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Pelizza L, Leuci E, Quattrone E, Azzali S, Pupo S, Paulillo G, Pellegrini P, Menchetti M. Short-term disengagement from early intervention service for first-episode psychosis: findings from the "Parma Early Psychosis" program. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1201-1213. [PMID: 37831081 PMCID: PMC11178576 DOI: 10.1007/s00127-023-02564-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Service disengagement is a major concern for "Early Intervention in Psychosis" (EIP). Indeed, identifying predictors of engagement is crucial to maximize mental healthcare interventions in first-episode psychosis (FEP). No Italian study on this topic has been reported to date. Thus, the aims of this investigation were: (1) to examine short-term disengagement rate in an Italian population of FEP patients treated within an EIP service across a 1-year follow-up period, and (b) to assess the most relevant predictors of disengagement in the first year of treatment. METHODS All participants were young FEP help-seeking patients, aged 12-35 years, enrolled within the "Parma Early Psychosis" (Pr-EP) protocol. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS), the Health of the Nation Outcome Scale (HoNOS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were used. RESULTS 496 FEP individuals were enrolled in this research. Across the follow-up, a 16.5% prevalence of short-term disengagement was found. Particularly robust predictors of service disengagement were poor baseline treatment non-adherence, living with parents and the presence of brief psychotic disorder or schizophreniform disorder at entry. CONCLUSION About 16% of FEP patients disengaged the Pr-EP program within the first year of treatment. A solution to reduce disengagement and/or to favor re-engagement of these subjects might be to remain on EIP program caseloads allowing the option for low-intensity support and monitoring, also via remote technology.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum", Università di Bologna, Viale Pepoli, 5, 40126, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Giuseppina Paulillo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum", Università di Bologna, Viale Pepoli, 5, 40126, Bologna, BO, Italy
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Pugliese V, de Filippis R, Aloi M, Rotella P, Carbone EA, Gaetano R, De Fazio P. Aberrant salience correlates with psychotic dimensions in outpatients with schizophrenia spectrum disorders. Ann Gen Psychiatry 2022; 21:25. [PMID: 35786401 PMCID: PMC9250738 DOI: 10.1186/s12991-022-00402-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Aberrant salience is a well-known construct associated with the development and maintenance of psychotic symptoms in schizophrenia. However, only a few studies have investigated aberrance salience as a trait, with no study investigating the association between the five aberrant salience domains and psychotic symptoms. We aimed to explore the role of aberrant salience and its domains on psychotic dimensions in both clinically remitted and non-remitted patients. METHODS A sample of 102 patients diagnosed with schizophrenia spectrum disorders was divided according to the Positive and Negative Syndrome Scale (PANSS) remission criteria into two groups: remitted and non-remitted. Differences regarding psychotic symptomatology assessed by the PANSS and aberrant salience measured by the Aberrant Salience Inventory (ASI) were explored. Finally, a correlation analysis between the PANSS and the ASI was run. RESULTS Significantly higher ASI scores were evident among non-remitted patients. Positive symptoms (i.e. delusions, conceptual disorganization, and hallucinatory behaviour) and general psychopathology (i.e. postural mannerisms, unusual thought content) were correlated to the aberrant salience subscales 'sharpening of senses', 'heightened emotionality' and 'heightened cognition' and with the ASI total score. Significant correlations emerged between negative symptoms (blunted affect and social withdrawal) and 'heightened cognition'. Finally, lack of spontaneity of conversation was related to the subscales 'heightened emotionality' and 'heightened cognition', as well as to the ASI total score. CONCLUSIONS These preliminary results support the hypothesis of an association between aberrant salience and psychotic symptoms in schizophrenia. Further research is needed, especially into the mechanisms underlying salience processing, in addition to social and environmental factors and cognitive variables.
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Affiliation(s)
- Valentina Pugliese
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Matteo Aloi
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Paola Rotella
- Department of Mental Health of Catanzaro, Lamezia Terme, Italy
| | - Elvira Anna Carbone
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Raffaele Gaetano
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
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Poletti M, Pelizza L, Azzali S, Scazza I, Paterlini F, Garlassi S, Chiri LR, Pupo S, Raballo A. Association between psychosocial interventions and aberrant salience in adolescents with early psychosis: A follow-up study. Scand J Psychol 2022; 63:290-296. [PMID: 35285026 DOI: 10.1111/sjop.12806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Simona Pupo
- Service of Anesthesiology and Resuscitation, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
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Azzali S, Pelizza L, Scazza I, Paterlini F, Garlassi S, Chiri LR, Poletti M, Pupo S, Raballo A. Examining subjective experience of aberrant salience in young individuals at ultra-high risk (UHR) of psychosis: A 1-year longitudinal study. Schizophr Res 2022; 241:52-58. [PMID: 35086058 DOI: 10.1016/j.schres.2021.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022]
Abstract
Aberrant salience (AS) is considered as a predisposing factor in early psychosis. Although it has been frequently examined in the general population as a measure of vulnerability to psychotic disorder, empirical evidence on AS in prodromal phases of psychosis is still relatively scarce. Thus, the aims of this research were (1) to investigate any significant association of AS with functioning, psychopathology and treatment components of an "early intervention in psychosis" program in a sample of young community help-seekers at Ultra-High Risk (UHR) of psychosis along a 1-year follow-up period, and (2) to longitudinally monitor the stability of AS across the 1 year of follow-up. Participants (87 UHR), aged 13-35 years, completed the Aberrant Salience Inventory (ASI), the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the brief version of the Schizotypal Personality Questionnaire (SPQ-B) at baseline and after the 1 year of follow-up. Spearman correlation analyses among psychopathological parameters and specialized treatment components were performed. A multiple linear regression analysis was also carried out. After a 1-year follow-up period, UHR subjects had a statistically relevant decrease in ASI total scores. This was significantly related to the number of individual cognitive-behavioral therapy (CBT) sessions and the number of family psychoeducational sessions offered to UHR participants and their family members during the same 12-month period. In conclusion, AS is clinically relevant in UHR individuals. However, it seems to improve over time along with the delivery of tailored, specialized psychosocial interventions for early psychosis.
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Affiliation(s)
- Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy; Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1, 43100 Parma (PR), Italy.
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Primary Care, Azienda USL di Parma, Strada del Quartiere n. 2, 43100 Parma (PR), Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n. 2, 42100 Reggio Emilia (RE), Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy; Service of Anesthesiology and Resuscitation, Azienda Ospedaliera-Universitaria di Parma, Via Gramsci n. 14, 43100 Parma (PR), Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Sant'Andrea delle Fratte, 06156 Perugia (PG), Italy; Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Sant'Andrea delle Fratte, 06156 Perugia (PG), Italy
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