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Sirts K, Anni K, Balõtšev R, Jakobsoo S, Jaanson KL, Haring L. Adapting the early recognition inventory ERIraos to Estonian: A validation study. Early Interv Psychiatry 2024. [PMID: 38385961 DOI: 10.1111/eip.13519] [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: 03/18/2023] [Revised: 11/09/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
AIM Validated assessment tools are needed to identify clinically high risk for psychosis. This study aimed to validate the early recognition inventory ERIraos, which consists of the ERIraos Checklist for risk screening and the ERIraos Symptom List for a more thorough risk assessment in the Estonian language to detect psychotic prodromal symptoms. METHODS A prospective cohort study provided an opportunity to evaluate the characteristics of the ERIraos instrument in predicting the increased risk of a psychotic disorder in the future. The 177 study participants, aged 13-42 years old, were divided into groups without an increased risk and three risk groups with different risk severity levels based on the ERIraos Symptom List assessment. RESULTS The results indicated excellent inter-rater reliability for the ERIraos Symptom List total score. The ability of the ERIraos checklist to screen persons with an elevated psychosis risk was very good (ROC-AUC = 0.86). The capability of the ERIraos Symptom List scores to predict the probability of transitioning to psychosis within 2 years was very good (ROC-AUC = 0.83). Brief limited intermittent psychotic symptoms and observable behavioural and affective symptoms were statistically significant predictors of transition to psychosis. There were strong and statistically significant correlations between the ERIraos Symptom List scores and other clinical measures assessing functioning and psychopathology. CONCLUSIONS The results of this study demonstrate the reliability and validity of the Estonian version of the ERIraos instrument and support the usability of ERIraos as a two-step tool for the early recognition of psychosis risk.
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Affiliation(s)
- Kairit Sirts
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Kätlin Anni
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Roman Balõtšev
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Psychiatry Clinic of Tartu University Hospital, Tartu, Estonia
| | - Siim Jakobsoo
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | | | - Liina Haring
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Psychiatry Clinic of Tartu University Hospital, Tartu, Estonia
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Meneghelli A, Ciancaglini P, Di Domenico M, Mazzola A, Ghio L, Preti A. Implementation of early intervention clinical services within the National Health System in Italy: Third wave survey with focus on structures, resources, and fidelity to the evidence-based model. Early Interv Psychiatry 2023; 17:884-892. [PMID: 36682817 DOI: 10.1111/eip.13380] [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: 04/26/2022] [Revised: 08/23/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early intervention in psychosis (EIP) is a well-established approach aimed at detecting and treating early signs and symptoms of psychosis to prevent its long-term consequences. The present study aimed at detailing the current status of EIP services in Italy, covering all the Departments of Mental Health (DMHs) operating in 2018. METHODS All directors of public DMHs operating in Italy in 2018 (n = 127) were invited to fill in a Census form about EIP structure and activities. The first episode psychosis services fidelity scale (FEPS-FS) was used to investigate fidelity to the EIP model of the centre. RESULTS An active EIP service was reported by 41 DMHs (32% of the total DMHs; 56% of those who took part in the survey). Most EIP services had an autonomous team. The large majority of the Italian EIP centres provided psychosocial interventions to their patients, principally psychotherapy, family support, and psychoeducation. Among those with an active EIP, 29 DMHs filled in the FEPS-FS. Internal consistency was good when based on the replies of the respondents, but reliability was weak when measured on the basis of an independent evaluation (Cohen's kappa = 0.571). The fidelity to the guidelines for early intervention was uneven, with some criteria met by most centres, especially those peculiar to the Italian community psychiatry. CONCLUSION A further spreading of the early intervention model across the Italian DMHs was found. A lack of resources might limit the use of specific psychosocial treatments, such as cognitive-behavioural therapy or manualized family support.
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Affiliation(s)
- Anna Meneghelli
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Panfilo Ciancaglini
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Marina Di Domenico
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Andrea Mazzola
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Lucio Ghio
- Department of Mental Health and Addiction, Azienda Sanitaria Locale 3 (ASL3) Genova, Genoa, Italy
| | - Antonio Preti
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
- Department of Neuroscience, University of Turin, Turin, Italy
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Estradé A, Salazar de Pablo G, Zanotti A, Wood S, Fisher HL, Fusar-Poli P. Public health primary prevention implemented by clinical high-risk services for psychosis. Transl Psychiatry 2022; 12:43. [PMID: 35091529 PMCID: PMC8799684 DOI: 10.1038/s41398-022-01805-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Clinical High Risk for Psychosis (CHR-P) services have been primarily developed to support young people with attenuated symptoms (indicated prevention). No evidence-based appraisal has systematically investigated to what extent these clinics may implement other preventive approaches. PRISMA 2020-compliant systematic review of Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO, from inception until 14th June 2021, identifying original studies describing public health strategies: (a) service characteristics (configuration of mental health service, outreach, pathways to care); (b) universal interventions (general population); (c) selective interventions targeting CHR-P service-users or family/carers. Public health preventive initiatives were systematically stratified according to core social determinants of mental disorders associated with the 2030 Sustainable Development Goals promoted by the United Nations Member States (UN 2030 SDG) and good mental health outcomes. A total of 66 publications were included, providing data on 13 standalone, 40 integrated, three networks, and six regional or international surveys of CHR-P services across Europe, Asia, Oceania, Africa, North and South America, providing care to >28 M people. CHR-P services implement numerous public health initiatives targeting social and cultural (16 initiatives), economic (seven initiatives), demographic (six initiatives), environmental events (four initiatives) and neighbourhood (three initiatives) UN 2030 SGD determinants of mental disorders. There is additional evidence for CHR-P services promoting good mental health. The main barriers were the lack of resources for expanding public health prevention at a large scale. CHR-P services implement numerous public health prevention initiatives and promotion of good mental health beyond indicated prevention of psychosis.
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Affiliation(s)
- Andrés Estradé
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Gonzalo Salazar de Pablo
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.410526.40000 0001 0277 7938Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain ,grid.37640.360000 0000 9439 0839Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alice Zanotti
- grid.8982.b0000 0004 1762 5736Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Scott Wood
- grid.47100.320000000419368710Yale School of Medicine, Yale University, New Heaven, CT USA
| | - Helen L. Fisher
- grid.13097.3c0000 0001 2322 6764King’s College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK ,grid.13097.3c0000 0001 2322 6764Economic & Social Research Council (ESRC) Centre for Society and Mental Health, King’s College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK. .,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
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O’Connell N, O’Connor K, McGrath D, Vagge L, Mockler D, Jennings R, Darker CD. Early Intervention in Psychosis services: A systematic review and narrative synthesis of the barriers and facilitators to implementation. Eur Psychiatry 2021; 65:e2. [PMID: 34913421 PMCID: PMC8792869 DOI: 10.1192/j.eurpsy.2021.2260] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services target the early manifestation of psychosis and provide multidisciplinary care. They demonstrate effectiveness and cost-effectiveness. Implementation of EIP services is inconsistent and piecemeal. This systematic review and narrative synthesis aims to identify barriers and facilitators to EIP service implementation. METHODS We conducted an electronic search of databases (EMBASE, Medline, Web of Science, and PsychINFO) to detect papers reporting EIP service implementation findings and associated barriers and facilitators. The search occurred between June to August 2020, and again in January 2021. Articles meeting inclusion criteria were extracted and narratively synthesized. A quality assessment was conducted using the Mixed Methods Appraisal Tool. RESULTS Twenty-three studies were selected. The most common study design was descriptive accounts of implementation. Patient age ranged varied from 14 to 35 years. We identified three barrier and facilitator domains: (a) system; (b) services; and (c) staff, and a range of subdomains. The most frequent subdomains were "funding" and "strength of collaboration and communication between EIP and outside groups and services". Associations between domains and subdomains were evident, particularly between systems and services. CONCLUSIONS A range of barriers and facilitators to EIP implementation exist. Some of these are generic factors germane across health systems and services, while others are specific to EIP services. A thorough prior understanding of these challenges and enablers are necessary before implementation is attempted. Accounting for these issues within local and national contexts may help predict and increase the likelihood of services' success, stability, and longevity.
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Affiliation(s)
- N. O’Connell
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - K. O’Connor
- National Clinical Programme for Early Intervention in Psychosis,
Health Service ExecutiveDublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of
Psychiatry, University College Cork
| | - D. McGrath
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - L. Vagge
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - D. Mockler
- Rise, South Lee Mental Health Services, Cork & Department of
Psychiatry, University College Cork
- Trinity College Dublin Library, Trinity College
Dublin, Dublin, Ireland
| | - R. Jennings
- National Clinical Programme for Early Intervention in Psychosis,
Health Service ExecutiveDublin, Ireland
| | - C. D. Darker
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
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Landi G, Leuci E, Quattrone E, Azzali S, Pellegrini C, Pellegrini P, Pelizza L. The 'Parma-Early Psychosis' programme: Characterization of help-seekers with first episode psychosis. Early Interv Psychiatry 2021; 15:380-390. [PMID: 32307896 DOI: 10.1111/eip.12968] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
AIM Research on early psychosis paradigm has demonstrated the importance of early intervention (EI) in reducing illness severity and persistence. From January 2013, the Parma Department of Mental Health developed a specific care pathway [the 'Parma-Early Psychosis' (Pr-EP) programme] as a diffused EI infrastructure aimed to offer an evidence-based protocol of care to help-seekers with a first episode psychosis (FEP). Aim of this study was to investigate sources of referral, drop-out rate, sociodemographic and clinical characteristics of patients enrolled in the Pr-EP programme during the first 6 years of activity. METHODS Participants (n = 279) were individuals (aged 12-54 years) completing an ad-hoc socio-demographic/clinical schedule. RESULTS At baseline, the most frequent diagnoses were schizophreniform disorder (30.5%) and schizophrenia (29.4%). Only 31 (11.1%) subjects dropped out during the first year of treatment. FEP participants were mainly referred by general practitioners (36.9%) and emergency room/general hospital (28.7%). FEP individuals who were referred by emergency room/general hospital showed a higher percentage of current suicidal ideation compared to those entering the Pr-EP protocol through other sources of referrals. CONCLUSIONS EI in FEP help-seekers within Italian public mental health services is feasible and desirable, also in adolescence, where the risk of falling through the child-adult service gap is high.
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Affiliation(s)
- Giulia Landi
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Clara Pellegrini
- Psychiatric Unit, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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Salazar de Pablo G, Estradé A, Cutroni M, Andlauer O, Fusar-Poli P. Establishing a clinical service to prevent psychosis: What, how and when? Systematic review. Transl Psychiatry 2021; 11:43. [PMID: 33441556 PMCID: PMC7807021 DOI: 10.1038/s41398-020-01165-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023] Open
Abstract
The first rate-limiting step to successfully translate prevention of psychosis in to clinical practice is to establish specialised Clinical High Risk for Psychosis (CHR-P) services. This study systematises the knowledge regarding CHR-P services and provides guidelines for translational implementation. We conducted a PRISMA/MOOSE-compliant (PROSPERO-CRD42020163640) systematic review of Web of Science to identify studies until 4/05/2020 reporting on CHR-P service configuration, outreach strategy and referrals, service user characteristics, interventions, and outcomes. Fifty-six studies (1998-2020) were included, encompassing 51 distinct CHR-P services across 15 countries and a catchment area of 17,252,666 people. Most services (80.4%) consisted of integrated multidisciplinary teams taking care of CHR-P and other patients. Outreach encompassed active (up to 97.6%) or passive (up to 63.4%) approaches: referrals came mostly (90%) from healthcare agencies. CHR-P individuals were more frequently males (57.2%). Most (70.6%) services accepted individuals aged 12-35 years, typically assessed with the CAARMS/SIPS (83.7%). Baseline comorbid mental conditions were reported in two-third (69.5%) of cases, and unemployment in one third (36.6%). Most services provided up to 2-years (72.4%), of clinical monitoring (100%), psychoeducation (81.1%), psychosocial support (73%), family interventions (73%), individual (67.6%) and group (18.9%) psychotherapy, physical health interventions (37.8%), antipsychotics (87.1%), antidepressants (74.2%), anxiolytics (51.6%), and mood stabilisers (38.7%). Outcomes were more frequently ascertained clinically (93.0%) and included: persistence of symptoms/comorbidities (67.4%), transition to psychosis (53.5%), and functional status (48.8%). We provide ten practical recommendations for implementation of CHR-P services. Health service knowledge summarised by the current study will facilitate translational efforts for implementation of CHR-P services worldwide.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Clinical and Health Psychology, Catholic University, Montevideo, Uruguay
| | - Marcello Cutroni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Olivier Andlauer
- Heads UP Service, East London NHS Foundation Trust, London, UK
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
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Leuci E, Quattrone E, Pellegrini P, Pelizza L. The "Parma-Early Psychosis" program: General description and process analysis after 5 years of clinical activity. Early Interv Psychiatry 2020; 14:356-364. [PMID: 31758672 DOI: 10.1111/eip.12897] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 10/05/2019] [Accepted: 10/19/2019] [Indexed: 01/08/2023]
Abstract
AIM From January 2013, the Parma Department of Mental Health developed a specific protocol of care (the "Parma-Early Psychosis" [Pr-EP] program) as a diffused service for early intervention in psychosis. The aims of the present research are (a) to describe the Pr-EP macroscopic organization and (b) to analyse specific process indicators across the first 5 years from its establishment. METHODS All participants were adolescent and adult help-seekers, aged 12-54 years, with a First Episode Psychosis (FEP) or at Ultra-High Risk for developing psychosis, according to well-defined diagnostic criteria. RESULTS At baseline, 358 individuals were offered a dedicated protocol of care and only 40 (11.8%) dropped out during the first year of intervention. In particular, an increase of referrals over time was notably found (especially in adolescence). Furthermore, Duration of Untreated Psychosis decreased over time. The baseline prevalence of FEP diagnosis was 61.4%, with schizophrenia as markedly prevalent Diagnostic and Statistical Manual of mental disorders, IV edition, Text Revised (DSM-IV-TR) diagnosis (41%). The vast majority of UHR individuals met criteria for "Attenuated Psychotic Symptoms" (>90%), and major depressive disorder was the most frequent diagnosis (>55%). Finally, we found considerable percentages of current history of substance abuse (>58%) and of comorbidity with DSM-IV-TR personality disorders (60%). CONCLUSIONS An "Early Intervention in psychosis" service in Italian child/adolescent and adult mental health services is feasible, also in adolescents, who have a high risk of falling through the child-adult service gap.
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Affiliation(s)
- Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Raballo A, Pelizza L. Familiarity for Serious Mental Illness in Help-Seeking Adolescents at Clinical High Risk of Psychosis. Front Psychiatry 2020; 11:552282. [PMID: 33488412 PMCID: PMC7819871 DOI: 10.3389/fpsyt.2020.552282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/27/2020] [Indexed: 01/24/2023] Open
Abstract
Aim: Ultrahigh-risk (UHR) individuals have an increased vulnerability to psychosis because of accumulating environmental and/or genetic risk factors. Although original research examined established risk factors for psychosis in the UHR state, these findings are scarce and often contradictory. The aims of this study were (a) to investigate the prevalence of severe mental illness (SMI) in family members of distinct subgroups of adolescents identified through the UHR criteria [i.e., non-UHR vs. UHR vs. first-episode psychosis (FEP)] and (b) to examine any relevant associations of family vulnerability and genetic risk and functioning deterioration (GRFD) syndrome with clinical and psychopathological characteristics in the UHR group. Methods: Adolescents (n = 147) completed an ad hoc sociodemographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States to investigate the clinical status. Results: More than 60% UHR patients had a family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI. A GRFD syndrome was detected in ~35% of UHR adolescents. GRFD adolescents showed baseline high levels of positive symptoms (especially non-bizarre ideas) and emotional disturbances (specifically, observed inappropriate affect). Conclusions: Our results confirm the importance of genetic and/or within-family risk factors in UHR adolescents, suggesting the crucial need of their early detection, also within the network of general practitioners, general hospitals, and the other community agencies (e.g., social services and school).
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Primary Care, Azienda Unità Sanitaria Locale (USL) di Parma, Parma, Italy
| | - Simona Pupo
- Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda Unità Sanitaria Locale (USL) di Parma, Parma, Italy
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9
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Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. The "Reggio Emilia At-Risk Mental States" program: A diffused, "liquid" model of early intervention in psychosis implemented in an Italian Department of Mental Health. Early Interv Psychiatry 2019; 13:1513-1524. [PMID: 31270956 DOI: 10.1111/eip.12851] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/25/2019] [Accepted: 06/09/2019] [Indexed: 12/26/2022]
Abstract
AIM From September 2012, the Reggio Emilia Department of Mental Health developed a specific program (the "Reggio Emilia At-Risk Mental States" [ReARMS] protocol) as a diffused, "liquid" infrastructure for early intervention in psychosis. Aims of the current study are (a) to describe the ReARMS macroscopic organization and (b) to examine specific process indicators during the first 5 years of clinical activity. METHODS All participants (n = 300) were young help-seekers, aged 13 to 35 years, who completed the Comprehensive Assessment of At-Risk Mental States (CAARMS). RESULTS At baseline, 95 (31.7%) participants did not meet CAARMS-defined criteria, while 205 (68.3%) were offered a dedicated protocol of care: 154 (75.1%) of them were enrolled in the program, 19 (9.3%) refused and 32 (15.6%) dropped out during the first year of treatment. Individuals enrolled in the ReARMS protocol were mainly referred by general practitioners (33.3%), emergency room/general hospital (24%) or they were self-referred (15%). In comparison with ultra-high risk individuals, patients with first episode psychosis showed significantly higher mean age at entry and preponderance of males, as well as higher percentages of history of substance abuse and previous hospitalization. CONCLUSIONS An early intervention in psychosis service in Italian child/adolescent and adult mental health services are feasible and clinically relevant, also in adolescents, who have a high risk of falling through the child-adult service gap as they cross the transition boundary between services.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi R Chiri
- Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Pupo
- Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Sant'Andrea University of Perugia, Perugia, Italy
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10
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Ferrara M, Tedeschini E, Baccari F, Musella V, Vacca F, Mazzi F, Ferri M, Srihari V, Starace F. Early intervention service for first episode psychosis in Modena, Northern Italy: The first hundred cases. Early Interv Psychiatry 2019; 13:1011-1017. [PMID: 30672134 DOI: 10.1111/eip.12788] [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: 09/27/2018] [Revised: 11/29/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
AIM To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. METHODS The 2-year service was offered to people aged 18-35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a "specialist within generalist" model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. RESULTS One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non-affective psychosis, yielding an estimated treated incidence of 19.1/105 . General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self-referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. CONCLUSIONS An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the "specialist within generalist" model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut.,Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Enrico Tedeschini
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Flavia Baccari
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Vincenzo Musella
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Francesca Vacca
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Fausto Mazzi
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Mila Ferri
- Servizio Assistenza Territoriale, Area Salute Mentale e Dipendenze Patologiche, Regione Emilia-Romagna, Bologna, Italy
| | - Vinod Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut
| | - Fabrizio Starace
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
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11
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Berze L, Civcisa S, Krone I, Kvartalovs D, Kikuste S, Sapele I, Lazovika J, Rancans E. Implementing the Latvian Early Intervention Program (LAT-EIP) for Patients With Schizophrenia Spectrum First-Episode Psychosis: Study Protocol. Front Psychiatry 2019; 10:829. [PMID: 31798475 PMCID: PMC6863883 DOI: 10.3389/fpsyt.2019.00829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Patients with first-episode psychosis are mainly young people in the active phase of their social and professional lives, and psychosis is a serious disruption of normal life with high risk of disability. Integrated biopsychosocial early intervention treatment is crucial for patients with first-time psychosis episode. The purpose of this trial is to adapt the first early intervention program for patients with first-time non-affective psychosis in Latvia, and to investigate whether it is possible to integrate this kind of treatment approach in the frame of existing services and whether it provides better outcomes for patients than existing services. Design/Methods: The study has a nonrandomized controlled design in a real-life environment. Participants are all consecutive patients presenting in the psychiatric emergency room with first-time non-affective schizophrenia spectrum psychosis episode (ICD criteria F23, F20) from a catchment area of 262,541 inhabitants, with urban and rural regions. The Latvian Early Intervention Program is a 6-month program developed from existing treatment guidelines and recommendations and adapted to a low-resource environment, integrated in an existing outpatient unit. This study aimed to test the hypothesis that the patients who received intervention have milder symptoms, higher functioning, and better adherence to outpatient treatment. The study primary aims are: 1) to establish and examine in practice the adapted early intervention for patients with first schizophrenia spectrum psychosis; 2) compare clinical and functional outcomes (including occupation, housing, and social relationships) between intervention treatment and standard treatment; and 3) compare the number of rehospitalizations, adherence to outpatient treatment, and assigned disability. Secondary aims are: 1) to compare full recovery status in both treatment groups at 12 months follow-up and 2) to develop recommendations for establishing early intervention programs in limited resource settings. Discussion/Conclusions: Across the world, there is wide inequality in the availably and accessibility to early intervention treatment. This study will increase our knowledge in early intervention treatment approach and outcomes for patients with schizophrenia spectrum first psychosis episode in real-life working clinical practices. We hope to provide theoretical and practical aspects to develop strategies for early intervention service implementation in limited resource mental healthcare settings.
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Affiliation(s)
- Liene Berze
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia.,Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Sandra Civcisa
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia.,Department of Psychiatry and Addiction Disorders, Riga Stradins University, Riga, Latvia
| | - Ilona Krone
- CBT Department, Latvian Association of Cognitive Behavioral Therapy, Riga, Latvia
| | - Dmitrijs Kvartalovs
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia.,Department of Psychiatry and Addiction Disorders, Riga Stradins University, Riga, Latvia
| | - Sarmite Kikuste
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Inna Sapele
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Jelena Lazovika
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Elmars Rancans
- Department of Psychiatry and Addiction Disorders, Riga Stradins University, Riga, Latvia
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12
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Monducci E, Battaglia C, Forte A, Masillo A, Telesforo L, Carlotto A, Piazzi G, Patanè M, De Angelis G, Romano A, Fagioli F, Girardi P, Cocchi A, Meneghelli A, Alpi A, Pafumi N, Moreno Granados N, Preti A, Masolo F, Benzoni S, Cavenaghi S, Molteni I, Salvadori L, Solbiati S, Costantino A, Di Lauro R, Piccinini A, Collins Eade A, Holmshaw J, Fiori Nastro P. Secondary school teachers and mental health competence: Italy-United Kingdom comparison. Early Interv Psychiatry 2018; 12:456-463. [PMID: 27172538 DOI: 10.1111/eip.12345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/14/2016] [Accepted: 03/28/2016] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate the differences between teachers' knowledge about early psychosis among three different Italian cities and a UK sample. METHODS The sample consisted of 556 secondary school teachers from three different cities in Italy (Milan, Rome and Lamezia Terme) and London (UK). The research was based on the Knowledge and Experience of Social Emotional Difficulties Among Young People Questionnaire. The Italian version of the questionnaire was used in Italy. RESULTS Overall, 67.6% of English teachers, 58.5% of Milan's teachers, 41.8% of Rome's teachers and 33.3% of Lamezia Terme's teachers were able to recognize psychotic symptoms from a case vignette. Logistic regression analysis showed that 'city' was the only independent variable significantly related to the correct/wrong answer about diagnosis. CONCLUSIONS We found statistically significant differences between the three Italian samples and the UK sample regarding teachers' knowledge about first signs of psychosis. English teachers showed a better knowledge than Italian teachers in general. Teachers from Milan, where a specific early detection program was established in 2000, seemed to be more familiar with early signs of psychosis than teachers in the other two Italian towns.
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Affiliation(s)
- Elena Monducci
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Claudia Battaglia
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto Forte
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alice Masillo
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Ludovica Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Gioia Piazzi
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Martina Patanè
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Romano
- Mental Health Department, Prevention and Early Intervention Mental Health (PIPSM), ASL Roma 1 (ex E), Rome, Italy
| | - Francesca Fagioli
- Mental Health Department, Prevention and Early Intervention Mental Health (PIPSM), ASL Roma 1 (ex E), Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelo Cocchi
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Anna Meneghelli
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Andrea Alpi
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Nicoletta Pafumi
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Noelia Moreno Granados
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Antonio Preti
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Francesca Masolo
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Benzoni
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Cavenaghi
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Molteni
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lavinia Salvadori
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Solbiati
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Costantino
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosalba Di Lauro
- Child and Adolescent Neuropsychiatric Unit, Melegnano Hospital, Milan, Italy
| | | | | | | | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
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13
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Cocchi A, Cavicchini A, Collavo M, Ghio L, Macchi S, Meneghelli A, Preti A. Implementation and development of early intervention in psychosis services in Italy: a national survey promoted by the Associazione Italiana Interventi Precoci nelle Psicosi. Early Interv Psychiatry 2018; 12:37-44. [PMID: 26416725 DOI: 10.1111/eip.12277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Abstract
AIM This is the first comprehensive, nationwide survey aimed at collecting evidence about the process of implementation and development of early intervention in psychosis (EIP) services (EIPs) in Italy, following the establishment of the pilot program 'Programma 2000' in 1999 and the publishing of the Italian National Guidelines in 2007. This survey covers all the Departments of Mental Health (DMHs) operating in Italy in 2013. METHODS Using a purpose-designed form to assess EIP implementation, all directors of public mental health services for adults throughout Italy (n = 216) were asked to provide information about the activities of EIP-relevant local services. The initial delivery was followed by a request for a prompt response. RESULTS Out of 216 enquired DMHs, 103 provided computable answers to the survey (response rate = 48%). Among responders, 45 (44%) reported the implementation of EIP (one out of five DMHs operating in Italy). About a half of the active EIPs also targeted patients at ultra-high risk of psychosis (n = 27). Strict application of guidelines related to drug prescription was reported in 35% of EIPs. Conversely, 90% provided some kind of structured psychotherapy and psychoeducation. Among EIPs, a minority reported willingness to provide initial assessment/contact at the patient's home. CONCLUSION Albeit slowly, the implementation of EIP is spreading throughout the Italian public network of mental health. There is still a wide variability in the distribution of EIP services across the Italian territory. Further efforts are necessary to stimulate policy endorsement and resource allocation, as well as to support the poorest zones.
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Affiliation(s)
- Angelo Cocchi
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Anna Cavicchini
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Marzia Collavo
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Lucio Ghio
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Genoa, Italy
| | - Sara Macchi
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Anna Meneghelli
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Antonio Preti
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy.,Psychiatry Branch, Genneruxi Medical Center, Cagliari, Italy.,Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
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14
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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