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Hirschtritt ME, Staglin B, Buttlaire S, Ahearn K, Oglesby S, Dixon LB, Shern D, Ewing T, Niendam TA. Reimbursement for a Broader Array of Services in Coordinated Specialty Care for Early Psychosis. Psychiatr Serv 2024; 75:932-934. [PMID: 38532691 DOI: 10.1176/appi.ps.20230551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Despite the growing evidence supporting the benefits of coordinated specialty care (CSC) for early psychosis, access to this multimodal, evidence-based program in the United States has been hindered by a lack of funding for core CSC services and activities. The recent approval of team-based reimbursement codes by the Centers for Medicare and Medicaid Services has the potential to fund substantially more CSC services for clients with insurance coverage that accepts the new team-based billing codes. This streamlined and more inclusive billing strategy may reduce administrative burden and support the financial viability of CSC programs.
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Affiliation(s)
- Matthew E Hirschtritt
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Brandon Staglin
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Stuart Buttlaire
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Kerry Ahearn
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Sarada Oglesby
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Lisa B Dixon
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - David Shern
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Toby Ewing
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Tara A Niendam
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
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Scarabelot LF, Araújo JM, Leal LR, Pessoa RMDP, Corsi-Zuelli F, Loureiro CM, Corrêa-Oliveira GE, Del-Ben CM. Disengagement from the Ribeirão Preto early intervention program for psychosis: A retrospective cohort study. Asian J Psychiatr 2024; 98:104119. [PMID: 38924943 DOI: 10.1016/j.ajp.2024.104119] [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: 12/23/2023] [Revised: 04/27/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Treatment discontinuation within Early Intervention Services (EIS) for psychosis poses a significant challenge to achieving better outcomes in the early stages of psychotic disorders. Prevalence and predictors of early disengagement from EIS located in low- and middle-income countries (LMICs) remain poorly investigated. We aimed to examine the rates and predictors of disengagement from the Ribeirão Preto Early Intervention Program for Psychosis (Ribeirão Preto-EIP) in Brazil. METHODS We conducted a retrospective cohort study using data from patients referred to the Ribeirão Preto-EIP between January 01, 2015, and December 31, 2018. Exclusion criteria were individuals with a single consultation, a diagnosis other than a psychotic disorder, and documented cases of death. RESULTS Our sample comprised 234 patients, with an overall median follow-up time of 14.2 months. Early treatment disengagement was observed in 26.5 % (n=62), with a median time to disengagement of 5.25 months. Univariable analysis identified non-white skin color (HR=2.10, 95 %CI 1.26-3.49), positive THC screening (HR=2.22, 95 %CI 1.23-4.01), and substance-induced psychosis (HR=2.15, 95 %CI 1.10-4.21) as significant predictors. In multivariable analysis, only non-white skin color remained a significant predictor of early disengagement (HR=1.87, 95 %CI 1.08-3.27). CONCLUSIONS The observed rates of early disengagement in our sample are similar to those reported in wealthy countries, but higher than previously reported for LMICs. Non-white skin color predicted early disengagement in our sample, probably due to social disadvantages. Our data highlights the need for enhanced research elucidating the specific features of EIS in LMICs.
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Affiliation(s)
- Luis Felipe Scarabelot
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | - Jéssica Morais Araújo
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Livio Rodrigues Leal
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Rebeca Mendes de Paula Pessoa
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiana Corsi-Zuelli
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Camila Marcelino Loureiro
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Gabriel Elias Corrêa-Oliveira
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Valle R, Singh SP, Loch AA, Iyer SN. How "global" is research in early intervention for psychosis? A bibliometric analysis. Asian J Psychiatr 2024; 98:104128. [PMID: 38964005 DOI: 10.1016/j.ajp.2024.104128] [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: 02/10/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Unlike high-income countries (HICs), there are few early intervention services for psychosis in low-and middle-income countries (LAMICs). In HICs, research spurred the growth of such services. Little is known about the state of EIP research in LAMICs, which we address by examining their research output and collaborations vis-à-vis that of HICs. METHODS We conducted a search in Scopus database for early psychosis publications in scientific journals since 1980. Data from each record, including title, author affiliation, and date, were downloaded. For HIC-LAMIC collaborations, data on first, corresponding and last authors' affiliations, and funding were manually extracted. Descriptive statistics and social network analysis were conducted. RESULTS Globally, early psychosis publications increased from 24 in 1980 to 1297 in 2022. Of 16,942 included publications, 16.1 % had LAMIC authors. 71.3 % involved authors from a single country (regardless of income level). 21.9 % were collaborations between HICs, 6.6 % between HICs and LAMICs, and 0.2 % among LAMICs. For research conducted in LAMICs and involving HIC-LAMIC collaborations, the first, last, and corresponding authors were LAMIC-based in 71.8 %, 60.7 %, and 63.0 %, respectively. These positions were dominated (80 %) by authors from four LAMICs. 29.4 % of the HIC-LAMIC subset was funded solely by LAMIC funders, predominantly two LAMICs. CONCLUSIONS LAMICs are starkly underrepresented in the otherwise flourishing body of early psychosis research. They have far fewer collaborations and less funding than HICs. Closing these gaps in LAMICs where most of the world's youth live is imperative to generate the local knowledge needed to strengthen early psychosis services that are known to improve outcomes.
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Affiliation(s)
- Ruben Valle
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Swaran P Singh
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; Research and Innovation, Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil; Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.
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Correll CU, Arango C, Fagerlund B, Galderisi S, Kas MJ, Leucht S. Identification and treatment of individuals with childhood-onset and early-onset schizophrenia. Eur Neuropsychopharmacol 2024; 82:57-71. [PMID: 38492329 DOI: 10.1016/j.euroneuro.2024.02.005] [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: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
Approximately 8 % of patients with schizophrenia are diagnosed before age 18, and 18 % experience their first symptoms before age 18. This narrative review explores the management of patients with early-onset schizophrenia (EOS) and childhood-onset schizophrenia (COS) from diagnosis to their transition to adult care settings. Early diagnosis of schizophrenia in children and adolescents is essential for improving outcomes, but delays are common due to overlapping of symptoms with developmental phenomena and other psychiatric conditions, including substance use, and lack of clinicians' awareness. Once diagnosed, antipsychotic treatment is key, with specific second-generation agents generally being preferred due to better tolerability and their broader efficacy evidence-base in youth. Dosing should be carefully individualized, considering age-related differences in drug metabolism and side effect liability. Clinicians must be vigilant in detecting early non-response and consider switching or dose escalation when appropriate. Since early age of illness onset is a consistent risk factor for treatment-resistant schizophrenia (TRS), clinicians need to be competent in diagnosing TRS and using clozapine. Since COS and EOS are associated with cognitive deficits and impaired functioning, psychosocial interventions should be considered to improve overall functioning and quality of life. Good long-term outcomes depend on continuous treatment engagement, and successful transitioning from pediatric to adult care requires careful planning, early preparation, and collaboration between pediatric and adult clinicians. Targeting functional outcomes and quality of life in addition to symptom remission can improve overall patient well-being. Comprehensive evaluations, age-specific assessments, and targeted interventions are needed to address the unique challenges of EOS and COS.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Birgitte Fagerlund
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences (GELIFES), Neurobiology, University of Groningen, the Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Germany; Department of Psychiatry, Department of Psychosis Studies, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Wykes T, Bell A, Carr S, Coldham T, Gilbody S, Hotopf M, Johnson S, Kabir T, Pinfold V, Sweeney A, Jones PB, Creswell C. Shared goals for mental health research: what, why and when for the 2020s. J Ment Health 2023; 32:997-1005. [PMID: 33966543 DOI: 10.1080/09638237.2021.1898552] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 02/08/2023]
Abstract
Mental health problems bring substantial individual, community and societal costs and the need for innovation to promote good mental health and to prevent and treat mental health problems has never been greater. However, we know that research findings can take up to 20 years to implement. One way to push the pace is to focus researchers and funders on shared, specific goals and targets. We describe a consultation process organised by the Department of Health and Social Care and convened by the Chief Medical Officer to consider high level goals for future research efforts and to begin to identify UK-specific targets to measure research impact. The process took account of new scientific methods and evidence, the UK context with a universal health care system (the NHS) and the embedded research support from the National Institute for Health Research Clinical Research Network, as well as the views of individual service users and service user organisations. The result of the consultation is a set of four overarching goals with the potential to be measured at intervals of three, five or ten years.
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Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andy Bell
- Centre for Mental Health, London, UK
| | - Sarah Carr
- School of Social Policy/Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Tina Coldham
- Participation, Involvement and Engagement Advisor to the NIHR Centre for Engagement and Dissemination, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | | | | | - Angela Sweeney
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Cathy Creswell
- Department of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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Hyam LE, Phillips M, Gracie L, Allen K, Schmidt U. Clinical staging across eating disorders: a scoping review protocol. BMJ Open 2023; 13:e077377. [PMID: 37993158 PMCID: PMC10668169 DOI: 10.1136/bmjopen-2023-077377] [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: 07/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Clinical staging models in psychiatry assert that there are earlier, less severe or more malleable forms of illness that are distinguishable from later, more chronic forms of illness, and that these stages may have different prognostic and treatment implications. Previous reviews on clinical staging in eating disorders (EDs) suggest a staging heuristic could be useful for anorexia nervosa, but less research is available on how this applies to other EDs. An up-to-date review is required to synthesise new and heterogenous avenues of research. This scoping review aims to explore the extent and types of evidence in relation to illness staging for EDs and how these concepts are associated with treatment response and outcomes. METHODS AND ANALYSIS This protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. We will consider any documents providing evidence for clinical staging such as those which describe full or partial staging models, for all EDs, across various domains of assessment and functioning. Participants will include clinical or non-clinical population samples with full-syndrome EDs or disordered eating behaviour. PubMed, PsycINFO, MEDLINE and Web of Science databases will be systematically searched for relevant literature. Two authors will export documents and screen titles, abstracts and full texts. Data will be extracted into a charting form drafted by the authors. A narrative summary of the documents will be conducted in line with the study aims. Finally, clinical and research recommendations will be outlined. ETHICS AND DISSEMINATION Ethical approval will not be required to synthesise published and unpublished literature. The study will be published in a peer-reviewed journal and shared at conferences, via social media, and in other communications.
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Affiliation(s)
- Lucy Elizabeth Hyam
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Matthew Phillips
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Lara Gracie
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham Medical School, Birmingham, UK
| | - Karina Allen
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
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Cohen DA, Klodnick VV, Reznik SJ, Lopez MA. Expanding Early Psychosis Care across a Large and Diverse State: Implementation Lessons Learned from Administrative Data and Clinical Team Leads in Texas. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:861-875. [PMID: 37530982 PMCID: PMC10543575 DOI: 10.1007/s10488-023-01285-8] [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] [Accepted: 06/29/2023] [Indexed: 08/03/2023]
Abstract
The U.S. is facing an unprecedented youth mental health crisis. Translating the findings from mental health intervention trials into large scale, accessible community-based services poses substantial challenges. Examination of state actions as a result of research-informed federal policy to improve youth access to quality mental healthcare is necessary. This mixed-methods study examines the implementation of evidence-informed multidisciplinary coordinated specialty care (CSC) for first-episode psychosis (FEP) services across Texas. The study explores CSC service model components, site location and participant characteristics, and implementation barriers. This cross-sectional study analyzes State of Texas public mental health administrative data from 2015 to 2020, including CSC site (n = 23) characteristics and CSC participant (n = 1682) demographics. Texas CSC site contracts were compared to OnTrackNY, a leading CSC model in the U.S. for CSC service element comparison. In-depth interviews with CSC Team Leads (n = 22) were analyzed to further understand CSC service elements and implementation barriers using qualitative content analysis. CSC was implemented across three waves in 2015, 2017, and 2019-serving 1682 participants and families. CSC sites were located in adult mental health programs; approximately one third of CSC participants were under 18 years. CSC implementation challenges reported by Team Leads included: staff role clarification, collaboration and turnover, community outreach and referrals, child and adult service billing issues, and adolescent and family engagement. Study findings have implications for large state-wide evidence-based practice implementation in transition-to-adulthood community mental health.
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Affiliation(s)
- Deborah A Cohen
- Dell Medical School Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, 1601 Trinity St., Bldg, B., Austin, TX, 78712, USA.
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
| | - Vanessa V Klodnick
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Samantha J Reznik
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Molly A Lopez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
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de Lacy N, Ramshaw MJ, McCauley E, Kerr KF, Kaufman J, Nathan Kutz J. Predicting individual cases of major adolescent psychiatric conditions with artificial intelligence. Transl Psychiatry 2023; 13:314. [PMID: 37816706 PMCID: PMC10564881 DOI: 10.1038/s41398-023-02599-9] [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: 06/03/2022] [Revised: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
Three-quarters of lifetime mental illness occurs by the age of 24, but relatively little is known about how to robustly identify youth at risk to target intervention efforts known to improve outcomes. Barriers to knowledge have included obtaining robust predictions while simultaneously analyzing large numbers of different types of candidate predictors. In a new, large, transdiagnostic youth sample and multidomain high-dimension data, we used 160 candidate predictors encompassing neural, prenatal, developmental, physiologic, sociocultural, environmental, emotional and cognitive features and leveraged three different machine learning algorithms optimized with a novel artificial intelligence meta-learning technique to predict individual cases of anxiety, depression, attention deficit, disruptive behaviors and post-traumatic stress. Our models tested well in unseen, held-out data (AUC ≥ 0.94). By utilizing a large-scale design and advanced computational approaches, we were able to compare the relative predictive ability of neural versus psychosocial features in a principled manner and found that psychosocial features consistently outperformed neural metrics in their relative ability to deliver robust predictions of individual cases. We found that deep learning with artificial neural networks and tree-based learning with XGBoost outperformed logistic regression with ElasticNet, supporting the conceptualization of mental illnesses as multifactorial disease processes with non-linear relationships among predictors that can be robustly modeled with computational psychiatry techniques. To our knowledge, this is the first study to test the relative predictive ability of these gold-standard algorithms from different classes across multiple mental health conditions in youth within the same study design in multidomain data utilizing >100 candidate predictors. Further research is suggested to explore these findings in longitudinal data and validate results in an external dataset.
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Affiliation(s)
- Nina de Lacy
- Huntsman Mental Health Institute, Salt Lake City, UT, 84103, USA.
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84103, USA.
| | - Michael J Ramshaw
- Huntsman Mental Health Institute, Salt Lake City, UT, 84103, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84103, USA
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - J Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
- AI Institute for Dynamical Systems, Seattle, WA, USA
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Chang SE, Lenartowicz A, Hellemann GS, Uddin LQ, Bearden CE. Variability in Cognitive Task Performance in Early Adolescence Is Associated With Stronger Between-Network Anticorrelation and Future Attention Problems. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:948-957. [PMID: 37881561 PMCID: PMC10593900 DOI: 10.1016/j.bpsgos.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/22/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Intraindividual variability (IIV) during cognitive task performance is a key behavioral index of attention and a consistent marker of attention-deficit/hyperactivity disorder. In adults, lower IIV has been associated with anticorrelation between the default mode network (DMN) and dorsal attention network (DAN)-thought to underlie effective allocation of attention. However, whether these behavioral and neural markers of attention are 1) associated with each other and 2) can predict future attention-related deficits has not been examined in a developmental, population-based cohort. Methods We examined relationships at the baseline visit between IIV on 3 cognitive tasks, DMN-DAN anticorrelation, and parent-reported attention problems using data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,878 participants, ages 9 to 10 years, female = 47.8%). We also investigated whether behavioral and neural markers of attention at baseline predicted attention problems 1, 2, and 3 years later. Results At baseline, greater DMN-DAN anticorrelation was associated with lower IIV across all 3 cognitive tasks (B = 0.22 to 0.25). Older age at baseline was associated with stronger DMN-DAN anticorrelation and lower IIV (B = -0.005 to -0.0004). Weaker DMN-DAN anticorrelation and IIV were cross-sectionally associated with attention problems (B = 1.41 to 7.63). Longitudinally, lower IIV at baseline was associated with less severe attention problems 1 to 3 years later, after accounting for baseline attention problems (B = 0.288 to 0.77). Conclusions The results suggest that IIV in early adolescence is associated with worsening attention problems in a representative cohort of U.S. youth. Attention deficits in early adolescence may be important for understanding and predicting future cognitive and clinical outcomes.
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Affiliation(s)
- Sarah E. Chang
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Agatha Lenartowicz
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
- Department of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lucina Q. Uddin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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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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11
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Williams R, Morris A, Gupta V, Penington E, Cullen AE, Quirk A, French P, Lennox B, Bottle A, Crawford MJ. Predictors of positive patient-reported outcomes from 'Early Intervention in Psychosis': a national cross-sectional study. BMJ MENTAL HEALTH 2023; 26:e300716. [PMID: 37541700 PMCID: PMC10577709 DOI: 10.1136/bmjment-2023-300716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The components of care delivered by Early Intervention in Psychosis (EIP) services vary, but the impact on patient experience is unknown. OBJECTIVE To investigate associations between components of care provided by EIP services in England and patient-reported outcomes. METHODS 2374 patients from EIP services in England were surveyed during the National Clinical Audit of Psychosis. Participants were asked about the care they received, and completed the 'Patient Global Impressions' Scale (rating whether their mental health had improved), and 'Friends and Family Test' (rating whether they would recommend their service). Information about service structure was obtained from service providers. We analysed associations between outcomes and components of care using multilevel regression. FINDINGS The majority of participants were likely to recommend the treatment they had received (89.8%), and felt that their mental health had improved (89.0%). Participants from services where care coordinators had larger case loads were less likely to recommend their care. Participants were more likely to recommend their care if they had been offered cognitive behavioural therapy for psychosis, family therapy or targeted interventions for carers. Participants were more likely to report that their mental health had improved if they had been offered cognitive behavioural therapy for psychosis or targeted interventions for carers. CONCLUSIONS Specific components of EIP care were associated with improved patient reported outcomes. Psychosocial interventions and carer support may be particularly important in optimising outcomes for patients. CLINICAL IMPLICATIONS These findings emphasise the need for small case load sizes and comprehensive packages of treatment in EIP services.
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Affiliation(s)
- Ryan Williams
- Department of Brain Sciences, Imperial College London, London, UK
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Aimee Morris
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Veenu Gupta
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Ed Penington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alexis E Cullen
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychosis Studies, King's College London, London, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Paul French
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Mike J Crawford
- Department of Brain Sciences, Imperial College London, London, UK
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12
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Jacinto RP, Ding T, Stafford J, Baio G, Kirkbride JB. The incidence of psychotic disorders in the Republic of Ireland: a systematic review. Ir J Psychol Med 2023:1-13. [PMID: 37522189 DOI: 10.1017/ipm.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Despite a substantial epidemiological literature on the incidence of psychotic disorders in Ireland, no systematic review has previously been undertaken. Such evidence can help inform understanding of need for psychosis care. METHODS We conducted a prospectively registered systematic review (PROSPERO: CRD42021245891) following PRISMA guidelines. We searched four databases (Medline, PsycInfo, Web of Science, Embase) for papers containing incidence data on non-organic psychotic disorders, in people 16-64 years, published between 1950 and 2021 in the general adult population. We conducted duplicate screening, risk of bias assessments, and extracted data to a standardised template. We undertook a narrative synthesis for each major diagnostic outcome. Random effects meta-analyses were conducted for comparisons with ≥5 incidence rates. RESULTS Our search yielded 1975 non-duplicate citations, of which 23 met inclusion criteria, containing incidence data ascertained between 1974 and 2016 (median study quality: 5/8; interquartile range: 4-6). Incidence of all psychotic disorders (N = 4 studies) varied from 22.0 (95%CI: 17.3-28.0) in Dublin to 34.1 per 100,000 person-years (95%CI: 31.0-37.5) in Cavan and Monaghan. The pooled incidence of schizophrenia (N = 6 studies, N = 8 settings) was 20.0 per 100,000 person-years, though with imprecision around this estimate (95%CI: 10.6-37.5; I2: 97.6%). Higher rates of most outcomes were observed in men. There was consistent evidence of raised rates in more deprived and fragmented social environments, but no clear pattern by rural-urban status. CONCLUSIONS Patterns of incidence of psychotic disorders in Ireland are broadly consistent with the wider literature from the Global North. Findings could help identify populations at higher risk of psychosis in Ireland.
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Affiliation(s)
| | - T Ding
- Department of Statistical Sciences, UCL, London, UK
| | - J Stafford
- Division of Psychiatry, UCL, London, UK
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - G Baio
- Department of Statistical Sciences, UCL, London, UK
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13
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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Barriers and facilitators to the implementation of an early intervention in psychosis service in three demonstration sites in Ireland. BMC Health Serv Res 2023; 23:653. [PMID: 37337176 DOI: 10.1186/s12913-023-09585-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Programmes for early intervention (EIP) in psychosis for people experiencing a first episode of psychosis (FEP) have been found to be both clinically and cost effective. Following the publication of a new EIP model of care (MoC) in Ireland, the aim of this research is to describe how people participated in and responded to the MoC including service users, family members, HSE clinical staff and HSE management. METHODS Qualitative design using the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were used. A total of N = 40 key informant semi-structured interviews were completed which included clinical staff (N = 22), health service managers and administrators (N = 9), service users (N = 8) and a family member (N = 1). Thematic analyses were conducted. RESULTS Unique features of the EIP service (e.g., speed of referral/assessment, multidisciplinary approach, a range of evidence-based interventions and assertive MDT follow up) and enthusiasm for EIP were identified as two key factors that facilitated implementation. In contrast, obstacles to staff recruitment and budget challenges emerged as two primary barriers to implementation. CONCLUSIONS The findings from this research provide real world insights into the complexity of implementing an innovative service within an existing health system. Clear and committed financial and human resource processes which allow new innovations to thrive and be protected during their initiation and early implementation phase are paramount. These elements should be considered in the planning and implementation of EIP services both nationally in Ireland and internationally.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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Gouveia M, Costa T, Morgado T, Sampaio F, Rosa A, Sequeira C. Intervention Programs for First-Episode Psychosis: A Scoping Review Protocol. NURSING REPORTS 2023; 13:273-283. [PMID: 36810277 PMCID: PMC9944946 DOI: 10.3390/nursrep13010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Early intervention programs for first-episode psychosis aim to intervene in the early stages of the disease. They are essential to prevent and delay the progression of the illness to a more advanced stage, but information about their characteristics is not systematized. The scoping review considered all studies of first-episode psychosis intervention programs, regardless of their context (hospital or community), and explored their characteristics. The scoping review was developed according to the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. The PCC mnemonic (population, concept, and context) addressed research questions, the inclusion and exclusion criteria, and the search strategy. The scoping review sought to identify the literature that meets the predefined inclusion criteria. The research was conducted in the following databases: Web of Science Core Collection, MEDLINE, CINAHL Complete and PsycINFO, Scopus, Cochrane Library, and JBI Evidence Synthesis. The search for unpublished studies included OpenGrey (a European repository) and MedNar. It used sources in English, Portuguese, Spanish, and French. It included quantitative, qualitative, and multi-method/mixed methods studies. It also considered gray or unpublished literature. After removing duplicates, two independent reviewers extracted the relevant information after selecting the articles. If there were disagreements, a third reviewer was used. The researchers have developed a tool based on the JBI model that will allow them to extract the relevant information for the review. The results are presented schematically in narratives and tables. This scoping review maps first-episode psychosis intervention programs by identifying their characteristics, participants, and specific implementation contexts and allows researchers to create multicomponent programs tailored to different contexts.
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Affiliation(s)
- Marta Gouveia
- Hospital Center of Tondela-Viseu, 3504-509 Viseu, Portugal
- Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
| | - Tiago Costa
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Hospital Center of Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
- Nursing School of Porto, 4200-072 Porto, Portugal
| | - Tânia Morgado
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Pediatric Hospital of the Centro Hospitalar e Universitário de Coimbra, 3000-602 Coimbra, Portugal
- Health Sciences Research Unit—Nursing (UICISA: E), Nursing School of Coimbra, 3000-232 Coimbra, Portugal
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Francisco Sampaio
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Nursing School of Porto, 4200-072 Porto, Portugal
| | - Amorim Rosa
- Health Sciences Research Unit—Nursing (UICISA: E), Nursing School of Coimbra, 3000-232 Coimbra, Portugal
- Nursing School of Coimbra, 3000-232 Coimbra, Portugal
| | - Carlos Sequeira
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Nursing School of Porto, 4200-072 Porto, Portugal
- Research Unit of the Nursing School of Porto, 4200-072 Porto, Portugal
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15
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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: 10] [Impact Index Per Article: 5.0] [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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16
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Millman ZB, Guvenek-Cokol PE, Kim HJ, Öngür D, Carol EE. The support, treatment, and resilience (STAR) program for youth at clinical high-risk of psychosis. Schizophr Res 2022; 248:122-123. [PMID: 36037644 DOI: 10.1016/j.schres.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Zachary B Millman
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America.
| | - P Esra Guvenek-Cokol
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
| | - Hyun Jung Kim
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
| | - Emily E Carol
- Psychotic Disorders Division, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02114, United States of America
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Affiliation(s)
- Robert K Heinssen
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Susan T Azrin
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
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18
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Tomaskova H, Kondrátová L, Winkler P, Addington D. Development and implementation of fidelity assessment in first episode psychosis services in Czechia: A pilot study. Early Interv Psychiatry 2022. [PMID: 36054065 DOI: 10.1111/eip.13350] [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: 03/29/2022] [Revised: 06/27/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to evaluate fidelity in first episode psychosis (FEP) teams in Czechia and to gage the feasibility and utility of the process in a mental health system that is undergoing a transformation. METHODS Fidelity assessment was conducted using The First Episode Psychosis Services Fidelity Scale (FEPS-FS). Fidelity assessment was based on a review of data abstracted from the health records of active clients, program documents, administrative data, and interviews with members of staff. The mean scores were compared across the teams. Feasibility and utility were assessed by program response to their fidelity results. RESULTS Three FEP teams were involved in the fidelity assessment. Across the 35 items, the mean fidelity score ranged from 2.5 to 3.1. Across the FEP teams, the percentage of the 35 items rated as 4 or 5 (satisfactory or exemplary) ranged from 34.3% to 51.4%. CONCLUSIONS This study provided an opportunity to implement FEPS-FS and assess fidelity in FEP teams in Czechia. The fidelity assessment also provided a baseline for measuring change.
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Affiliation(s)
- Hana Tomaskova
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia.,Department of Psychology, Charles University, Prague, Czechia
| | - Lucie Kondrátová
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Bertulies-Esposito B, Iyer S, Abdel-Baki A. The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:585-597. [PMID: 35014891 PMCID: PMC9301149 DOI: 10.1177/07067437211065726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Early intervention services for psychosis (EIS) are associated with improved clinical and economic outcomes. In Quebec, clinicians led the development of EIS from the late 1980s until 2017 when the provincial government announced EIS-specific funding, implementation support and provincial standards. This provides an interesting context to understand the impacts of policy commitments on EIS. Our primary objective was to describe the implementation of EIS three years after this increased political involvement. METHODS This cross-sectional descriptive study was conducted in 2020 through a 161-question online survey, modeled after our team's earlier surveys, on the following themes: program characteristics, accessibility, program operations, clinical services, training/supervision, and quality assurance. Descriptive statistics were performed. When relevant, we compared data on programs founded before and after 2017. RESULTS Twenty-eight of 33 existing EIS completed the survey. Between 2016 and 2020, the proportion of Quebec's population having access to EIS rose from 46% to 88%; >1,300 yearly admissions were reported by surveyed EIS, surpassing governments' epidemiological estimates. Most programs set accessibility targets; adopted inclusive intake criteria and an open referral policy; engaged in education of referral sources. A wide range of biopsychosocial interventions and assertive outreach were offered by interdisciplinary teams. Administrative/organisational components were less widely implemented, such as clinical/administrative data collection, respecting recommended patient-to-case manager ratios and quality assurance. CONCLUSION Increased governmental implementation support including dedicated funding led to widespread implementation of good-quality, accessible EIS. Though some differences were found between programs founded before and after 2017, there was no overall discernible impact of year of implementation. Persisting challenges to collecting data may impede monitoring, data-informed decision-making, and quality improvement. Maintaining fidelity and meeting provincial standards may prove challenging as programs mature and adapt to their catchment area's specificities and as caseloads increase. Governmental incidence estimates may need recalculation considering recent epidemiological data.
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Affiliation(s)
- Bastian Bertulies-Esposito
- Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, Canada.,Quebec Integrated University Centre for Health and Social Services of Centre-Sud-de-l'Ile-de-Montreal, Montreal, Canada.,177460Centre de recherche du CHUM, Montreal, Canada
| | - Srividya Iyer
- Department of Psychiatry, 5620McGill University, Montreal, Canada.,Montréal West Island Integrated University Health and Social Services Centre, Douglas Hospital Research Centre & Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, Canada.,177460Centre de recherche du CHUM, Montreal, Canada.,Clinique JAP (Early Intervention for Psychosis Clinic) and the Youth Mental Health Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
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20
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Corrêa-Oliveira GE, Scarabelot LF, Araújo JM, Boin AC, de Paula Pessoa RM, Leal LR, Del-Ben CM. Early intervention in psychosis in emerging countries: Findings from a first-episode psychosis programme in the Ribeirão Preto catchment area, southeastern Brazil. Early Interv Psychiatry 2022; 16:800-807. [PMID: 34794209 DOI: 10.1111/eip.13252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/27/2021] [Accepted: 11/07/2021] [Indexed: 12/15/2022]
Abstract
AIM People presenting with first-episode psychosis (FEP) can benefit from early intervention programmes. However, such programmes are scarce in low- and middle-income countries (LMICs). In Brazil, there are a few programmes, but they are unequally distributed across the country. We aimed to describe the implementation and performance of the Ribeirão Preto Early Intervention in Psychosis Programme (Ribeirão Preto-EIP), an outpatient service for patients presenting with FEP residing in the Ribeirão Preto catchment area in Southeastern Brazil. METHODS A detailed description of the service, staff and theoretical framework was compiled. Furthermore, a retrospective cohort study of patients attending the programme throughout 4 years (2015-2018) was conducted. Data were obtained by analysing the medical records of all patients, and sociodemographic and diagnostic stability information for this period was recorded. RESULTS The Ribeirão Preto-EIP had 358 new referrals during the study period. Among them, 237 patients were assessed for an average (median) duration of 14 months. Most patients were male (64.1%) and single (84.8%). The median age was 23.5 years (range, 9-86 years). Schizophrenia was the main diagnosis (43.4%), followed by substance-induced (25.7%) and affective (18.6%) psychosis. Referrals occurred from emergency, inpatient, community-based mental health and primary care services. CONCLUSIONS Programmes such as the Ribeirão Preto-EIP demonstrate that early intervention in psychosis is feasible in LMICs despite significant challenges for their access and integration in the health system. Strategic scale-up policies could be undertaken to offer better short- and long-term outcomes for individuals presenting with FEP and their families.
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Affiliation(s)
- Gabriel Elias Corrêa-Oliveira
- Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Luis Felipe Scarabelot
- Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jéssica Morais Araújo
- Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - André Campiolo Boin
- Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rebeca Mendes de Paula Pessoa
- Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Livio Rodrigues Leal
- Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Department of Neurosciences and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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21
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Arango C, Buitelaar JK, Correll CU, Díaz-Caneja CM, Figueira ML, Fleischhacker WW, Marcotulli D, Parellada M, Vitiello B. The transition from adolescence to adulthood in patients with schizophrenia: Challenges, opportunities and recommendations. Eur Neuropsychopharmacol 2022; 59:45-55. [PMID: 35550205 DOI: 10.1016/j.euroneuro.2022.04.005] [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: 01/03/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Schizophrenia is a severely debilitating neurodevelopmental disorder that requires continuous multidisciplinary treatment. Early onset schizophrenia (EOS, onset before 18) is associated with poorer outcomes than the adult-onset type. The transition from adolescent to adult mental healthcare services (AMHS) poses various challenges for maintaining continuity of care. The heterogeneous availability of specialized mental health services and resources for people with schizophrenia across Europe and the inadequacy of training programs in creating a shared culture and knowledge base between child and adult mental health professionals are major challenges at the policy level. More flexible and individualized transition timing is also needed. While changes in the relationship between patients, caregivers and mental health professionals at a time when young people should acquire full responsibility for their own care are challenges common to all mental health disorders, these are particularly relevant to the care of schizophrenia because of the severe associated disability. This Expert Opinion Paper examines the main aspects of transitioning of care in schizophrenia with the aim of identifying the challenges and the potential approaches that could enhance continuity of care.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, the Netherlands
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | | | | | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
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22
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Uchino T, Kotsuji Y, Kitano T, Shiozawa T, Iida S, Aoki A, Iwai M, Shirahata M, Seki A, Mizuno M, Tanaka K, Nemoto T. An integrated youth mental health service in a densely populated metropolitan area in Japan: Clinical case management bridges the gap between mental health and illness services. Early Interv Psychiatry 2022; 16:568-575. [PMID: 34743415 DOI: 10.1111/eip.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
AIMS A global movement, including in Asia, is seeking to establish integrated youth mental health services that provide early intervention in the continuum from mental health to mental illness. Clinical case management (CCM), in which a case manager becomes not only a coordinator of services but also a provider of psychosocial support, can establish a 'one-stop network' that supports youth in densely populated areas with various social resources. In 2019, we opened a community-based centre called 'SODA' in front of a metropolitan railway station, which was designed to be highly accessible, stigma-free and youth-friendly to provide CCM. We aimed to clarify its services and effectiveness of CCM. METHODS Data from 105 youths were investigated in a case-controlled study, dividing them into two groups: those who had received CCM for 6 months, and those whose needs were met in fewer sessions. RESULTS Twenty-one subjects who received CCM for 6 months had difficulties in more domains than the others. The mean of the total service minutes for the subjects who received CCM for 6 months was 491.3 min: psychological support (accounted for 24.8% of the time), support for community living (31.2%), work support (13.8%), family support (10.5%) and support for cooperation with other organizations (19.8%). Global Assessment of Functioning (GAF) score improved significantly, from 46.6 at baseline to 59.3 at 6 months. CONCLUSION Even in metropolitan areas with numerous medical facilities, young people can face high barriers to access. CCM can be effective as an early intervention for subjects developing mental illness.
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Affiliation(s)
- Takashi Uchino
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Yumi Kotsuji
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Tomoji Kitano
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Takuma Shiozawa
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Satomi Iida
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Akiko Aoki
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan
| | - Momoko Iwai
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan
| | - Masanori Shirahata
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Akihiko Seki
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Japan
| | - Kuniaki Tanaka
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan
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Ferrari M, Iyer S, LeBlanc A, Roy MA, Abdel-Baki A. A Rapid Learning Health System to Support Implementation of Early Intervention Services for Psychosis in Quebec, Canada: Study Protocol. (Preprint). JMIR Res Protoc 2022; 11:e37346. [PMID: 35852849 PMCID: PMC9346564 DOI: 10.2196/37346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Given the strong evidence of their effectiveness, early intervention services (EIS) for psychosis are being widely implemented. However, heterogeneity in the implementation of essential components remains an ongoing challenge. Rapid-learning health systems (RLHSs) that embed data collection in clinical settings for real-time learning and continuous quality improvement can address this challenge. Therefore, we implemented an RLHS in 11 EIS in Quebec, Canada. Objective This project aims to determine the feasibility and acceptability of implementing an RLHS in EIS and assess its impact on compliance with standards for essential EIS components. Methods Funding for this project was secured in July 2019, and ethics approval was received in December 2019. The implementation of this RLHS involves 6 iterative phases: external and internal scan, design, implementation, evaluation, adjustment, and dissemination. Multiple stakeholder groups (service users, families, clinicians, researchers, decision makers, and provincial EIS associations) are involved in all phases. Meaningful EIS quality indicators (eg, satisfaction and timeliness of response to referrals) were selected based on a literature review, provincial guidelines, and stakeholder consensus on prioritization of indicators. A digital infrastructure was designed and deployed comprising a user-friendly interface for routinely collecting data from programs; a digital terminal and mobile app to collect feedback from service users and families regarding care received, health, and quality of life; and data analytic, visualization, and reporting functionalities to provide participating programs with real-time feedback on their ongoing performance in relation to standards and to other programs, including tailored recommendations. Our community of practice conducts activities, leveraging insights from data to build program capacity while continuously aligning their practices with standards and best practices. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, we are collecting quantitative and qualitative data on the reach, effectiveness, adoption, implementation, and maintenance of our RLHS for evaluating its impacts. Results Phase 1 (identifying RLHS indicators for EIS based on a literature synthesis, a survey, and consensus meetings with all stakeholder groups) and phase 2 (developing and implementing the RLHS digital infrastructure) are completed (September 2019 to May 2020). Phases 3 to 5 have been ongoing (June 2020 to June 2022). Continuous data collection through the RLHS data capture platforms and real-time feedback to all stakeholders are deployed. Phase 6 will be implemented in 2022 to assess the impact of the RLHS using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework with quantitative and qualitative data. Conclusions This project will yield valuable insights into the implementation of RLHS in EIS, offering preliminary evidence of its acceptability, feasibility, and impacts on program-level outcomes. The findings will refine our RLHS further and advance approaches that use data, stakeholder voices, and collaborative learning to improve outcomes and quality in services for psychosis. International Registered Report Identifier (IRRID) DERR1-10.2196/37346
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Affiliation(s)
- Manuela Ferrari
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Srividya Iyer
- Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Annie LeBlanc
- Department of Family Medicine, Laval University, Quebec, QC, Canada
- Vitam - Centre de recherche en santé durable, Laval University, Quebec, QC, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Quebec, QC, Canada
- Cervo Brain Research Centre, Quebec, QC, Canada
| | - Amal Abdel-Baki
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
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24
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The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases. Epidemiol Psychiatr Sci 2022; 31:e15. [PMID: 35156603 PMCID: PMC8851066 DOI: 10.1017/s2045796022000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). METHODS Thirty-one clinical indicators concerning accessibility, appropriateness, continuity and safety were defined and estimated using healthcare utilisation (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions. RESULTS A total of 70 586 prevalent patients with schizophrenia and related disorders treated in 2015 were identified, of whom 1752 were newly taken-in-care by the facilities of regional mental health services. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a General Hospital Psychiatric Ward (GHPW); higher values were identified in new cases. In general hospitals, few patients had a length of stay (LoS) of more than 30 days, while one-fifth of the admissions were followed by readmission within 30 days of discharge. For two-thirds of patients, continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within 2 weeks. For cases newly taken-in-care, the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent in all the quality domains. CONCLUSIONS The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.
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25
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McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. World Psychiatry 2022; 21:61-76. [PMID: 35015367 PMCID: PMC8751571 DOI: 10.1002/wps.20938] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental ill-health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID-19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co-designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad-spectrum, integrated primary youth mental health care services. They represent a blueprint and beach-head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, "soft entry" youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill-health in young people globally demands that this focus be elevated to a top priority in global health.
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Affiliation(s)
- Patrick D McGorry
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Cristina Mei
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Craig Hodges
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eóin Killackey
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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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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27
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Samburskis D, Renemane L. Premorbid personality and cognitive function impact on schizophrenia. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2021. [DOI: 10.1002/pnp.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daniels Samburskis
- Dr Samburskis is a Psychiatrist at Riga Center of Psychiatry and Addiction Disorders, Riga, Latvia
| | - Lubova Renemane
- Professor Renemane is Assistant Professor at Department of Psychiatry and Addiction, Riga Stradins University, Latvia
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28
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McDonald K, Ding T, Ker H, Dliwayo TR, Osborn DP, Wohland P, Coid JW, French P, Jones PB, Baio G, Kirkbride JB. Using epidemiological evidence to forecast population need for early treatment programmes in mental health: a generalisable Bayesian prediction methodology applied to and validated for first-episode psychosis in England. Br J Psychiatry 2021; 219:383-391. [PMID: 34475575 PMCID: PMC7611597 DOI: 10.1192/bjp.2021.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mental health policy makers require evidence-based information to optimise effective care provision based on local need, but tools are unavailable. AIMS To develop and validate a population-level prediction model for need for early intervention in psychosis (EIP) care for first-episode psychosis (FEP) in England up to 2025, based on epidemiological evidence and demographic projections. METHOD We used Bayesian Poisson regression to model small-area-level variation in FEP incidence for people aged 16-64 years. We compared six candidate models, validated against observed National Health Service FEP data in 2017. Our best-fitting model predicted annual incidence case-loads for EIP services in England up to 2025, for probable FEP, treatment in EIP services, initial assessment by EIP services and referral to EIP services for 'suspected psychosis'. Forecasts were stratified by gender, age and ethnicity, at national and Clinical Commissioning Group levels. RESULTS A model with age, gender, ethnicity, small-area-level deprivation, social fragmentation and regional cannabis use provided best fit to observed new FEP cases at national and Clinical Commissioning Group levels in 2017 (predicted 8112, 95% CI 7623-8597; observed 8038, difference of 74 [0.92%]). By 2025, the model forecasted 11 067 new treated cases per annum (95% CI 10383-11740). For every 10 new treated cases, 21 and 23 people would be assessed by and referred to EIP services for suspected psychosis, respectively. CONCLUSIONS Our evidence-based methodology provides an accurate, validated tool to inform clinical provision of EIP services about future population need for care, based on local variation of major social determinants of psychosis.
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Affiliation(s)
| | - Tao Ding
- Department of Statistical Sciences, University College London, UK
| | - Hannah Ker
- Division of Psychiatry, University College London, UK
| | | | | | - Pia Wohland
- School of Earth and Environmental Sciences, University of Queensland, Australia; Hull-York Medical School, University of Hull, UK
| | - Jeremy W. Coid
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, China
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | | | - Gianluca Baio
- Department of Statistical Sciences, University College London, UK
| | - James B. Kirkbride
- Division of Psychiatry, University College London, UK,Correspondence: James B. Kirkbride.
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Bourgeois C, Lecomte T, McDuff P, Daigneault I. Child Sexual Abuse and Age at Onset of Psychotic Disorders: A Matched-cohort Study: L'âge d'apparition des troubles psychotiques chez les victimes d'agression sexuelle à l'enfance: Une étude prospective de cohortes appariées. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:569-576. [PMID: 33155838 PMCID: PMC8138738 DOI: 10.1177/0706743720970853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Victims of child sexual abuse (CSA) present with a higher risk of psychotic disorders. However, the developmental course of psychosis following CSA, such as the age at onset, remains unknown. This study aimed to determine whether the age at onset of psychotic disorders was influenced by sexual abuse, sex, and confounding factors (substance misuse, intellectual disability, and socioeconomic status). METHOD A prospective matched-cohort design was used, with administrative databases from a child protection agency (CPA) and a public health system. Children who received a substantiated report of CSA at the CPA and whose health data could be retrieved were selected (n = 882) and matched with children from the general population using their date of birth, sex, and geographical area. Survival analysis was performed to estimate the association between sexual abuse, sex, and confounding factors and the age at onset of psychotic disorders. RESULTS Sexual abuse and substance misuse are significantly associated with the age at onset of psychotic disorders. In the sexually abused group, only substance misuse is associated with the age at onset of psychotic disorders, but this was not significant for the general population. CONCLUSIONS These findings highlight the importance of prevention of psychotic disorders among sexually abused youth, especially those with a substance misuse diagnosis.
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Affiliation(s)
| | - Tania Lecomte
- Department of Psychology, 5622Université de Montréal, Quebec, Canada
| | - Pierre McDuff
- Department of Psychology, 5622Université de Montréal, Quebec, Canada
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30
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Addington D, Cheng CC, French P, Killackey E, Melau M, Meneghelli A, Nordentoft M, Nossel I, Preti A, Smith J. International application of standards for health care quality, access and evaluation of services for early intervention in psychotic disorders. Early Interv Psychiatry 2021; 15:723-730. [PMID: 32449289 DOI: 10.1111/eip.12990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022]
Abstract
AIM Standards for health care quality, access and evaluation of early intervention in psychosis services are required to assess implementation, provide accountability to service users and funders and support quality assurance. The aim of this article is to review the application of standards in Europe and North America. METHODS Descriptive methods will be used to illustrate the organizational context in which standards are being applied and used, specific measures being applied and results so far. RESULTS Both fidelity scales and quality indicators of health care are being used. Fidelity scales are being applied in Australia, Canada, Denmark, Italy and United States. In England, quality indicators derived from the National Institute for Health and Care Excellence guidance are being used. CONCLUSION In the last 4 years, significant progress has been made in the development and application of measures that assess quality and access to evidence-based practices for early intervention in psychosis services. This represents an important step towards providing accountability, improving outcomes and service user experience. The methods used allow for comparison between the services that are assessed with the same methods, but there is a need to compare the different methods. Further research is also required to explore links between quality of care and outcomes for community mental health services that deliver early intervention in psychotic disorders.
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Affiliation(s)
- Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | | | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Eoin Killackey
- Division Medicine, Dentistry And Health Sciences, Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Marianne Melau
- Psychiatric Centre Copenhagen, University of Copenhagen, Denmark
| | - Anna Meneghelli
- Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, Programma 2000, Milan, Italy
| | - Merete Nordentoft
- University of Copenhagen · Psychiatric Center Copenhagen, Psychiatric Center Copenhagen, Denmark
| | - Ilana Nossel
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Antonio Preti
- Genneruxi Medical Center, Programma 2000, Milan, Italy
| | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, UK
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31
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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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Howes OD, Whitehurst T, Shatalina E, Townsend L, Onwordi EC, Mak TLA, Arumuham A, O’Brien O, Lobo M, Vano L, Zahid U, Butler E, Osugo M. The clinical significance of duration of untreated psychosis: an umbrella review and random-effects meta-analysis. World Psychiatry 2021; 20:75-95. [PMID: 33432766 PMCID: PMC7801839 DOI: 10.1002/wps.20822] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The idea that a longer duration of untreated psychosis (DUP) leads to poorer outcomes has contributed to extensive changes in mental health ser-vices worldwide and has attracted considerable research interest over the past 30 years. However, the strength of the evidence underlying this notion is unclear. To address this issue, we conducted an umbrella review of available meta-analyses and performed a random-effects meta-analysis of primary studies. MEDLINE, Web of Science, PsycINFO and EMBASE were searched from inception to September 3, 2020 to identify relevant meta-analyses of studies including patients with schizophrenia spectrum disorders, first-episode psychosis, or affective and non-affective psychosis. Thirteen meta-analyses were included, corresponding to 129 individual studies with a total sample size of 25,657 patients. We detected potential violations of statistical assumptions in some of these meta-analyses. We therefore conducted a new random-effects meta-analysis of primary studies. The association between DUP and each outcome was graded according to a standardized classification into convincing, highly suggestive, suggestive, weak, or non-significant. At first presentation, there was suggestive evidence for a relationship between longer DUP and more severe negative symptoms (beta=-0.07, p=3.6×10-5 ) and higher chance of previous self-harm (odds ratio, OR=1.89, p=1.1×10-5 ). At follow-up, there was highly suggestive evidence for a relationship between longer DUP and more severe positive symptoms (beta=-0.16, p=4.5×10-8 ), more severe negative symptoms (beta=-0.11, p=3.5×10-10 ) and lower chance of remission (OR=2.16, p=3.0×10-10 ), and suggestive evidence for a relationship between longer DUP and poorer overall functioning (beta=-0.11, p=2.2×10-6 ) and more severe global psychopathology (beta=-0.16, p=4.7×10-6 ). Results were unchanged when analysis was restricted to prospective studies. These effect sizes are clinically meaningful, with a DUP of four weeks predicting >20% more severe symptoms at follow-up relative to a DUP of one week. We conclude that DUP is an important prognostic factor at first presentation and predicts clinically relevant outcomes over the course of illness. We discuss conceptual issues in DUP research and methodological limitations of current evidence, and provide recommendations for future research.
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Affiliation(s)
- Oliver D. Howes
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | - Thomas Whitehurst
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Ekaterina Shatalina
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Leigh Townsend
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
| | - Ellis Chika Onwordi
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | | | - Atheeshaan Arumuham
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | - Oisín O’Brien
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Maria Lobo
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Luke Vano
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Uzma Zahid
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Emma Butler
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley Foundation NHS TrustMaudsley HospitalLondonUK
| | - Martin Osugo
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,MRC London Institute of Medical SciencesHammersmith HospitalLondonUK,Institute of Clinical Sciences, Faculty of MedicineImperial College LondonLondonUK
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Bertulies-Esposito B, Abdel-Baki A, Conus P, Krebs MO. L’union fait la force : initier un mouvement francophone national et international pour l’implantation de l’intervention précoce. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088189ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ayesa-Arriola R, Ortíz-García de la Foz V, Martínez-García O, Setién-Suero E, Ramírez ML, Suárez-Pinilla P, Mayoral-van Son J, Vázquez-Bourgon J, Juncal-Ruiz M, Gómez-Revuelta M, Tordesillas-Gutiérrez D, Crespo-Facorro B. Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort. Psychol Med 2021; 51:264-277. [PMID: 31736458 DOI: 10.1017/s0033291719003179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of the current study was to examine the heterogeneity of functional outcomes in first episode psychosis (FEP) patients and related clinical, neurocognitive and sociodemographic factors using a cluster analytic approach. METHOD A large sample of FEP patients (N = 209) was functionally reassessed 10 years after the first contact with an early intervention service. Multiple baseline, 3-year and 10-year follow-up variables were explored. RESULTS The cluster analysis emphasized the existence of six independent clusters of functioning: one cluster was normal overall (42.16%), two clusters showed moderate interpersonal (9.63%) or instrumental (12.65%) deficits, two clusters showed more severe interpersonal (12.05%) or interpersonal and instrumental (13.85%) deficits and there was a significantly overall impaired cluster (9.63%). Cluster comparisons showed that several baseline and follow-up factors were differentially involved in functional outcomes. CONCLUSIONS The current study demonstrated that distinct clusters of functioning in FEP patients can be identified. The fact that a variety of profiles was observed contributes to a better understanding of the nature of the heterogeneity characterizing FEP patients and has clinical implications for developing individualized treatment plans.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Víctor Ortíz-García de la Foz
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Obdulia Martínez-García
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Esther Setién-Suero
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - María Luz Ramírez
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Paula Suárez-Pinilla
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Jacqueline Mayoral-van Son
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Sierrallana Hospital, Torrelavega, Cantabria, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - María Juncal-Ruiz
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Sierrallana Hospital, Torrelavega, Cantabria, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Diana Tordesillas-Gutiérrez
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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Bertulies-Esposito B, Sicotte R, Iyer SN, Delfosse C, Girard N, Nolin M, Villeneuve M, Conus P, Abdel-Baki A. Détection et intervention précoce pour la psychose : pourquoi et comment ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088178ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Kotlicka-Antczak M, Podgórski M, Oliver D, Maric NP, Valmaggia L, Fusar-Poli P. Worldwide implementation of clinical services for the prevention of psychosis: The IEPA early intervention in mental health survey. Early Interv Psychiatry 2020; 14:741-750. [PMID: 32067369 DOI: 10.1111/eip.12950] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 12/31/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Clinical research into the Clinical High Risk state for Psychosis (CHR-P) has allowed primary indicated prevention in psychiatry to improve outcomes of psychotic disorders. The strategic component of this approach is the implementation of clinical services to detect and take care of CHR-P individuals, which are recommended by several guidelines. The actual level of implementation of CHR-P services worldwide is not completely clear. AIM To assess the global geographical distribution, core characteristics relating to the level of implementation of CHR-P services; to overview of the main barriers that limit their implementation at scale. METHODS CHR-P services worldwide were invited to complete an online survey. The survey addressed the geographical distribution, general implementation characteristics and implementation barriers. RESULTS The survey was completed by 47 CHR-P services offering care to 22 248 CHR-P individuals: Western Europe (51.1%), North America (17.0%), East Asia (17.0%), Australia (6.4%), South America (6.4%) and Africa (2.1%). Their implementation characteristics included heterogeneous clinical settings, assessment instruments and length of care offered. Most CHR-P patients were recruited through mental or physical health services. Preventive interventions included clinical monitoring and crisis management (80.1%), supportive therapy (70.2%) or structured psychotherapy (61.7%), in combination with pharmacological treatment (in 74.5%). Core implementation barriers were staffing and financial constraints, and the recruitment of CHR-P individuals. The dynamic map of CHR-P services has been implemented on the IEPA website: https://iepa.org.au/list-a-service/. CONCLUSIONS Worldwide primary indicated prevention of psychosis in CHR-P individuals is possible, but the implementation of CHR-P services is heterogeneous and constrained by pragmatic challenges.
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Affiliation(s)
| | - Michał Podgórski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade & Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, 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.,OASIS service, South London and Maudsley NHS Foundation Trust, 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
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37
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Bertulies-Esposito B, Nolin M, Iyer SN, Malla A, Tibbo P, Otter N, Ferrari M, Abdel-Baki A. Où en sommes-nous? An Overview of Successes and Challenges after 30 Years of Early Intervention Services for Psychosis in Quebec: Où en sommes-nous? Un aperçu des réussites et des problèmes après 30 ans de services d'intervention précoce pour la psychose au Québec. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:536-547. [PMID: 31910659 PMCID: PMC7492883 DOI: 10.1177/0706743719895193] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address. METHODS Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations. RESULTS Half of Quebec's population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient-clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up. CONCLUSIONS Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.
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Affiliation(s)
- Bastian Bertulies-Esposito
- Department of Psychiatry, Université de Montréal, Montreal, Quebec,
Canada
- Centre de recherche du Centre hospitalier de l’Université de
Montréal, Montreal, Quebec, Canada
| | - Marie Nolin
- Hôpital Pierre-Le Gardeur, Terrbonne, Quebec, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP),
Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP),
Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
| | - Phil Tibbo
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicola Otter
- Canadian Consortium for Early Intervention in Psychosis, Hamilton,
Ontario, Canada
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
- Douglas Mental Health University Institute, Montreal, Quebec,
Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Université de Montréal, Montreal, Quebec,
Canada
- Centre de recherche du Centre hospitalier de l’Université de
Montréal, Montreal, Quebec, Canada
- Clinique Jeunes adultes psychotiques, Centre hospitalier de
l’Université de Montréal, Montreal, Quebec, Canada
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Coentre R, Levy P. Early intervention in psychosis: The first national survey in Portugal. Schizophr Res 2020; 218:298-299. [PMID: 32192795 DOI: 10.1016/j.schres.2020.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Ricardo Coentre
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal.
| | - Pedro Levy
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal
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Miglietta E, Lasalvia A, Bonetto C, Comacchio C, Cristofalo D, Tosato S, De Santi K, Petterlini S, Zanatta G, Cremonese C, Ramon L, Ruggeri M. Pathways to care, DUP, and types of interventions over 5 years following psychosis onset: findings from a naturalistic study conducted in routine generalist mental health services. Soc Psychiatry Psychiatr Epidemiol 2020; 55:175-186. [PMID: 31511926 DOI: 10.1007/s00127-019-01775-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/04/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To describe pathways to care, duration of untreated psychosis (DUP), and types of interventions provided to first-episode psychosis (FEP) patients by routine Italian mental health services over 5 years since the first service contact. METHODS Naturalistic study conducted in Veneto, within the context of the Psychosis Incident Cohort Outcome Study (PICOS). A comprehensive set of measures was used, including schedules designed to collect information on referrals to psychiatric services and on psychological and pharmacological treatments at 1, 2, and 5 years since first service contact. RESULTS Overall, 397 patients were assessed. Most engaged with services with the help of family members (47.4%) and through emergency routes (60.3%). Those referred by clinicians were more likely to access care in a non-emergency way. Mean DUP was 5.62 months (SD 11.8) and longer DUP was associated with poorer functioning at 2 and 5 years. Interventions provided over 5 years were mainly constituted by antipsychotic medications (95.4% at 1 year; 85.8% at 2 years; 80.6% at 5 years), whereas a lower percentage (69.1% at 1 year; 61.5% at 2 years; 44.9% at 5 years) also received some forms of psychological interventions, mainly consisting of unspecific support sessions. Other structured interventions, such as CBT or family interventions, were seldom provided at each time-point. CONCLUSIONS Mental health services in Veneto seem effective in engaging FEP patients within a short time since illness onset. However, type of care provided does not meet quality standards recommended by treatment guidelines, especially regarding psychological interventions.
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Affiliation(s)
- Elisabetta Miglietta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. .,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy.
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Katia De Santi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Sara Petterlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Gioia Zanatta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Cremonese
- Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Luana Ramon
- Department of Mental Health, NHS, Local Health Authority Portogruaro (VE), Portogruaro, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
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40
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Coentre R, Mendes T, Rebelo A, Fonseca A, Levy P. PROFIP: A Portuguese early intervention programme for first-episode psychosis in Lisbon. Early Interv Psychiatry 2019; 13:1525-1529. [PMID: 31264775 DOI: 10.1111/eip.12852] [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: 12/13/2018] [Revised: 04/25/2019] [Accepted: 06/09/2019] [Indexed: 12/15/2022]
Abstract
AIM There is currently no national plan for early intervention in first-episode psychosis in Portugal. Consequently, there is some heterogeneity in the evaluation and treatment of first-episode psychosis across the country. The aim of this article is to provide a complete description of the early intervention programme Programa de Intervenção nas Fases Iniciais da Psicose (PROFIP) in Lisbon, a pioneering team in Portugal for treating first-episode psychosis (FEP) patients. We also describe the baseline socio-demographic and clinical data obtained from new patients over a 1-year period. PROFIP programme accepts all cases of FEP, taking a transdiagnostic approach. METHODS Description of PROFIP programme and baseline socio-demographic and clinical data obtained from new patients over a 1-year period. RESULTS The team was constituted to provide early detection, treatment and support to people aged 16 to 35 years with affective and non-affective FEP. Over a 1-year period, 39 patients were included in the PROFIP programme. The majority of patients were young male patients with a diagnosis of non-affective psychosis, and with 56% of patients reporting cannabis use. Patients received pharmacological and psychosocial interventions based on evidence and individual needs. CONCLUSIONS Our team allowed young people with early psychosis to receive effective care. We do need improvements, namely in referrals and the education of health professionals. More teams in our country should be constituted, allowing larger numbers of patients with early psychosis to be treated by specialized teams.
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Affiliation(s)
- Ricardo Coentre
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Tiago Mendes
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana Rebelo
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Alexandra Fonseca
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Pedro Levy
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
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Abstract
Early intervention in psychosis (EIP) services are now a priority for Ireland’s Health Service Executive (HSE). A Model of Care for EIP services has been completed after wide consultation. It has just been launched by the Minister for Mental Health and the aim now is to roll out EIP services throughout the country. The Model of Care outlines the rational, configuration, resources, governance, and quality assurance required to operate EIP services. Two models are recommended. The first is a Hub & Spoke service model for rural and smaller urban areas. The second is a Stand-Alone service model for large urban and metropolitan areas. Introducing EIP services is going to be a challenge but there are plenty of good examples overseas. They have been shown to greatly enhance local services’ ability to meet the needs of people developing psychotic disorders. They bring with them better outcomes, service satisfaction and cost savings.
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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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