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McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore SJ, Browne V, Dooley B, Hickie IB, Jones PB, McDaid D, Mihalopoulos C, Wood SJ, El Azzouzi FA, Fazio J, Gow E, Hanjabam S, Hayes A, Morris A, Pang E, Paramasivam K, Quagliato Nogueira I, Tan J, Adelsheim S, Broome MR, Cannon M, Chanen AM, Chen EYH, Danese A, Davis M, Ford T, Gonsalves PP, Hamilton MP, Henderson J, John A, Kay-Lambkin F, Le LKD, Kieling C, Mac Dhonnagáin N, Malla A, Nieman DH, Rickwood D, Robinson J, Shah JL, Singh S, Soosay I, Tee K, Twenge J, Valmaggia L, van Amelsvoort T, Verma S, Wilson J, Yung A, Iyer SN, Killackey E. The Lancet Psychiatry Commission on youth mental health. Lancet Psychiatry 2024; 11:731-774. [PMID: 39147461 DOI: 10.1016/s2215-0366(24)00163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Patrick D McGorry
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Cristina Mei
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Vivienne Browne
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbara Dooley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | | | | | - Ella Gow
- Orygen, Melbourne, VIC, Australia; Melbourne, VIC, Australia
| | | | | | | | - Elina Pang
- Hong Kong Special Administrative Region, China
| | | | | | | | - Steven Adelsheim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric Y H Chen
- Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; LKS School of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pattie P Gonsalves
- Youth Mental Health Group, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Matthew P Hamilton
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Dorien H Nieman
- Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, ACT, Australia; headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Jo Robinson
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Swaran Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick and Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Ian Soosay
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Jean Twenge
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Lucia Valmaggia
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alison Yung
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia; School of Health Sciences, The University of Manchester, Manchester, UK
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Eóin Killackey
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Pitigala N, Zeng I, Narayanan N, Cullum S, Ng L. Tracking the 3-year trajectory of referrals to an early psychosis intervention service. Australas Psychiatry 2024; 32:336-341. [PMID: 38722057 PMCID: PMC11318223 DOI: 10.1177/10398562241251999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
AIM To review the baseline and clinical characteristics of patients referred to a New Zealand Early Psychosis Intervention (EPI) service across a 4-year timeframe. METHOD We compared two cohorts, and identified variables associated with being accepted or declined, and reasons for decline, by an EPI service between 2013 and 2017. RESULTS There were 576 people with suspected psychosis referred to the EPI service for assessment: 300 (52%) were accepted, 221 (38%) declined and 55 (10%) were not processed. Reasons for being declined by EPI services were a long duration of psychosis (DUP, 48%) and no evidence of psychosis (47%). There were no significant differences between the accepted and declined group in Emergency Department presentations for self-harm or suicide attempts and acute admissions to a psychiatric inpatient unit over the 3-year follow-up period. CONCLUSION To optimise the identification of true positive cases, EPI services require clear entry criteria. Replicating this study in other EPI services with different entry criteria may provide evidence to develop a more uniform screening process. Improved outcomes may be enhanced by measuring effectiveness and liaising with other EPI services.
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Affiliation(s)
| | - Irene Zeng
- Auckland University of Technology, Auckland, New Zealand
| | | | - Sarah Cullum
- Health New Zealand Te Whatu Ora Counties Manukau, Auckland, New Zealand; The University of Auckland, Auckland, New Zealand; Counties Manukau Health, Auckland, New Zealand
| | - Lillian Ng
- Health New Zealand Te Whatu Ora Counties Manukau, Auckland, New Zealand; The University of Auckland, Auckland, New Zealand; Counties Manukau Health, Auckland, New Zealand
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3
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Scarabelot LF, Araújo JM, Leal LR, Pessoa RMDP, Corsi-Zuelli F, Loureiro CM, Corrêa-Oliveira GE, Del-Ben CM. Disengagement from the Ribeirão Preto early intervention program for psychosis: A retrospective cohort study. Asian J Psychiatr 2024; 98:104119. [PMID: 38924943 DOI: 10.1016/j.ajp.2024.104119] [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: 12/23/2023] [Revised: 04/27/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Treatment discontinuation within Early Intervention Services (EIS) for psychosis poses a significant challenge to achieving better outcomes in the early stages of psychotic disorders. Prevalence and predictors of early disengagement from EIS located in low- and middle-income countries (LMICs) remain poorly investigated. We aimed to examine the rates and predictors of disengagement from the Ribeirão Preto Early Intervention Program for Psychosis (Ribeirão Preto-EIP) in Brazil. METHODS We conducted a retrospective cohort study using data from patients referred to the Ribeirão Preto-EIP between January 01, 2015, and December 31, 2018. Exclusion criteria were individuals with a single consultation, a diagnosis other than a psychotic disorder, and documented cases of death. RESULTS Our sample comprised 234 patients, with an overall median follow-up time of 14.2 months. Early treatment disengagement was observed in 26.5 % (n=62), with a median time to disengagement of 5.25 months. Univariable analysis identified non-white skin color (HR=2.10, 95 %CI 1.26-3.49), positive THC screening (HR=2.22, 95 %CI 1.23-4.01), and substance-induced psychosis (HR=2.15, 95 %CI 1.10-4.21) as significant predictors. In multivariable analysis, only non-white skin color remained a significant predictor of early disengagement (HR=1.87, 95 %CI 1.08-3.27). CONCLUSIONS The observed rates of early disengagement in our sample are similar to those reported in wealthy countries, but higher than previously reported for LMICs. Non-white skin color predicted early disengagement in our sample, probably due to social disadvantages. Our data highlights the need for enhanced research elucidating the specific features of EIS in LMICs.
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Affiliation(s)
- Luis Felipe Scarabelot
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | - Jéssica Morais Araújo
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Livio Rodrigues Leal
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Rebeca Mendes de Paula Pessoa
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiana Corsi-Zuelli
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Camila Marcelino Loureiro
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Gabriel Elias Corrêa-Oliveira
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Bhogal J, Singh SP, Chadda R, Sood M, Shah JL, Iyer SN, Madan J. An analysis of financial hardship faced by patients with First Episode Psychosis, and their families, in an Indian setting. Asian J Psychiatr 2024; 97:104066. [PMID: 38815440 DOI: 10.1016/j.ajp.2024.104066] [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: 12/21/2023] [Revised: 02/09/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The economic burden of psychotic disorders is not well documented in LMICs like India, due to several bottlenecks present in Indian healthcare system like lack of adequate resources, low budget for mental health services and inequity in accessibility of treatment. Hence, a large proportion of health expenditure is paid out of pocket by the households. OBJECTIVE To evaluate the direct and indirect costs incurred by patients with First Episode Psychosis and their families in a North Indian setting. METHOD Direct and Indirect costs were estimated for 87 patients diagnosed at AIIMS, New Delhi with first-episode psychosis (nonaffective) in the first- and sixth month following diagnosis, and the six months before diagnosis, using a bespoke questionnaire. Indirect costs were valued using the Human Capital Approach. RESULTS Mean total costs in month one were INR 7991 ($107.5). Indirect costs were 78.3% of this total. Productivity losses was a major component of the indirect cost. Transportation was a key component of direct costs. Costs fell substantially at six months (INR 2732, Indirect Costs 61%). Respondents incurred substantial costs pre-diagnosis, related to formal and informal care seeking and loss of income. CONCLUSION Families suffered substantial productivity loss. Care models and financial protection that address this could substantially reduce the financial burden of mental illness. Measures to address disruption to work and education during FEP are likely to have significant long-term benefits. Families also suffered prolonged income loss pre-diagnosis, highlighting the benefits of early and effective diagnosis.
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Affiliation(s)
- Jasmine Bhogal
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Swaran Preet Singh
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK; Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Jason Madan
- Centre for Health Economics, Warwick Medical School, Coventry, UK.
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5
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Myers NL, Wilkey J, Chacon M, Hutnyan M, Janssen C, Tarvin H, Cohen D, Holmes I, Klodnick VV, Mihiret MA, Reznik SJ, Shimizu TK, Stein E, Lopez MA. Perspectives of young adults diagnosed with early psychosis using coordinated specialty care in Texas on substance use and substance use interventions. Early Interv Psychiatry 2024; 18:502-512. [PMID: 38030586 PMCID: PMC11133765 DOI: 10.1111/eip.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/29/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM Despite known prevalence of substance use (SU) among young people experiencing early psychosis and increasing evidence for the relationship between certain substances (e.g., cannabis) and psychosis, there are no specialized interventions developed for effectively addressing substance use among young people participating in coordinated early psychosis services. This study elicited the perspectives of young people with early psychosis participating in Coordinated Specialty Care (CSC) programs about their substance use, including their motivations and concerns around their use, and their ideas on how to best support young people who are interested in reducing or quitting substance use. METHODS We recruited young adults (ages 18 to 30) from CSC programs across Texas through flyers sent to program staff inviting young persons willing to talk about substance use to engage in a 60-90 min person-centered, semi-structured, audio-recorded Zoom interview. RESULTS A total of 22 young adults were recruited and 18 completed an interview. Participants described mixed positive and negative responses to substance use, and while many understood the importance of discontinuing substance use, many expressed ambivalence related to social, contextual, mental and physical factors that motivated them to keep using. Participants desired practical substance use information, opportunities to explore their substance use ambivalence in supportive relationships, positive peer communities to support healthy choices, help engage, with work, school, and hobbies, and strategies for addressing psychological and physical pain that did not include substance use. CONCLUSION Study findings illuminate what motivates young people with early psychosis to initiate, continue, or cut back on substance use, and ideas for CSC practices for exploring substances and helping young people to reduce substance use.
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Affiliation(s)
- Neely Laurenzo Myers
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Justin Wilkey
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Marne Chacon
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Matthew Hutnyan
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Janssen
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Halle Tarvin
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Deborah Cohen
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Imani Holmes
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Vanessa Vorhies Klodnick
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Mesganaw A Mihiret
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Samantha J Reznik
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | | | - Emily Stein
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Molly A Lopez
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
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6
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Lo Buglio G, Boldrini T, Polari A, Fiorentino F, Nelson B, Solmi M, Lingiardi V, Tanzilli A. Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder. Front Psychol 2024; 15:1381864. [PMID: 38966724 PMCID: PMC11223645 DOI: 10.3389/fpsyg.2024.1381864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 07/06/2024] Open
Abstract
Aims To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations. Methods We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023. Results 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders. Conclusion The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries. Systematic Review Registration https://osf.io/8mz7a.
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Affiliation(s)
- Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Psychology and Educational Science, Pegaso Telematic University, Naples, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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7
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Hanlon C, Roberts T, Misganaw E, Malla A, Cohen A, Shibre T, Fekadu W, Teferra S, Kebede D, Mulushoa A, Girma Z, Tsehay M, Kiross D, Lund C, Fekadu A, Morgan C, Alem A. Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper. PLoS One 2024; 19:e0293232. [PMID: 38722946 PMCID: PMC11081395 DOI: 10.1371/journal.pone.0293232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. METHODS The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.
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Affiliation(s)
- Charlotte Hanlon
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tessa Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Eleni Misganaw
- Mental Health Service User Association, Addis Ababa, Ethiopia
| | - Ashok Malla
- Department of Psychiatry and Douglas Mental Health Institute, McGill University, Montreal, Canada
| | - Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Wubalem Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Derege Kebede
- Department of Preventive Medicine, School of Public Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiyam Mulushoa
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zerihun Girma
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessalegn Kiross
- Victoria University of Wellington, School of Nursing, Midwifery and Health Practice, Wellington, New Zealand
| | - Crick Lund
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abebaw Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Atalay Alem
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Farooq S, Fonseka N, Ali MW, Milner A, Hamid S, Sheikh S, Khan MF, Azeemi MMUH, Ariyadasa G, Khan AJ, Ayub M. Early Intervention in Psychosis and Management of First Episode Psychosis in Low- and Lower-Middle-Income Countries: A Systematic Review. Schizophr Bull 2024; 50:521-532. [PMID: 38525604 PMCID: PMC11059814 DOI: 10.1093/schbul/sbae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND HYPOTHESIS People with first-episode psychosis (FEP) in low- and lower-middle-income countries (LMIC) experience delays in receiving treatment, resulting in poorer outcomes and higher mortality. There is robust evidence for effective and cost-effective early intervention in psychosis (EIP) services for FEP, but the evidence for EIP in LMIC has not been reviewed. We aim to review the evidence on early intervention for the management of FEP in LMIC. STUDY DESIGN We searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) to identify studies describing EIP services and interventions to treat FEP in LMIC published from 1980 onward. The bibliography of relevant articles was hand-searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. STUDY RESULTS The search strategy produced 5074 records; we included 18 studies with 2294 participants from 6 LMIC countries. Thirteen studies (1553 participants) described different approaches for EIP. Pharmacological intervention studies (n = 4; 433 participants) found a high prevalence of metabolic syndrome among FEP receiving antipsychotics (P ≤ .005). One study found a better quality of life in patients using injectables compared to oral antipsychotics (P = .023). Among the non-pharmacological interventions (n = 3; 308 participants), SMS reminders improved treatment engagement (OR = 1.80, CI = 1.02-3.19). The methodological quality of studies evidence was relatively low. CONCLUSIONS The limited evidence showed that EIP can be provided in LMIC with adaptations for cultural factors and limited resources. Adaptations included collaboration with traditional healers, involving nonspecialist healthcare professionals, using mobile technology, considering the optimum use of long-acting antipsychotics, and monitoring antipsychotic side effects.
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Affiliation(s)
- Saeed Farooq
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
- Research and Innovation Department, Midlands Partnership NHS Foundation Trust, St George’s Hospital, Stafford, UK
| | - Nishani Fonseka
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Malik Wajid Ali
- Armed Forces, Institute of Mental Health, Rawalpindi, Pakistan
| | - Abbie Milner
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Shumaila Hamid
- Public Health Department, Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Saima Sheikh
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Muhammad Firaz Khan
- Institute of Mental Health & Behavioral Sciences, Khyber Medical University, Peshawar, Pakistan
| | | | - Gayan Ariyadasa
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Abdul Jalil Khan
- Department of Family Medicine, Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Muhammad Ayub
- Department of Psychiatry, Queen’s University, Kingston, Canada
- Primary Department of Psychiatry, University College London, London
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9
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Aceituno D, Razzouk D, Jin H, Pennington M, Gadelha A, Bressan R, Noto C, Crossley N, Prina M. Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil. Epidemiol Psychiatr Sci 2024; 33:e21. [PMID: 38576239 PMCID: PMC11022262 DOI: 10.1017/s2045796024000222] [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: 07/27/2023] [Revised: 01/16/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
AIMS The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil. METHODS A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in São Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results. RESULTS The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses. CONCLUSIONS This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.
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Affiliation(s)
- D. Aceituno
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, David Goldberg Centre, London, UK
- Mental Health Service, Complejo Asistencial Dr. Sotero del Rio, Puente Alto, Chile
| | - D. Razzouk
- Centre of Mental Health Economics, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - H. Jin
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, David Goldberg Centre, London, UK
| | - M. Pennington
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, David Goldberg Centre, London, UK
| | - A. Gadelha
- Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - R. Bressan
- Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - C. Noto
- Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - N. Crossley
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M. Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Williams R, Ostinelli EG, Agorinya J, Minichino A, De Crescenzo F, Maughan D, Puntis S, Cliffe C, Kurtulmus A, Lennox BR, Cipriani A. Comparing interventions for early psychosis: a systematic review and component network meta-analysis. EClinicalMedicine 2024; 70:102537. [PMID: 38516103 PMCID: PMC10955207 DOI: 10.1016/j.eclinm.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background 'Early Intervention in Psychosis' (EIP) services have been associated with improved outcomes for early psychosis. However, these services are heterogeneous and many provide different components of treatment. The impact of this variation on the sustained treatment effects is unknown. Methods We performed a systematic review and component network meta-analysis (cNMA) of randomised controlled trials (RCTs) that compared specialised intervention services for early psychosis. We searched CENTRAL (published and unpublished), EMBASE, MEDLINE, CINAHL, PsycINFO and Web of Science from inception to February 2023. Primary outcomes were negative and positive psychotic symptoms at 3-month and 1-year follow-up and treatment dropouts. Secondary outcomes were depressive symptoms and social functioning at 1-year follow-up. We registered a protocol for our study in PROSPERO (CRD42017057420). Findings We identified 37 RCTs including 4599 participants. Participants' mean age was 25.8 years (SD 6.0) and 64.0% were men. We found evidence that psychological interventions (this component grouped all psychological treatment intended to treat, or ameliorate the consequences of, psychotic symptoms) are beneficial for reducing negative symptoms (iSMD -0.24, 95% CI -0.44 to -0.05, p = 0.014) at 3-month follow-up and may be associated with clinically relevant benefits in improving social functioning scores at 1-year follow-up (iSMD -0.52, 95% CI -1.05 to 0.01, p = 0.052). The addition of case management has a beneficial effect on reducing negative symptoms (iSMD -1.17, 95% CI -2.24 to -0.11, p = 0.030) and positive symptoms (iSMD -1.05, 95% CI -2.02 to -0.08, p = 0.033) at 1-year follow-up. Pharmacotherapy was present in all trial arms, meaning it was not possible to examine the specific effects of this component. Interpretation Our findings suggest psychological interventions and case management in addition to pharmacotherapy as the core components of services for early psychosis to achieve sustained clinical benefits. Our conclusions are limited by the small number of studies and sparsely connected networks. Funding National Institute for Health and Care Research.
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Affiliation(s)
- Ryan Williams
- Department of Brain Sciences, Imperial College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Edoardo G. Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | - Amedeo Minichino
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Daniel Maughan
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Stephen Puntis
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Charlotte Cliffe
- Biomedical Research Centre, Kings College London, London, UK
- Surrey and Borders Partnership NHS Foundation Trust, UK
| | - Ayse Kurtulmus
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Belinda R. Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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11
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Krcmar M, Wannan CMJ, Lavoie S, Allott K, Davey CG, Yuen HP, Whitford T, Formica M, Youn S, Shetty J, Beedham R, Rayner V, Murray G, Polari A, Gawęda Ł, Koren D, Sass L, Parnas J, Rasmussen AR, McGorry P, Hartmann JA, Nelson B. The self, neuroscience and psychosis study: Testing a neurophenomenological model of the onset of psychosis. Early Interv Psychiatry 2024; 18:153-164. [PMID: 37394278 DOI: 10.1111/eip.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023]
Abstract
AIM Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR patients, and (2) develop a prediction model using these neurophenomenological disturbances for persistence or deterioration of UHR symptoms at 12-month follow-up. METHODS SNAP is a longitudinal observational study. Participants include 400 UHR individuals, 100 clinical controls with no attenuated psychotic symptoms, and 50 healthy controls. All participants complete baseline clinical and neurocognitive assessments and electroencephalography. The UHR sample are followed up for a total of 24 months, with clinical assessment completed every 6 months. RESULTS This paper presents the protocol of the SNAP study, including background rationale, aims and hypotheses, design, and assessment procedures. CONCLUSIONS The SNAP study will test whether neurophenomenological disturbances associated with basic self-disturbance predict persistence or intensification of UHR symptomatology over a 2-year follow up period, and how specific these disturbances are to a clinical population with attenuated psychotic symptoms. This may ultimately inform clinical care and pathoaetiological models of psychosis.
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Affiliation(s)
- Marija Krcmar
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Cassandra M J Wannan
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher G Davey
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Whitford
- School of Psychology, University of New South Wales (UNSW), Kensington, New South Wales, Australia
| | - Melanie Formica
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Youn
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jashmina Shetty
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Beedham
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Rayner
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Graham Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrea Polari
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Dan Koren
- Psychology Department, University of Haifa, Haifa, Israel
| | - Louis Sass
- Department of Clinical Psychology, GSAPP-Rutgers University, Piscataway, New Jersey, USA
| | - Josef Parnas
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Andreas R Rasmussen
- Orygen, Parkville, Parkville, Victoria, Australia
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Patrick McGorry
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica A Hartmann
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barnaby Nelson
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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12
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Ibarrondo O, Recio-Barbero M, Ustarroz I, Cabezas-Garduño J, Mentxaka O, Acaiturri T, Gómez E, Segarra R. First-episode psychosis intervention programme versus standard care for the clinical management of early phases of psychosis: cost analysis. BJPsych Open 2023; 10:e17. [PMID: 38130121 PMCID: PMC10755560 DOI: 10.1192/bjo.2023.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/27/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Early intervention programmes (EIPs) in psychosis have gained attention as specialised interventions to improve health-related and societal impacts for people with psychotic disorders. Previous studies have presented evidence in favour of EIPs over the first year of intervention, despite none considering the critical period before psychosis onset (5 years). AIMS To compare the associated costs of the First Episode Psychosis Intervention Program (CRUPEP) and treatment as usual (TAU) in a real-world cohort in a non-specialised psychiatric community setting. METHOD Direct and indirect mental health-related costs were calculated over 1 year and up to 7 years. Healthcare and societal costs were calculated from economic data related to the consumption of all healthcare resources, including emergency department attendances, hospital admissions, psychotropic medication prescriptions and societal costs. RESULTS From a healthcare perspective, the intervention (CRUPEP) group initially showed a marginally higher cost per patient than the TAU group (€7621 TAU group v. €11 904 CRUPEP group) over the first year of follow-up. However, this difference was reversed between the groups on considering the entire follow-up, with the TAU group showing considerably higher associated costs per patient (€77 026 TAU v. €25 247 CRUPEP). CONCLUSIONS The EIP (CRUPEP) showed clinical benefits and minimised the direct and indirect health-related costs of the management of psychosis. Although the CRUPEP intervention initially reported increased costs over 1 year, TAU surpassed the global costs over the entire follow-up.
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Affiliation(s)
- Oliver Ibarrondo
- RS-Statistics, Arrasate-Mondragón, Gipuzkoa, Spain; and Research Unit, Debagoiena Integrated Healthcare Organisation, Basque Health Service (Osakidetza), Arrasate-Mondragón, Guipúzcoa, Spain
| | - María Recio-Barbero
- Early Stages of Psychosis Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain; and Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Biscay, Spain
| | - Iker Ustarroz
- Economic-Financial Directorate, Cruces University Hospital, Barakaldo, Biscay, Spain
| | - Janire Cabezas-Garduño
- Early Stages of Psychosis Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain; and Department of Psychiatry, Cruces University Hospital, Barakaldo, Biscay, Spain
| | - Oihane Mentxaka
- Early Stages of Psychosis Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain; Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Biscay, Spain; and Department of Psychiatry, Cruces University Hospital, Barakaldo, Biscay, Spain
| | - Teresa Acaiturri
- Economic-Financial Directorate, Cruces University Hospital, Barakaldo, Biscay, Spain
| | - Elisa Gómez
- Economic-Financial Directorate, Cruces University Hospital, Barakaldo, Biscay, Spain
| | - Rafael Segarra
- Early Stages of Psychosis Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain; Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Biscay, Spain; Department of Psychiatry, Cruces University Hospital, Barakaldo, Biscay, Spain; and Centre for Biomedical Research in Mental Health, Carlos III Institute of Health (CIBERSAM ISCIII), Leioa, Biscay, Spain
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13
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Ologundudu OM, Palaniyappan L, Cipriano LE, Wijnen BFM, Anderson KK, Ali S. Risk stratification for treating people at ultra-high risk for psychosis: A cost-effectiveness analysis. Schizophr Res 2023; 261:225-233. [PMID: 37804598 DOI: 10.1016/j.schres.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 10/09/2023]
Abstract
People who are at ultra-high risk (UHR) for psychosis receive clinical care with the aim to prevent first-episode psychosis (FEP), regardless of the risk of conversion to psychosis. An economic model from the Canadian health system perspective was developed to evaluate the cost-effectiveness of treating all with UHR compared to risk stratification over a 15-year time horizon, based on conversion probability, expected quality-of-life and costs. The analysis used a decision tree followed by a Markov model. Health states included: Not UHR, UHR with <20 % risk of conversion to FEP (based on the North American Prodrome Longitudinal Study risk calculator), UHR with ≥20 % risk, FEP, Remission, Post-FEP, and Death. The analysis found that: risk stratification (i.e., only treating those with ≥20 % risk) had lower costs ($1398) and quality-adjusted life-years (0.055 QALYs) per person compared to treating all. The incremental cost-effectiveness ratio for 'treat all' was $25,448/QALY, and suggests treating all may be cost-effective. The model was sensitive to changes to the probability of conversion.
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Affiliation(s)
- Olajumoke M Ologundudu
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Lauren E Cipriano
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada
| | - Ben F M Wijnen
- Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Health Sciences, University of York, United Kingdom; Department of Psychology, Macquarie University, Australia.
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14
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Thompson DM, Bernard M, Maxfield B, Halsall T, Mathers J. Focusing a realist evaluation of peer support for paediatric mental health. DISCOVER MENTAL HEALTH 2023; 3:18. [PMID: 37861950 PMCID: PMC10555983 DOI: 10.1007/s44192-023-00045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Mental health problems are a leading and increasing cause of health-related burden in children across the world. Peer support interventions are increasingly used to meet this need using the lived experience of people with a history of mental health problems. However, much of the research underpinning this work has focused on adults, leaving a gap in knowledge about how these complex interventions may work for different children in different circumstances. Realist research may help us to understand how such complex interventions may trigger different mechanisms to produce different outcomes in children. This paper reports on an important first step in realist research, namely the construction of an embryonic initial programme theory to help 'focus' realist evaluation exploring how children's peer support services work in different contexts to produce different outcomes in the West Midlands (UK). METHODS A survey and preliminary semi-structured realist interviews were conducted with 10 people involved in the delivery of peer support services. Realist analysis was carried out to produce context-mechanism-outcome configurations (CMOC). RESULTS Analysis produced an initial programme theory of peer support for children's mental health. This included 12 CMOCs. Important outcomes identified by peer support staff included hope, service engagement, wellbeing, resilience, and confidence; each generated by different mechanisms including contextualisation of psychoeducation, navigating barriers to accessing services, validation, skill development, therapeutic relationship, empowerment, and reducing stigma. CONCLUSION These data lay the groundwork for designing youth mental health realist research to evaluate with nuance the complexities of what components of peer support work for whom in varying circumstances.
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Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Room 239, Edgbaston, Birmingham, B15 2TT, UK.
| | - Mark Bernard
- Forward Thinking Birmingham, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Bob Maxfield
- Forward Thinking Birmingham, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Tanya Halsall
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Jonathan Mathers
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Room 239, Edgbaston, Birmingham, B15 2TT, UK
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Chang SE, Lenartowicz A, Hellemann GS, Uddin LQ, Bearden CE. Variability in Cognitive Task Performance in Early Adolescence Is Associated With Stronger Between-Network Anticorrelation and Future Attention Problems. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:948-957. [PMID: 37881561 PMCID: PMC10593900 DOI: 10.1016/j.bpsgos.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/22/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Intraindividual variability (IIV) during cognitive task performance is a key behavioral index of attention and a consistent marker of attention-deficit/hyperactivity disorder. In adults, lower IIV has been associated with anticorrelation between the default mode network (DMN) and dorsal attention network (DAN)-thought to underlie effective allocation of attention. However, whether these behavioral and neural markers of attention are 1) associated with each other and 2) can predict future attention-related deficits has not been examined in a developmental, population-based cohort. Methods We examined relationships at the baseline visit between IIV on 3 cognitive tasks, DMN-DAN anticorrelation, and parent-reported attention problems using data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,878 participants, ages 9 to 10 years, female = 47.8%). We also investigated whether behavioral and neural markers of attention at baseline predicted attention problems 1, 2, and 3 years later. Results At baseline, greater DMN-DAN anticorrelation was associated with lower IIV across all 3 cognitive tasks (B = 0.22 to 0.25). Older age at baseline was associated with stronger DMN-DAN anticorrelation and lower IIV (B = -0.005 to -0.0004). Weaker DMN-DAN anticorrelation and IIV were cross-sectionally associated with attention problems (B = 1.41 to 7.63). Longitudinally, lower IIV at baseline was associated with less severe attention problems 1 to 3 years later, after accounting for baseline attention problems (B = 0.288 to 0.77). Conclusions The results suggest that IIV in early adolescence is associated with worsening attention problems in a representative cohort of U.S. youth. Attention deficits in early adolescence may be important for understanding and predicting future cognitive and clinical outcomes.
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Affiliation(s)
- Sarah E. Chang
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Agatha Lenartowicz
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
- Department of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lucina Q. Uddin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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16
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Williams R, Morris A, Gupta V, Penington E, Cullen AE, Quirk A, French P, Lennox B, Bottle A, Crawford MJ. Predictors of positive patient-reported outcomes from 'Early Intervention in Psychosis': a national cross-sectional study. BMJ MENTAL HEALTH 2023; 26:e300716. [PMID: 37541700 PMCID: PMC10577709 DOI: 10.1136/bmjment-2023-300716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The components of care delivered by Early Intervention in Psychosis (EIP) services vary, but the impact on patient experience is unknown. OBJECTIVE To investigate associations between components of care provided by EIP services in England and patient-reported outcomes. METHODS 2374 patients from EIP services in England were surveyed during the National Clinical Audit of Psychosis. Participants were asked about the care they received, and completed the 'Patient Global Impressions' Scale (rating whether their mental health had improved), and 'Friends and Family Test' (rating whether they would recommend their service). Information about service structure was obtained from service providers. We analysed associations between outcomes and components of care using multilevel regression. FINDINGS The majority of participants were likely to recommend the treatment they had received (89.8%), and felt that their mental health had improved (89.0%). Participants from services where care coordinators had larger case loads were less likely to recommend their care. Participants were more likely to recommend their care if they had been offered cognitive behavioural therapy for psychosis, family therapy or targeted interventions for carers. Participants were more likely to report that their mental health had improved if they had been offered cognitive behavioural therapy for psychosis or targeted interventions for carers. CONCLUSIONS Specific components of EIP care were associated with improved patient reported outcomes. Psychosocial interventions and carer support may be particularly important in optimising outcomes for patients. CLINICAL IMPLICATIONS These findings emphasise the need for small case load sizes and comprehensive packages of treatment in EIP services.
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Affiliation(s)
- Ryan Williams
- Department of Brain Sciences, Imperial College London, London, UK
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Aimee Morris
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Veenu Gupta
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Ed Penington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alexis E Cullen
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychosis Studies, King's College London, London, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Paul French
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Mike J Crawford
- Department of Brain Sciences, Imperial College London, London, UK
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17
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Myers N, Hutnyan M, Daley TC, Bello I, Chacon M, Currie A, Davis BJ, Dixon LB, George PE, Giannicchi A, Kwashie AN, McCormick KA, Meyer-Kalos P, Nagendra A, Nayar S, Sarpal DK, Sepahpour TY, Shapiro DI, Taylor-Zoghby J. Pathways Through Early Psychosis Care for U.S. Youths From Ethnically and Racially Minoritized Groups: A Systematic Review. Psychiatr Serv 2023; 74:859-868. [PMID: 36789610 PMCID: PMC10425565 DOI: 10.1176/appi.ps.20220121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The authors of this systematic review examined service utilization and outcomes among youths from ethnoracially minoritized groups after the youths initiated treatment for a psychotic disorder-that is, the youths' "pathway through care." Also examined were potential moderating variables in pathways through care for these youths at the clinic, family, and cultural levels. The goal was to describe methodologies, summarize relevant findings, highlight knowledge gaps, and propose future research on pathways through care for young persons from ethnoracially minoritized groups who experience early psychosis. METHODS The PubMed, PsycInfo, and Web of Science literature databases were systematically searched for studies published between January 1, 2010, and June 1, 2021. Included articles were from the United States and focused on young people after they initiated treatment for early psychosis. Eighteen studies met inclusion criteria. RESULTS Sixteen of the 18 studies were published in the past 5 years, and 11 had an explicit focus on race and ethnicity as defined by the studies' authors. Studies varied in terminology, outcomes measures, methodologies, and depth of analysis. Being an individual from an ethnoracially minoritized group appeared to affect care utilization and outcomes. Insufficient research was found about potential moderating variables at the clinic, family, and cultural levels. CONCLUSIONS Studies of pathways through care for persons from minoritized groups warrant further funding and attention.
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Affiliation(s)
- Neely Myers
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Matthew Hutnyan
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Tamara C Daley
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Iruma Bello
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Marne Chacon
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Ariel Currie
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Beshaun J Davis
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Lisa B Dixon
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Preethy E George
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Anna Giannicchi
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Anita N Kwashie
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Katie A McCormick
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Piper Meyer-Kalos
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Arundati Nagendra
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Swati Nayar
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Deepak K Sarpal
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Tiana Y Sepahpour
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Daniel I Shapiro
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
| | - Jessica Taylor-Zoghby
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Chacon); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute (Bello, Dixon, Giannicchi) and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Bello, Dixon), New York City; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis (Currie, Meyer-Kalos); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Davis, Taylor-Zoghby); Westat, Rockville, Maryland (George); Department of Psychology, University of Minnesota, Minneapolis (Kwashie); Steve Hicks School of Social Work, University of Texas at Austin, Austin (McCormick); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Nagendra); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Nayar, Sarpal); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, and Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York City (Sepahpour); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Shapiro)
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18
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Uchino T, Fukui E, Takubo Y, Iwai M, Katagiri N, Tsujino N, Imamura H, Fujii C, Tanaka K, Shimizu T, Nemoto T. Perceptions and attitudes of users and non-users of mental health services concerning mental illness and services in Japan. Front Psychiatry 2023; 14:1138866. [PMID: 37588026 PMCID: PMC10425963 DOI: 10.3389/fpsyt.2023.1138866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/22/2023] [Indexed: 08/18/2023] Open
Abstract
Objectives There is a global movement to develop and implement community-based integrated mental health systems. The present study attempted to clarify the perceptions and attitudes of users and non-users of mental health services concerning mental illness and services in Japan. Methods A new questionnaire was developed for this internet survey. Data from 500 outpatients with depression and 500 healthy subjects were sampled according to the demographics of the Japanese population. Results Over 90% of healthy subjects and over 70% of patients were unaware of the common age of onset or lifetime prevalence of mental illness. Over 90% of the healthy subjects and about 70% of the patients could not describe any services where they would feel comfortable discussing mental health problems. In both groups, "adolescents and young adults" were ranked first as a target population for mental health and illness policies. The top requirement for the integrated care systems was the promotion and awareness of correct knowledge of mental illness in both the healthy subjects and patients. Conclusion Societal requirements could include disseminating correct knowledge, awareness-raising actions for society, and implementing services where people, especially young people, can easily consult and receive support in the community.
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Affiliation(s)
- Takashi Uchino
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Tokyo, Japan
- Tokyo Adachi Hospital, Tokyo, Japan
- SODA Youth Mental Health Council, Tokyo, Japan
| | - Eriko Fukui
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
- SODA Youth Mental Health Council, Tokyo, Japan
| | - Youji Takubo
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
| | - Momoko Iwai
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
- SODA Youth Mental Health Council, Tokyo, Japan
| | - Naoyuki Katagiri
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
- SODA Youth Mental Health Council, Tokyo, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
- Department of Psychiatry, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Haruhiko Imamura
- Graduate School of Health and Nutrition Sciences, The University of Nagano, Nagano, Japan
| | - Chiyo Fujii
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kuniaki Tanaka
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
- Tokyo Adachi Hospital, Tokyo, Japan
| | - Tetsuo Shimizu
- Akita Prefectural Mental Health and Welfare Center, Akita, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Tokyo, Japan
- SODA Youth Mental Health Council, Tokyo, Japan
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19
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García de Jalón E, Ariz MC, Aquerreta A, Aranguren L, Gutierrez G, Corrales A, Sánchez-Torres AM, Gil-Berrozpe GJ, Peralta V, Cuesta MJ. Effectiveness of the early intervention service for first-episode psychosis in Navarra (PEPsNa): Broadening the scope of outcome measures. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:192-203. [PMID: 38520115 DOI: 10.1016/j.rpsm.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study compares the effectiveness of a new early intervention service for firstepisode psychosis (FEP) in patients under conventional treatment. Six primary and 10 secondary outcome measures are used to better characterize the comparative effectiveness between two FEP groups. METHODS This study plans to enroll 250 patients aged 15-55 years with FEP from all inpatient and outpatient mental health services and primary health care from January 2020 until December 2022. The control group will be composed of 130 FEP patients treated in mental health centers in the 2 years prior to the start of PEPsNa (Programa de Primeros Episodios de Psicosis de Navarra). The primary outcome measures are symptomatic remission, functional recovery, personal recovery, cognitive performance, functional capacity in real-world settings, and costs. The secondary outcome measures are duration of untreated psychosis, substance abuse rate, antipsychotic monotherapy, minimal effective dose of antipsychotic drugs, therapeutic alliance, drop-out rate, number of relapses, global mortality and suicidality, resource use, and general satisfaction in the program. DISCUSSION This study arises from the growing need to broaden the scope of outcome measures in FEP patients and to account for unmet needs of recovery for FEPs. It aims to contribute in the dissemination of the NAVIGATE model in Europe and to provide new evidence of the effectiveness of early intervention services for stakeholders of the National Health Service.
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Affiliation(s)
- Elena García de Jalón
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mari Cruz Ariz
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Ainhoa Aquerreta
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Lidia Aranguren
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Gerardo Gutierrez
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Asier Corrales
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - Gustavo J Gil-Berrozpe
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - Víctor Peralta
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Manuel J Cuesta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain.
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20
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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Barriers and facilitators to the implementation of an early intervention in psychosis service in three demonstration sites in Ireland. BMC Health Serv Res 2023; 23:653. [PMID: 37337176 DOI: 10.1186/s12913-023-09585-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Programmes for early intervention (EIP) in psychosis for people experiencing a first episode of psychosis (FEP) have been found to be both clinically and cost effective. Following the publication of a new EIP model of care (MoC) in Ireland, the aim of this research is to describe how people participated in and responded to the MoC including service users, family members, HSE clinical staff and HSE management. METHODS Qualitative design using the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were used. A total of N = 40 key informant semi-structured interviews were completed which included clinical staff (N = 22), health service managers and administrators (N = 9), service users (N = 8) and a family member (N = 1). Thematic analyses were conducted. RESULTS Unique features of the EIP service (e.g., speed of referral/assessment, multidisciplinary approach, a range of evidence-based interventions and assertive MDT follow up) and enthusiasm for EIP were identified as two key factors that facilitated implementation. In contrast, obstacles to staff recruitment and budget challenges emerged as two primary barriers to implementation. CONCLUSIONS The findings from this research provide real world insights into the complexity of implementing an innovative service within an existing health system. Clear and committed financial and human resource processes which allow new innovations to thrive and be protected during their initiation and early implementation phase are paramount. These elements should be considered in the planning and implementation of EIP services both nationally in Ireland and internationally.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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21
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Belvederi Murri M, Ferrara M, Imbesi M, Leuci E, Marchi M, Musella V, Natali A, Neri A, Ragni S, Saponaro A, Tarricone I, Tullini A, Starace F. A public early intervention approach to first-episode psychosis: Treated incidence over 7 years in the Emilia-Romagna region. Early Interv Psychiatry 2023. [PMID: 37221039 DOI: 10.1111/eip.13437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/28/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
AIM To estimate the treated incidence of individuals with first-episode psychosis (FEP) who contacted the Emilia-Romagna public mental healthcare system (Italy); to examine the variability of incidence and user characteristics across centres and years. METHODS We computed the raw treated incidence in 2013-2019, based on FEP users aged 18-35, seen within or outside the regional program for FEP. We modelled FEP incidence across 10 catchment areas and 7 years using Bayesian Poisson and Negative Binomial Generalized Linear Models of varying complexity. We explored associations between user characteristics, study centre and year comparing variables and socioclinical clusters of subjects. RESULTS Thousand three hundred and eighteen individuals were treated for FEP (raw incidence: 25.3 / 100.000 inhabitant year, IQR: 15.3). A Negative Binomial location-scale model with area, population density and year as predictors found that incidence and its variability changed across centres (Bologna: 36.55; 95% CrI: 30.39-43.86; Imola: 3.07; 95% CrI: 1.61-4.99) but did not follow linear temporal trends or density. Centers were associated with different user age, gender, migrant status, occupation, living conditions and cluster distribution. Year was associated negatively with HoNOS score (R = -0.09, p < .001), duration of untreated psychosis (R = -0.12, p < .001) and referral type. CONCLUSIONS The Emilia-Romagna region presents a relatively high but variable incidence of FEP across areas, but not in time. More granular information on social, ethnic and cultural factors may increase the level of explanation and prediction of FEP incidence and characteristics, shedding light on social and healthcare factors influencing FEP.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Massimiliano Imbesi
- Department of Mental Health and Substance Abuse, AUSL Piacenza, Piacenza, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, AUSL Parma, Parma, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Musella
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL, Modena, Italy
| | - Alba Natali
- Department of Mental Health and Pathological Addiction, AUSL Imola, Imola, Italy
| | - Anastasia Neri
- Department of Mental Health and Pathological Addiction, AUSL Ravenna, Ravenna, Italy
| | - Sabrina Ragni
- Department of Mental Health and Pathological Addiction, AUSL Cesena, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
| | - Andrea Tullini
- Department of Mental Health and Pathological Addiction, AUSL Rimini, Rimini, Italy
| | - Fabrizio Starace
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL, Modena, Italy
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22
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Hagler MA, Ferrara M, Yoviene Sykes LA, Li F, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Mathalon DH, Seidman LJ, Tsuang MT, Walker EF, Powers AR, Allen AR, Srihari VH, Woods SW. Sampling from different populations: Sociodemographic, clinical, and functional differences between samples of first episode psychosis individuals and clinical high-risk individuals who progressed to psychosis. Schizophr Res 2023; 255:239-245. [PMID: 37028205 PMCID: PMC10207144 DOI: 10.1016/j.schres.2023.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Over the past two decades, research and clinical resources on clinical high risk (CHR) for psychosis have both expanded, with goals to better understanding risk and protective factors on the course of illness and inform early intervention efforts. However, some studies have highlighted potential sampling bias among CHR research studies, raising questions about generalizability of findings and inequitable access to early detection and intervention. The current study sought to explore these questions by comparing 94 participants in a CHR longitudinal monitoring study across North America (NAPLS-2) who converted to syndromal psychosis over the course of the study (CHR-CV) to 171 participants who presented for treatment at a localized first-episode psychosis service (FES) after converting. CHR-CV participants were significantly more likely to be White and have a college-educated parent, while FES participants were more likely to be Black and first- or second-generation immigrants. On average, CHR-CV participants were younger at onset of attenuated positive symptoms, had a longer period of attenuated symptoms prior to conversion, and were more likely to be treated with antipsychotics prior to conversion compared to those in FES programs. After controlling for time since conversion, CHR-CV participants had higher global functioning and were less likely to have experienced recent psychiatric hospitalization. Findings suggest that CHR research and FES clinics may be sampling from different populations, although conclusions are limited by inconsistent sampling frames and methods. Integrated early detection that targets defined geographic catchments may deliver more epidemiologically representative samples to both CHR research and FES.
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Affiliation(s)
- Matthew A Hagler
- Department of Psychiatry, Yale University, New Haven, CT, United States of America.
| | - Maria Ferrara
- Department of Psychiatry, Yale University, New Haven, CT, United States of America; Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Fangyong Li
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | | | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Adrienne R Allen
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
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23
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Allen KL, Mountford VA, Elwyn R, Flynn M, Fursland A, Obeid N, Partida G, Richards K, Schmidt U, Serpell L, Silverstein S, Wade T. A framework for conceptualising early intervention for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:320-334. [PMID: 36426567 PMCID: PMC10100476 DOI: 10.1002/erv.2959] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. METHOD AND RESULTS Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these. CONCLUSIONS We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.
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Affiliation(s)
- Karina L Allen
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Victoria A Mountford
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,LightHouse Arabia, Dubai, United Arab Emirates
| | - Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Gubbi Gubbi Country, Queensland, Australia
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Georgina Partida
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Katie Richards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Eating Disorder Service, North East London NHS Foundation Trust, Essex, UK
| | | | - Tracey Wade
- Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
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24
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Reininghaus U, Rauschenberg C, Schick A, Hartmann JA. [Public mental health from an international perspective: from "shifting the curve" to inclusion of vulnerable populations]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:371-378. [PMID: 36847854 PMCID: PMC9969372 DOI: 10.1007/s00103-023-03673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
In recent years, efforts in the field of public mental health have increased that seek to promote mental health and mental health literacy at population level and yield advances in the prevention, treatment and care of mental health conditions. This paper provides an overview of contemporary conceptualisations of indicators and determinants of public mental health as well as population-based intervention strategies from an international perspective. Current conceptual and methodological challenges of so-called high-risk, whole-population and vulnerable population strategies are critically discussed. Future efforts in research, policy and practice need to address fundamental causes of social and health inequalities, drawing on all societal fields, to contribute to improving population mental health.
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Affiliation(s)
- Ulrich Reininghaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland. .,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Großbritannien. .,ESRC Centre for Society and Mental Health, King's College London, London, Großbritannien.
| | - Christian Rauschenberg
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Anita Schick
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Jessica A. Hartmann
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland ,Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australien
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25
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Allison S, Jorm A, Bastiampillai T, Looi JC. Headspace early intervention for psychosis in Australia: Is it still a 'best buy'? Australas Psychiatry 2022; 30:701-704. [PMID: 35708147 DOI: 10.1177/10398562221108917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Australia is piloting a stand-alone early intervention programme for psychosis, based on the Early Psychosis Prevention and Intervention Centre (EPPIC) model that was developed within mainstream Victorian State Government psychiatric services. The Australian early intervention programme is located in primary care, and badged as 'headspace Early Psychosis Youth Services'. There are currently six metropolitan early intervention services with two further services planned for the 2023 Financial Year. We discuss key findings from an external evaluation of the first six services, released by the Australian Government Department of Health under a Freedom of Information request. CONCLUSIONS headspace Early Psychosis Youth Services received high ratings for patient satisfaction and engagement, which was associated with symptomatic improvement and functional recovery. However, governance was complicated, costs were relatively high, and caseload targets were not met. The cost for an additional year of good quality life was estimated at AUD 318,954, which exceeds the usual thresholds for defining a 'good buy'. Integrated models should be investigated, as they seem in principle to offer efficiencies and improved continuity of care.
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Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Anthony Jorm
- Centre for Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
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26
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Tarride JE, Blackhouse G, Abdel-Baki A, Latimer E, Mulvale G, Cooper B, Langill G, Milinkovic D, Stennett R, Hurley J. Economic Evaluation of Early Psychosis Interventions From A Canadian Perspective. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:768-777. [PMID: 35306862 PMCID: PMC9510998 DOI: 10.1177/07067437221087044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Compared to treatment as usual (TAU), early psychosis intervention programs (EPI) have been shown to reduce mortality, hospitalizations and days of assisted living while improving employment status. AIMS The study aim was to conduct a cost-benefit analysis (CBA) and a cost-effectiveness analysis (CEA) to compare EPI and TAU in Canada. METHODS A decision-analytic model was used to estimate the 5-year costs and benefits of treating patients with a first episode of psychosis with EPI or TAU. EPI benefits were derived from randomized controlled trials (RCTs) and Canadian administrative data. The cost of EPI was based on a published survey of 52 EPI centers in Canada while hospitalizations, employment and days of assisted living were valued using Canadian unit costs. The outcomes of the CBA and CEA were expressed in terms of net benefit (NB) and incremental cost per life year gained (LYG), respectively. Scenario analyses were conducted to examine the impact of key assumptions. Costs are reported in 2019 Canadian dollars. RESULTS Base case results indicated that EPI had a NB of $85,441 (95% CI: $41,140; $126,386) compared to TAU while the incremental cost per LYG was $26,366 (95% CI: EPI dominates TAU (less costs, more life years); $102,269). In all sensitivity analyses the NB of EPI remained positive and the incremental cost per LYG was less than $50,000. CONCLUSIONS In addition to EPI demonstrated clinical benefits, our results suggest that large-scale implementation of EPI in Canada would be desirable from an economic point of view .
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Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada.,Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, 5622Université de Montréal, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Eric Latimer
- Mental Health and Society Division, Douglas Research Centre, Montreal, Quebec, Canada.,Department of Psychiatry, 248191McGill University, Montreal, Quebec, Canada
| | - Gillian Mulvale
- Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada.,DeGroote School of Business, 3710McMaster University, Hamilton, Ontario, Canada
| | - Brian Cooper
- Cleghorn Early Intervention Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gord Langill
- Canadian Mental Health Association Haliburton Kawartha Pine Ridge Branch, Peterborough, Ontario, Canada
| | - Deborah Milinkovic
- Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada.,Department of Economics, 3710McMaster University, Hamilton, Ontario, Canada
| | - Rosain Stennett
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
| | - Jeremiah Hurley
- Center for Health Economics and Policy Analysis (CHEPA), 3710McMaster University, Hamilton, Ontario, Canada.,Department of Economics, 3710McMaster University, Hamilton, Ontario, Canada
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Addington D, French P, Smith J. A comparison of the National Clinical Audit of Psychosis 2019/2020 standards and First Episode Psychosis Services Fidelity Scale 1.0. Early Interv Psychiatry 2022; 16:1028-1035. [PMID: 34882974 DOI: 10.1111/eip.13262] [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: 04/16/2021] [Revised: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022]
Abstract
AIM The authors compare two approaches to assessment of the quality of early psychosis intervention services, the National Clinical Audit of Psychosis used in the United Kingdom and the First Episode Psychosis Services Fidelity Scale used in North America and Europe. METHODS We compare the two approaches on the source of standards, measurement type, data collection, time requirements, scoring and reliability. Finally, we review their strengths and limitations. RESULTS Both measures are based on standards derived from the same research evidence base. Both methods rely on data from health records and administrative data. The audit is supplemented with user survey data, the fidelity scale with clinician interviews. The audit requires more time. The audit is based on quality indicators rated as present or absent which yields a statistical benchmark. The Fidelity Scale is based on quality indicators that are rated on a five-point scale yielding a standards-based measure. The two methods cover similar service components, but the FEPS-FS has a broader coverage of team functioning. The National audit also collects data on the user experience directly from patients. The fidelity scale has achieved good to excellent inter-rater reliability, the reliability of the audit has not been tested. CONCLUSIONS Both methods have face validity and provide reliable and useful measures of quality of care. The NCAP works in the context of a single provider health system, the FEPS-FS works in a more variable health system. Comparing the two systems in the field would support international comparison of standards of care.
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Affiliation(s)
- Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Paul French
- Department of Psychology, Manchester Metropolitan University - All Saints Campus, Manchester, England
| | - Jo Smith
- University of Worcester, Worcester, England
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Sediqzadah S, Portnoy A, Kim JJ, Keshavan M, Pandya A. Cost-Effectiveness of Early Intervention in Psychosis: A Modeling Study. Psychiatr Serv 2022; 73:970-977. [PMID: 35193372 DOI: 10.1176/appi.ps.202100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Programs for early intervention in psychosis have shown clinical efficacy. The authors aimed to evaluate the cost-effectiveness of early intervention programs compared with standard care for the treatment of first-episode psychosis in the United States. METHODS A decision-analytic model integrating published data on clinical efficacy, costs, and health utilities was developed to evaluate early intervention versus standard care over the lifetime of patients after their first psychotic episode. Model input data were derived from meta-analyses, clinical trials, and U.S. national data. The main outcomes included hospitalizations, employment rate, quality-adjusted life years (QALYs), lifetime health care costs, and incremental cost-effectiveness ratios (ICERs). RESULTS Compared with patients receiving standard care, patients in the early intervention strategy had 3.2 fewer hospitalizations and 2.7 more years of employment over the course of their remaining life expectancy. From a health care perspective, early intervention had an ICER of approximately $51,600 per QALY. From a societal perspective, early intervention saved costs (i.e., yielded greater health benefits and had lower costs compared with standard care). Results were sensitive to the effect of early intervention on suicide, cost of standard care, cost of early intervention, and the effect (relative risk) of early intervention on employment. A scenario analysis that excluded the effect (i.e., hazard ratio) of early intervention on suicide yielded an ICER of approximately $197,000 per QALY. CONCLUSIONS These results suggest that it is economically beneficial to fund early intervention in psychosis programs in the United States. The findings indicate that early intervention in psychosis saves costs (from the societal perspective) and is cost-effective (health care sector perspective).
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Affiliation(s)
- Saadia Sediqzadah
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Allison Portnoy
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Jane J Kim
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Matcheri Keshavan
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
| | - Ankur Pandya
- Department of Psychiatry and Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Psychiatry, University of Toronto, Toronto (Sediqzadah); Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Portnoy, Kim, Pandya); Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Keshavan)
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Dimitrakopoulos S, Stefanatou P, Vlachos I, Selakovic M, Xenaki LA, Ralli I, Soldatos RF, Nianiakas N, Kosteletos I, Foteli S, Mantonakis L, Kollias CT, Stefanis NC. Don't blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model. BMC Psychiatry 2022; 22:565. [PMID: 35996121 PMCID: PMC9396840 DOI: 10.1186/s12888-022-04212-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early Intervention Services (EIS) aim to reduce relapse rates and achieve better treatment and functional outcomes for first episode psychosis (FEP) patients. Existing models of services in Greece are still treatment as usual (TAU), however a reform of mental health services is underway and initial steps have been taken to shift standard care towards EIS. The purpose of the study is to address therapeutic gaps by exploring service engagement and relapse rates in the current standard care model for psychosis. METHODS We examined follow-up and relapse rates one year after initial treatment contact in the first longitudinal FEP study conducted in Greece. 225 patients were enrolled between 2015-2020. Sociodemographic, clinical and functional characteristics were assessed in association with follow-up and relapse rates. RESULTS Within a TAU follow-up setting, one year attrition rates were high. Only 87 patients (38,7%) retained contact with services after one year and within this time frame, 19 of them (21,8%) experienced a severe relapse requiring rehospitalization. Demographic, clinical and functional contributors failed to predict service engagement and relapse rates, with the exception of treatment adherence. CONCLUSION Both follow-up and one-year rehospitalization rates in our FEP sample, highlight the need for the implementation of early intervention services, that will aim at engagement maximization and relapse prevention. These indexes also provide a benchmark against which future early intervention services for psychosis in Greece will have to demonstrate superior efficacy.
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Affiliation(s)
- Stefanos Dimitrakopoulos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece.
- 414 Military Hospital of Athens, P. Penteli, Greece.
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Ilias Vlachos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Mirjana Selakovic
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Lida-Alkisti Xenaki
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Irene Ralli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Rigas-Filippos Soldatos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Nikolaos Nianiakas
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Ioannis Kosteletos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Stefania Foteli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Leonidas Mantonakis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Costas T Kollias
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
| | - Nikos C Stefanis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece
- Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, Athens, Greece
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30
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Arango C, Buitelaar JK, Correll CU, Díaz-Caneja CM, Figueira ML, Fleischhacker WW, Marcotulli D, Parellada M, Vitiello B. The transition from adolescence to adulthood in patients with schizophrenia: Challenges, opportunities and recommendations. Eur Neuropsychopharmacol 2022; 59:45-55. [PMID: 35550205 DOI: 10.1016/j.euroneuro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Schizophrenia is a severely debilitating neurodevelopmental disorder that requires continuous multidisciplinary treatment. Early onset schizophrenia (EOS, onset before 18) is associated with poorer outcomes than the adult-onset type. The transition from adolescent to adult mental healthcare services (AMHS) poses various challenges for maintaining continuity of care. The heterogeneous availability of specialized mental health services and resources for people with schizophrenia across Europe and the inadequacy of training programs in creating a shared culture and knowledge base between child and adult mental health professionals are major challenges at the policy level. More flexible and individualized transition timing is also needed. While changes in the relationship between patients, caregivers and mental health professionals at a time when young people should acquire full responsibility for their own care are challenges common to all mental health disorders, these are particularly relevant to the care of schizophrenia because of the severe associated disability. This Expert Opinion Paper examines the main aspects of transitioning of care in schizophrenia with the aim of identifying the challenges and the potential approaches that could enhance continuity of care.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, the Netherlands
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | | | | | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid 28009, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid 28029, Spain
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
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Bell I, Pot-Kolder RM, Wood SJ, Nelson B, Acevedo N, Stainton A, Nicol K, Kean J, Bryce S, Bartholomeusz CF, Watson A, Schwartz O, Daglas-Georgiou R, Walton CC, Martin D, Simmons M, Zbukvic I, Thompson A, Nicholas J, Alvarez-Jimenez M, Allott K. Digital technology for addressing cognitive impairment in recent-onset psychosis: A perspective. Schizophr Res Cogn 2022; 28:100247. [PMID: 35281550 PMCID: PMC8914197 DOI: 10.1016/j.scog.2022.100247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023]
Abstract
Cognitive impairments in psychosis negatively impact functional recovery and quality of life. Existing interventions for improving cognitive impairment in recent-onset psychosis show inconsistent treatment efficacy, small effects, suboptimal engagement and limited generalizability to daily life functioning. In this perspective we explore how digital technology has the potential to address these limitations in order to improve cognitive and functional outcomes in recent-onset psychosis. Computer programs can be used for standardized, automated delivery of cognitive remediation training. Virtual reality provides the opportunity for learning and practicing cognitive skills in real-world scenarios within a virtual environment. Smartphone apps could be used for notification reminders for everyday tasks to compensate for cognitive difficulties. Internet-based technologies can offer psychoeducation and training materials for enhancing cognitive skills. Early findings indicate some forms of digital interventions for cognitive enhancement can be effective, with well-established evidence for human-supported computer-based cognitive remediation in recent-onset psychosis. Emerging evidence regarding virtual reality is favorable for improving social cognition. Overall, blending digital interventions with human support improves engagement and effectiveness. Despite the potential of digital interventions for enhancing cognition in recent-onset psychosis, few studies have been conducted to date. Implementation challenges affecting application of digital technologies for cognitive impairment in recent-onset psychosis are sustained engagement, clinical integration, and lack of quality in the commercial marketplace. Future opportunities lie in including motivational frameworks and behavioral change interventions, increasing service engagement in young people and lived experience involvement in digital intervention development.
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Affiliation(s)
- Imogen Bell
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Roos M.C.A. Pot-Kolder
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Stephen J. Wood
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, UK
| | - Barnaby Nelson
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Nicola Acevedo
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Alexandra Stainton
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Katie Nicol
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - James Kean
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Shayden Bryce
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Cali F. Bartholomeusz
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Amity Watson
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Orli Schwartz
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rothanthi Daglas-Georgiou
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Courtney C. Walton
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Donel Martin
- School of Psychiatry, University of New South Wales and Black Dog Institute, NSW, Australia
| | - Magenta Simmons
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Isabel Zbukvic
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Thompson
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jennifer Nicholas
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Kelly Allott
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Uchino T, Kotsuji Y, Kitano T, Shiozawa T, Iida S, Aoki A, Iwai M, Shirahata M, Seki A, Mizuno M, Tanaka K, Nemoto T. An integrated youth mental health service in a densely populated metropolitan area in Japan: Clinical case management bridges the gap between mental health and illness services. Early Interv Psychiatry 2022; 16:568-575. [PMID: 34743415 DOI: 10.1111/eip.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
AIMS A global movement, including in Asia, is seeking to establish integrated youth mental health services that provide early intervention in the continuum from mental health to mental illness. Clinical case management (CCM), in which a case manager becomes not only a coordinator of services but also a provider of psychosocial support, can establish a 'one-stop network' that supports youth in densely populated areas with various social resources. In 2019, we opened a community-based centre called 'SODA' in front of a metropolitan railway station, which was designed to be highly accessible, stigma-free and youth-friendly to provide CCM. We aimed to clarify its services and effectiveness of CCM. METHODS Data from 105 youths were investigated in a case-controlled study, dividing them into two groups: those who had received CCM for 6 months, and those whose needs were met in fewer sessions. RESULTS Twenty-one subjects who received CCM for 6 months had difficulties in more domains than the others. The mean of the total service minutes for the subjects who received CCM for 6 months was 491.3 min: psychological support (accounted for 24.8% of the time), support for community living (31.2%), work support (13.8%), family support (10.5%) and support for cooperation with other organizations (19.8%). Global Assessment of Functioning (GAF) score improved significantly, from 46.6 at baseline to 59.3 at 6 months. CONCLUSION Even in metropolitan areas with numerous medical facilities, young people can face high barriers to access. CCM can be effective as an early intervention for subjects developing mental illness.
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Affiliation(s)
- Takashi Uchino
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Yumi Kotsuji
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Tomoji Kitano
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Takuma Shiozawa
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Satomi Iida
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Akiko Aoki
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan
| | - Momoko Iwai
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan
| | - Masanori Shirahata
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Akihiko Seki
- SODA, Youth Mental Health Council, Adachi, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Japan
| | - Kuniaki Tanaka
- SODA, Youth Mental Health Council, Adachi, Japan.,Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan.,Tokyo Adachi Hospital, Adachi, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Japan
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33
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Butt HS. Specialised early intervention for recent-onset psychosis. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Specialised early intervention (SEI) services have seen significant investment and expansion in the UK, aiming to improve long-term outcomes for psychotic disorders. This commentary discusses a recent Cochrane review that examines the evidence for SEI services delivered within the first 3 years of onset of psychotic illness. From a small number of studies conducted in high-income countries, the review draws the conclusion that there is low- to moderate-certainty evidence that SEI services improve recovery and reduce disengagement.
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Poletti M, Pelizza L, Azzali S, Scazza I, Paterlini F, Garlassi S, Chiri LR, Pupo S, Raballo A. Association between psychosocial interventions and aberrant salience in adolescents with early psychosis: A follow-up study. Scand J Psychol 2022; 63:290-296. [PMID: 35285026 DOI: 10.1111/sjop.12806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Simona Pupo
- Service of Anesthesiology and Resuscitation, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
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Bradford DW, Austin K, Nelson SM, Merrill S, Bowersox NW. Predictors of High-Intensity Psychiatric Service Utilization by Veterans Health Administration Patients With Early Psychosis. Psychiatr Serv 2022; 73:287-292. [PMID: 34346728 DOI: 10.1176/appi.ps.202000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People with early episode psychosis (EEP) have more negative care outcomes than do people with later episode psychosis (LEP), including higher levels of high-intensity psychiatric service use. It is unclear whether these differences are best explained by clinical differences between these two groups or whether people with EEP have specific treatment needs. An assessment of the treatment needs of patients with EEP can help inform the implementation of national treatment programming designed to provide better care to this group. METHODS Administrative data were used to compare characteristics of Veterans Health Administration patients who had EEP (i.e., a psychotic diagnosis, diagnosis history of ≤4 years, and age ≤30 years; N=4,595) with those with LEP (i.e., a psychotic diagnosis, longer diagnosis history, and older age; N=108,713) who received care during a 1-year evaluation period. The authors generated logistic regressions to assess the potential impact of EEP status on the likelihood of receipt of emergency department (ED) and inpatient psychiatric admissions while controlling for other patient characteristics. RESULTS Patients with EEP had elevated psychiatric comorbidity and mental health severity yet received equivalent outpatient mental health services. Patients with EEP were more likely to have had an ED visit for the treatment of a mental health condition and inpatient psychiatric admissions; this pattern persisted in analyses that controlled for group differences. CONCLUSIONS Patients with EEP have unique mental health treatment needs. The development and implementation of EEP-specific treatments could help address these needs and reduce the number of patients using higher levels of psychiatric services within large health care systems.
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Affiliation(s)
- Daniel W Bradford
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Karen Austin
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Sharon M Nelson
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Stephanie Merrill
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Nicholas W Bowersox
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
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Shields GE, Buck D, Varese F, Yung AR, Thompson A, Husain N, Broome MR, Upthegrove R, Byrne R, Davies LM. A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis. BMC Psychiatry 2022; 22:126. [PMID: 35177010 PMCID: PMC8851734 DOI: 10.1186/s12888-022-03769-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis. METHODS Electronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively. RESULTS Searching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability (> 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty. CONCLUSIONS Study findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions.
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Affiliation(s)
- Gemma E. Shields
- grid.5379.80000000121662407Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Deborah Buck
- grid.5379.80000000121662407Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK ,grid.83440.3b0000000121901201Institute of Education, University College London, London, UK
| | - Filippo Varese
- grid.5379.80000000121662407Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK ,grid.507603.70000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R. Yung
- grid.5379.80000000121662407Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK ,grid.507603.70000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.1021.20000 0001 0526 7079Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Andrew Thompson
- grid.1008.90000 0001 2179 088XOrygen, The Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.7372.10000 0000 8809 1613Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
| | - Nusrat Husain
- grid.5379.80000000121662407Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matthew R. Broome
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.498025.20000 0004 0376 6175Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.498025.20000 0004 0376 6175Birmingham Early Intervention Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Rory Byrne
- grid.507603.70000 0004 0430 6955Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda M. Davies
- grid.5379.80000000121662407Manchester Centre for Health Economics, Division of Population Health, School of Health Sciences, University of Manchester, Manchester, UK
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McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. World Psychiatry 2022; 21:61-76. [PMID: 35015367 PMCID: PMC8751571 DOI: 10.1002/wps.20938] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental ill-health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID-19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co-designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad-spectrum, integrated primary youth mental health care services. They represent a blueprint and beach-head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, "soft entry" youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill-health in young people globally demands that this focus be elevated to a top priority in global health.
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Affiliation(s)
- Patrick D McGorry
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Cristina Mei
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Craig Hodges
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eóin Killackey
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Pelizza L, Maestri D, Leuci E, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Individual psychotherapy can reduce suicidal ideation in first episode psychosis: Further findings from the 2-year follow-up of the 'Parma Early Psychosis' programme. Clin Psychol Psychother 2021; 29:982-989. [PMID: 34704336 DOI: 10.1002/cpp.2678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Suicidal thinking is relevant in patients with First Episode Psychosis (FEP). However, longitudinal studies specifically examining treatment response for suicidal ideation in FEP are still relatively scarce, especially with long-term design and in real-world clinical settings. The aims of this research were (A) to longitudinally assess suicidal thoughts in people with FEP along a 2-year follow-up period and (B) to overtime investigate any significant association of suicidal ideation levels with the specific treatment components of an 'Early Intervention in Psychosis' (EIP) protocol along the 2 years of follow-up. METHODS At entry, 232 FEP participants (aged 12-35 years) completed the Brief Psychiatric Rating Scale (BPRS), including a 'Suicidality' item subscore. Multiple linear regression analysis was then performed. RESULTS Across the follow-up, FEP subjects showed a relevant decrease in suicidal thinking levels overtime. This was specifically predicted by the total number of individual psychotherapy sessions offered within the 2-year EIP protocol and antidepressant dose (at least as regards the first year of our intervention). CONCLUSION Suicidal ideation is clinically relevant in FEP but seems to improve overtime together with the provision of specific, patient-tailored and integrated EIP treatments, especially individual psychotherapy.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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Aceituno D, Mena C, Vera N, Gonzalez-Valderrama A, Gadelha A, Diniz E, Crossley N, Pennington M, Prina M. Implementation of early psychosis services in Latin America: A scoping review. Early Interv Psychiatry 2021; 15:1104-1114. [PMID: 33047889 DOI: 10.1111/eip.13060] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/26/2020] [Indexed: 12/01/2022]
Abstract
AIM The evidence of the effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services has motivated their implementation worldwide. However, complex interventions of such EIP services require local adaptations to successfully match population needs and cultural differences. Latin America is a heterogenous region where EIP services are progressively being adopted. Our aim is to map such initiatives in the region with a focus on implementation outcomes. METHODS A scoping review following the Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews guidelines was conducted. International and regional databases were searched for publications describing EIP programmes in the region. Besides mapping the services, we described implementation outcomes based on the Standards for Reporting Implementation Studies Checklist. RESULTS Ten articles describing seven EIP initiatives from the region were found. Four countries were represented: Argentina, Brazil, Chile and Mexico. The implementation outcomes reporting was heterogenous, although it was possible to ascertain EIP services are feasible and adequate for the region's context. Also, there is some evidence of effectiveness in terms of reducing hospitalizations and improving symptoms. Information about fidelity measures was scarce and there was no information about costs or cost-effectiveness. CONCLUSIONS Only a small proportion of Latin American countries have adopted EIP services. Although these programmes seem to be feasible and effective, data on other implementation outcomes, such as fidelity, cultural appropriateness, cost-effectiveness and affordability are not available. This might in part explain why this effective approach has not been yet scaled-up at nationwide levels.
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Affiliation(s)
- David Aceituno
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Mena
- Early Intervention Program, J. Horwitz Psychiatric Institute, Santiago, Chile.,School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Norha Vera
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alfonso Gonzalez-Valderrama
- Early Intervention Program, J. Horwitz Psychiatric Institute, Santiago, Chile.,School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Ary Gadelha
- Programa de Esquizofrenia (PROESQ), Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil.,Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e uso de álcool e outras drogas (CEPIPREV), School of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elton Diniz
- Programa de Esquizofrenia (PROESQ), Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Nicolas Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Pennington
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Prina
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Ologundudu OM, Lau T, Palaniyappan L, Ali S, Anderson KK. Interventions for people at ultra-high risk for psychosis: A systematic review of economic evaluations. Early Interv Psychiatry 2021; 15:1115-1126. [PMID: 33047497 DOI: 10.1111/eip.13061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/02/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
AIM Psychotic disorders have long-term negative consequences for functioning and quality of life. Ultra-high risk (UHR) programs aim to identify and treat people during the prodromal period before their first psychotic episode. Though studies on the clinical effectiveness of treating prodromal symptoms in people at UHR for psychosis exist, no review has exclusively and comprehensively evaluated the economic impact of UHR programs. Our objective was to systematically review the literature on economic evaluations of UHR programs. METHODS We searched the Cochrane, EMBASE, MEDLINE, and PsycInfo electronic databases, in addition to grey literature, from inception to March 2020 to identify economic evaluations of UHR programs. We included all cost and cost-effectiveness studies of interventions for people at UHR. The data were synthesized qualitatively, and a risk of bias assessment was performed. RESULTS Of the 1916 articles retrieved, six studies met our inclusion criteria. These included three cost analysis studies and three cost-effectiveness studies. Five studies were conducted from the health system perspective and the time horizon varied between six months and ten years. Only two reported quality-adjusted life-years (QALYs) as their outcome. Overall, all cost-effectiveness studies and one cost analysis suggested that UHR programs were cost-effective and cost saving, respectively. The risk of bias assessment suggested moderate levels of bias across all studies. CONCLUSION Economic evaluations of UHR programs varied in terms of outcomes and length of follow-up; however, most studies found them to be cost-effective. Future studies would benefit from long-term evaluations of UHR programs and consistent valuation of outcomes.
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Affiliation(s)
- Olajumoke M Ologundudu
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Tammy Lau
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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Kar SK, Menon V, Arafat SMY. Early augmentation in early intervention for mental illness: A potential turbo-boost? Asian J Psychiatr 2021; 63:102751. [PMID: 34271535 DOI: 10.1016/j.ajp.2021.102751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/25/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Vikas Menon
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, 1340, Bangladesh
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Ramon S. Family Group Conferences as a Shared Decision-Making Strategy in Adults Mental Health Work. Front Psychiatry 2021; 12:663288. [PMID: 34326782 PMCID: PMC8315278 DOI: 10.3389/fpsyt.2021.663288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/27/2021] [Indexed: 12/03/2022] Open
Abstract
Family Group conferences (FGC) provide a system by which a client and their family reach jointly key intervention decisions, from a number of options proposed by professionals. The system originated in child protection social work. Conceptually FGC is based on the assumption that the family is potentially a supportive social system for an individual with a variety of difficulties, including mental ill health. Reaching a family network agreement can lead to long term positive outcomes in self-confidence and social relationships. This strategy of shared decision making (SDM) can re-unite the family around the client's needs and wishes. It fits well the strengths based and the recovery-oriented approaches to mental ill health. Methodologically, this article provides a narrative review of existing empirical research about FGC in the context of adult mental health. In addition, two community case studies consisting of videos of a mother experiencing mental ill health and a daughter are analysed in terms of their subjective experience of the FGCs they were involved in, and looks at both the process and the outcomes of FGCs. The key findings demonstrate a high level of satisfaction from participating in the FGC meeting, while the evidence pertaining to the outcomes is inconclusive. Only very few systematic review studies, or comparative studies of different approaches to family decision making, exist, and there are no studies which offer cost effectiveness analysis. Discussion: The observed gap between the satisfaction from the process of FGC by the participants vs. the inconclusive outcomes relates to the implementation phase, in which the decisions made by the family are tested. Evaluating FGC processes and outcomes is complex. A systematic and comprehensive research of the implementation process is missing at this stage. In conclusion, FGC is a promising strategy of SDM in adult mental health. The research evidence indicates the need for further exploration of its implementation process, evaluative methodology and methods.
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Affiliation(s)
- Shulamit Ramon
- Department of Allied Health, Midwifery and Social Work, University of Hertfordshire, Hatfield, United Kingdom
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McDonald K, Ding T, Ker H, Dliwayo TR, Osborn DP, Wohland P, Coid JW, French P, Jones PB, Baio G, Kirkbride JB. Using epidemiological evidence to forecast population need for early treatment programmes in mental health: a generalisable Bayesian prediction methodology applied to and validated for first-episode psychosis in England. Br J Psychiatry 2021; 219:383-391. [PMID: 34475575 PMCID: PMC7611597 DOI: 10.1192/bjp.2021.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mental health policy makers require evidence-based information to optimise effective care provision based on local need, but tools are unavailable. AIMS To develop and validate a population-level prediction model for need for early intervention in psychosis (EIP) care for first-episode psychosis (FEP) in England up to 2025, based on epidemiological evidence and demographic projections. METHOD We used Bayesian Poisson regression to model small-area-level variation in FEP incidence for people aged 16-64 years. We compared six candidate models, validated against observed National Health Service FEP data in 2017. Our best-fitting model predicted annual incidence case-loads for EIP services in England up to 2025, for probable FEP, treatment in EIP services, initial assessment by EIP services and referral to EIP services for 'suspected psychosis'. Forecasts were stratified by gender, age and ethnicity, at national and Clinical Commissioning Group levels. RESULTS A model with age, gender, ethnicity, small-area-level deprivation, social fragmentation and regional cannabis use provided best fit to observed new FEP cases at national and Clinical Commissioning Group levels in 2017 (predicted 8112, 95% CI 7623-8597; observed 8038, difference of 74 [0.92%]). By 2025, the model forecasted 11 067 new treated cases per annum (95% CI 10383-11740). For every 10 new treated cases, 21 and 23 people would be assessed by and referred to EIP services for suspected psychosis, respectively. CONCLUSIONS Our evidence-based methodology provides an accurate, validated tool to inform clinical provision of EIP services about future population need for care, based on local variation of major social determinants of psychosis.
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Affiliation(s)
| | - Tao Ding
- Department of Statistical Sciences, University College London, UK
| | - Hannah Ker
- Division of Psychiatry, University College London, UK
| | | | | | - Pia Wohland
- School of Earth and Environmental Sciences, University of Queensland, Australia; Hull-York Medical School, University of Hull, UK
| | - Jeremy W. Coid
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, China
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | | | - Gianluca Baio
- Department of Statistical Sciences, University College London, UK
| | - James B. Kirkbride
- Division of Psychiatry, University College London, UK,Correspondence: James B. Kirkbride.
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Fusar‐Poli P, Correll CU, Arango C, Berk M, Patel V, Ioannidis JP. Preventive psychiatry: a blueprint for improving the mental health of young people. World Psychiatry 2021; 20:200-221. [PMID: 34002494 PMCID: PMC8129854 DOI: 10.1002/wps.20869] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | - Celso Arango
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry and Mental Health, Hospital General Universitario Gregorio MarañónMadridSpain,Health Research Institute (IiGSM), School of MedicineUniversidad Complutense de MadridMadridSpain,Biomedical Research Center for Mental Health (CIBERSAM)MadridSpain
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityBarwon HealthGeelongVICAustralia,Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,Orygen Youth HealthUniversity of MelbourneMelbourneVICAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard University T.H. Chan School of Public HealthBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - John P.A. Ioannidis
- Stanford Prevention Research Center, Department of MedicineStanford UniversityStanfordCAUSA,Department of Biomedical Data ScienceStanford UniversityStanfordCAUSA,Department of Epidemiology and Population HealthStanford UniversityStanfordCAUSA
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Mari JJ, Gadelha A, Kieling C, Ferri CP, Kapczinski F, Nardi AE, Almeida-Filho N, Sanchez ZM, Salum GA. Translating science into policy: mental health challenges during the COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 43:638-649. [PMID: 33710250 PMCID: PMC8639016 DOI: 10.1590/1516-4446-2020-1577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.
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Affiliation(s)
- Jair J Mari
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Christian Kieling
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Psiquiatria e Medicina Legal, UFRGS, Porto Alegre, RS, Brazil
| | - Cleusa P Ferri
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Flavio Kapczinski
- Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil.,McMaster University, Hamilton, Canada
| | - Antonio E Nardi
- Instituto de Psiquiatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Academia Nacional de Medicina, Rio de Janeiro, RJ, Brazil.,Academia Brasileira de Ciências, Rio de Janeiro, RJ, Brazil
| | - Naomar Almeida-Filho
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Giovanni A Salum
- Seção de Afeto Negativo e Processos Sociais, Departamento de Psiquiatria e Medicina Legal, HCPA, UFRGS, Porto Alegre, RS, Brazil
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Keating D, McWilliams S, Boland F, Doyle R, Behan C, Strawbridge J, Clarke M. Prescribing pattern of antipsychotic medication for first-episode psychosis: a retrospective cohort study. BMJ Open 2021; 11:e040387. [PMID: 33518516 PMCID: PMC7852941 DOI: 10.1136/bmjopen-2020-040387] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Guidelines for antipsychotic use in first-episode psychosis (FEP) recommend that medication be chosen initially on the basis of side effect profile with doses at the lower end of the range. Our objective was to describe the pattern of antipsychotic use in FEP over a period of 21 years in the context of changing clinical guidelines and the development of specialist early intervention in psychosis (EIP) services. SETTING A community-based mental health service in South County Dublin (population 187 000) and a large private hospital. PARTICIPANTS Participants included 465 patients with FEP (146 from an epidemiological study (1995-1999) and 319 from a specialist EIP service (2005-2016)). Treatment with antipsychotic medication did not exceed 30 days at study entry. OUTCOME MEASURES This is a descriptive study of prescribing practices in the context of service development and changing guidelines. RESULTS First-generation antipsychotics were prescribed for 65% of the early cohort compared with 4.3% of the EIP cohort. Olanzapine was initially prescribed for 79.7% of EIP patients. Initial doses of medication were frequently low (≤50% British National Formulary (BNF) maximum) in both cohorts (71% and 78.6%). The demographic and clinical factors investigated did not influence the initial choice of antipsychotic medication significantly. Univariate logistic regression analysis suggested inpatient treatment setting was associated with a higher initial dose (>50% BNF maximum) of antipsychotic medication. Increasing dose requirements over the first month of engagement with an EIP service was associated with poorer global functioning at baseline, greater positive symptoms at baseline and the inpatient treatment setting. However, these associations were not seen in the multivariable model. CONCLUSIONS Second-generation antipsychotic prescribing predominates, but guidelines are often overlooked when choosing olanzapine notwithstanding lower initial dosages. EIP services should include proactive support for optimising medicines in line with evidence-based guidelines.
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Affiliation(s)
- Dolores Keating
- Pharmacy Department, Saint John of God Hospital, Dublin, Ireland
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen McWilliams
- Department of Medicine, Saint John of God Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre and HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roisin Doyle
- Dublin and East Treatment and Early Care Team, Blackrock, Co Dublin, Ireland
| | - Caragh Behan
- Dublin and East Treatment and Early Care Team, Blackrock, Co Dublin, Ireland
| | - Judith Strawbridge
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Clarke
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Dublin and East Treatment and Early Care Team, Blackrock, Co Dublin, Ireland
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Bertulies-Esposito B, Sicotte R, Iyer SN, Delfosse C, Girard N, Nolin M, Villeneuve M, Conus P, Abdel-Baki A. Détection et intervention précoce pour la psychose : pourquoi et comment ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088178ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Kozloff N, Foussias G, Durbin J, Sockalingam S, Addington J, Addington D, Ampofo A, Anderson KK, Barwick M, Bromley S, Cunningham JEA, Dahrouge S, Duda L, Ford C, Gallagher S, Haltigan JD, Henderson J, Jaouich A, Miranda D, Mitchell P, Morin J, de Oliveira C, Primeau V, Serhal E, Soklaridis S, Urajnik D, Whittard K, Zaheer J, Kurdyak P, Voineskos AN. Early Psychosis Intervention-Spreading Evidence-based Treatment (EPI-SET): protocol for an effectiveness-implementation study of a structured model of care for psychosis in youth and emerging adults. BMJ Open 2020; 10:e034280. [PMID: 32499262 PMCID: PMC7282307 DOI: 10.1136/bmjopen-2019-034280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION While early psychosis intervention (EPI) has proliferated in recent years amid evidence of its effectiveness, programmes often struggle to deliver consistent, recovery-based care. NAVIGATE is a manualised model of EPI with demonstrated effectiveness consisting of four components: individualised medication management, individual resiliency training, supported employment and education and family education. We aim to implement NAVIGATE in geographically diverse EPI programmes in Ontario, Canada, evaluating implementation and its effect on fidelity to the EPI model, as well as individual-level outcomes (patient/family member-reported and interviewer-rated), system-level outcomes (captured in provincial administrative databases) and engagement of participants with lived experience. METHODS AND ANALYSIS This is a multisite, non-randomised pragmatic hybrid effectiveness-implementation type III mixed methods study coordinated at the Centre for Addiction and Mental Health (CAMH) in Toronto. Implementation is supported by the Provincial System Support Program, a CAMH-based programme with provincial offices across Ontario, and Extension of Community Healthcare Outcomes Ontario Mental Health at CAMH and the University of Toronto. The primary outcome is fidelity to the EPI model as measured using the First Episode Psychosis Services-Fidelity Scale. Four hundred participants in the EPI programmes will be recruited and followed using both individual-level assessments and health administrative data for 2 years following NAVIGATE initiation. People with lived experience will be engaged in all aspects of the project, including through youth and family advisory committees. ETHICS AND DISSEMINATION Research ethics board approval has been obtained from CAMH and institutions overseeing the local EPI programmes. Study findings will be reported in scientific journal articles and shared with key stakeholders including youth, family members, programme staff and policymakers. TRIAL REGISTRATION NUMBER NCT03919760; Pre-results.
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Affiliation(s)
- Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - George Foussias
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Janet Durbin
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Augustina Ampofo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly K Anderson
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Melanie Barwick
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Sarah Bromley
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jasmyn E A Cunningham
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lillian Duda
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Sheila Gallagher
- Durham Amaze Early Psychosis Intervention Program, Lakeridge Health, Whitby, Ontario, Canada
| | - John D Haltigan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joanna Henderson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexia Jaouich
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Dielle Miranda
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Josette Morin
- Regional Early Intervention in Psychosis Service, North Bay Regional Health Centre, North Bay, Ontario, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Valerie Primeau
- Regional Early Intervention in Psychosis Service, North Bay Regional Health Centre, North Bay, Ontario, Canada
| | - Eva Serhal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Telepsychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Diana Urajnik
- Human Sciences, Social and Population Health, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Krista Whittard
- Early Psychosis Intervention, Niagara Region Public Health, Thorold, Ontario, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Abstract
In the last three decades, early intervention for psychosis (EIP) services have been established worldwide and have resulted in superior symptomatic and functional outcomes for people affected by psychotic disorders. These improved outcomes are a result of reducing delays to treatment and the provision of specialised, holistic interventions. The COVID-19 pandemic poses significant challenges to the delivery of these services, such as undetected cases or long delays to treatment. Furthermore, the COVID-19 pandemic will likely increase the mental health needs of communities, including the incidence of psychotic disorders. In this perspective piece, we provide suggestions as to how EIP services can adapt within this environment, such as utilising novel technologies. Finally, we argue that despite the economic consequences of the pandemic, the funding for mental health services, including EI services, should be increased in line with the need for these services during and beyond the pandemic.
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Lane NM, Hunter SA, Lawrie SM. The benefit of foresight? An ethical evaluation of predictive testing for psychosis in clinical practice. Neuroimage Clin 2020; 26:102228. [PMID: 32173346 PMCID: PMC7229349 DOI: 10.1016/j.nicl.2020.102228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/05/2020] [Accepted: 02/23/2020] [Indexed: 12/12/2022]
Abstract
Risk prediction for psychosis has advanced to the stage at which it could feasibly become a clinical reality. Neuroimaging biomarkers play a central role in many risk prediction models. Using such models to predict the likelihood of transition to psychosis in individuals known to be at high risk has the potential to meaningfully improve outcomes, principally through facilitating early intervention. However, this compelling benefit must be evaluated in light of the broader ethical ramifications of this prospective development in clinical practice. This paper advances ethical discussion in the field in two ways: firstly, through in-depth consideration of the distinctive implications of the clinical application of predictive tools; and, secondly, by evaluating the manner in which newer predictive models incorporating neuroimaging alter the ethical landscape. We outline the current state of the science of predictive testing for psychosis, with a particular focus on emerging neuroimaging biomarkers. We then proceed to ethical analysis employing the four principles of biomedical ethics as a conceptual framework. We conclude with a call for scientific advancement to proceed in tandem with ethical consideration, informed by empirical study of the views of high risk individuals and their families. This collaborative approach will help ensure that predictive testing progresses in an ethically acceptable manner that minimizes potential adverse effects and maximizes meaningful benefits for those at high risk of psychosis.
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Affiliation(s)
- Natalie M Lane
- Department of Psychiatry, NHS Lanarkshire, Glasgow, Scotland G71 8BB, United Kingdom.
| | - Stuart A Hunter
- Department of Psychiatry, NHS Lothian, Edinburgh, Scotland EH1 3EG, United Kingdom
| | - Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland EH10 5HF, United Kingdom
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