1
|
Salazar de Pablo G, Guinart D, Armendariz A, Aymerich C, Catalan A, Alameda L, Rogdaki M, Martinez Baringo E, Soler-Vidal J, Oliver D, Rubio JM, Arango C, Kane JM, Fusar-Poli P, Correll CU. Duration of Untreated Psychosis and Outcomes in First-Episode Psychosis: Systematic Review and Meta-analysis of Early Detection and Intervention Strategies. Schizophr Bull 2024; 50:771-783. [PMID: 38491933 PMCID: PMC11283197 DOI: 10.1093/schbul/sbae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND The role of duration of untreated psychosis (DUP) as an early detection and intervention target to improve outcomes for individuals with first-episode psychosis is unknown. STUDY DESIGN PRISMA/MOOSE-compliant systematic review to identify studies until February 1, 2023, with an intervention and a control group, reporting DUP in both groups. Random effects meta-analysis to evaluate (1) differences in DUP in early detection/intervention services vs the control group, (2) the efficacy of early detection strategies regarding eight real-world outcomes at baseline (service entry), and (3) the efficacy of early intervention strategies on ten real-world outcomes at follow-up. We conducted quality assessment, heterogeneity, publication bias, and meta-regression analyses (PROSPERO: CRD42020163640). STUDY RESULTS From 6229 citations, 33 intervention studies were retrieved. The intervention group achieved a small DUP reduction (Hedges' g = 0.168, 95% CI = 0.055-0.283) vs the control group. The early detection group had better functioning levels (g = 0.281, 95% CI = 0.073-0.488) at baseline. Both groups did not differ regarding total psychopathology, admission rates, quality of life, positive/negative/depressive symptoms, and employment rates (P > .05). Early interventions improved quality of life (g = 0.600, 95% CI = 0.408-0.791), employment rates (g = 0.427, 95% CI = 0.135-0.718), negative symptoms (g = 0.417, 95% CI = 0.153-0.682), relapse rates (g = 0.364, 95% CI = 0.117-0.612), admissions rates (g = 0.335, 95% CI = 0.198-0.468), total psychopathology (g = 0.298, 95% CI = 0.014-0.582), depressive symptoms (g = 0.268, 95% CI = 0.008-0.528), and functioning (g = 0.180, 95% CI = 0.065-0.295) at follow-up but not positive symptoms or remission (P > .05). CONCLUSIONS Comparing interventions targeting DUP and control groups, the impact of early detection strategies on DUP and other correlates is limited. However, the impact of early intervention was significant regarding relevant outcomes, underscoring the importance of supporting early intervention services worldwide.
Collapse
Affiliation(s)
- Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Daniel Guinart
- Institut de Salut Mental, Hospital del Mar, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Psychiatry, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Alvaro Armendariz
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Etiopatogenia i Tractament Dels Trastorns Mental Severs (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Claudia Aymerich
- Psychiatry Department, Basurto University Hospital, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Barakaldo, Bizkaia, Spain
| | - Ana Catalan
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychiatry Department, Basurto University Hospital, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Barakaldo, Bizkaia, Spain
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- TiPP Program Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Department of Psychiatry, Centro Investigación Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, University of Sevilla, Sevilla, Spain
| | - Maria Rogdaki
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Estrella Martinez Baringo
- Department of Child and Adolescent Psychiatry, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Spain
| | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Barcelona, Spain
- Hospital Benito Menni CASM, Hermanas Hospitalarias, Sant Boi de Llobregat, Spain
| | - Dominic Oliver
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jose M Rubio
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
2
|
Murden R, Allan SM, Hodgekins J, Oduola S. The effectiveness of public health interventions, initiatives, and campaigns designed to improve pathways to care for individuals with psychotic disorders: A systematic review. Schizophr Res 2024; 266:165-179. [PMID: 38412687 DOI: 10.1016/j.schres.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/19/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Lengthy duration of untreated psychosis (DUP) and duration of untreated illness (DUI) in people at clinical high-risk for psychosis (CHR-P) and first episode psychosis (FEP) is associated with poorer outcomes. However, individuals with FEP often experience negative pathways to care involving contacts with police, crisis services and requiring compulsory admissions, and evidence suggests individuals with both FEP and CHR-P often experience lengthy delays to treatment. Early detection interventions, such as public health interventions, may be one way to reduce delays. This systematic review aimed to synthesise the available evidence on such interventions. METHODS The EMBASE, PsychINFO, CINAHL, and MEDLINE databases were searched. Studies were included if they compared an intervention designed to improve timely access to treatment for individuals with FEP or CHR-P to standard treatment provision. Interventions may be targeted at potential patients, their families, the general public, or non-healthcare professionals. Outcomes of interest were DUP or DUI, and/or characteristics of pathways to care. RESULTS Nineteen studies met the inclusion criteria. All consisted of FEP populations, none of CHR-P populations. Employing narrative synthesis, we found mixed results about the effectiveness of interventions at reducing DUP and interventions appeared to differentially impact groups. Pathways to care information was limited and mixed. CONCLUSION Findings on the effectiveness of interventions designed to improve timely access to treatment were inconclusive. More research is warranted to better understand where delays occur and factors which may influence this for both FEP and CHR-P populations which may help to develop targeted interventions to address delays.
Collapse
Affiliation(s)
- Rhiannon Murden
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; Birmingham and Solihull Mental Health NHS Foundation Trust, Uffculme Centre, 52 Queensbridge Road, Moseley, Birmingham B13 8QY, UK.
| | - Sophie M Allan
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Sheri Oduola
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, Cambridgeshire CB21 5EF, UK; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| |
Collapse
|
3
|
Saavedra JL, Crisanti A, Lardier DT, Tohen M, Lenroot R, Bustillo J, Halperin D, Friedman B, Loewy R, Murray-Krezan C, McIver S. The Cascade of Care for Early Psychosis Detection in a College Counseling Center. Psychiatr Serv 2024; 75:161-166. [PMID: 37554003 DOI: 10.1176/appi.ps.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Programs for early detection of psychosis help identify individuals experiencing emerging psychosis and link them with appropriate services, thereby reducing the duration of untreated psychosis (DUP). The authors used the cascade-of-care framework to identify various care stages between screening and enrollment in coordinated specialty care (CSC) and to determine attrition at each stage, with the goal of identifying points in the referral process that may affect DUP. METHODS Project partners included a college counseling center and CSC program. All college students seeking mental health services at a counseling center between 2020 and 2022 (N=1,945) completed the Prodromal Questionnaire-Brief (PQ-B) at intake. Students who met the distress cutoff score were referred for a phone screening. Those who met criteria on the basis of this screening were referred for assessment and possible enrollment into CSC. RESULTS Six stages in the cascade of care for early detection were identified. Of the students who completed the PQ-B as part of intake (stage 1), 547 (28%) met the PQ-B cutoff score (stage 2). Counselors referred 428 (78%) students who met the PQ-B cutoff score (stage 3), and 212 (50%) of these students completed the phone screening (stage 4). Seventy-two (34%) students completed a CSC eligibility assessment (stage 5), 21 (29%) of whom were enrolled in CSC (stage 6). CONCLUSIONS The cascade-of-care framework helped conceptualize the flow within a program for early psychosis detection in order to identify stages that may contribute to lengthier DUP. Future research is warranted to better understand the factors that contribute to DUP at these stages.
Collapse
Affiliation(s)
- Justine L Saavedra
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Annette Crisanti
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - David T Lardier
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Rhoshel Lenroot
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Juan Bustillo
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Dawn Halperin
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Bess Friedman
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Rachel Loewy
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Cristina Murray-Krezan
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| | - Stephanie McIver
- Department of Psychiatry and Behavioral Sciences (Saavedra, Crisanti, Lardier, Tohen, Lenroot, Bustillo, Halperin, Friedman) and Student Health and Counseling (McIver), University of New Mexico, Albuquerque; Weill Institute for Neurosciences, University of California San Francisco, San Francisco (Loewy); Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (Murray-Krezan)
| |
Collapse
|
4
|
Niendam TA, Loewy R, Savill M, Delucchi KL, Lesh TA, Ragland JD, Bolden K, Skymba HV, Gobrial S, Meyer MS, Pierce KM, Rosenthal A, Fedechko TL, Tully LM, Tryon VL, Goldman H, Cress RD, Kravitz RL, Carter CS. Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis: A Cluster Randomized Clinical Trial. JAMA Psychiatry 2023; 80:119-126. [PMID: 36598770 PMCID: PMC9857799 DOI: 10.1001/jamapsychiatry.2022.4436] [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: 05/10/2022] [Accepted: 11/02/2022] [Indexed: 01/05/2023]
Abstract
Importance Reducing the duration of untreated psychosis (DUP) is essential to improving outcomes for people with first-episode psychosis (FEP). Current US approaches are insufficient to reduce DUP to international standards of less than 90 days. Objective To determine whether population-based electronic screening in addition to standard targeted clinician education increases early detection of psychosis and decreases DUP, compared with clinician education alone. Design, Setting, and Participants This cluster randomized clinical trial included individuals aged 12 to 30 years presenting for services between March 2015 and September 2017 at participating sites that included community mental health clinics and school support and special education services. Eligible participants were referred to the Early Diagnosis and Preventative Treatment (EDAPT) Clinic. Data analyses were performed in September and October 2019 for the primary and secondary analyses, with the exploratory subgroup analyses completed in May 2021. Interventions All sites in both groups received targeted education about early psychosis for health care professionals. In the active screening group, clients also completed the Prodromal Questionnaire-Brief using tablets at intake; referrals were based on those scores and clinical judgment. In the group receiving treatment as usual (TAU), referrals were based on clinical judgment alone. Main Outcomes and Measures Primary outcomes included DUP, defined as the period from full psychosis onset to the date of the EDAPT diagnostic telephone interview, and the number of individuals identified with FEP or a psychosis spectrum disorder. Exploratory analyses examined differences by site type, completion rates between conditions, and days from service entry to telephone interview. Results Twenty-four sites agreed to participate, and 12 sites were randomized to either the active screening or TAU group. However, only 10 community clinics and 4 school sites were able to fully implement population screening and were included in the final analysis. The total potentially eligible population size within each study group was similar, with 2432 individuals entering at active screening group sites and 2455 at TAU group sites. A total of 303 diagnostic telephone interviews were completed (178 [58.7%] female individuals; mean [SD] age, 17.09 years [4.57]). Active screening sites reported a significantly higher detection rate of psychosis spectrum disorders (136 cases [5.6%], relative to 65 [2.6%]; P < .001) and referred a higher proportion of individuals with FEP and DUP less than 90 days (13 cases, relative to 4; odds ratio, 0.30; 95% CI, 0.10-0.93; P = .03). There was no difference in mean (SD) DUP between groups (active screening group, 239.0 days [207.4]; TAU group 262.3 days [170.2]). Conclusions and Relevance In this cluster trial, population-based technology-enhanced screening across community settings detected more than twice as many individuals with psychosis spectrum disorders compared with clinical judgment alone but did not reduce DUP. Screening could identify people undetected in US mental health services. Significant DUP reduction may require interventions to reduce time to the first mental health contact. Trial Registration ClinicalTrials.gov Identifier: NCT02841956.
Collapse
Affiliation(s)
- Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Rachel Loewy
- Department of Psychiatry, University of California, San Francisco
- UCSF Weill Institute for Neurosciences, San Francisco, California
| | - Mark Savill
- Department of Psychiatry, University of California, San Francisco
- UCSF Weill Institute for Neurosciences, San Francisco, California
| | - Kevin L Delucchi
- Department of Psychiatry, University of California, San Francisco
- UCSF Weill Institute for Neurosciences, San Francisco, California
| | - Tyler A Lesh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - J Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Khalima Bolden
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Haley V Skymba
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Sarah Gobrial
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Monet S Meyer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Katherine M Pierce
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Adi Rosenthal
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Taylor L Fedechko
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Laura M Tully
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | | | - Howard Goldman
- Department of Psychiatry, University of Maryland, Baltimore
| | - Rosemary D Cress
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Richard L Kravitz
- Department of General Medicine, Geriatrics, and Bioethics, University of California, Davis, Sacramento
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| |
Collapse
|
5
|
Mathis WS, Ferrara M, Burke S, Hyun E, Li F, Zhou B, Cahill J, Kline ER, Keshavan MS, Srihari VH. Granular analysis of pathways to care and durations of untreated psychosis: A marginal delay model. PLoS One 2022; 17:e0270234. [PMID: 36472968 PMCID: PMC9725156 DOI: 10.1371/journal.pone.0270234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE An extensive international literature demonstrates that understanding pathways to care (PTC) is essential for efforts to reduce community Duration of Untreated Psychosis (DUP). However, knowledge from these studies is difficult to translate to new settings. We present a novel approach to characterize and analyze PTC and demonstrate its value for the design and implementation of early detection efforts. METHODS Type and date of every encounter, or node, along the PTC were encoded for 156 participants enrolled in the clinic for Specialized Treatment Early in Psychosis (STEP), within the context of an early detection campaign. Marginal-delay, or the portion of overall delay attributable to a specific node, was computed as the number of days between the start dates of contiguous nodes on the PTC. Sources of delay within the network of care were quantified and patient characteristic (sex, age, race, income, insurance, living, education, employment, and function) influences on such delays were analyzed via bivariate and mixed model testing. RESULTS The period from psychosis onset to antipsychotic prescription was significantly longer (52 vs. 20.5 days, [p = 0.004]), involved more interactions (3 vs. 1 nodes, [p<0.001]), and was predominated by encounters with non-clinical nodes while the period from antipsychotic to STEP enrollment was shorter and predominated by clinical nodes. Outpatient programs were the greatest contributor of marginal delays on both before antipsychotic prescription (median [IQR] of 36.5 [1.3-132.8] days) and (median [IQR] of 56 [15-210.5] days). Sharper functional declines in the year before enrollment correlated significantly with longer DUP (p<0.001), while those with higher functioning moved significantly faster through nodes (p<0.001). No other associations were found with patient characteristics and PTCs. CONCLUSIONS The conceptual model and analytic approach outlined in this study give first episode services tools to measure, analyze, and inform strategies to reduce untreated psychosis.
Collapse
Affiliation(s)
- Walter S. Mathis
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
- * E-mail:
| | - Maria Ferrara
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Shadie Burke
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Emily Hyun
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Bin Zhou
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - John Cahill
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| | - Emily R. Kline
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Massachusetts Mental Health Center, Boston, Massachusetts, United States of America
| | - Matcheri S. Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Massachusetts Mental Health Center, Boston, Massachusetts, United States of America
| | - Vinod H. Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, Connecticut, United States of America
| |
Collapse
|
6
|
López SR, Kopelowicz A, Ullman J, Mayer D, Santos MM, Kratzer M, Vega WA, Barrio C, Calderon V. Toward reducing the duration of untreated psychosis in a Latinx community. J Consult Clin Psychol 2022; 90:815-826. [PMID: 35588388 PMCID: PMC9949997 DOI: 10.1037/ccp0000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To carry out and evaluate a communications campaign (La CLAve) to reduce the duration of untreated psychosis (DUP) in a U.S. Latinx community. METHOD We employed evidence-based messaging in multiple media outlets. We recruited 132 Latinxs with first-episode psychosis (FEP) and caregivers seeking mental health care within a high-density Latinx community. We evaluated the campaign's dissemination, the extent to which the community received the campaign message, and the campaign outcome. We tested whether DUP (number of weeks) changed across three time periods (16-month baseline, 2-year campaign, and 16-month postcampaign) and whether participants' language background (primarily Spanish speaking or English speaking) moderated change in DUP. RESULTS The campaign was disseminated widely. During the height of the campaign over a 1-year period, our team distributed 22,039 brochures and performed 740 workshops. The campaign message was received by the community as noted for example by increases in the number of unduplicated weekly calls to the campaign's 1-800 number. Applying square root transformations to DUP, we found a significant main effect for language background but not for campaign period nor their interaction. The unadjusted mean DUP for Spanish-speaking persons with FEP was more than twice as high as the mean DUP for English-speaking persons with FEP. CONCLUSION Spanish-speaking Latinxs with FEP are especially in need of early psychosis treatment. The campaign reached the community but additional steps are needed to reduce treatment delay. Greater attention is needed to increase access to early intervention services for communities of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
|
7
|
Abstract
This invited commentary provides a conceptual history of modern early intervention services, briefly reviews the accomplishments of an international clinical and research community, and offers proposals for how such services might participate in the next generation of progress. In keeping with the theme of this column, we make the argument that such services should orient around bi-directional knowledge translation across basic, clinical and policy domains.
Collapse
Affiliation(s)
- Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, CT, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
8
|
Malla A. Reducing Duration of Untreated Psychosis: The Neglected Dimension of Early Intervention Services. Am J Psychiatry 2022; 179:259-261. [PMID: 35360915 DOI: 10.1176/appi.ajp.20220154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montréal, Canada
| |
Collapse
|
9
|
van Beek A, de Zeeuw J, de Leeuw M, Poplawska M, Kerkvliet L, Dwarkasing R, Nanda R, Veling W. Duration of untreated psychosis and pathways to care in Suriname: a qualitative study among patients, relatives and general practitioners. BMJ Open 2022; 12:e050731. [PMID: 35110311 PMCID: PMC8811554 DOI: 10.1136/bmjopen-2021-050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Psychosis is a severe mental health problem and is responsible for poor health outcomes, premature mortality and morbidity, especially in low- and middle-income countries. The duration of untreated psychosis (DUP), that is the time period between onset of symptoms until initiation of appropriate treatment by a healthcare professional, is one of the main determinants for successful treatment in western settings. This study aims to explore the factors related to the DUP among Surinamese patients using the perspectives from patients, their families and first-line healthcare professionals in Suriname. METHODS Semi-structured interviews were conducted with patients having a history of psychosis, family members and general practitioners between February 2019 and April 2019 in Suriname. Interviews were tape-recorded and transcribed verbatim. Data were analysed using a thematic analysis for which an inductive and deductive approach was applied. RESULTS In total, 28 patients, 13 family members and 8 general practitioners were interviewed. Five patients were excluded from the study. A median DUP of 4 months was found (IQR 1-36). Identified themes related to DUP included presentation of symptoms and illness awareness, help-seeking behaviour and alternative medicine, social support and stigma, financial and practical factors. CONCLUSION Multiple factors were related to DUP, of which poor illness awareness, traditional medicine, stigma and social support were predominant. Poor illness awareness and use of alternative medicine were related to a longer DUP. Stigma was often an obstacle for patients and their families. Social and family support was important in helping patients to get medical help sooner. Other explored factors including financial and practical factors did not contribute to DUP.
Collapse
Affiliation(s)
- Atousa van Beek
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Janine de Zeeuw
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Menno de Leeuw
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mia Poplawska
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lise Kerkvliet
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Wim Veling
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
10
|
Calderon V, Cain R, Torres E, Lopez SR. Evaluating the message of an ongoing communication campaign to reduce the duration of untreated psychosis in a Latinx community in the United States. Early Interv Psychiatry 2022; 16:147-152. [PMID: 33768718 DOI: 10.1111/eip.13140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022]
Abstract
AIM Initiatives aimed at reducing the duration of untreated psychosis (DUP) attempt to increase the community's level of psychosis literacy. Most of these efforts, however, have failed to reduce DUP. One plausible explanation is that the campaigns do not actually increase psychosis literacy. To date, there have been few efforts to assess whether the campaign messaging does indeed increase psychosis literacy prior to or during the campaign. This study evaluated whether the message of the La CLAve DUP reduction program delivered during the campaign increased the psychosis literacy of a U.S. Latinx community. METHODS The sample consisted of 81 Latinx community residents aged 15-84. Two community health educators of the La CLAve campaign facilitated workshops using a narrative film to initiate a conversation in the community about the signs of psychosis and the importance of professional help-seeking early in the illness course. Psychosis literacy was assessed via questionnaires pertaining to a hypothetical vignette administered before and after the workshops. RESULTS The psychosis literacy of participants increased after the workshops in several domains. Participants' knowledge of multiple psychotic symptoms, self-efficacy in their ability to recognize psychosis in others, and correct attributions of a hypothetical vignette's psychotic symptoms significantly increased. No changes were observed in recommendations for professional help-seeking. CONCLUSIONS These findings provide support for the effectiveness of the La CLAve messaging in increasing psychosis literacy of U.S. Latinx community residents. Evidence-based campaign messaging is needed to increase the success of DUP reduction programs especially among underserved communities.
Collapse
Affiliation(s)
- Vanessa Calderon
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Rosalba Cain
- USC Alzheimer's Disease Research Center, Los Angeles, California, USA
| | - Eva Torres
- Los Angeles County Department of Mental Health, Los Angeles, California, USA
| | - Steven R Lopez
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
11
|
Allan SM, Hodgekins J, Beazley P, Oduola S. Pathways to care in at-risk mental states: A systematic review. Early Interv Psychiatry 2021; 15:1092-1103. [PMID: 33047505 DOI: 10.1111/eip.13053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/23/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
AIM Pathways to care are well studied in the First Episode Psychosis field, but less attention has been given to At-Risk Mental States or prodromal psychosis. This is important because accessing appropriate help at the earliest opportunity is likely to improve outcomes, particularly for those who make transition to psychosis. The present systematic review aimed to synthesize the available literature on pathways to care in ARMS or prodromal psychosis, and investigate the barriers and facilitators to receiving care for ARMS. METHODS The CINAHL Complete, EMBASE, Medline Complete, PsycINFO and PubMED databases were searched. Studies were included if they were published in English between 1985 and 2019, where reported data came exclusively from an At-Risk Mental State population, and the study described or related to pathways to care. RESULTS Ten studies met the inclusion criteria, of which 8 were quantitative. Screening tools and pathways to care instruments varied. Mental health professionals, and general practitioners played a key role in help seeking. Family involvement was also found to be an important factor. CONCLUSIONS Pathways to care research in At-Risk Mental States are more scarce than in the field of First Episode Psychosis. More research is warranted, especially concerning the role of patient-level characteristics on pathways to care. A validated measure of pathways to care may also be of benefit.
Collapse
Affiliation(s)
- Sophie M Allan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Cambridgeshire, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Peter Beazley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| |
Collapse
|
12
|
Cawkwell PB, Bolton KW, Karmacharya R, Öngür D, Shinn AK. Two-year diagnostic stability in a real-world sample of individuals with early psychosis. Early Interv Psychiatry 2020; 14:751-754. [PMID: 32043313 PMCID: PMC7774998 DOI: 10.1111/eip.12930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/16/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diagnostic shifts in first episode psychosis (FEP) are not uncommon. Many studies examining diagnostic stability use structured diagnostic interviews. Less is known about the stability of FEP diagnoses made clinically. METHODS We conducted a retrospective chart review of patients enrolled in a transdiagnostic FEP clinic. For the 96 patients followed clinically at least 2 years, we compared diagnoses at intake and 24 months. RESULTS Diagnostic stability was high for bipolar disorder (89%), schizoaffective disorder (89%), and schizophrenia (82%). Psychosis not otherwise specified (13%) was more unstable, with limited baseline differences that would enable clinicians to predict who would convert to a primary psychotic vs affective psychotic disorder. CONCLUSIONS Our real-world clinical sample shows that FEP diagnoses, with the exception of unspecified psychosis, are diagnostically stable, even without structured diagnostic interviews.
Collapse
Affiliation(s)
- Philip B Cawkwell
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts
| | - Kirsten W Bolton
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts
| | | | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts
| | - Ann K Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts
| |
Collapse
|
13
|
Marino L, Scodes J, Ngo H, Nossel I, Bello I, Wall M, Dixon L. Determinants of pathways to care among young adults with early psychosis entering a coordinated specialty care program. Early Interv Psychiatry 2020; 14:544-552. [PMID: 31502409 DOI: 10.1111/eip.12877] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/05/2019] [Accepted: 08/25/2019] [Indexed: 02/03/2023]
Abstract
AIM To describe the characteristics of the pathway to coordinated specialty care for young adults with early psychosis in the United States, to examine how various factors correlate with the duration of untreated psychosis (DUP), and to explore factors associated with time from onset of symptoms to first mental health service contact (help-seeking DUP). METHODS The sample included 779 individuals ages 16 to 30 with recent-onset non-affective psychosis enrolled in OnTrackNY. Domains assessed included demographics, clinical characteristics, mental health service utilization and characteristics of the pathway to care. Primary outcomes included the time from onset of psychotic symptoms to admission to OnTrackNY (DUP) and time from onset of psychotic symptoms to first mental health service contact (help-seeking DUP). RESULTS The mean DUP was 231.2 days (SD = 87.7, median = 169) and mean help-seeking DUP was 73.7 days (SD = 110.8, median = 27). Being in school, better social functioning, and greater number of ER visits or hospitalizations were associated with shorter DUP. Violent ideation or behaviour and having an outpatient mental health visit as the first service contact or hallucinations as the reason for first service contact were significantly associated with longer DUP. Only the type of first service contact (outpatient mental health treatment or other non-mental health service provider) and having hallucinations as the clinical reason for the first service contact were associated with help-seeking DUP. CONCLUSIONS Referral delays were longer than help-seeking delays. Strategies to reduce treatment referral delays through systems-level interventions may be most likely to reduce the overall DUP in this population.
Collapse
Affiliation(s)
- Leslie Marino
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Scodes
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Hong Ngo
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ilana Nossel
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Iruma Bello
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Melanie Wall
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
14
|
Abstract
OBJECTIVE To explore lay understanding and perceptions of schizophrenia in university students. DESIGN Qualitative study using semi-structured interviews and thematic analysis. SETTING The University of Birmingham, West Midlands. PARTICIPANTS 20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1). RESULTS Findings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms that were not mentioned. There were mixed ideas on the causes and sources of available help for schizophrenia; however, positively many said they would consult their general practitioner. While there was a general misconception among the students that schizophrenia caused multiple personalities and was a dangerous illness, there were some differences in perceptions and understanding between ethnic groups, with more Indian students perceiving upbringing as a causal factor in the development of the illness and more Pakistani students perceiving possession by a spirit as a cause. CONCLUSIONS The university students interviewed lacked knowledge about schizophrenia and stigma was widespread, both of which may delay help-seeking. Public health campaigns educating young people about schizophrenia are required to improve early identification and intervention and improve outcomes. Further research exploring ways to effectively tackle stigma is also required.
Collapse
Affiliation(s)
- Charlotte Cadge
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Charlotte Connor
- Mental Health and Wellbeing, University of Warwick Warwick Medical School, Coventry, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| |
Collapse
|
15
|
Chan SKW, Hui CLM, Chang WC, Lee EHM, Chen EYH. Ten-year follow up of patients with first-episode schizophrenia spectrum disorder from an early intervention service: Predictors of clinical remission and functional recovery. Schizophr Res 2019; 204:65-71. [PMID: 30126816 DOI: 10.1016/j.schres.2018.08.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022]
Abstract
The long-term recovery rate of patients with schizophrenia-spectrum disorders has been persistently low despite the implementation of early intervention (EI) services internationally. It is, therefore, important to identify the modifiable factors during the early stage of the illness that predict long-term remission and recovery. The aim of this study is to explore the predictive value of the early stage clinical factors on the clinical remission and functional recovery at 10-year follow-up of patients with schizophrenia-spectrum disorders who received a 2-year EI service. Patients who received the EI service throughout the region of Hong Kong between 1st July 2001 and 30th June 2002 and with a diagnosis of schizophrenia-spectrum disorder were identified from the centralized hospital database (Clinical Management system, CMS). Semi-structured clinical interview was conducted at 10-year follow-up with a successful interview rate of 74.3% (n = 107). Clinical data was systematically retrieved each month for the first three years from the CMS and written clinical records using a standardized data entry form based on operationalized definitions. Results found shorter duration of untreated psychosis (DUP) predicted long-term clinical remission; higher educational level and shorter period of unemployment during the initial three years of the illness predicted functional recovery. Higher educational level, longer period of employment and planned medication discontinuation during the initial three years predicted complete recovery. The current study demonstrates the long-term impact of DUP and suggests improvement of employment during the early stage of illness could be a potential target for further improvement of the service.
Collapse
Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| |
Collapse
|
16
|
Oliver D, Davies C, Crossland G, Lim S, Gifford G, McGuire P, Fusar-Poli P. Can We Reduce the Duration of Untreated Psychosis? A Systematic Review and Meta-Analysis of Controlled Interventional Studies. Schizophr Bull 2018; 44:1362-1372. [PMID: 29373755 PMCID: PMC6192469 DOI: 10.1093/schbul/sbx166] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reduction of duration of untreated psychosis (DUP) is the key strategy of early interventions for improving the outcomes of first-episode psychosis. Although several controlled interventional studies have been conducted with the aim of reducing DUP, the results are highly inconsistent and conflicting. The current study systematically searches Web of Science and Ovid for English original articles investigating interventions adopted to reduce DUP, compared to a control intervention, up to April 6, 2017. Sixteen controlled interventional studies were retrieved, including 1964 patients in the intervention arm and 1358 in the control arm. The controlled intervention studies were characterized by standalone first episode psychosis services, standalone clinical high risk services, community interventions, healthcare professional training, and multifocus interventions. Random effects meta-analyses were conducted. There was no summary evidence that available interventions are successful in reducing DUP during the first episode of psychosis (Hedges' g = -0.12, 95% CI = -0.25 to 0.01). Subgroup analyses showed no differences within each subgroup, with the exception of clinical high risk services (Hedges' g = -0.386, 95% CI = -0.726 to -0.045). These negative findings may reflect a parceled research base in the area, lack of prospective randomized controlled trials (only 2 randomized cluster designed studies were present) and small sample sizes. There was substantial heterogeneity (I2 = 66.4%), most of which was accounted by different definitions of DUP onset (R2 = .88). Psychometric standardization of DUP definition, improvement of study design, and implementation of preventative strategies seem the most promising avenues for reducing DUP and improving outcomes of first-episode psychosis.
Collapse
Affiliation(s)
- Dominic Oliver
- Early Psychosis: Interventions & Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,To whom correspondence should be addressed; tel: 02078480355, fax: 02078480976, e-mail:
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Georgia Crossland
- Early Psychosis: Interventions & Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Steffiany Lim
- Early Psychosis: Interventions & Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - George Gifford
- Department of Psychosis Studies, IoPPN, King’s College London, UK
| | - Philip McGuire
- Department of Psychosis Studies, IoPPN, King’s College London, UK,National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, IoPPN, King’s College London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,OASIS Service, South London and the Maudsley NHS National Health Service Foundation Trust, UK,National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, IoPPN, King’s College London, UK
| |
Collapse
|
17
|
Baby or bathwater? Referrals of "non-cases" in a targeted early identification intervention for psychosis. Soc Psychiatry Psychiatr Epidemiol 2018. [PMID: 29541798 DOI: 10.1007/s00127-018-1502-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To explore the unintended impact of a targeted case identification (TCI) campaign for first episode psychosis (FEP) on people not experiencing FEP ("non-cases") with respect to referral patterns and reasons for being a non-case. METHODS Sources of referral, reasons for being a non-case, and subsequent referral destinations of non-cases were examined before and after a TCI. RESULTS Following the TCI, a greater proportion of non-cases lived outside the study catchment area. A smaller proportion was referred by the parent hospital's emergency room or had a substance-induced psychosis. CONCLUSIONS TCIs for FEP may have unintended effects, with implications for early case identification and early intervention services.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Affiliation(s)
- Swaran Singh
- Division of Health SciencesWarwick Medical School, University of WarwickWarwickUK
| |
Collapse
|
20
|
Connor C. Listen and learn: engaging young people, their families and schools in early intervention research. MEDICAL HUMANITIES 2017; 43:124-129. [PMID: 28559370 PMCID: PMC5520005 DOI: 10.1136/medhum-2016-011090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 05/29/2023]
Abstract
Recent policy guidelines highlight the importance of increasing the identification of young people at risk of developing mental health problems in order to prevent their transition to long-term problems, avoid crisis and remove the need for care through specialist mental health services or hospitalisation. Early awareness of the often insidious behavioural and cognitive changes associated with deteriorating mental well-being, however, is difficult, but it is vital if young people, their families and those who work with them are to be fully equipped with the skills to aid early help-seeking. Our early intervention research continues to highlight the necessity of engaging with and listening to the voices of young people, families and those who work with children and young people, in developing greater understanding of why some young people may be more at risk in terms of their mental health, and to provide children and young people with the best mental health support we can. Collaborative working with young people, their families and those who work with them has been an essential dimension of our youth mental health research in Birmingham, UK, enabling us to listen to the personal narratives of those with lived experience and to work alongside them. This paper highlights some of our key studies and how we have endeavoured to make intra-agency working successful at each stage of the research process through increasing use of digital and youth-informed resources to engage young people: a methodology which continues to inform, guide and develop our early intervention research and implementation.
Collapse
Affiliation(s)
- Charlotte Connor
- Research Lead Youth Mental Health Theme Collaboration for Leadership in Applied Health Research and Care West Midlands (CLAHRC-WM), University of Warwick, Coventry, UK
- Research and Innovation Centre for Mental Health, The Barberry Centre, Birmingham, UK
| |
Collapse
|