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Bennett ME, Medoff D, Cowan T, Fang L, Kacmarek C, Oikonomou MT, Calkins ME, Baker KK, Bencivengo D, Boumaiz Y, Buchanan RW, Campbell P, Chengappa KNR, Conroy CG, Cooke A, Dong F, Fauble M, Goldberg RW, Harvin A, Jumper MBE, Kauffman B, Kelly C, Kohler CG, Kreyenbuhl J, Li L, Lucksted A, Margolis RL, Marsteller JA, Moxam A, Namowicz D, Oko J, Riggs J, Saravana A, Sarpal DK, Scheinberg R, Smith WR, States R, Taylor J, Vatza C, Wolcott M, Dickerson F. Tobacco smoking and nicotine vaping in persons with first episode psychosis. Schizophr Res 2024; 267:141-149. [PMID: 38547716 PMCID: PMC11102839 DOI: 10.1016/j.schres.2024.03.020] [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: 10/26/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
Tobacco smoking is highly prevalent in persons with psychosis and is the leading cause of preventable mortality in this population. Less is known about tobacco smoking in persons with first episode psychosis (FEP) and there have been no estimates about the prevalence of nicotine vaping in FEP. This study reports rates of tobacco smoking and nicotine vaping in young people with FEP enrolled in Coordinated Specialty Care programs in Pennsylvania and Maryland. Using data collected from 2021 to 2023, we examined lifetime and recent smoking and vaping and compared smokers and vapers to nonusers on symptoms, functioning, and substance use. The sample included 445 participants aged 13-35 with recent psychosis onset. Assessments were collected by program staff. Overall, 28 % of participants engaged in either smoking or vaping within 30 days of the admission assessment. Smokers and vapers were disproportionately male, cannabis users, and had lower negative symptom severity than non-smokers. Vapers had higher role and social functioning. Both smoking and vaping were related to a longer time from psychosis onset to program enrollment. We compare these findings to previous studies and suggest steps for addressing smoking and vaping in this vulnerable population.
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Affiliation(s)
- Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tovah Cowan
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Lijuan Fang
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Corinne Kacmarek
- VA VISN5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA
| | - Maria Theodora Oikonomou
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Krista K Baker
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Donna Bencivengo
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yasmine Boumaiz
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Phillip Campbell
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K N Roy Chengappa
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Catherine G Conroy
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Akinyi Cooke
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Fanghong Dong
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mandy Fauble
- University of Pittsburgh Medical Center, Western Behavioral Health at Safe Harbor, Erie, PA, USA
| | - Richard W Goldberg
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Megan B E Jumper
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Belinda Kauffman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie Kreyenbuhl
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lan Li
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alicia Lucksted
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Russell L Margolis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alex Moxam
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jamie Oko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessie Riggs
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arunadevi Saravana
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC, Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Rachel Scheinberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William R Smith
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard States
- University of Pittsburgh Medical Center, Western Behavioral Health at Safe Harbor, Erie, PA, USA
| | - Jerome Taylor
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Crystal Vatza
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Max Wolcott
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Faith Dickerson
- Department of Psychology, Sheppard Pratt, Baltimore, MD, USA
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2
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Zoghbi AW, Lieberman JA, Girgis RR. The neurobiology of duration of untreated psychosis: a comprehensive review. Mol Psychiatry 2023; 28:168-190. [PMID: 35931757 PMCID: PMC10979514 DOI: 10.1038/s41380-022-01718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Duration of untreated psychosis (DUP) is defined as the time from the onset of psychotic symptoms until the first treatment. Studies have shown that longer DUP is associated with poorer response rates to antipsychotic medications and impaired cognition, yet the neurobiologic correlates of DUP are poorly understood. Moreover, it has been hypothesized that untreated psychosis may be neurotoxic. Here, we conducted a comprehensive review of studies that have examined the neurobiology of DUP. Specifically, we included studies that evaluated DUP using a range of neurobiologic and imaging techniques and identified 83 articles that met inclusion and exclusion criteria. Overall, 27 out of the total 83 studies (32.5%) reported a significant neurobiological correlate with DUP. These results provide evidence against the notion of psychosis as structurally or functionally neurotoxic on a global scale and suggest that specific regions of the brain, such as temporal regions, may be more vulnerable to the effects of DUP. It is also possible that current methodologies lack the resolution needed to more accurately examine the effects of DUP on the brain, such as effects on synaptic density. Newer methodologies, such as MR scanners with stronger magnets, PET imaging with newer ligands capable of measuring subcellular structures (e.g., the PET ligand [11C]UCB-J) may be better able to capture these limited neuropathologic processes. Lastly, to ensure robust and replicable results, future studies of DUP should be adequately powered and specifically designed to test for the effects of DUP on localized brain structure and function with careful attention paid to potential confounds and methodological issues.
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Affiliation(s)
- Anthony W Zoghbi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA.
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA.
- Office of Mental Health, New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA.
- Office of Mental Health, New York State Psychiatric Institute, New York, NY, 10032, USA.
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Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev 2022; 11:CD007297. [PMID: 36367232 PMCID: PMC9650912 DOI: 10.1002/14651858.cd007297.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010. OBJECTIVES To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes. SEARCH METHODS We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence. MAIN RESULTS This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported. AUTHORS' CONCLUSIONS This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
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Affiliation(s)
- Yumi Aoki
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yukari Yaju
- Department of Epidemiology and Biostatistics for Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Leigh Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, The University of Stirling, Scotland, UK
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4
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Mascayano F, Bello I, Andrews H, Arancibia D, Arratia T, Burrone MS, Conover S, Fader K, Jorquera MJ, Gomez M, Malverde S, Martínez-Alés G, Ramírez J, Reginatto G, Restrepo-Henao A, Rosencheck RA, Schilling S, Smith TE, Soto-Brandt G, Tapia E, Tapia T, Velasco P, Wall MM, Yang LH, Cabassa LJ, Susser E, Dixon L, Alvarado R. OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial. Trials 2022; 23:751. [PMID: 36064643 PMCID: PMC9444092 DOI: 10.1186/s13063-022-06661-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. METHODS The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. DISCUSSION Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. TRIAL REGISTRATION www. CLINICALTRIALS gov NCT04247711 . Registered 30 January 2020. TRIAL STATUS The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).
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Affiliation(s)
- Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA
| | - Iruma Bello
- New York State Psychiatric Institute, New York, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Howard Andrews
- New York State Psychiatric Institute, New York, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, United States
| | - Diego Arancibia
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile.,Research and Postgraduate Institute, Faculty of Health Sciences, Universidad Central, Santiago, Chile
| | - Tamara Arratia
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | | | - Sarah Conover
- Silberman School of Social Work, Hunter College, New York, USA
| | - Kim Fader
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Maria Jose Jorquera
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Mauricio Gomez
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Sergio Malverde
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Jorge Ramírez
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Gabriel Reginatto
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Alexandra Restrepo-Henao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Epidemiology Research Group, National School of Public Health, Universidad de Antioquia, Medellin, Colombia
| | - Robert A Rosencheck
- Research, Education and Clinical Center, VA New England Mental Illness, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sara Schilling
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Thomas E Smith
- New York State Psychiatric Institute, New York, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Gonzalo Soto-Brandt
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Eric Tapia
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Tamara Tapia
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paola Velasco
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | | | - Lawrence H Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,School of Global Public Health, New York University, New York, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile. .,Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
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Thomas EC, Ben-David S, Treichler E, Roth S, Dixon L, Salzer M, Zisman-Ilani Y. A Systematic Review of Shared Decision-Making Interventions for Service Users With Serious Mental Illnesses: State of the Science and Future Directions. Psychiatr Serv 2021; 72:1288-1300. [PMID: 34369801 PMCID: PMC8570969 DOI: 10.1176/appi.ps.202000429] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Shared decision making (SDM) is a health communication model that may be particularly appealing to service users with serious mental illnesses, who often want to be involved in making decisions about their mental health care. The purpose of this systematic review was to describe and evaluate participant, intervention, methodological, and outcome characteristics of SDM intervention studies conducted within this population. METHODS Systematic searches of the literature through April 2020 were conducted and supplemented by hand searching of reference lists of identified studies. A total of 53 independent studies of SDM interventions that were conducted with service users with serious mental illnesses and that included a quantitative or qualitative measure of the intervention were included in the review. Data were independently extracted by at least two authors. RESULTS Most studies were conducted with middle-age, male, White individuals from Western countries. Interventions fell into the following categories: decision support tools only, multicomponent interventions involving decision support tools, multicomponent interventions not involving decision support tools, and shared care planning and preference elicitation interventions. Most studies were randomized controlled trials with sufficient sample sizes. Outcomes assessed were diverse, spanning decision-making constructs, clinical and functional, treatment engagement or adherence, and other constructs. CONCLUSIONS Findings suggest important future directions for research, including the need to evaluate the impact of SDM in special populations (e.g., young adults and racial-ethnic minority groups); to expand interventions to a broader array of decisions, users, and contexts; and to establish consensus measures to assess intervention effectiveness.
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Affiliation(s)
| | | | - Emily Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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6
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Zisman-Ilani Y, Hurford I, Bowen A, Salzer M, Thomas EC. Evaluating the feasibility of a decision aid to promote shared decision making among young adults with first-episode psychosis: protocol for a pilot study. Pilot Feasibility Stud 2021; 7:22. [PMID: 33431018 PMCID: PMC7798319 DOI: 10.1186/s40814-020-00757-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patient-level factors on SDM. METHODS A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the appointment (T1), and at 3- and 6-month follow-ups (T2 and T3). The study staff and participating psychiatrists are not blinded to the intervention. The data are de-identified to maintain blinding during the analysis process. The primary aims are feasibility of intervention delivery and research procedures and preliminary impact of the intervention on SDM-related outcomes, medication adherence, and service engagement. As a secondary aim, we will explore the contribution of personality and motivation variables, clinical relationships, cognitive functioning, and mental-health-related stigma to SDM. If the sample size permits, we plan to conduct parametric tests such as independent-samples t tests at T1 to compare differences in SDM, adherence, and engagement scales. In the case of a small sample size, we will use non-parametric tests and descriptive statistics. DISCUSSION This protocol outlines the methodology for a feasibility pilot comparing the effect of a novel SDM Antipsychotic Medication encounter DA with treatment as usual on SDM, medication adherence, and service engagement in FEP care. SDM is endorsed as a framework for use in FEP and antipsychotic pharmacotherapy, but its impact on adherence and health outcomes is unclear. Understanding the potential contribution of an SDM Antipsychotic Medication DA compared with usual care in psychosis pharmacotherapy is critical. The study will help answer several key questions new to SDM research, including the contribution of personality and clinical relationships to SDM in mental health and psychosis in particular. The study will serve to gather feasibility data to inform future studies and scale-up. TRIAL REGISTRATION Ethics approval was obtained through Temple University's institutional review board (IRB) and the City of Philadelphia's Department of Public Health IRB. The study has been retrospectively registered with ClinicalTrials.gov as NCT04373590 on 29 April 2020. https://clinicaltrials.gov/ct2/show/NCT04373590?term=NCT04373590&draw=2&rank=1.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Irene Hurford
- Psychosis Education, Assessment, Care and Empowerment (PEACE), Horizon House, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Bowen
- Psychosis Education, Assessment, Care and Empowerment (PEACE), Horizon House, Philadelphia, PA, USA
| | - Mark Salzer
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Elizabeth C Thomas
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA
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7
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Aoki Y. Shared decision making for adults with severe mental illness: A concept analysis. Jpn J Nurs Sci 2020; 17:e12365. [PMID: 32761783 PMCID: PMC7590107 DOI: 10.1111/jjns.12365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/08/2020] [Accepted: 06/27/2020] [Indexed: 12/01/2022]
Abstract
AIM Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition. METHODS Rodgers' evolutionary concept analysis was used. MEDLINE, PsychINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were "psychiatr*" or "mental" or "schizophren*" or "depression" or "bipolar disorder", combined with "shared decision making". In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub-themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described. RESULTS Four key attributes were identified: user-professional relationship, communication process, user-friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow-up. The antecedents as prominent predisposing factors were long-term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision-related outcomes, users' changes, professionals' changes, and enhanced relationship. CONCLUSIONS Shared decision making for adults with severe mental illness is a communication process, involving both user-friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.
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Affiliation(s)
- Yumi Aoki
- Psychiatric & Mental Health Nursing, Graduate School of NursingSt. Luke's International UniversityTokyoJapan
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8
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Yi W, She S, Zhang J, Wu H, Zheng Y, Ning Y. Clozapine Use in Patients with Early-Stage Schizophrenia in a Chinese Psychiatric Hospital. Neuropsychiatr Dis Treat 2020; 16:2827-2836. [PMID: 33262597 PMCID: PMC7699990 DOI: 10.2147/ndt.s261503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Previous studies suggest that clozapine is commonly underutilized and that its initiation is delayed in patients with first-episode schizophrenia. Knowledge regarding clozapine use among Chinese patients with early-stage schizophrenia is limited. The aim of the present study was to investigate the point prevalence of and patterns and factors associated with clozapine use in patients with early-stage schizophrenia discharged from a psychiatric hospital in China. METHODS A retrospective study was conducted to analyze the prescriptions of 867 consecutive patients with early-stage schizophrenia who were admitted to the Affiliated Brain Hospital of Guangzhou Medical University between Jan 1, 2011 and Dec 31, 2016. RESULTS At discharge from the hospital, 114 (13.1%) patients were prescribed clozapine. Among the patients taking clozapine, 93 patients (81.6%) were prescribed clozapine polypharmacy, and only 21 patients (18.4%) were prescribed clozapine monotherapy. None of the patients were prescribed an overdose of clozapine. The mean daily dosage of clozapine was 160.97 mg, 149.05 mg and 213.69 mg among all patients taking clozapine, patients taking clozapine polypharmacy and patients taking clozapine monotherapy, respectively. The antipsychotic most frequently combined with clozapine was risperidone. Logistic regression suggested that the length of hospital stay, high school education, lower benzodiazepine use and antipsychotic polypharmacy were independently and significantly associated with clozapine use (P<0.05). CONCLUSION Although clozapine has been commonly used in China in recent years, the present study found that clozapine was not commonly used in patients with early-stage schizophrenia. An underutilization and delayed initiation of clozapine may exist in a portion of patients with early-stage schizophrenia. Given the unfavorable outcomes of underutilized and delayed clozapine use, future studies may be needed to assess and increase clozapine use in this population.
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Affiliation(s)
- Wenying Yi
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Shenglin She
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jie Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Haibo Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yingjun Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yuping Ning
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
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9
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Lieberman JA, Small SA, Girgis RR. Early Detection and Preventive Intervention in Schizophrenia: From Fantasy to Reality. Am J Psychiatry 2019; 176:794-810. [PMID: 31569988 DOI: 10.1176/appi.ajp.2019.19080865] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Scientific progress in understanding human disease can be measured by the effectiveness of its treatment. Antipsychotic drugs have been proven to alleviate acute psychotic symptoms and prevent their recurrence in schizophrenia, but the outcomes of most patients historically have been suboptimal. However, a series of findings in studies of first-episode schizophrenia patients transformed the psychiatric field's thinking about the pathophysiology, course, and potential for disease-modifying effects of treatment. These include the relationship between the duration of untreated psychotic symptoms and outcome; the superior responses of first-episode patients to antipsychotics compared with patients with chronic illness, and the reduction in brain gray matter volume over the course of the illness. Studies of the effectiveness of early detection and intervention models of care have provided encouraging but inconclusive results in limiting the morbidity and modifying the course of illness. Nevertheless, first-episode psychosis studies have established an evidentiary basis for considering a team-based, coordinated specialty approach as the standard of care for treating early psychosis, which has led to their global proliferation. In contrast, while clinical high-risk research has developed an evidence-based care model for decreasing the burden of attenuated symptoms, no treatment has been shown to reduce risk or prevent the transition to syndromal psychosis. Moreover, the current diagnostic criteria for clinical high risk lack adequate specificity for clinical application. What limits our ability to realize the potential of early detection and intervention models of care are the lack of sensitive and specific diagnostic criteria for pre-syndromal schizophrenia, validated biomarkers, and proven therapeutic strategies. Future research requires methodologically rigorous studies in large patient samples, across multiple sites, that ideally are guided by scientifically credible pathophysiological theories for which there is compelling evidence. These caveats notwithstanding, we can reasonably expect future studies to build on the research of the past four decades to advance our knowledge and enable this game-changing model of care to become a reality.
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Affiliation(s)
- Jeffrey A Lieberman
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Scott A Small
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Ragy R Girgis
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
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10
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Bell Lynum KS, Turkoz I, Kim E. Paliperidone palmitate once-every-3-months in adults with early illness schizophrenia. Early Interv Psychiatry 2019; 13:667-672. [PMID: 29968279 PMCID: PMC6585630 DOI: 10.1111/eip.12685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/05/2018] [Accepted: 05/16/2018] [Indexed: 11/08/2022]
Abstract
AIM This post hoc analysis of a double-blind (DB), randomized, placebo-controlled, relapse-prevention study evaluated the effects of paliperidone palmitate once-every-3-months (PP3M) in a subpopulation of adults with early illness schizophrenia (duration ≤5 years) from a clinical trial. METHODS Patients received either PP3M or placebo every 3 months in the DB phase. The primary efficacy variable was time from randomization to first relapse. Symptom severity, patient functioning, and safety were also assessed. RESULTS A total of 119 patients who entered the DB phase met the criteria for early illness schizophrenia (PP3M, n = 62; placebo, n = 57). PP3M significantly delayed time to relapse vs placebo (P = .035; hazard ratio, 3.08; 95% CI, 1.08-8.80). Symptomatic control and patient functioning were maintained in the PP3M group but significantly worsened in the placebo group. There were no unexpected tolerability findings. CONCLUSIONS PP3M reduced relapse risk and maintained symptomatic and functional improvements compared with placebo in patients with early illness schizophrenia.
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Affiliation(s)
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
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11
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Hamilton JE, Srivastava D, Womack D, Brown A, Schulz B, Macakanja A, Walker A, Wu MJ, Williamson M, Cho RY. Treatment Retention Among Patients Participating in Coordinated Specialty Care for First-Episode Psychosis: a Mixed-Methods Analysis. J Behav Health Serv Res 2018; 46:415-433. [PMID: 29873034 DOI: 10.1007/s11414-018-9619-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Young adults experiencing first-episode psychosis have historically been difficult to retain in mental health treatment. Communities across the United States are implementing Coordinated Specialty Care to improve outcomes for individuals experiencing first-episode psychosis. This mixed-methods research study examined the relationship between program services and treatment retention, operationalized as the likelihood of remaining in the program for 9 months or more. In the adjusted analysis, male gender and participation in home-based cognitive behavioral therapy were associated with an increased likelihood of remaining in treatment. The key informant interview findings suggest the shared decision-making process and the breadth, flexibility, and focus on functional recovery of the home-based cognitive behavioral therapy intervention may have positively influenced treatment retention. These findings suggest the use of shared decision-making and improved access to home-based cognitive behavioral therapy for first-episode psychosis patients may improve outcomes for this vulnerable population.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, 1941 East Road, Suite 1204, Houston, TX, 77054, USA.
| | | | - Danica Womack
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ashlie Brown
- Harris Center for Mental Health and IDD, Houston, TX, USA
| | - Brian Schulz
- Harris Center for Mental Health and IDD, Houston, TX, USA
| | | | - April Walker
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mon-Ju Wu
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, 1941 East Road, Suite 1204, Houston, TX, 77054, USA
| | | | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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12
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Robinson DG, Schooler NR, Correll CU, John M, Kurian BT, Marcy P, Miller AL, Pipes R, Trivedi MH, Kane JM. Psychopharmacological Treatment in the RAISE-ETP Study: Outcomes of a Manual and Computer Decision Support System Based Intervention. Am J Psychiatry 2018; 175:169-179. [PMID: 28945118 PMCID: PMC5794655 DOI: 10.1176/appi.ajp.2017.16080919] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Recovery After an Initial Schizophrenia Episode-Early Treatment Program compared NAVIGATE, a comprehensive program for first-episode psychosis, to clinician-choice community care over 2 years. Quality of life and psychotic and depressive symptom outcomes were found to be better with NAVIGATE. Compared with previous comprehensive first-episode psychosis interventions, NAVIGATE medication treatment included unique elements of detailed first-episode-specific psychotropic medication guidelines and a computerized decision support system to facilitate shared decision making regarding prescriptions. In the present study, the authors compared NAVIGATE and community care on the psychotropic medications prescribed, side effects experienced, metabolic outcomes, and scores on the Adherence Estimator scale, which assesses beliefs related to nonadherence. METHOD Prescription data were obtained monthly. At baseline and at 3, 6, 12, 18, and 24 months, participants reported whether they were experiencing any of 21 common antipsychotic side effects, vital signs were obtained, fasting blood samples were collected, and the Adherence Estimator scale was completed. RESULTS Over the 2-year study period, compared with the 181 community care participants, the 223 NAVIGATE participants had more medication visits, were more likely to receive a prescription for an antipsychotic and more likely to receive one conforming to NAVIGATE prescribing principles, and were less likely to receive a prescription for an antidepressant. NAVIGATE participants experienced fewer side effects and gained less weight; other vital signs and cardiometabolic laboratory findings did not differ between groups. Adherence Estimator scores improved in the NAVIGATE group but not in the community care group. CONCLUSIONS As part of comprehensive care services, medication prescription can be optimized for first-episode psychosis, contributing to better outcomes with a lower side effect burden than standard care.
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Affiliation(s)
- Delbert G Robinson
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA,Hofstra Northwell School of Medicine, Departments of Psychiatry and of Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Nina R. Schooler
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA,SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA
| | - Christoph U. Correll
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA,Hofstra Northwell School of Medicine, Departments of Psychiatry and of Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA,Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | - Majnu John
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA,The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA,Hofstra University, Department of Mathematics, Hempstead, NY, USA
| | - Benji T. Kurian
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patricia Marcy
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Alexander L. Miller
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, San Antonio, TX, USA
| | - Ronny Pipes
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - John M. Kane
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA,Hofstra Northwell School of Medicine, Departments of Psychiatry and of Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA,Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
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13
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Hoagwood KE, Atkins M, Kelleher K, Peth-Pierce R, Olin S, Burns B, Landsverk J, Horwitz SM. Trends in Children's Mental Health Services Research Funding by the National Institute of Mental Health From 2005 to 2015: A 42% Reduction. J Am Acad Child Adolesc Psychiatry 2018; 57:10-13. [PMID: 29301659 DOI: 10.1016/j.jaac.2017.09.433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/12/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Kelly Kelleher
- The Ohio State University, Columbus, and the Nationwide Children's Hospital, Center for Pediatric Innovation, Columbus
| | | | - Serene Olin
- New York University School of Medicine, Child Study Center, New York
| | - Barbara Burns
- Duke University, Duke University School of Medicine, Services Effectiveness Research Program, Durham, NC
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14
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Abstract
Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state-of-the-art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients' satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well-being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre-emptive interventions to high-risk groups identified across the early stages of the disorder. Only a systematic implementation of these models of care in the national health care systems will render these strategies accessible to the 23 million people worldwide suffering from the most severe psychiatric disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK
| | - Patrick D. McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - John M. Kane
- Zucker Hillside Hospital, Glen Oaks, NY, USA; Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA
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15
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Chan V. Schizophrenia and Psychosis: Diagnosis, Current Research Trends, and Model Treatment Approaches with Implications for Transitional Age Youth. Child Adolesc Psychiatr Clin N Am 2017; 26:341-366. [PMID: 28314460 DOI: 10.1016/j.chc.2016.12.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article reviews the current state of diagnosis and treatment of schizophrenia, describing the recent proliferation of research in high-risk psychosis spectrum conditions, which are different from childhood-onset and early onset schizophrenia, and findings of psychotic-like experiences in the normal population. Taken from adult and childhood literature, clinical quandaries in accurate diagnosis, and treatment gaps in co-occurring, or sometimes confounding, conditions are discussed. Thoughts on the impact of schizophrenia on an emerging adulthood trajectory are offered. Recent best practices in the treatment of schizophrenia are consistent with a recovery-oriented model of mental health services for transitional age youth.
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Affiliation(s)
- Vivien Chan
- 501 Student Health, Student Health Center, University of California Irvine, Irvine, CA 92697-5200, USA; Behavioral Health Services, Children, Youth & Prevention Division, Center for Resiliency Wellness & Education (First Episode Psychosis), Orange County Health Care Agency, 729 W Town & Country Road, Building E, Orange, CA 92868, USA; Department of Psychiatry & Human Behavior, UCI Health, Orange, CA 92868, USA.
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