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De Carlo V, Grancini B, Vismara M, Benatti B, Arici C, Cremaschi L, Cirnigliaro G, Degoni L, Oldani L, Palazzo C, Glick ID, Viganò C, Dell'Osso B. Exploring characteristics associated with first benzodiazepine prescription in patients with affective disorders and related diagnoses. Hum Psychopharmacol 2019; 34:e2695. [PMID: 31044486 DOI: 10.1002/hup.2695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In patients with affective disorders, benzodiazepines (BZDs) are frequently administered at the onset, sometimes inappropriately. We sought to identify clinical variables associated with first BZD prescription in a large sample of patients with affective disorders. METHODS Four hundred sixty patients with mood or anxiety disorders attending different psychiatric services were assessed comparing those who received BZD as first treatment (BZD w/) and those who did not (BZD w/o). RESULTS More than one third (35.7%) of the total sample had received BZDs as first prescription. In relation to mood disorders, BZD w/ subjects more frequently (a) had not a psychiatrist as first therapist, (b) had anxious symptoms at onset, (c) had adjustment disorder as first diagnosis, (d) were treated as outpatients. In relation to specific diagnoses, (a) personal decision of treatment for major depressive disorder, (b) outpatient status for bipolar disorder and (c) longer duration of untreated illness for adjustment disorder were more frequently associated with first BZD prescription. For anxiety disorders, the presence of stressful life events and the diagnoses of panic disorder or specific phobias were more frequently observed in BZD w/ patients. CONCLUSION Patients with affective disorders frequently received BZDs as first prescription with significant differences between and within mood and anxiety disorders.
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Affiliation(s)
- Vera De Carlo
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Benedetta Grancini
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Matteo Vismara
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Chiara Arici
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Laura Cremaschi
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Luca Degoni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Lucio Oldani
- Department of Mental Health, Fondazione IRCCS Cà Granda Policlinico, Milan, Italy
| | - Carlotta Palazzo
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Ira D Glick
- Department of Psychiatry and Behavioural Sciences, Stanford Medical School, Stanford University, Stanford, California
| | - Caterina Viganò
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Psychiatry Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioural Sciences, Stanford Medical School, Stanford University, Stanford, California.,CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
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Monducci E, Battaglia C, Forte A, Masillo A, Telesforo L, Carlotto A, Piazzi G, Patanè M, De Angelis G, Romano A, Fagioli F, Girardi P, Cocchi A, Meneghelli A, Alpi A, Pafumi N, Moreno Granados N, Preti A, Masolo F, Benzoni S, Cavenaghi S, Molteni I, Salvadori L, Solbiati S, Costantino A, Di Lauro R, Piccinini A, Collins Eade A, Holmshaw J, Fiori Nastro P. Secondary school teachers and mental health competence: Italy-United Kingdom comparison. Early Interv Psychiatry 2018; 12:456-463. [PMID: 27172538 DOI: 10.1111/eip.12345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/14/2016] [Accepted: 03/28/2016] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate the differences between teachers' knowledge about early psychosis among three different Italian cities and a UK sample. METHODS The sample consisted of 556 secondary school teachers from three different cities in Italy (Milan, Rome and Lamezia Terme) and London (UK). The research was based on the Knowledge and Experience of Social Emotional Difficulties Among Young People Questionnaire. The Italian version of the questionnaire was used in Italy. RESULTS Overall, 67.6% of English teachers, 58.5% of Milan's teachers, 41.8% of Rome's teachers and 33.3% of Lamezia Terme's teachers were able to recognize psychotic symptoms from a case vignette. Logistic regression analysis showed that 'city' was the only independent variable significantly related to the correct/wrong answer about diagnosis. CONCLUSIONS We found statistically significant differences between the three Italian samples and the UK sample regarding teachers' knowledge about first signs of psychosis. English teachers showed a better knowledge than Italian teachers in general. Teachers from Milan, where a specific early detection program was established in 2000, seemed to be more familiar with early signs of psychosis than teachers in the other two Italian towns.
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Affiliation(s)
- Elena Monducci
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Claudia Battaglia
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto Forte
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alice Masillo
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Ludovica Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Gioia Piazzi
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Martina Patanè
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Romano
- Mental Health Department, Prevention and Early Intervention Mental Health (PIPSM), ASL Roma 1 (ex E), Rome, Italy
| | - Francesca Fagioli
- Mental Health Department, Prevention and Early Intervention Mental Health (PIPSM), ASL Roma 1 (ex E), Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelo Cocchi
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Anna Meneghelli
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Andrea Alpi
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Nicoletta Pafumi
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Noelia Moreno Granados
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Antonio Preti
- Department of Mental Health, Center for Early Detection and Intervention in Psychosis-Programma 2000, Milan, Italy
| | - Francesca Masolo
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Benzoni
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Cavenaghi
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Molteni
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lavinia Salvadori
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Solbiati
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Costantino
- Child and Adolescent Neuropsychiatric Unit, IRCSS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosalba Di Lauro
- Child and Adolescent Neuropsychiatric Unit, Melegnano Hospital, Milan, Italy
| | | | | | | | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
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Does initial use of benzodiazepines delay an adequate pharmacological treatment? A multicentre analysis in patients with psychotic and affective disorders. Int Clin Psychopharmacol 2018; 33:140-146. [PMID: 29461302 DOI: 10.1097/yic.0000000000000210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is established that delayed effective pharmacotherapy plays a significant role in the overall burden of psychiatric disorders, which are often treated with symptomatic drugs, that is benzodiazepines (BZDs), in relation to their rapid onset of action and safety, despite long-term side effects. We aimed to assess the influence of initial treatment with BZDs on the duration of untreated illness (DUI) and whether specific sociodemographic and clinical factors could influence the choice of BZDs as first treatment in 545 patients affected by schizophrenia, mood and anxiety spectrum disorders. Statistical analyses (one-way analysis of variance and χ) were carried out to compare patients who used BZDs as first treatment (BZD w/) and those who did not (BZD w/o). The overall DUI, irrespective of diagnosis, resulted in significantly longer in BZD w/ versus w/o patients, who also experienced more frequently anxious/depressive symptoms at onset. Furthermore, BZD w/ patients more frequently autonomously decided to look for treatment (mainly refering to psychologists or general practitioners) and experimented more frequently phobias, than BZD w/o ones. The present findings suggest that initial BZDs treatment may prolong the overall DUI, although their prescription seems to be influenced by specific sociodemographic and clinical factors. Further studies are needed to confirm the present findings.
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Brunet K, Birchwood M, Lester H, Thornhill K. Delays in mental health services and duration of untreated psychosis. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.106.013995] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND METHODTo dissect duration of untreated psychosis (DUP) into three components: help-seeking delay, referral delay and delay in mental health services, all mental health services in a defined geographical region were screened over a period of 1 year. All cases of first-episode psychosis without a primary mood disorder were identified (n=55).RESULTSThe median delay within secondary services was over seven times the delay in the referral pathway. The mean delay in mental health services accounted for 35% of overall DUP.CLINICAL IMPLICATIONSIntervention is required in secondary as well as primary care services if DUP is to be reduced.
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Del Vecchio V, Luciano M, Sampogna G, De Rosa C, Giacco D, Tarricone I, Catapano F, Fiorillo A. The role of relatives in pathways to care of patients with a first episode of psychosis. Int J Soc Psychiatry 2015; 61:631-7. [PMID: 25614470 DOI: 10.1177/0020764014568129] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To explore the role of relatives in pathways to care of patients with a recent onset of psychosis. METHODS A total of 34 consecutive patients and their relatives from the Department of Psychiatry of the University of Naples SUN participated in the study. Pathways to care were retrospectively evaluated by administering the Pathways to Care Form and the Nottingham Onset Schedule (NOS) to patients, relatives and treating physicians. Relatives were addressed with the Family Involvement in Pathways to care Schedule (FIPS). RESULTS Duration of untreated illness (DUI) and duration of untreated psychosis (DUP) were 145.4 (±141.9) and 33.3 (±54.0) weeks, respectively. Help-seeking delay was 17.6 (±45.0) weeks. The first request for help was made by relatives in 76% of cases. Among health professionals, general practitioners were those most frequently contacted, followed by psychiatrists, neurologists or psychologists. Stigma and wrong attribution of psychotic symptoms were the main reasons for help-seeking delays. CONCLUSIONS Relatives play a crucial role in pathways to care of patients with psychosis. DUI and DUP could be reduced by interventions aimed at increasing knowledge of early symptoms in the general population, and by the provision of psychiatric consultations in non-stigmatizing settings for young people with psychological distress.
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Affiliation(s)
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Corrado De Rosa
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Domenico Giacco
- Department of Psychiatry, University of Naples SUN, Naples, Italy Unit for Social and Community Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Bologna, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Hassab Errasoul A, Sutton M, Doran C, Robertson G, Fenlon NP, Turner N, Clarke M. Creating a curriculum on psychosis: a pilot training programme with youth workers. Early Interv Psychiatry 2015; 9:412-21. [PMID: 24962714 DOI: 10.1111/eip.12158] [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: 10/14/2013] [Accepted: 04/29/2014] [Indexed: 11/28/2022]
Abstract
AIMS Public education may constitute an effective early intervention strategy to reduce delays in the treatment of psychotic disorders and thereby improve outcome. The purpose of this project was to design, implement and validate a curriculum on early intervention in psychosis for youth workers. METHOD A training intervention on early intervention in psychosis was designed and delivered through 1-day workshops. Objective and self-perceived competencies were measured before and after the intervention and at 3-month follow up. An additional question was added to assess social distancing from subjects with psychosis. RESULTS Compared with baseline, the training programme resulted in an improvement in problem identification and symptom recognition skills for vignettes on psychosis (P < 0.05), and in advice on help-seeking behaviour (P < 0.001) and in self-perceived competencies (P < 0.001). Additionally, there was a reduction in social distancing (P < 0.001). These desired outcomes were found to be sustained over a 3-month period. CONCLUSIONS The training course improved case recognition skills and advice on help-seeking behaviour and resulted in reduction in social distancing in this cohort of youth workers.
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Affiliation(s)
- Ahmed Hassab Errasoul
- Dublin and East Treatment and Early Care Team (DETECT) Services, Co. Dublin, Ireland
| | - Marie Sutton
- Dublin and East Treatment and Early Care Team (DETECT) Services, Co. Dublin, Ireland
| | - Cormac Doran
- Swords-Baldoyle Youth Service, Co. Dublin, Ireland
| | | | | | - Niall Turner
- Dublin and East Treatment and Early Care Team (DETECT) Services, Co. Dublin, Ireland
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Services, Co. Dublin, Ireland
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Tait L, Michail M. Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol. Syst Rev 2014; 3:145. [PMID: 25510820 PMCID: PMC4276044 DOI: 10.1186/2046-4053-3-145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/08/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Suicide is a major public health problem and globally is the second leading cause of death in young adults. Globally, there are 164,000 suicides per year in young people under 25 years. Depression is a strong risk factor for suicide. Evidence shows that 45% of those completing suicide, including young adults, contact their general practitioner rather than a mental health professional in the month before their death. Further evidence indicates that risk factors or early warning signs of suicide in young people go undetected and untreated by general practitioners. Healthcare-based suicide prevention interventions targeted at general practitioners are designed to increase identification of at-risk young people. The rationale of this type of intervention is that early identification and improved clinical management of at-risk individuals will reduce morbidity and mortality. This systematic review will synthesise evidence on the effectiveness of education interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people. METHODS/DESIGN We shall conduct a systematic review and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions guidelines and conform to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases will be systematically searched for randomised controlled trials and quasi-experimental studies investigating the effectiveness of interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people in comparison to any other intervention, no intervention, usual care or waiting list. Grey literature will be searched by screening trial registers. Only studies published in English will be included. No date restrictions will be applied. Two authors will independently screen titles and abstracts of potential studies. The primary outcome is identification and management of depression. Secondary outcomes are suicidal ideation, suicide attempts, deliberate self-harm, knowledge of suicide risk factors and suicide-related behaviours, attitudes towards suicide risk and suicide-related behaviours, confidence in dealing with suicide risk factors and suicide-related behaviour. DISCUSSION Our study will inform the development of future education interventions and provide feasibility and acceptability evidence, to help general practitioners identify and manage suicidal behaviour in young people. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42014009110.
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Affiliation(s)
- Lynda Tait
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
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Tang JYM, Chang WC, Hui CLM, Wong GHY, Chan SKW, Lee EHM, Yeung WS, Wong CK, Tang WN, Chan WF, Pang EPF, Tso S, Ng RMK, Hung SF, Dunn ELW, Sham PC, Chen EYH. Prospective relationship between duration of untreated psychosis and 13-year clinical outcome: a first-episode psychosis study. Schizophr Res 2014; 153:1-8. [PMID: 24529612 DOI: 10.1016/j.schres.2014.01.022] [Citation(s) in RCA: 43] [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] [Received: 06/12/2013] [Revised: 01/01/2014] [Accepted: 01/22/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP-outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined. OBJECTIVE To explore the relationship between DUP and long-term symptomatic remission. METHODS This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤30days), medium (31-180days) and long (>180days) DUP groups. RESULTS The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission. CONCLUSION The findings support the threshold theory that DUP longer than 30days adversely impacts the long-term outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on long-term outcomes based on well-defined criteria and adequate statistical adjustment.
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Affiliation(s)
| | - Wing-Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | | | | | - Wai-Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Chi-Keung Wong
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Wai-Nang Tang
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Wah-Fat Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Edwin Pui-Fai Pang
- Department of Psychiatry, United Christian Hospital, Hospital Authority, Hong Kong
| | - Steve Tso
- Department of Psychiatry, Castle Peak Hospital, Hospital Authority, Hong Kong
| | - Roger Man-Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hospital Authority, Hong Kong
| | - Se-Fong Hung
- Department of Psychiatry, Kwai Chung Hospital, Hospital Authority, Hong Kong
| | - Eva Lai-Wah Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Pak-Chung Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Eric Yu-Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Hagi N, Takamura M, Yokoyama K. Factors affecting early psychiatric intervention for patients with first-episode psychosis in Japan. Early Interv Psychiatry 2013; 7:255-60. [PMID: 22816433 DOI: 10.1111/j.1751-7893.2012.00385.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/20/2012] [Indexed: 11/28/2022]
Abstract
AIM The present study aimed to clarify the factors affecting early psychiatric intervention for patients with first-episode psychosis in Japan. METHODS A postal questionnaire survey was conducted in 346 members of the Association of Family of Psychosis Patients, in Mie, Japan. RESULTS The questionnaire was completed by 138 respondents. The mean interval between a suspected first episode of psychosis and the first visit to a medical institution was 18.4 months (SD: 40.0, range: 0-336 months). Forty-five respondents consulted a family member first and required a mean duration of 9.8 months (SD: 11.2) before their first visit; this was significantly shorter than those who did not. Eighteen respondents consulted their class teacher at school first and required a mean duration of 40.2 months (SD: 63.0) before their first visit; this was significantly longer (P < 0.05) than those who did not. When loss of sleep or appetite was present, the mean duration before their first visit was 9.3 months (SD: 12.1), which was significantly shorter (P < 0.05) than the time required by those who did not. Logistic regression analysis using the first episode-first visit interval as an independent variable, and independent variables such as age, gender of the patient and family member, and loss of sleep, revealed that variables relating to the respondent's notion about the psychosis were mitigating factors (e.g. 'prejudice-causing' and 'nothing to do with me'). CONCLUSION Prejudice towards psychosis and poor awareness about mental illnesses are two factors that may affect early psychiatric intervention.
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Affiliation(s)
- Noriko Hagi
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, Tokyo, Japan
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Masillo A, Monducci E, Pucci D, Telesforo L, Battaglia C, Carlotto A, Forte A, Bonaccorsi E, Romano A, Fiori Nastro P, Girardi P. Evaluation of secondary school teachers' knowledge about psychosis: a contribution to early detection. Early Interv Psychiatry 2012; 6:76-82. [PMID: 21951941 DOI: 10.1111/j.1751-7893.2011.00298.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS We sought to evaluate secondary school teachers' knowledge about psychosis and their level of interest in this topic given the key role they may be able to play in the early detection of psychosis. METHODS A questionnaire survey of 268 secondary school teachers from eight secondary schools within the Azienda Sanitaria Locale Rome/E and Rome/A catchment areas (two of the five city health districts) in Rome. Teachers were asked to complete the Italian version Esperienza e Conoscenza delle Difficoltò Sociali ed Emotive dei Giovani of the Knowledge and Experience of Social Emotional Difficulties among Young people self-report questionnaire that investigates the diagnosis, age of onset, aetiology, prognosis and treatment of psychosis. They were also asked about their experience with pupils with possible psychosis. RESULTS Most of teachers were able to recognize psychotic symptoms from a case vignette. Approximately 25% of the teachers had experienced a pupil with possible symptoms of psychosis. However, teachers displayed little awareness of psychiatric community services available for young people. CONCLUSIONS Our study shows that teachers may play an important role in early detection and psychosis prevention strategies. The teachers also displayed a keen interest in gaining a deeper knowledge of early psychotic signs and in cooperating closely with a mental health specialist to obtain guidance and support when faced with serious mentally ill pupils.
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Affiliation(s)
- Alice Masillo
- NESMOS Department (Neurosciences, Mental Health and Sensory Functions), Sapienza University of Rome, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy.
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Cullen W, Broderick N, Connolly D, Meagher D. What is the role of general practice in addressing youth mental health? A discussion paper. Ir J Med Sci 2011; 181:189-97. [PMID: 21935738 DOI: 10.1007/s11845-011-0757-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 09/03/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental and substance use disorders are a leading cause of morbidity among young people. Policy and clinical services in Ireland are endeavouring to address these twin issues. AIMS To review the emerging literature on the role of general practice in addressing youth mental health and to discuss the implications of this literature for further research, education and service delivery. METHODS We conducted a review of 'PubMed' and a web search of relevant national/international primary/mental healthcare agencies and professional bodies. RESULTS Although general practice has an important role in addressing youth mental health, there are challenges in how young people seek help. Specifically, young people do not engage with healthcare agencies and many factors which act as barriers and enablers in this regard have been identified. The detection and treatment of mental and substance use disorders by GPs can be improved and implementing interventions to improve screening and early intervention are likely to be valuable. CONCLUSIONS General practice is a central agency in addressing youth mental health and complex multifaceted interventions (education, clinical guidelines, and promoting awareness) are likely to support its role. Further research exploring this issue is a priority.
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Affiliation(s)
- W Cullen
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Takamura M, Hagi N, Yokoyama K. Motivation of primary care physicians for participating in early intervention for psychosis in Japan. TOHOKU J EXP MED 2011; 225:43-9. [PMID: 21869590 DOI: 10.1620/tjem.225.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
People with psychosis as represented by schizophrenia experience lengthy delays between the onset and the start of treatment. This duration is called Duration of Untreated Psychosis (DUP). Since it has been indicated that shorter DUP leads to their better prognosis, early intervention has been a hot topic for decades in clinical psychiatry. In Japan, as any patient can visit either specialists or primary care physicians using medical insurance, a considerable portion of psychosis patients are supposed to visit the latter first. Thus, a role of primary care physicians seems keys of success in implementation of early intervention system in the Japanese society. In this study, to clarify the motivation of physicians to participate in early intervention, we sent postal questionnaires to 4030 private clinics throughout Japan, inquiring physicians' situations around psychiatric disorders. Seven hundred and fourteen questionnaires were used for analysis (17.7%). Among these 714 respondents, 364 (51.0%) reported that they have willingness to participate in early intervention. Similarly, 494 (69.2%) were interested in psychiatric disorders, whereas only 168 (23.5%) were confident in identifying schizophrenia. The interest in psychiatric disorders was most strongly associated with their willingness to participate (Odds ratio = 3.54 by logistic regression analysis). These results, therefore, suggest that the interest in psychiatric disorders motivates them to participate in early intervention for psychosis; this has considerable implications for future approach to build up early intervention system in Japan.
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Affiliation(s)
- Mitsuyuki Takamura
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, Tokyo, Japan
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Abstract
BACKGROUND Proponents of early intervention have argued that outcomes might be improved if more therapeutic efforts were focused on the early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has two elements that are distinct from standard care: early detection, and phase-specific treatment (phase-specific treatment is a psychological, social or physical treatment developed, or modified, specifically for use with people at an early stage of the illness).Early detection and phase-specific treatment may both be offered as supplements to standard care, or may be provided through a specialised early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe and Australasia. OBJECTIVES To evaluate the effects of: (a) early detection; (b) phase-specific treatments; and (c) specialised early intervention teams in the treatment of people with prodromal symptoms or first-episode psychosis. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group Trials Register (March 2009), inspected reference lists of all identified trials and reviews and contacted experts in the field. SELECTION CRITERIA We included all randomised controlled trials (RCTs) designed to prevent progression to psychosis in people showing prodromal symptoms, or to improve outcome for people with first-episode psychosis. Eligible interventions, alone and in combination, included: early detection, phase-specific treatments, and care from specialised early intervention teams. We accepted cluster-randomised trials but excluded non-randomised trials. DATA COLLECTION AND ANALYSIS We reliably selected studies, quality rated them and extracted data. For dichotomous data, we estimated relative risks (RR), with the 95% confidence intervals (CI). Where possible, we calculated the number needed to treat/harm statistic (NNT/H) and used intention-to-treat analysis (ITT). MAIN RESULTS Studies were diverse, mostly small, undertaken by pioneering researchers and with many methodological limitations (18 RCTs, total n=1808). Mostly, meta-analyses were inappropriate. For the six studies addressing prevention of psychosis for people with prodromal symptoms, olanzapine seemed of little benefit (n=60, 1 RCT, RR conversion to psychosis 0.58 CI 0.3 to 1.2), and cognitive behavioural therapy (CBT) equally so (n=60, 1 RCT, RR conversion to psychosis 0.50 CI 0.2 to 1.7). A risperidone plus CBT plus specialised team did have benefit over specialist team alone at six months (n=59, 1 RCT, RR conversion to psychosis 0.27 CI 0.1 to 0.9, NNT 4 CI 2 to 20), but this was not seen by 12 months (n=59, 1 RCT, RR 0.54 CI 0.2 to 1.3). Omega 3 fatty acids (EPA) had advantage over placebo (n=76, 1 RCT, RR transition to psychosis 0.13 CI 0.02 to 1.0, NNT 6 CI 5 to 96). We know of no replications of this finding.The remaining trials aimed to improve outcome in first-episode psychosis. Phase-specific CBT for suicidality seemed to have little effect, but the single study was small (n=56, 1 RCT, RR suicide 0.81 CI 0.05 to 12.26). Family therapy plus a specialised team in the Netherlands did not clearly affect relapse (n=76, RR 1.05 CI 0.4 to 3.0), but without the specialised team in China it may (n=83, 1 RCT, RR admitted to hospital 0.28 CI 0.1 to 0.6, NNT 3 CI 2 to 6). The largest and highest quality study compared specialised team with standard care. Leaving the study early was reduced (n=547, 1 RCT, RR 0.59 CI 0.4 to 0.8, NNT 9 CI 6 to 18) and compliance with treatment improved (n=507, RR stopped treatment 0.20 CI 0.1 to 0.4, NNT 9 CI 8 to 12). The mean number of days spent in hospital at one year were not significantly different (n=507, WMD, -1.39 CI -2.8 to 0.1), neither were data for 'Not hospitalised' by five years (n=547, RR 1.05 CI 0.90 to 1.2). There were no significant differences in numbers 'not living independently' by one year (n=507, RR 0.55 CI 0.3 to 1.2). At five years significantly fewer participants in the treatment group were 'not living independently' (n=547, RR 0.42 CI 0.21 to 0.8, NNT 19 CI 14 to 62). When phase-specific treatment (CBT) was compared with befriending no significant differences emerged in the number of participants being hospitalised over the 12 months (n=62, 1 RCT, RR 1.08 CI 0.59 to 1.99).Phase-specific treatment E-EPA oils suggested no benefit (n=80, 1 RCT, RR no response 0.90 CI 0.6 to 1.4) as did phase-specific treatment brief intervention (n=106, 1 RCT, RR admission 0.86 CI 0.4 to 1.7). Phase-specific ACE found no benefit but participants given vocational intervention were more likely to be employed (n=41, 1 RCT, RR 0.39 CI 0.21 to 0.7, NNT 2 CI 2 to 4). Phase-specific cannabis and psychosis therapy did not show benefit (n=47, RR cannabis use 1.30 CI 0.8 to 2.2) and crisis assessment did not reduce hospitalisation (n=98, RR 0.85 CI 0.6 to 1.3). Weight was unaffected by early behavioural intervention. AUTHORS' CONCLUSIONS There is emerging, but as yet inconclusive evidence, to suggest that people in the prodrome of psychosis can be helped by some interventions. There is some support for specialised early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained. There is some support for phase-specific treatment focused on employment and family therapy, but again, this needs replicating with larger and longer trials.
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Affiliation(s)
- Max Marshall
- University of Manchester, The Lantern Centre, Preston., UK
| | - John Rathbone
- HEDS, ScHARR, The University of Sheffield, Sheffield, UK
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Abstract
BACKGROUND Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. OBJECTIVES To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. SELECTION CRITERIA Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. DATA COLLECTION AND ANALYSIS Working independently, we critically appraised records from 681studies, of which five studies met inclusion criteria. John Rathbone from the Schizophrenia Group supported us with the data extraction. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. MAIN RESULTS Five studies with a combined N = 998 met inclusion criteria. Four studies (N = 724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs N = 353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT N = 240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT N = 236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT N = 94, RR 0.96 CI 0.3 to 3.6). Two studies (Cole 1964; May 1976) contributed data to assessment of side effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications compared to placebo. Rappaport 1978 suggested a higher rehospitalisation rate for those receiving chlorpromazine compared to placebo (N = 80, RR 2.29 CI 1.3 to 4.0, NNH 2.9). However, a higher attrition in the placebo group is likely to have introduced a survivor bias into this comparison, as this difference becomes non-significant in a sensitivity analysis on intent-to-treat participants (N = 127, RR 1.69 CI 0.9 to 3.0). One study (May 1976) contributes data to a comparison of trifluoperazine to psychotherapy on long-term health in favour of the trifluoperazine group (N = 92, MD 5.8 CI 1.6 to 0.0); however, data from this study are also likely to contain biases due to selection and attrition. One study (Mosher 1995) contributes data to a comparison of typical antipsychotic medication to psychosocial treatment on six-week outcome measures of global psychopathology (N = 89, MD 0.01 CI -0.6 to 0.6) and global improvement (N = 89, MD -0.03 CI -0.5 to 0.4), indicating no between-group differences. On the whole, there is very little useable data in the few studies meeting inclusion criteria. AUTHORS' CONCLUSIONS With only a few studies meeting inclusion criteria, and with limited useable data in these studies, it is not possible to arrive at definitive conclusions. The preliminary pattern of evidence suggests that people with early episode schizophrenia treated with typical antipsychotic medications are less likely to leave the study early, but more likely to experience medication-related side effects. Data are too sparse to assess the effects of antipsychotic medication on outcomes in early episode schizophrenia.
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Affiliation(s)
- John R Bola
- City University of Hong KongDepartment of Applied Social Studies83 Tat Chee AvenueKowloon TongHong Kong000000
| | - Dennis Kao
- University of HoustonGraduate College of Social Work110HA Social Work BuildingHoustonUSA77204‐4013
| | - Haluk Soydan
- University of Southern CaliforniaSchool of Social WorkUniversity Park CampusMontgomery Ross Fisher BuildingLos AngelesUSA90089‐0411
| | - Clive E Adams
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthInnovation Park, Triumph Road,NottinghamUKNG7 2TU
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Catts SV, O'Toole BI, Carr VJ, Lewin T, Neil A, Harris MG, Frost ADJ, Crissman BR, Eadie K, Evans RW. Appraising evidence for intervention effectiveness in early psychosis: conceptual framework and review of evaluation approaches. Aust N Z J Psychiatry 2010; 44:195-219. [PMID: 20180724 DOI: 10.3109/00048670903487167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The literature that is relevant to evaluation of treatment effectiveness is large, scattered and difficult to assemble for appraisal. This scoping review first develops a conceptual framework to help organize the field, and second, uses the framework to appraise early psychosis intervention (EPI) studies. Literature searches were used to identify representative study designs, which were then sorted according to evaluation approach. The groupings provided a conceptual framework upon which a map of the field could be drawn. Key words were cross-checked against definitions in dictionaries of scientific terms and the National Library of Medicine Medical Subject Headings (MeSH) browser. Using the final list of key words as search terms, the EPI evaluation literature was appraised. Experimental studies could be grouped into two classes: efficacy and effectiveness randomized controlled trials. Non-experimental studies could be subgrouped into at least four overlapping categories: clinical epidemiological; health service evaluations; quality assurance studies; and, quasi-experimental assessments of treatment effects. Applying this framework to appraise EPI studies indicated promising evidence for the effectiveness of EPI irrespective of study design type, and a clearer picture of where future evaluation efforts should be focused. Reliance on clinical trials alone will restrict the type of information that can inform clinical practice. There is convergent evidence for the benefits of specialized EPI service functions across a range of study designs. Greater investment in health services research and quality assurance approaches in evaluating EPI effectiveness should be made, which will involve scaling up of study sizes and development of an EPI programme fidelity rating template. The degree of complexity of the evaluation field suggests that greater focus on research methodology in the training of Australasian psychiatrists is urgently needed.
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Affiliation(s)
- Stanley V Catts
- School of Medicine, University of Queensland, K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
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Lester H, Birchwood M, Freemantle N, Michail M, Tait L. REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis. Br J Gen Pract 2009; 59:e183-90. [PMID: 19520016 PMCID: PMC2688067 DOI: 10.3399/bjgp09x420851] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 07/22/2008] [Accepted: 10/15/2008] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates. AIM To assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis. DESIGN OF STUDY Stratified cluster randomised controlled trial, clustered at practice level. SETTING Birmingham, England. METHOD Practices with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion. Intervention practices received an educational intervention addressing GP knowledge, skills, and attitudes about first-episode psychosis. The primary outcome was the difference in the number of referrals to early-intervention services between practices. Secondary outcomes were duration of untreated psychosis, time to recovery, use of the Mental Health Act, and GP consultation rate during the developing illness. RESULTS A total of 110 of 135 eligible practices (81%) were recruited; 179 young people were referred, 97 from intervention and 82 from control practices. The relative risk of referral was not significant: 1.20 (95% confidence interval [CI] = 0.74 to 1.95; P = 0.48). No effect was observed on secondary outcomes except for 'delay in reaching early-intervention services', which was statistically significantly shorter in patients registered in intervention practices (95% CI = 83.5 to 360.5; P = 0.002). CONCLUSION GP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis; however, there is a suggestion that training facilitates access to the new specialist teams for early psychosis.
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Oud MJT, Schuling J, Slooff CJ, Groenier KH, Dekker JH, Meyboom-de Jong B. Care for patients with severe mental illness: the general practitioner's role perspective. BMC FAMILY PRACTICE 2009; 10:29. [PMID: 19419547 PMCID: PMC2685366 DOI: 10.1186/1471-2296-10-29] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 05/06/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with severe mental illness (SMI) experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. METHODS A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. RESULTS 186 general practitioners distributed over urban areas (49%), urbanised rural areas (38%) and rural areas (15%) of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices.GPs also saw their role as giving support and information to the patient's family.However, they felt a need for recognition of their competencies when working with mental health care specialists. CONCLUSION GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients.
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Affiliation(s)
- Marian JT Oud
- Department of General Practice, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jan Schuling
- Department of General Practice, University Medical Centre Groningen, Groningen, The Netherlands
| | - Cees J Slooff
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
- Mental Health Centre Drenthe, Assen, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University Medical Centre Groningen, Groningen, The Netherlands
| | - Janny H Dekker
- Department of General Practice, University Medical Centre Groningen, Groningen, The Netherlands
| | - Betty Meyboom-de Jong
- Department of General Practice, University Medical Centre Groningen, Groningen, The Netherlands
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Renwick L, Gavin B, McGlade N, Lacey P, Goggins R, Jackson D, Turner N, Foley S, McWilliams S, Behan C, Lawlor E, Cullen W, O'Callaghan E. Early intervention service for psychosis: views from primary care. Early Interv Psychiatry 2008; 2:285-90. [PMID: 21352162 DOI: 10.1111/j.1751-7893.2008.00090.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Although General Practitioners (GPs) have a pivotal role in early detection and treatment of psychosis, there is sparse information on their views of early intervention (EI) services and how information related to EI should be delivered. METHOD Since inception, DETECT (Dublin East Treatment and Early Care Team), Ireland's pilot EI project, mailed information packs and provided information through the local GP continuing medical education (CME) network. After 1 year, we surveyed GPs within DETECT's catchment area for their views on the service being provided. RESULTS One hundred and twenty-six (36%) responded and 80% found the EI service very/extremely useful. GPs reported that the combination of CME session and information packs were more useful than information packs alone. Those who attended CME meetings were significantly more likely to refer suspected cases (P < 0.01) and more likely to find the service useful (P < 0.001). CONCLUSION The EI service for psychosis is well-received among GPs. Information about EI delivered through CME appears to have a greater impact on referral rates and satisfaction levels than mailed information.
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Affiliation(s)
- Laoise Renwick
- DETECT, Avila House, Block 5, Blackrock Business Park, Blackrock, Co Dublin, Ireland
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Gavin B, Cullen W, Foley S, McWilliams S, Turner N, O'Callaghan E, Bury G. Integrating primary care and early intervention in psychosis services: a general practitioner perspective. Early Interv Psychiatry 2008; 2:103-7. [PMID: 21352140 DOI: 10.1111/j.1751-7893.2008.00065.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Earlier detection and treatment of psychosis is associated with improved health outcomes. While the role of specialist services to facilitate early diagnosis and treatment has been extensively described internationally, little data on their impact on general practice has been reported. A new specialist service for psychosis - the 'Dublin East Treatment and Early Care Team (DETECT)'- has recently been established. This study aimed to describe general practitioners' (GPs) attitudes towards working within the catchment area of an early intervention service. METHODS A purposive sample of GPs practising in DETECT's catchment area was identified from the Irish Medical Directory and invited to participate in a semi-structured interview. The sampling parameters were solo/practice and area of practice. Participants were provided with information regarding the new service and a range of educational material. Each interview was reviewed by two researchers who identified dominant themes. The study was approved by the Research Ethics Committee of the Irish College of GPs. RESULTS 16 GPs were interviewed. The DETECT early intervention model was identified as reducing the challenges of managing psychosis in primary care including the practical difficulties of accessing psychiatric assessment and the pervasive effect of stigma. Participants viewed communication between primary and specialist care as essential to the success of early intervention services. CONCLUSIONS General Practice has an important role in early detection of psychosis and accessing timely psychiatric evaluations of suspected psychosis. Increasing awareness among GPs and ensuring the early intervention model is responsive to primary care can support this role.
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Affiliation(s)
- Blanaid Gavin
- Lucena Clinic, 59 Orwell Road, Rathgar, Dublin 6, Ireland.
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Power P, Iacoponi E, Reynolds N, Fisher H, Russell M, Garety P, McGuire PK, Craig T. The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis. Br J Psychiatry 2008; 51:s133-9. [PMID: 18055931 DOI: 10.1192/bjp.191.51.s133] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are few evaluations of strategies to improve rates of early detection and treatment of patients with first-episode psychosis. AIMS To evaluate the effectiveness of a general practitioner (GP) education programme and an early detection assessment team (the Lambeth Early Onset Crisis Assessment Team; LEO CAT) in reducing delays in accessing treatment for first-episode psychosis patients. METHOD 46 clusters of GP practices randomised to GP education in early detection with direct access to LEO CAT v. care as usual. Primary outcome measures were GP referral rates, duration of untreated psychosis (DUP) and delays in receiving treatment. RESULTS 150 patients with first-episode psychosis were recruited; 113 were registered with the study GPs, who referred 54 (47.7%) directly to mental health services. Significantly more intervention group GPs (86.1% v. 65.7%) referred their patients directly to mental health services and fewer patients experienced long delays in receiving treatment. However, their overall DUP was unaffected. CONCLUSIONS Educating GPs improves detection and referral rates of first-episode psychosis patients. An early detection team reduces the long delays in initial assessment and treatment. However, these only impact on the later phases of the DUP. Broader measures, such as public health education, are needed to reduce the earlier delays in DUP.
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Affiliation(s)
- Paddy Power
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, LEO Services, South London and Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, UK.
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Oud MJT, Schuling J, Slooff CJ, Jong BMD. How do General Practitioners experience providing care for their psychotic patients? BMC FAMILY PRACTICE 2007; 8:37. [PMID: 17598879 PMCID: PMC1933537 DOI: 10.1186/1471-2296-8-37] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 06/28/2007] [Indexed: 11/10/2022]
Abstract
BACKGROUND In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing care for these patients hinder the development and implementation of such guidelines. This study aims to explore the chances and problems GPs meet when providing care for patients susceptible for recurring psychoses, including schizophrenia and related disorders, bipolar disorder, and psychotic depression. METHODS A qualitative study of focus group discussions with practising GPs in both town and rural areas. Transcripts from three focus groups with 19 GPs were analysed with the computer program 'Kwalitan'. Theoretical saturation was achieved after these three groups. RESULTS Analysis showed that eight categories of factors influenced the GPs' care for psychotic patients: patient presentation (acute vs. chronic phase), emotional impact, expertise, professional attitude, patient related factors, patient's family, practice organization, and collaboration with psychiatric specialists. CONCLUSION Current primary care for psychotic patients depends very much on personal characteristics of the GP and the quality of local collaboration with the Mental Health Service. A quantitative study among GPs using a questionnaire based on the eight categories mentioned above would determine the extent of the problems and limitations experienced with this type of care. From the results of this quantitative study, new realistic guidelines could be developed to improve the quality of care for psychotic patients.
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Affiliation(s)
- Marian JT Oud
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Schuling
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | - Cees J Slooff
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- Mental Health Center Drenthe, Assen, The Netherlands
| | - Betty Meyboom-de Jong
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
BACKGROUND Proponents of early intervention have argued that outcome might be improved if more therapeutic efforts were focused on the early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has two elements that are distinct from standard care: early detection and phase-specific treatment. Both elements may be offered as supplements to standard care, or may be provided through a specialised early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe and Australasia, but it is unclear how far early detection, phase-specific treatments, and the use of early intervention teams are underpinned by evidence of effectiveness. OBJECTIVES To evaluate the effects of: (a) early detection; (b) phase-specific treatments; and (c) specialised early intervention teams in the treatment of people with prodromal symptoms or first episode psychosis. SEARCH STRATEGY We searched CINAHL (1982-2002), The Cochrane Controlled Trials Register (November 2001), The Cochrane Schizophrenia Group Register (July 2003), EMBASE (1980-2002), MEDLINE (1966-2002), PsycINFO (1967-2002), reference lists and contacted the European First Episode Network (2003). For the 2006 update we searched the Cochrane Schizophrenia Group's register. SELECTION CRITERIA We included all randomised controlled trials designed to prevent progression to psychosis in people showing prodromal symptoms, or to improve outcome for people with first episode psychosis. Eligible interventions, alone and in combination, included early detection, phase-specific treatments, and care from specialised early intervention teams. We accepted cluster-randomised trials but excluded non-randomised trials. DATA COLLECTION AND ANALYSIS We reliably selected studies, quality rated them and extracted data. For dichotomous data, we estimated relative risks (RR), with the 95% confidence intervals (CI). Where possible, we calculated the number needed to treat/harm statistic (NNT/H) and used intention-to-treat analysis (ITT). MAIN RESULTS We included seven studies with a total of 941 participants. Six studies were small with numbers of participants ranging between 56 and 83, and one study randomised 547 people. None of the studies had similar interventions and therefore they were analysed separately. One small Australian trial (n=59) was concerned with a phase-specific intervention (low dose risperidone and cognitive behavioural therapy) for people with prodromal symptoms. This group were significantly less likely to develop psychosis at a six month follow up than people who only received care from a specialised team which did not involve phase-specific treatment (n=59, RR 0.27 CI 0.1 to 0.9, NNT 4 CI 2 to 20). This effect was not significant at 12 month follow up (n=59, 1 RCT, RR 0.54 CI 0.2 to 1.3). A UK-based study (EDIE) randomised 60 people with prodromal symptoms, to cognitive behavioural therapy (CBT) or a monitoring group. Only two outcomes were reported: leaving the study early and transition to psychosis, both sets of data were non-significant. A Chinese trial used a phase-specific intervention (family therapy) plus out patient care trial for people in their first episode of psychosis and found reduced admission rates care compared with those who received only outpatient care (n=83, RR 0.28 CI 0.1 to 0.6, NNT 3 CI 2 to 6). The applicability of this finding was, however, questionable. One Dutch study (n=76) comparing phase-specific intervention (family therapy) plus specialised team with specialised team for people in their first episode of schizophrenia found no difference between intervention and control groups at 12 months for the outcome of relapse (n=76, RR 1.05 CI 0.4 to 3.0). The large Scandinavian study (n=547) allocated people with first episode schizophrenia to integrated treatment (assertive community treatment plus family therapy, social skills training and a modified medication regime) or standard care. Global state outcome GAF significantly favoured integrated treatment (n=419, WMD -3.71 CI -6.7 to -0.7) by one year, but by two years data were non-significant. Rates of attrition were significantly lower (n=547, RR 0.59 CI 0.4 to 0.8, NNT 9 CI 6 to 18) for integrated treatment by one and two year follow-up. PRIME (USA) was the only double blind study and allocated people with prodromal symptoms to olanzapine or placebo. No significant differences were found between olanzapine and placebo in preventing conversion to psychosis by about 12 months (n=60, RR 0.58 CI 0.3 to 1.2). Clinical Global Impression change scores 'severity of illness' were equivocal by 12 months. Scale of Prodromal Symptoms (SOPS) scores were also equivocal and the PANSS, total, positive and negative outcomes were non-significant. There were no significant differences between the olanzapine and placebo group on adverse effects rating scales - SAS, BAS and AIMS scores; Weight gain was significantly higher in the olanzapine group (n=59, WMD 7.63 CI 4.0 to 11.2) by 12 months. Finally one more Australian study included people in their first episode of psychosis who were acutely suicidal and allocated people to phase-specific cognitively orientated therapy or standard care. Outcome data for leaving the study early and suicide were equivocal. AUTHORS' CONCLUSIONS We identified insufficient trials to draw any definitive conclusions. The substantial international interest in early intervention offers an opportunity to make major positive changes in psychiatric practice, but making the most of this opportunity requires a concerted international programme of research to address key unanswered questions.
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Affiliation(s)
- M Marshall
- The Lantern Centre, Vicarage Lane, Of Watling Street Road, Fulwood, Preston, Lancashire, UK.
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