
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Affiliation(s)
- Lillian J Gehue
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Jacob J Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia.
| | - Robert A Battisti
- Cancer Centre for Children, The Children's Hospital at Westmead, NSW, Australia
| | - Mark Yim
- St Vincent's Private Hospital, Sydney, NSW, Australia
| | - Joanne S Carpenter
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Elizabeth M Scott
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia; St Vincent's and Mater Clinical School, The University of Notre Dame, NSW, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
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10
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Development and external validation of an admission risk prediction model after treatment from early intervention in psychosis services. Transl Psychiatry 2021; 11:35. [PMID: 33431803 PMCID: PMC7801610 DOI: 10.1038/s41398-020-01172-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022] Open
Abstract
Early Intervention in psychosis (EIP) teams are the gold standard treatment for first-episode psychosis (FEP). EIP is time-limited and clinicians are required to make difficult aftercare decisions that require weighing up individuals' wishes for treatment, risk of relapse, and health service capacity. Reliable decision-making tools could assist with appropriate resource allocation and better care. We aimed to develop and externally validate a readmission risk tool for application at the point of EIP discharge. All persons from EIP caseloads in two NHS Trusts were eligible for the study. We excluded those who moved out of the area or were only seen for assessment. We developed a model to predict the risk of hospital admission within a year of ending EIP treatment in one Trust and externally validated it in another. There were n = 831 participants in the development dataset and n = 1393 in the external validation dataset, with 79 (9.5%) and 162 (11.6%) admissions to inpatient hospital, respectively. Discrimination was AUC = 0.76 (95% CI 0.75; 0.77) in the development dataset and AUC = 0.70 (95% CI 0.66; 0.75) in the external dataset. Calibration plots in external validation suggested an underestimation of risk in the lower predicted probabilities and slight overestimation at predicted probabilities in the 0.1-0.2 range (calibration slope = 0.86, 95% CI 0.68; 1.05). Recalibration improved performance at lower predicted probabilities but underestimated risk at the highest range of predicted probabilities (calibration slope = 1.00, 95% CI 0.79; 1.21). We showed that a tool for predicting admission risk using routine data has good performance and could assist clinical decision-making. Refinement of the model, testing its implementation and further external validation are needed.
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11
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McCay E, Tibbo P, Conrad G, Crocker C, Langley J, Kirwan N, Aiello A, Danaher A, Sheasgreen C. Prepared for transition? A cross-sectional descriptive study of the gains attained in early psychosis programs. Early Interv Psychiatry 2020; 14:636-640. [PMID: 31943787 DOI: 10.1111/eip.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 10/24/2019] [Accepted: 12/14/2019] [Indexed: 11/28/2022]
Abstract
AIM To examine the degree to which youth identified as ready for discharge from three Canadian early psychosis intervention (EPI) programs had achieved optimal outcomes (ie, symptom remission, quality of life, self-esteem and functioning). METHODS This cross-sectional descriptive study is part of a larger study assessing the effectiveness of an evidence-based intervention to sustain the gains acquired in EPI programs in two Canadian provinces (Ontario and Nova Scotia), as youth transition from EPI services to community-based care. Baseline data collected from 39 participants receiving usual treatment in these three EPI programs comprised the comparison group. Participants completed measures to assess symptoms, quality of life, self-esteem and functional level just prior to discharge. RESULTS Participants demonstrated lower levels of symptoms, greater quality of life, greater self-esteem and greater levels of functioning, following EPI treatment when compared to similar youth described in the literature. These findings suggest that study participants had achieved optimal outcomes following EPI treatment. CONCLUSION The study findings have laid the ground work for the current Canadian Institutes of Health Research partnership study in which our research group is assessing the effectiveness of an evidence-based transitional intervention in order to address critical psychosocial issues of identity, stigma, effective relationships and meaningful life goals, along with the development of an individualized 'passport for transition'. It is anticipated that implementing an evidence-based transitional intervention will support participants to maintain the gains made in EPI programs once they transition to community-based care and will inform future research addressing this challenging issue.
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Affiliation(s)
- Elizabeth McCay
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Philip Tibbo
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Gretchen Conrad
- Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, Ottawa, Ontario, Canada
| | - Candice Crocker
- Department of Psychiatry, Nova Scotia Psychosis Research Unit, Dalhousie University, Nova Scotia Early Psychosis Program, Halifax, Nova Scotia, Canada
| | - John Langley
- Department of Psychiatry, St. Michael's Hospital, Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kirwan
- Mental Health and Addictions Service, Community Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andria Aiello
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Audrey Danaher
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Clare Sheasgreen
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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12
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Steare T, O'Hanlon P, Eskinazi M, Osborn D, Lloyd-Evans B, Jones R, Rostill H, Amani S, Johnson S. Smartphone-delivered self-management for first-episode psychosis: the ARIES feasibility randomised controlled trial. BMJ Open 2020; 10:e034927. [PMID: 32847902 PMCID: PMC7451533 DOI: 10.1136/bmjopen-2019-034927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To test the feasibility and acceptability of a randomised controlled trial (RCT) to evaluate a Smartphone-based self-management tool in Early Intervention in Psychosis (EIP) services. DESIGN A two-arm unblinded feasibility RCT. SETTING Six NHS EIP services in England. PARTICIPANTS Adults using EIP services who own an Android Smartphone. Participants were recruited until the recruitment target was met (n=40). INTERVENTIONS Participants were randomised with a 1:1 allocation to one of two conditions: (1) treatment as usual from EIP services (TAU) or (2) TAU plus access to My Journey 3 on their own Smartphone. My Journey 3 features a range of self-management components including access to digital recovery and relapse prevention plans, medication tracking and symptom monitoring. My Journey 3 use was at the users' discretion and was supported by EIP service clinicians. Participants had access for a median of 38.1 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility outcomes included recruitment, follow-up rates and intervention engagement. Participant data on mental health outcomes were collected from clinical records and from research assessments at baseline, 4 months and 12 months. RESULTS 83% and 75% of participants were retained in the trial at the 4-month and 12-month assessments. All treatment group participants had access to My Journey 3 during the trial, but technical difficulties caused delays in ensuring timely access to the intervention. The median number of My Journey 3 uses was 16.5 (IQR 8.5 to 23) and median total minutes spent using My Journey 3 was 26.8 (IQR 18.3 to 57.3). No serious adverse events were reported. CONCLUSIONS Recruitment and retention were feasible. Within a trial context, My Journey 3 could be successfully delivered to adults using EIP services, but with relatively low usage rates. Further evaluation of the intervention in a larger trial may be warranted, but should include attention to implementation. TRIAL REGISTRATION ISRCTN10004994.
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Affiliation(s)
- Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | - Puffin O'Hanlon
- Division of Psychiatry, University College London, London, UK
| | | | - David Osborn
- Division of Psychiatry, University College London, London, UK
- R&D Department, Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK
- R&D Department, Camden and Islington NHS Foundation Trust, London, UK
| | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
| | - Helen Rostill
- University of Surrey, Guildford, Surrey, UK
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, UK
| | - Sarah Amani
- Early Intervention in Psychosis Programme (South of England), Oxford, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- R&D Department, Camden and Islington NHS Foundation Trust, London, UK
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13
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Brown E, Bedi G, McGorry P, O’Donoghue B. Rates and Predictors of Relapse in First-Episode Psychosis: An Australian Cohort Study. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Background
Clinical and functional recovery is usually achieved after treatment for a first episode of psychosis (FEP). Unfortunately, subsequent relapse remains common, occurring within a year for approximately 30% of individuals and up to 80% over 5 years. Factors that make relapse more likely in any given individual remain poorly understood.
Methods
This article presents a naturalistic cohort study of young people (15–24 years old) accessing an early intervention in psychosis service in Melbourne, Australia between January 1, 2011 and December 31, 2016. Demographic and clinical predictors of relapse were collected and analyzed using Cox regression analysis.
Results
A total of 1220 young people presented with an FEP during the study period; 37.7% (N = 460) experienced at least 1 relapse during their episode of care. Over half of all relapses resulted in an admission to hospital. Non-adherence to medication, substance use, and psychosocial stressors were commonly noted as clinical precipitants of relapse. Significant predictors of relapse (vs no relapse) were a diagnosis of schizophrenia spectrum disorder (adjusted hazard ratio [aHR] = 1.62) or affective psychotic disorder (aHR = 1.37), lifetime amphetamine use (aHR = 1.48), and any substance use during treatment (aHR = 1.63).
Conclusion
These findings suggest that relapse occurs frequently for young people who have experienced FEP. This is one of the first studies to report that amphetamine use (predominantly illicit methamphetamine) increases the risk of relapse. Clinical services, especially in Australasia, need to consider how best to manage this comorbidity in young people with FEP.
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Affiliation(s)
- Ellie Brown
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gillinder Bedi
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Pat McGorry
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brian O’Donoghue
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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14
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Zhou C, Kong D, Zhu X, Wu W, Xue R, Li G, Xu Y, Liu S, Tian H, Zhuo C. Rethinking Schizophrenia and Depression Comorbidity as One Psychiatric Disorder Entity: Evidence From Mouse Model. Front Neurosci 2020; 14:115. [PMID: 32218718 PMCID: PMC7078335 DOI: 10.3389/fnins.2020.00115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/29/2020] [Indexed: 01/27/2023] Open
Abstract
Schizophrenia is frequently accompanied by depressive symptoms, but the pathological mechanisms remain to be elucidated. In this study, we used chronic unpredicted mild stress plus MK801 injection to generate a mouse model of schizophrenia with depression, in which in vivo 2-photon calcium imaging and electrophysiological recordings were performed in conjunction with behavioral phenotyping. Compared to mice models with classical depression or to schizophrenia models, the animal models with schizophrenia and depression comorbidity presented worse psychotic and depressive symptoms. These behavioral deficits are associated with impaired neuronal calcium activities in the frontal cortex and thalamic nuclei. Moreover, in sharp contrast to classical models that have a satisfactory response to antipsychotic or antidepressant drugs, this novel schizophrenia with depression model is resilient to combined drug treatment in terms of behavioral and functional recovery. Taken together, these data indicate that schizophrenia with depression likely involves a unique pathophysiology that is different from schizophrenia or depression alone.
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Affiliation(s)
- Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dezhi Kong
- Two-Photon In Vivo Imaging Centre, Institute of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
| | - Xiaodong Zhu
- Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Wu
- Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Xue
- Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Gongying Li
- Institute of Brain Micro Scale Imaging Centre, School of Mental Health, Jining Medical University, Jining, China
| | - Yong Xu
- MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Hongjun Tian
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Chuanjun Zhuo
- Institute of Brain Micro Scale Imaging Centre, School of Mental Health, Jining Medical University, Jining, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
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15
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Rakhshan Rouhakhtar P, Schiffman J. Community Rehabilitation for Youth with Psychosis Spectrum Disorders. Child Adolesc Psychiatr Clin N Am 2020; 29:225-239. [PMID: 31708049 DOI: 10.1016/j.chc.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recovery-oriented treatment for youth with psychosis goes beyond a symptom and deficit-amelioration model, promoting engagement and functioning within the community. Given the challenges young people with psychosis face, early psychosis treatment programs often integrate rehabilitative components targeting functional outcomes. The current article reviews 4 community rehabilitation programs in early psychosis: care coordination, cognitive rehabilitation, supported education and employment, and peer support. For each of these rehabilitative intervention programs, we discuss challenges faced by youth with psychosis, clinical intervention practices, the current state of evidence, and clinical and/or research considerations.
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Affiliation(s)
- Pamela Rakhshan Rouhakhtar
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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16
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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17
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Li N, Zhuo JM, Turkoz I, Mathews M, Feng Y, Tan W. A post hoc analysis on hospitalization risk in Asian patients with schizophrenia switching to once-monthly paliperidone palmitate from oral antipsychotics. Expert Opin Pharmacother 2019; 20:2033-2039. [PMID: 31393186 DOI: 10.1080/14656566.2019.1650022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In this post hoc analysis in patients recently diagnosed (≤5 years) with schizophrenia, the effect on hospitalization risk after switching from oral antipsychotic to once-monthly paliperidone palmitate (PP1M) was evaluated. Research design and methods: Change in hospitalization risk following PP1M initiation among patients switching from oral antipsychotics was assessed using prescription sequence symmetry analysis. Hospitalization risk was expressed as an adjusted sequence ratio (ASR) of the number of patients hospitalized prior to PP1M initiation/post PP1M initiation. Cumulative distribution of the time to hospitalization was estimated by the Kaplan-Meier method and symmetry of distribution was assessed using log-rank test. Hazard ratio and 95% CI were calculated using the Cox proportional hazard model. Results: The number of patients hospitalized after switching to PP1M: no change, 203/300 (67.7%); increase, 18/300 (6.0%); and decrease, 79/300 (26.3%). Following PP1M initiation, ASR (95% CI) was 3.56 (2.67, 5.33) suggesting asymmetry and a significant decline in hospitalization risk. Asymmetry in distribution of hospitalization events with significant (p ≤ 0.001) delay in time to hospitalization was also observed. Conclusion: Switching to PP1M treatment from oral antipsychotics is likely to be associated with a significant reduction in hospitalization risk along with a delay in time to hospitalization and rehospitalization.
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Affiliation(s)
- Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital , Beijing , China
| | - Jian Min Zhuo
- Janssen China Research & Development, Johnson & Johnson (China) Investment Ltd ., Shanghai , China
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC , Titusville , NJ , USA
| | - Maju Mathews
- Janssen Research & Development, LLC , Titusville , NJ , USA
| | - Yu Feng
- Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore , Singapore
| | - Wilson Tan
- Janssen Pharmaceutical Companies of Johnson and Johnson , Singapore , Singapore
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18
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McInnis P, Lee A. Methamphetamine use in an early psychosis service: a cross-sectional retrospective cohort study. Australas Psychiatry 2019; 27:383-387. [PMID: 31264898 DOI: 10.1177/1039856219859811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Methamphetamine-associated psychotic symptoms are common among regular users, and can overlap with the emergence of a primary psychotic disorder. In contrast to previous research, this retrospective observational study aims to describe the characteristics of young people experiencing early psychosis who use methamphetamine regularly. We also aimed to investigate associations between regular methamphetamine use and markers of psychosocial functioning, psychosis outcomes and substance use. METHOD This study involved 116 young people (19 using methamphetamine regularly) referred to the Camperdown Early Intervention in Psychosis Service from January 2015 to January 2016. Variables including demographic information, psychosocial functioning and psychosis outcomes were collected on referral to the service, updated throughout treatment and at discharge. RESULTS There were significant associations found between regular methamphetamine use and a criminal history (p<0.001), regular cannabis use (p=0.002) and regular nicotine use (p<0.001). CONCLUSION This study suggests that in early psychosis, regular methamphetamine use could signify a subgroup of young people who use multiple substances and may engage in criminal activity. Addressing substance use in early psychosis may be an important treatment target for this vulnerable group of young people.
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Affiliation(s)
- Peter McInnis
- Rivendell Child Adolescent and Family Mental Health Service, Sydney Local Health District, Concord West, NSW, Australia
| | - Anna Lee
- Early Intervention in Psychosis Service, Sydney Local Health District, Camperdown, NSW, Australia
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Woodward S, Bucci S, Edge D, Berry K. Barriers and facilitators to "moving on" from early intervention in psychosis services. Early Interv Psychiatry 2019; 13:914-921. [PMID: 30051626 DOI: 10.1111/eip.12708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 12/30/2017] [Accepted: 06/10/2018] [Indexed: 11/28/2022]
Abstract
AIM Transition from early intervention in psychosis services (EIPS) to ongoing care can be challenging for staff and service users. This study aims to explore staff views of the barriers and facilitators to transition from EIPS. METHODS Eighteen EIPS staff were interviewed about their experiences of discharge processes and interviews were analysed thematically. RESULTS Four themes were identified: (1) "nowhere to go": illustrated how service users remained in EIPS because other teams lacked capacity to take them; (2) "collaboration between agencies" highlights the challenges of working across boundaries; (3) "therapeutic relationships": reflects the loss service users and staff experienced at discharge; (4) "advanced planning" relates to the necessity for advanced planning and service user empowerment to facilitate the discharge process. CONCLUSIONS This is the first in-depth exploration of EIPS staff views on discharge processes. To ensure seamless transitions throughout care pathways, services need better inter-agency collaboration and more adequate preparation for transition.
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Affiliation(s)
- Sarah Woodward
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Ayesa-Arriola R, Pelayo Terán JM, Setién-Suero E, Neergaard K, Ochoa S, Ramírez-Bonilla M, Pérez-Iglesias R, Crespo-Facorro B. Patterns of recovery course in early intervention for FIRST episode non-affective psychosis patients: The role of timing. Schizophr Res 2019; 209:245-254. [PMID: 30772066 DOI: 10.1016/j.schres.2019.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/07/2019] [Accepted: 01/19/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prevention of symptom relapse and promotion of functional recovery are the two main goals of early intervention following a first episode of non-affective psychosis (FEP). The identification of patterns of recovery is important in developing and implementing recovery focused interventions at set time interval. METHOD Patterns of recovery course, in terms of symptomatic and functional remission, were explored at 1 and 3-year follow-up in a sample of 373 consecutive FEP patients. Relapses during this period were considered. RESULTS Four patterns of recovery course were defined: good stable (26%), good unstable (21%), poor unstable (10%), poor stable (43%). Those who met criteria for good stable recovery were more likely have less severe baseline negative symptoms (OR = 2.092; 95% CI = 0.99-4.419) and to not be diagnosed with schizophrenia (OR = 2.242; 95% CI = 1.015-4.954). Short DUP (OR = 2.152; 95% CI = 0.879-5.27) and low premorbid IQ (OR = 2.281; 95% CI = 0.954-5.457) increased the likelihood of good unstable recovery. Less severe baseline negative symptoms (OR = 3.851; 95% CI = 1.422-10.435) and single status (OR = 4.307; 95% CI = 1.014-18.293) increased the likelihood of a poor unstable recovery. Poor unstable pattern was significantly associated with a high relapse rate (73%). CONCLUSIONS Our results shed light on identifying different recovery patterns in FEP. Despite evidence for early intervention effectiveness, we should explore ways to prevent relapse and improve long-term recovery, particularly in reference to the role of timing in the design of interventions.
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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, Spain.
| | - Jose María Pelayo Terán
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Unidad de Gestión Clínica de Psiquiatría y Salud Mental, Gerencia de Asistencia Sanitaria de El Bierzo, Servicio de Salud de Castilla y Leon (SACYL), Ponferrada, León, 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, Spain
| | - Karl Neergaard
- Laboratoire Parole et Langage, Aix-Marseille University, Aix-en-Provence, France
| | - Susana Ochoa
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Mariluz Ramírez-Bonilla
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Rocío Pérez-Iglesias
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London
| | - 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, Spain
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Lal S, Malla A, Marandola G, Thériault J, Tibbo P, Manchanda R, Williams R, Joober R, Banks N. "Worried about relapse": Family members' experiences and perspectives of relapse in first-episode psychosis. Early Interv Psychiatry 2019; 13:24-29. [PMID: 28524541 DOI: 10.1111/eip.12440] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/19/2016] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to gain an in-depth understanding on the subject of relapse from the perspectives of family members of young people receiving services for a first-episode psychosis (FEP). METHODS A qualitative descriptive approach, using focus group methods, was used to elicit experiences, understandings, and knowledge of relapse in FEP. Family members were recruited from 4 specialized early intervention programmes for psychosis in Canada. A total of 24 (6 male, 18 female) family members participated in the study. Thematic analysis was used to examine the data. RESULTS The core underlying theme in all focus groups was worrying about relapse, which was often accompanied by significant levels of fear and anxiety, and was influenced by: (1) impact of an episode of psychosis; (2) limited confidence in recognizing and coping with relapse; (3) unmet needs for coping skills and emotional support and (4) unmet needs regarding frequency and continuity of communication with clinicians. CONCLUSIONS Family members' unmet needs for relapse-focused education, support and communication with service providers and peers, can have a negative impact on relapse prevention. Addressing family members' education and support needs in a tailored manner (including preferences for types of peer support) can contribute positively to their confidence and ability to recognize and respond to relapse. This can help reduce fear and anxieties about relapse, and positively influence the ability to function as caregivers. Future research should focus on best approaches for providing education, sustained contact with the clinical team and family peer support.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, University of Montreal, Québec, Canada.,Health Innovation and Evaluation Hub, University of Montreal's Hospital Research Centre (CRCHUM), Montréal, Québec, Canada.,PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Ashok Malla
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Gina Marandola
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Joanie Thériault
- School of Rehabilitation, University of Montreal, Québec, Canada
| | - Phil Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rahul Manchanda
- PEPP-London, London Health Sciences Centre, London, Ontario, Canada
| | - Richard Williams
- Victoria EPI Program, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Ridha Joober
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Nicola Banks
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada
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22
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Employment Rates in Flexible Assertive Community Treatment Teams in The Netherlands: An Observational Study. Community Ment Health J 2019; 55:350-359. [PMID: 29344834 DOI: 10.1007/s10597-018-0233-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
Abstract
We determined the proportions of clients treated in Flexible Assertive Community Treatment teams who were unemployed and gained employment and who were employed and lost employment. Secondly, we explored the demographical and clinical factors associated with employment. Data were collected during routine outcome monitoring. We calculated differences in employment rates over a year and explored differences in demographic characteristics at baseline between patient groups. Logistic regression analysis was used to estimate the role of clinical predictor variables on employment status. Over time, 10% remained employed, 5% lost their employment, 3% gained employment and 82% remained unemployed. Clients who found employment were younger, more often male, and had significantly fewer psychosocial problems and a higher subjective quality of life during follow-up than those who remained unemployed. Problems with motivation for treatment at baseline were related to losing employment or remaining unemployed. Better implementation of vocational services is very important for increasing the number of clients gaining employment.
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Fowler D, Hodgekins J, French P. Social Recovery Therapy in improving activity and social outcomes in early psychosis: Current evidence and longer term outcomes. Schizophr Res 2019; 203:99-104. [PMID: 29070442 PMCID: PMC6336979 DOI: 10.1016/j.schres.2017.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/24/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social Recovery Therapy (SRT) is a cognitive behavioural therapy which targets young people with early psychosis who have complex problems associated with severe social disability. This paper provides a narrative overview of current evidence for SRT and reports new data on a 2year follow-up of participants recruited into the Improving Social Recovery in Early Psychosis (ISREP) trial. METHOD In the ISREP study 50 participants (86%) were followed up at 2years, 15months post treatment. The primary outcome was engagement in paid work, assessed using the Time Use Survey. Engagement in education and voluntary work were also assessed. In addition, the Positive and Negative Syndrome Scales (PANSS) and the Beck Hopelessness Scale (BHS) were administered. RESULTS 25% of individuals with non-affective psychosis in the treatment group had engaged in paid work at some point in the year following the end of therapy, compared with none of the control group. Data from the PANSS and BHS suggested no worsening of symptoms and an indication that gains in hope were maintained over the 15month period following the end of therapy. CONCLUSION Social Recovery Therapy is a promising psychological intervention which may improve social recovery in individuals with early psychosis. The new data reported in this paper shows evidence of gains in engagement in paid employment outcomes that persisted 15months beyond the period of active intervention.
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Affiliation(s)
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Paul French
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Di Capite S, Upthegrove R, Mallikarjun P. The relapse rate and predictors of relapse in patients with first-episode psychosis following discontinuation of antipsychotic medication. Early Interv Psychiatry 2018; 12:893-899. [PMID: 27734591 DOI: 10.1111/eip.12385] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/12/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To determine the "real world" relapse rate in patients with first-episode psychosis (FEP) who had discontinued antipsychotic medication and identify socio-demographic and clinical factors associated with the risk of relapse. METHODS Quantitative data were obtained via case-note review on 63 patients with FEP who had discontinued antipsychotic medication from Birmingham Early Intervention Service between 2012 and 2015. The follow-up period was until either: an occurrence of a relapse; end of 12-month study period; end of patient's case-note record. Relapse was defined as a return of symptoms requiring one of the following: home treatment, hospital admission or was based on clinical teams' decision as having a relapse. A pro-forma targeted pre-defined socio-demographic and clinical factors. Survival analysis was undertaken to estimate the 12-month relapse rate following discontinuation of antipsychotics and Cox regression performed to identify relapse predictors. RESULTS The Kaplan-Meier 12-month relapse estimate was 67% (95% confidence interval, 54%, 80%). Significant factors (P < .05) independently associated with an increased risk of relapse following discontinuation of antipsychotic medication were: male gender, not being in education, employment or training (NEET) and number of previous psychiatric hospital admissions. CONCLUSIONS Relapse is common after discontinuation of antipsychotic medication following recovery from a FEP. It is important that patients who wish to discontinue their medication are informed of the high relapse rates and the associated risks. Furthermore, male patients, patients with NEET status and those who have had previous hospital admissions may require closer monitoring.
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Affiliation(s)
- Suzanne Di Capite
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Pavan Mallikarjun
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK.,School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Puntis S, Oke J, Lennox B. Discharge pathways and relapse following treatment from early intervention in psychosis services. BJPsych Open 2018; 4:368-374. [PMID: 30202598 PMCID: PMC6127960 DOI: 10.1192/bjo.2018.50] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/19/2018] [Accepted: 03/03/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services are the dominant service model in the treatment of first-episode psychosis. They are a time-limited intervention and little is known about discharge destinations and outcomes once EIP treatment has concluded. AIMS To understand discharge pathways and predictors of relapse in an EIP service. METHOD We collected data on all patients with an electronic health record treated by EIP services in Oxford Health NHS Foundation Trust in the UK between 12 January 2006 and 7 March 2017 (n = 701). Our primary outcomes were discharge destination at end of treatment and relapse. RESULTS Most patients (83.5%) were discharged to primary care. Transfer to secondary care was associated with previous in-patient admissions (odds ratio (OR) = 1.92, 95% CI 1.54-2.39) and longer EIP treatment (OR = 1.04, 95% CI 1.03-1.06). Relapse rate was highest shortly after leaving EIP services. Relapse was associated with transfer to secondary care (hazard ratio (HR) = 2.75, 95% CI 1.75-4.31), higher deprivation (HR = 1.03, 95% CI, 1.01-1.05), a substance misuse disorder (HR = 1.81, 95% CI 1.01-3.26) and a comorbid diagnosis of a personality disorder (HR = 2.96, 95% CI 1.39-6.29). CONCLUSIONS Most patients treated by the EIP service in Oxfordshire did not receive ongoing mental healthcare from secondary mental health services. We identified high deprivation and those with substance misuse problems or personality disorders as EIP populations with a high risk of relapse. DECLARATION OF INTEREST None.
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Affiliation(s)
- Stephen Puntis
- Research Fellow, Department of Psychiatry, University of Oxford, Warneford Hospital, UK
| | - Jason Oke
- Senior Statistician, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Belinda Lennox
- Associate Professor, Department of Psychiatry, University of Oxford, Warneford Hospital, UK
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26
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Bowtell M, Ratheesh A, McGorry P, Killackey E, O'Donoghue B. Clinical and demographic predictors of continuing remission or relapse following discontinuation of antipsychotic medication after a first episode of psychosis. A systematic review. Schizophr Res 2018; 197:9-18. [PMID: 29146020 DOI: 10.1016/j.schres.2017.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/28/2017] [Accepted: 11/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical guidelines recommend maintenance treatment with antipsychotic medication for one to two years following remission of symptoms after a first episode of psychosis. However, recent research has suggested that this may not be indicated. Consistent predictors of outcome would be beneficial to guide clinicians as to which individuals are likely to have a successful discontinuation. OBJECTIVES This study reviews the literature with the aim of identifying demographic and clinical predictors of either relapse or continued remission in those with a first episode of psychosis following discontinuation of antipsychotic medication. METHODOLOGY Data Sources: A systematic search of PubMed, CINAHL, and PsychInfo databases was performed. Eligibility Criteria: Cohort, case-control and clinical trials that were published in English, included participants with a first episode of psychosis, and examined clinical and demographic predictors of relapse or continued remission after antipsychotic discontinuation. RESULTS Eleven studies fulfilled inclusion criteria. No positive findings were replicated across cohorts. Predictors of relapse: male sex, unemployment, prior psychiatric admission, premorbid adjustment, childhood isolation, premorbid functioning, schizoid-schizotypal traits, schizophrenia diagnosis, concomitant medication, and more severe negative symptoms. Some positive findings must be interpreted in the context of conflicting and replicated negative findings: sex, employment status, level of education, premorbid functioning, symptom severity, and schizophrenia diagnosis. Other replicated non-predictive findings: age, ethnicity, marital status, family history, disorganized thoughts, affective symptoms, cannabis abuse, clinical global impression, social integration, duration and dose of antipsychotic treatment, and compliance. CONCLUSION No positive findings have been replicated across study cohorts. Non-predictive findings have been replicated.
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Affiliation(s)
- Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne; Orygen Youth Health, 35 Poplar rd, Parkville, VIC 3052, Australia.
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne.
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne.
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne; Orygen Youth Health, 35 Poplar rd, Parkville, VIC 3052, Australia.
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27
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Rates and predictors of relapse following discontinuation of antipsychotic medication after a first episode of psychosis. Schizophr Res 2018; 195:231-236. [PMID: 29066258 DOI: 10.1016/j.schres.2017.10.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/19/2017] [Accepted: 10/15/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis. Robust predictors of relapse after discontinuation are yet to be identified. The present study aimed to determine the proportion of young people who discontinue their antipsychotic medication after a first episode of psychosis, the proportion who experience relapse, and predictors of relapse. METHODS A retrospective study of all individuals presenting to the Early Psychosis Prevention and Intervention Centre between 01/01/11 and 31/12/13 was conducted. A Cox regression analysis was conducted to identify predictors of relapse. RESULTS A total of 544 young people with a FEP were included. A trial of discontinuation was undertaken by 61% of the cohort. Median duration of antipsychotic medication prior to first trial of discontinuation was 174.50days. Amongst those trialing discontinuation, 149 (45.8%) experienced relapse in a median follow-up time post discontinuation of 372days. On multivariate analysis, predictors of relapse were a diagnosis of cannabis abuse disorder (HR: 1.40), and longer duration of antipsychotic medication (HR: 1.05). CONCLUSION Antipsychotic discontinuation frequently occurs earlier than guidelines recommend. Individuals with a diagnosis of cannabis abuse are more likely to experience relapse and addressing this substance abuse prior to discontinuation could possibly reduce relapse rates.
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Untreated illness and recovery in clients of an early psychosis intervention program: a 10-year prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:171-182. [PMID: 29188310 DOI: 10.1007/s00127-017-1464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether duration of untreated psychosis (DUP) and duration of untreated illness (DUI) are associated with measures of both subjective and objective recovery 10 years after a first episode of psychosis. METHODS A cohort of 65 clients from an early psychosis intervention program completed a battery of outcome measures 10 years following initial treatment for first-episode psychosis (FEP). The outcomes of interest were self-perceived recovery scores (Maryland Assessment of Recovery in People with Serious Mental Illness Scale) and occupational activity, defined as engagement in work and/or school on a full/part-time basis. Multiple linear and logistic regression analyses were used to estimate the associations between DUP and DUI with each measure of recovery, adjusting for potential confounding factors. RESULTS We did not find a statistically significant association between DUP and either occupational activity (OR = 1.26, 95% CI 0.81-1.95) or self-perceived recovery score (β = - 0.73, 95% CI - 2.42 to 0.97). However, we found a significant negative association between DUI and self-perceived recovery score (β = - 0.52, 95% CI - 0.87 to - 0.16). CONCLUSIONS Our findings suggest that DUI may have a stronger influence than DUP on recovery from FEP at 10-year follow-up. This suggests the potential value in targeted interventions for people with a long DUI to increase the likelihood of achieving recovery after the first episode of psychosis.
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Fowler D, Hodgekins J, French P, Marshall M, Freemantle N, McCrone P, Everard L, Lavis A, Jones PB, Amos T, Singh S, Sharma V, Birchwood M. Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial. Lancet Psychiatry 2018; 5:41-50. [PMID: 29242000 PMCID: PMC5818038 DOI: 10.1016/s2215-0366(17)30476-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 10/28/2022]
Abstract
BACKGROUND Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery. METHODS We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16-35 years, had non-affective psychosis, had been clients of early intervention services for 12-30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. FINDINGS Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5-13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy. INTERPRETATION Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so. FUNDING National Institute for Health Research.
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Affiliation(s)
- David Fowler
- Psychology Department, University of Sussex, Brighton, UK.
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; Institute of Health and Psychology, University of Liverpool, Liverpool, UK
| | - Max Marshall
- Lancashire Care NHS Foundation Trust, Preston, UK
| | | | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Linda Everard
- Birmingham and Solihull NHS Mental Health Foundation Trust, Birmingham, UK
| | - Anna Lavis
- University of Birmingham, Birmingham, UK
| | | | - Tim Amos
- University of Bristol, Bristol, UK
| | | | - Vimal Sharma
- University of Chester, Chester, UK; Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
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A NEET distinction: youths not in employment, education or training follow different pathways to illness and care in psychosis. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1401-1411. [PMID: 30094632 PMCID: PMC6267132 DOI: 10.1007/s00127-018-1565-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE The early phases of psychosis, including the prodrome, often feature educational/occupational difficulties and various symptoms and signs, that can render or keep youths "Not in Employment, Education or Training" (NEET). Conversely, NEET status itself may increase risk for illness progression and impaired functioning, and impede access to appropriate services for psychosis. As these issues have not been investigated, we aimed to examine differences in the illness and care pathways and characteristics of youths with psychosis who are NEET and non-NEET. METHODS Youths entering a catchment-based Canadian early intervention service for psychosis (N = 416) were assessed as being NEET or non-NEET and compared on symptomatology, premorbid adjustment, prodrome and duration of untreated psychosis (DUP). RESULTS Thirty-nine percent of the sample was NEET. Compared to non-NEET youths, NEET youths had 34% higher negative symptoms scores, longer prodromes (median of 52 weeks vs. 24 weeks), and were more often continuously ill after their first psychiatric change until the onset of psychosis (62% vs. 45%). Both groups had similar premorbid adjustment scores until late adolescence when scores were significantly worse for NEET youths. Accounting for other predictors, NEET youths had 23% longer DUPs on average, despite having made more help-seeking attempts. CONCLUSIONS Despite being more narrowly defined, NEET status was thrice as prevalent in our sample as in the Canadian population. The NEET group followed a distinct trajectory of persistent symptoms and functional decline before presenting with a psychotic disorder. The systemic delays that NEET youths encountered indicate a need for better-targeted early identification efforts.
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Marwaha S, Thompson A, Upthegrove R, Broome MR. Fifteen years on - early intervention for a new generation. Br J Psychiatry 2016; 209:186-8. [PMID: 27587758 DOI: 10.1192/bjp.bp.115.170035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/07/2016] [Indexed: 11/23/2022]
Abstract
Early intervention for psychosis (EIP) is a model of service delivery that aims to support young people with first-episode psychosis by providing the best available treatments, supporting recovery and preventing relapse. In this editorial, we review the evidence for EIP, how the model has developed since its inclusion in the NHS policy implementation guideline for mental health in 2001, challenges and areas of ongoing debate, and future development.
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Affiliation(s)
- Steven Marwaha
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Andrew Thompson
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rachel Upthegrove
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Matthew R Broome
- Steven Marwaha, MA(Cantab), PhD, MRCPsych, Andrew Thompson, MA(Oxon), MBBS, MMedSci, MD, FRANZCP, FRCPsych, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry and Coventry and Warwickshire Partnership Trust, UK; Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical and Experimental Medicine, Institute of Clinical Sciences, University of Birmingham and Early Intervention in Psychosis Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; Matthew R. Broome, MBChB, PhD, PGCAP, MRCPsych, Department of Psychiatry and Faculty of Philosophy, University of Oxford and Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust, Oxford, UK
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