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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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2
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Williams R, Ostinelli EG, Agorinya J, Minichino A, De Crescenzo F, Maughan D, Puntis S, Cliffe C, Kurtulmus A, Lennox BR, Cipriani A. Comparing interventions for early psychosis: a systematic review and component network meta-analysis. EClinicalMedicine 2024; 70:102537. [PMID: 38516103 PMCID: PMC10955207 DOI: 10.1016/j.eclinm.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background 'Early Intervention in Psychosis' (EIP) services have been associated with improved outcomes for early psychosis. However, these services are heterogeneous and many provide different components of treatment. The impact of this variation on the sustained treatment effects is unknown. Methods We performed a systematic review and component network meta-analysis (cNMA) of randomised controlled trials (RCTs) that compared specialised intervention services for early psychosis. We searched CENTRAL (published and unpublished), EMBASE, MEDLINE, CINAHL, PsycINFO and Web of Science from inception to February 2023. Primary outcomes were negative and positive psychotic symptoms at 3-month and 1-year follow-up and treatment dropouts. Secondary outcomes were depressive symptoms and social functioning at 1-year follow-up. We registered a protocol for our study in PROSPERO (CRD42017057420). Findings We identified 37 RCTs including 4599 participants. Participants' mean age was 25.8 years (SD 6.0) and 64.0% were men. We found evidence that psychological interventions (this component grouped all psychological treatment intended to treat, or ameliorate the consequences of, psychotic symptoms) are beneficial for reducing negative symptoms (iSMD -0.24, 95% CI -0.44 to -0.05, p = 0.014) at 3-month follow-up and may be associated with clinically relevant benefits in improving social functioning scores at 1-year follow-up (iSMD -0.52, 95% CI -1.05 to 0.01, p = 0.052). The addition of case management has a beneficial effect on reducing negative symptoms (iSMD -1.17, 95% CI -2.24 to -0.11, p = 0.030) and positive symptoms (iSMD -1.05, 95% CI -2.02 to -0.08, p = 0.033) at 1-year follow-up. Pharmacotherapy was present in all trial arms, meaning it was not possible to examine the specific effects of this component. Interpretation Our findings suggest psychological interventions and case management in addition to pharmacotherapy as the core components of services for early psychosis to achieve sustained clinical benefits. Our conclusions are limited by the small number of studies and sparsely connected networks. Funding National Institute for Health and Care Research.
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Affiliation(s)
- Ryan Williams
- Department of Brain Sciences, Imperial College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Edoardo G. Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | - Amedeo Minichino
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Daniel Maughan
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Stephen Puntis
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Charlotte Cliffe
- Biomedical Research Centre, Kings College London, London, UK
- Surrey and Borders Partnership NHS Foundation Trust, UK
| | - Ayse Kurtulmus
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Belinda R. Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Tiller J, Maguire T, Newman-Taylor K. Early intervention in psychosis services: A systematic review and narrative synthesis of barriers and facilitators to seeking access. Eur Psychiatry 2023; 66:e92. [PMID: 37929296 PMCID: PMC10755576 DOI: 10.1192/j.eurpsy.2023.2465] [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: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The duration of untreated psychosis (DUP) continues to be a global priority. Early intervention services were established to reduce treatment delays but have had limited impact. This systematic review examines barriers and facilitators to seeking access to these services, to identify targets for service level change. METHODS We conducted a systematic review of relevant databases (PsychINFO, MEDLINE, CINAHL, and PsychARTICLES) using pre-defined search terms for psychosis, early intervention, and barriers and facilitators. Given the majority of qualitative studies, a thematic synthesis rather than meta-analysis was indicated. RESULTS The search yielded 10 studies. Mental health stigma and discrimination predict DUP, compounded by structural barriers which limit the impact of early intervention services on timely access to recommended treatments. Synthesis of the qualitative studies generated three themes: knowledge, relationships, and stigma. Lack of knowledge, absence of supportive relationships (social and professional), and self-stigma constitute significant barriers to seeking access to early intervention services. CONCLUSIONS This is the first review of the barriers and facilitators to seeking access to early intervention services. The findings highlight public health and secondary care service targets to expedite access to recommended treatments and thereby reduce the DUP.
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Affiliation(s)
- Jacqui Tiller
- School of Psychology, University of Southampton, Southampton, UK
| | - Tess Maguire
- School of Psychology, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Katherine Newman-Taylor
- School of Psychology, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
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4
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Williams R, Penington E, Gupta V, Tsiachristas A, French P, Lennox B, Bottle A, Crawford MJ. Predictors of positive outcomes from 'Early Intervention in Psychosis': protocol for a national retrospective cohort study. Front Psychiatry 2023; 14:1274820. [PMID: 38025474 PMCID: PMC10654738 DOI: 10.3389/fpsyt.2023.1274820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Psychotic disorders are severe and prevalent mental health conditions associated with long-term disability, reduced quality of life, and substantial economic costs. Early Intervention in Psychosis (EIP) services aim to provide timely and comprehensive treatment for psychotic disorders, and EIP service input is associated with improved outcomes. However, there is limited understanding of the specific components of EIP care that contribute to these improvements. There is significant nationwide variability in the commissioning and delivery of EIP, with individuals receiving different packages of components from different services. In this study, we seek to explore associations between EIP components and clinically significant outcomes, in order to understand the mechanisms underlying improved psychosis care. Methods This national retrospective cohort study will utilize data from the 2019 National Clinical Audit of Psychosis (NCAP), examining the care received by 10,560 individuals treated by EIP services in England. Exposure data from the NCAP, capturing the components of care delivered by EIP services, will be linked with outcome data from routine NHS Digital datasets over a three-year follow-up period. This will be the first study to use this method to examine this population in England. The primary outcomes will be surrogate measures of relapse of psychosis (hospital admission and referral to community-based crisis intervention services). Secondary outcomes include duration of admissions, emergency hospital attendances, episodes of detention under the Mental Health Act, and all-cause mortality. We will use multilevel regression to examine associations between exposures and outcome events. We will handle missing data using appropriate imputation techniques. Discussion This study aims to provide valuable insights into the long-term effects of variations in EIP service delivery. The study involves a large, diverse cohort including individuals treated by every EIP service in England. While there are limitations inherent in the observational nature of the study, any associations identified will be of great relevance to clinicians, researchers, and policymakers seeking to optimize EIP care. The results will enable more targeted treatment planning, resource allocation, and potential innovations in EIP care, ultimately leading to improved prognoses for people experiencing psychosis.
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Affiliation(s)
- Ryan Williams
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Royal College of Psychiatrists, London, United Kingdom
| | - Ed Penington
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Veenu Gupta
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | | | - Paul French
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Alex Bottle
- School of Public Health, Imperial College London, London, United Kingdom
| | - Mike J. Crawford
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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5
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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
- Correspondence: ; Tel.: +351-969654461
| | - 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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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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7
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Peebo K, Saluveer E, Küünarpuu H, Orgse T, Harro J. First-episode psychosis integrative treatment: Estonian experience. Nord J Psychiatry 2022; 76:207-214. [PMID: 34275409 DOI: 10.1080/08039488.2021.1946139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Research on first-episode psychosis early intervention has shown significant positive effects on psychopathological, functional and quality-of-life outcome measures. The effects reported have however been short-term and there is still only limited information about the long-term effects. This article will present the short-term results of an effectiveness study in a Baltic country and the first results of a registry-based long-term follow-up. METHODS One hundred and ninety-nine first-episode psychosis patients were included in the early intervention effectiveness study in 2004-2008, and 107 were available for a follow-up after two years. Registry-based ten-year follow-up (n = 116) was conducted with a retrospectively formed control group (n = 114). RESULTS Patients who received early intervention had substantial symptomatic improvement (BPRS score reduction > 50%) after 6 months of treatment, the Global Assessment of Functioning (GAF) scores were significantly improved after 6 months, and the quality of life after 12 months was significantly higher than at the beginning of treatment. After 2 years employment increased by 14% (43.9-57.9%). Long-term follow-up revealed that significantly fewer patients in the intervention group had been in supported housing compared to the control group. Patients in the intervention group had spent more time working during the follow-up period and had almost two times larger incomes, suggestive of higher employment/salary level. CONCLUSIONS Early intervention with flexible duration has positive long-term effects on the functioning of patients.
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Affiliation(s)
- Karola Peebo
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Erika Saluveer
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia
| | - Harri Küünarpuu
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia
| | - Teele Orgse
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia
| | - Jaanus Harro
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia.,Chair of Neuropsychopharmacology, Institute of Chemistry, Faculty of Science and Technology, University of Tartu, Tartumaa, Estonia
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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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9
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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: 52] [Impact Index Per Article: 13.0] [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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Maric NP, Andric Petrovic S, Rojnic-Kuzman M, Riecher-Rössler A. Implementation of early detection and intervention services for psychosis in Central and Eastern Europe: Current status. Early Interv Psychiatry 2019; 13:1283-1288. [PMID: 30900823 DOI: 10.1111/eip.12805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/10/2019] [Accepted: 02/17/2019] [Indexed: 11/28/2022]
Abstract
AIM Unequal development of early detection (ED) and early intervention (EI) programs/services for psychosis has been shown across Europe. The present report aims to fill in the knowledge gap regarding the implementation and several other important aspects of ED/EI services in Central and Eastern Europe (CEE), a region with highly underdeveloped mental health service research. METHODS A 17-item questionnaire was created to address the information regarding ED/EI organization and factors limiting their implementation. This questionnaire was distributed to professionals recognized as experts in the field from 23 CEE countries. The data were collected between December 2017 and February 2018. RESULTS We found that ED/EI services were rather an exception than a rule in CEE. The majority of the countries involved in the present survey reported no national plans or programmes for ED/EI development. The existing services were mostly state-funded, hospital-based, healthcare sites for both adolescent and adult help-seekers. The lack of adequate infrastructure, finances and governmental support, as well as the insufficient number of staff, were identified as the most important factors limiting service implementation. CONCLUSIONS Although ED/EI services for psychosis exist in some CEE countries, this could be largely attributed to enthusiastic individuals and organizations, rather than to a strategic development. To the best of our knowledge, this was the first mapping of ED/EI development in the region, which could be used as a starting point to plan the improvement of services, to accelerate their implementation and to facilitate timely detection of and intervention in psychosis across Europe.
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Affiliation(s)
- Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department for Research and Early Interventions in Psychiatry, Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Andric Petrovic
- Department for Research and Early Interventions in Psychiatry, Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Martina Rojnic-Kuzman
- Department of Psychiatry, Zagreb School of Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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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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