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Grunfeld G, Lemonde AC, Gold I, Paquin V, Iyer SN, Lepage M, Joober R, Malla A, Shah JL. Consistency of Delusion Themes Across First and Subsequent Episodes of Psychosis. JAMA Psychiatry 2024:2821873. [PMID: 39110444 PMCID: PMC11307164 DOI: 10.1001/jamapsychiatry.2024.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/21/2024] [Indexed: 08/10/2024]
Abstract
Importance Despite growing interest in the phenomenology of delusions in psychosis, at present little is known about their content and evolution over time, including whether delusion themes are consistent across episodes. Objective To examine the course of delusions and thematic delusion content across relapse episodes in patients presenting to an early intervention service for psychosis. Design, Setting, and Participants This longitudinal, observational study used clinical data systematically collected from January 2003 to March 2018 from a cohort of consenting patients with affective or nonaffective first-episode psychosis, followed up naturalistically for up to 2 years in an early intervention service for psychosis in Montréal, Quebec, Canada. Data included the thematic content and severity of delusions (scores ≥3 using the Scale for the Assessment of Positive Symptoms) and associated psychotic and nonpsychotic symptoms, both across an initial episode and, in the event of remission, a potential relapse. Data were analyzed from September 2021 to February 2023. Exposure An early intervention service for psychosis, organized around intensive case management and a multidisciplinary team approach, which observed each patient for up to 2 years of care. Main Outcomes and Measures The primary outcome was positive symptom relapse and remission, including the presence and content of delusions, which was coded per the Scale for the Assessment of Positive Symptoms and accepted definitions. The main statistical measures included repeated paired-sample t tests and binary logistic regression analyses. Results Of 636 consenting patients, mean (SD) age was 23.8 (4.75) years; 191 patients were female, 444 were male, and 1 patient was nonbinary. Remission rates were high, and relapse rates were relatively low: 591 individuals had baseline delusions, of which 558 (94.4%) achieved remission. Of these 558 patients, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis. Of the 182 patients who did relapse, however, a large proportion (115 [63.2%]) reported threshold-level delusions. Of these 115, 104 patients (90.4%) had thematic delusion content consistent with that reported during the index (first) episode. Those who relapsed with delusions had fewer delusion themes present during subsequent episodes of psychosis compared with the index episode and lower levels of other psychotic and nonpsychotic symptoms. Conclusions and Relevance Specialized early intervention services for psychosis can achieve high rates of sustained remission. However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes. These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.
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Affiliation(s)
- Gil Grunfeld
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ann-Catherine Lemonde
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ian Gold
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Department of Philosophy, Faculty of Arts, McGill University, Montréal, Quebec, Canada
| | - Vincent Paquin
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Srividya N. Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Martin Lepage
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Jai L. Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada
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Taksal A, Mohan G, Malla A, Rabouin D, Levasseur M, Rangaswamy T, Padmavati R, Joober R, Margolese HC, Schmitz N, Iyer SN. Patient- and family-reported experiences of their treating teams in early psychosis services in Chennai, India and Montreal, Canada. Asian J Psychiatr 2024; 98:104118. [PMID: 38908214 DOI: 10.1016/j.ajp.2024.104118] [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: 12/19/2023] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Cross-cultural psychosis research has mostly focused on outcomes, rather than patient and family experiences. Therefore, our aim was to examine differences in patients' and families' experiences of their treating teams in early intervention services for psychosis in Chennai, India [low- and middle-income country] and Montreal, Canada [high-income country]. METHODS Patients (165 in Chennai, 128 in Montreal) and their families (135 in Chennai, 110 in Montreal) completed Show me you care, a patient- and family-reported experience measure, after Months 3, 12, and 24 in treatment. The measure assesses the extent to which patients and families view treating teams as being supportive. A linear mixed model with longitudinal data from patient and family dyads was used to test the effect of site (Chennai, Montreal), stakeholder (patient, family), and time on Show me you care scores. This was followed by separate linear mixed effect models for patients and families with age and gender, as well as symptom severity and functioning as time-varying covariates. RESULTS As hypothesized, Chennai patients and families reported more supportive behaviours from their treating teams (β=4.04; β= 9, respectively) than did Montreal patients (Intercept =49.6) and families (Intercept=42.45). Higher symptom severity over follow-up was associated with patients reporting lower supportive behaviours from treating teams. Higher levels of positive symptoms (but lower levels of negative symptoms) over follow-up were associated with families reporting lower supportive behaviours from treating teams. There was no effect of time, age, gender and functioning. CONCLUSIONS The levels to which treating teams are perceived as supportive may reflect culturally shaped attitudes (e.g., warmer attitudes towards healthcare providers in India vis-à-vis Canada) and actual differences in how supportive treating teams are, which too may be culturally shaped. Being expected to be more involved in treatment, Chennai families may receive more attention and support, which may further reinforce their involvement. Across contexts, those who improve over follow-up may see their treating teams more positively.
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Affiliation(s)
- Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 6875, Lasalle Boulevard, Montreal, QC H4H 1R3, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R/7A North Main Road, Anna Nagar (West Extn.), Chennai, TN 600101, India
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 6875, Lasalle Boulevard, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC H3A 1A1, Canada
| | - Daniel Rabouin
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 6875, Lasalle Boulevard, Montreal, QC H4H 1R3, Canada
| | | | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R/7A North Main Road, Anna Nagar (West Extn.), Chennai, TN 600101, India
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R/7A North Main Road, Anna Nagar (West Extn.), Chennai, TN 600101, India
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 6875, Lasalle Boulevard, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC H3A 1A1, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC H3A 1A1, Canada; Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), Institute Allan Memorial, 1025, avenue Pine Ouest, Montréal, QC H3A 1A, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC H3A 1A1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 6875, Lasalle Boulevard, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC H3A 1A1, Canada.
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Valle R, Singh SP, Loch AA, Iyer SN. How "global" is research in early intervention for psychosis? A bibliometric analysis. Asian J Psychiatr 2024; 98:104128. [PMID: 38964005 DOI: 10.1016/j.ajp.2024.104128] [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: 02/10/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Unlike high-income countries (HICs), there are few early intervention services for psychosis in low-and middle-income countries (LAMICs). In HICs, research spurred the growth of such services. Little is known about the state of EIP research in LAMICs, which we address by examining their research output and collaborations vis-à-vis that of HICs. METHODS We conducted a search in Scopus database for early psychosis publications in scientific journals since 1980. Data from each record, including title, author affiliation, and date, were downloaded. For HIC-LAMIC collaborations, data on first, corresponding and last authors' affiliations, and funding were manually extracted. Descriptive statistics and social network analysis were conducted. RESULTS Globally, early psychosis publications increased from 24 in 1980 to 1297 in 2022. Of 16,942 included publications, 16.1 % had LAMIC authors. 71.3 % involved authors from a single country (regardless of income level). 21.9 % were collaborations between HICs, 6.6 % between HICs and LAMICs, and 0.2 % among LAMICs. For research conducted in LAMICs and involving HIC-LAMIC collaborations, the first, last, and corresponding authors were LAMIC-based in 71.8 %, 60.7 %, and 63.0 %, respectively. These positions were dominated (80 %) by authors from four LAMICs. 29.4 % of the HIC-LAMIC subset was funded solely by LAMIC funders, predominantly two LAMICs. CONCLUSIONS LAMICs are starkly underrepresented in the otherwise flourishing body of early psychosis research. They have far fewer collaborations and less funding than HICs. Closing these gaps in LAMICs where most of the world's youth live is imperative to generate the local knowledge needed to strengthen early psychosis services that are known to improve outcomes.
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Affiliation(s)
- Ruben Valle
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Swaran P Singh
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; Research and Innovation, Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil; Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.
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Aversa S, Ghanem J, Grunfeld G, Lemonde AC, Malla A, Iyer S, Joober R, Lepage M, Shah J. Sociodemographic and clinical correlates of hallucinations in patients entering an early intervention program for first episode psychosis. Schizophr Res 2024; 269:86-92. [PMID: 38754313 DOI: 10.1016/j.schres.2024.04.026] [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: 11/18/2023] [Revised: 03/28/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
Hallucinations are a core feature of psychosis, and their severity during the acute phase of illness is associated with a range of poor outcomes. Various clinical and sociodemographic factors may predict hallucinations and other positive psychotic symptoms in first episode psychosis (FEP). Despite this, the precise factors associated with hallucinations at first presentation to an early intervention service have not been extensively researched. Through detailed interviews and chart reviews, we investigated sociodemographic and clinical predictors in 636 minimally-medicated patients who entered PEPP-Montréal, an early intervention service for FEP, between 2003 and 2018. Hallucinations were measured using the Scale for the Assessment of Positive Symptoms (SAPS), while negative symptoms were assessed using the Scale for the Assessment of Negative symptoms (SANS). Depressive symptoms were evaluated through the Calgary Depression Scale for Schizophrenia (CDSS), and anxiety symptoms via the Hamilton Rating Scale for Anxiety (HAS). A majority (n = 381, 59.9 %) of the sample presented with clinically significant hallucinations (SAPS global hallucinations score ≥ 3) at program entry. These patients had an earlier age at onset, fewer years of education, and a higher severity of delusions, depression and negative symptoms than those without clinical-level hallucinations. These results suggest that individuals with clinically significant hallucinations at admission tend to be younger and have a greater overall symptom burden. This makes it especially important to monitor hallucinations alongside delusions, depression and negative symptoms in order to identify who might benefit from targeted interventions. The implications of these findings for early intervention and person-centered care are discussed.
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Affiliation(s)
- Samantha Aversa
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada.
| | - Joseph Ghanem
- Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychology, Faculty of Science, McGill University, 2001 Av. McGill College, Montréal, QC H3A 1G1, Canada.
| | - Gili Grunfeld
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Ann-Catherine Lemonde
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychology, Faculty of Science, McGill University, 2001 Av. McGill College, Montréal, QC H3A 1G1, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, Montreal, Quebec H4H 1A8, Canada; Douglas Mental Health University Institute, 6875 Bd LaSalle, Verdun, Montreal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, 1033 Pine Ave W, Montreal, Quebec H3A 1A1, Canada.
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Nair N, Taksal A, Mohan G, Rangaswamy T, Padmavati R, Schmitz N, Malla A, Iyer SN. Patient-reported outcome measures in early psychosis: Evaluating the psychometric properties of the single-item self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada. Early Interv Psychiatry 2024; 18:524-534. [PMID: 38062908 DOI: 10.1111/eip.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/18/2023] [Accepted: 11/19/2023] [Indexed: 07/11/2024]
Abstract
AIM Patient-reported outcome measures (PROMs) provide valuable information and promote shared decision-making but are infrequently used in psychosis. Self-rated Health (SRH) and Self-rated Mental Health (SRMH) are single-item PROMs in which respondents rate their health and mental health from 'poor' to 'excellent'. We examined the psychometric properties of the SRH and SRMH in early psychosis services in Chennai, India and Montreal, Canada. METHODS Assessments were completed in Tamil/English in Chennai and French/English in Montreal. Test-retest reliability included data from 59 patients in Chennai and Montreal. Criterion validity was examined against clinician-rated measures of depression, anxiety, positive and negative symptoms, and a quality-of-life PROM for 261 patients in Chennai and Montreal. RESULTS SRH and SRMH had good to excellent test-retest reliability (ICC >0.63) at both sites and in English and Tamil (but not French). Results for criterion validity were mixed. In Montreal, low SRH was associated with not being in positive symptom remission, and poorer functioning and quality of life. SRH was associated only with functioning in Chennai. No associations were found for SRMH in Montreal. In Chennai, low SRMH was associated with not being in positive symptom remission and poorer functioning. CONCLUSIONS Patient-reported outcome measures may perform differently across contexts as a potential function of variations in sociodemographics, illness characteristics/course, understandings of health/mental health, and so forth. More work is needed to understand if discrepancies between PROMs and CROMs indicate poor validity of PROMs or 'valid' differences between patient and clinician perceptions. Our work suggests that single-item PROMs can be feasibly integrated into clinical settings.
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Affiliation(s)
- Neha Nair
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | | | | | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Population-Based Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Senger B, MacDonald Q, Pencer A, Crocker CE, Hughes J, Tibbo PG. Referral pathways to early intervention services for psychosis and their influence on perceptions of care: An interpretive phenomenological analysis. Early Interv Psychiatry 2024. [PMID: 38797712 DOI: 10.1111/eip.13553] [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: 08/16/2023] [Revised: 12/26/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
AIM Most young adults experiencing psychosis enter early intervention services (EIS) via inpatient and emergency departments. These experiences are suggested to negatively impact their views of treatment and engagement in EIS. However, limited research has examined the impact of young adults' prior help-seeking experiences on these outcomes. The present study aimed to explore how young adults engaged in EIS have experienced initial help-seeking and make sense of these experiences in the context of their current treatment. METHODS Using an interpretative phenomenological analysis approach, semi-structured interviews were conducted with 12 young adults (mean age = 24.83) within their first 3-12 months of treatment in EIS. Interviews aimed to examine their experiences of help-seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS. RESULTS 3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Help-Seeking and Referral Experiences. Participants with referral pathways involving urgent care services described more adversity during their referral pathway and tended to describe help-seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment. CONCLUSIONS The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants' accounts. Sense making was further contextualized by participants' illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users' dignity and for EIS to provide opportunities for patients to process past negative mental healthcare experiences to strengthen engagement.
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Affiliation(s)
- Brannon Senger
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Quinn MacDonald
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alissa Pencer
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean Hughes
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philip G Tibbo
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Sicotte R, Abdel-Baki A, Mohan G, Rabouin D, Malla A, Padmavati R, Moro L, Joober R, Rangaswamy T, Iyer SN. Similar and different? A cross-cultural comparison of the prevalence, course of and factors associated with suicidal thoughts and behaviors in first-episode psychosis in Chennai, India and Montreal, Canada. Int J Soc Psychiatry 2024; 70:457-469. [PMID: 38174721 PMCID: PMC11067410 DOI: 10.1177/00207640231214979] [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: 01/05/2024]
Abstract
BACKGROUND Data from high-income countries (HICs) show a high risk of suicidal thoughts and behaviors (STBs) in first-episode psychosis (FEP). It is unknown, however, whether rates and associated factors differ in low- and middle-income countries (LMICs). AIMS We therefore aimed to compare the 2-year course of STBs and associated factors in persons with FEP treated in two similarly structured early intervention services in Chennai, India and Montreal, Canada. METHOD To ensure fit to the data that included persons without STBs and with varying STBs' severity, a hurdle model was conducted by site, including known predictors of STBs. The 2-year evolution of STBs was compared by site with mixed-effects ordered logistic regression. RESULTS The study included 333 FEP patients (168 in Chennai, 165 in Montreal). A significant decrease in STBs was observed at both sites (OR = 0.87; 95% CI [0.84, 0.90]), with the greatest decline in the first 2 months of follow-up. Although three Chennai women died by suicide in the first 4 months (none in Montreal), Chennai patients had a lower risk of STBs over follow-up (OR = 0.44; 95% CI [0.23, 0.81]). Some factors (depression, history of suicide attempts) were consistently associated with STBs across contexts, while others (gender, history of suicidal ideation, relationship status) were associated at only one of the two sites. CONCLUSIONS This is the first study to compare STBs in FEP between two distinct geo-sociocultural contexts (an HIC and an LMIC). At both sites, STBs reduced after treatment initiation, suggesting that early intervention reduces STBs across contexts. At both sites, for some patients, STBs persisted or first appeared during follow-up, indicating need for suicide prevention throughout follow-up. Our study demonstrates contextual variations in rates and factors associated with STBs. This has implications for tailoring suicide prevention and makes the case for more research on STBs in FEP in diverse contexts.
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Affiliation(s)
- Roxanne Sicotte
- Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Amal Abdel-Baki
- Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
| | - Daniel Rabouin
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | | | - Laura Moro
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
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Nair N, Xavier S, Rabouin D, Mohan G, Rangaswamy T, Ramachandran P, Joober R, Schmitz N, Malla A, Iyer SN. Patient-reported outcome measures in early psychosis: A cross-cultural, longitudinal examination of the self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada. Schizophr Res 2024; 267:75-83. [PMID: 38520813 DOI: 10.1016/j.schres.2024.03.006] [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: 10/26/2023] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Despite their acknowledged value, patient-reported outcome measures (PROMs) are infrequently used in psychosis, particularly in low-and middle-income countries. We compared ratings on two single-item PROMs, Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH), of persons receiving similar early psychosis services in Chennai, India and Montreal, Canada. We hypothesized greater improvements in SRH and SRMH in the Chennai (compared to the Montreal) sample. METHODS Participants (Chennai N = 159/168 who participated in the larger study; Montreal N = 74/165 who participated in the larger study) completed the SRH and SRMH during at least two out of three timepoints (entry, months 12 and 24). Repeated measures proportional odds logistic regressions examined the effects of time (baseline to month 24), site, and relevant baseline (e.g., gender) and time-varying covariates (i.e., symptoms) on SRH and SRMH scores. RESULTS SRH (but not SRMH) scores significantly differed between the sites at baseline, with Chennai patients reporting poorer health (OR: 0.33; CI: 0.18, 0.63). While Chennai patients reported similar significant improvements in their SRH (OR: 7.03; CI: 3.13; 15.78) and SRMH (OR: 2.29, CI: 1.03, 5.11) over time, Montreal patients only reported significant improvements in their SRMH. Women in Chennai (but not Montreal) reported lower mental health than men. Higher anxiety and longer durations of untreated psychosis were associated with poorer SRH and SRMH, while negative symptoms were associated with SRH. CONCLUSIONS As hypothesized, Chennai patients reported greater improvements in health and mental health. The marked differences between health and mental health in Montreal, in contrast to the overlap between the two in Chennai, aligns with previous findings of clearer distinctions between mind and body in Western societies. Cross-context (e.g., anxiety) and context-specific (e.g., gender) factors influence patients' health perceptions. Our results highlight the value of integrating simple PROMs in early psychosis.
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Affiliation(s)
- Neha Nair
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Salomé Xavier
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Daniel Rabouin
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | | | | | | | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Norbert Schmitz
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada; Department of Population-Based Medicine, University Hospital Tübingen, Tübingen, Germany.
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
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9
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Xavier SM, Malla A, Mohan G, Mustafa S, Padmavati R, Rangaswamy T, Joober R, Schmitz N, Margolese HC, Iyer SN. Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 2024; 59:813-825. [PMID: 37848572 DOI: 10.1007/s00127-023-02576-z] [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: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. METHODS Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. RESULTS The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. CONCLUSION This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.
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Affiliation(s)
- Salomé M Xavier
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
- University of Warwick, Coventry, CV4 7AL, UK
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- University of Tübingen, Geschwister-Scholl-Platz 72074, Tübingen, Germany
| | - Howard C Margolese
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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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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11
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Iyer SN, Rangaswamy T, Mustafa S, Pawliuk N, Mohan G, Joober R, Schmitz N, Margolese H, Padmavati R, Malla A. Context and Expectations Matter: Social, Recreational, and Independent Functioning among Youth with Psychosis in Chennai, India and Montreal, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:766-779. [PMID: 36744381 PMCID: PMC10517650 DOI: 10.1177/07067437231153796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Most cross-cultural psychosis research has focused on a limited number of outcomes (generally symptom-related) and perspectives (often clinician-/observer-rated). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to patient-reported measures of social, recreational, and independent functioning. Addressing this gap, this study aimed to compare these outcomes in first-episode psychosis at a high-income site and a lower middle-income site. METHODS Patients receiving similarly designed early intervention for psychosis in Chennai, India (N = 164) and Montreal, Canada (N = 140) completed the self-reported Social Functioning Scale-Early Intervention, which measures prosocial, recreation, and independence-performance functioning. Their case managers rated expected independence-performance functioning. Both sets of assessments were done at entry and Months 6, 18, and 24. Linear mixed model analyses of differences between sites and over time were conducted, accounting for other pertinent variables, especially negative symptoms. RESULTS Linear mixed models showed that prosocial, recreation, and independence-performance functioning scores were significantly higher in Montreal than Chennai and did not change over time. Expected independence-performance was also higher in Montreal and increased over time. Negative symptoms and education independently predicted prosocial, recreation, and expected independence-performance functioning. When added to the model, expected independence-performance predicted actual independence-performance and site was no longer significant. At both sites, prosocial and recreation scores were consistently lower (<40%) than independence-performance (40-65%). CONCLUSION This is the first cross-cultural investigation of prosocial, recreation, and independent functioning in early psychosis. It demonstrates that these outcomes differ by socio-cultural context. Differing levels of expectations about patients, themselves shaped by cultural, illness, and social determinants, may contribute to cross-cultural variations in functional outcomes. At both sites, social, recreational, and independent functioning were in the low-to-moderate range and there was no improvement over time, underscoring the need for effective interventions specifically designed to impact these outcomes.
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Affiliation(s)
- Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | | | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Nicole Pawliuk
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Canada
- Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | | | | | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
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Singh SP, Javed A, Thara R, Chadda R, Iyer S, Stefanis N. The WPA Expert International Advisory Panel for Early Intervention in Psychosis in Low- and Middle-Income Countries: an update on recent relevant activities. World Psychiatry 2023; 22:489-490. [PMID: 37713571 PMCID: PMC10503914 DOI: 10.1002/wps.21130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
- Swaran P Singh
- Centre for Mental Health and Wellbeing Research, University of Warwick, Warwick, UK
| | - Afzal Javed
- WPA President
- Fountain House, Lahore, Pakistan
| | | | - Rakesh Chadda
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Nikos Stefanis
- National and Kapodistrian University of Athens, Athens, Greece
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13
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Menon J, Kantipudi SJ, Mani A, Radhakrishnan R. Characterization of an extreme phenotype of schizophrenia among women with homelessness. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.29.23293378. [PMID: 37577469 PMCID: PMC10418294 DOI: 10.1101/2023.07.29.23293378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Studies of schizophrenia and homelessness are often confounded by comorbid substance use. Women with schizophrenia and homelessness in India have very low rates of substance use and provide a unique opportunity to disentangle the effects of illness from that of substance use. We examined the clinical characteristics of women with schizophrenia and homelessness and compared it to an age-matched group of women with schizophrenia living with their family. Methods 36 women with schizophrenia and homelessness, and 32 women with schizophrenia who were illness living with family were evaluated for psychopathology using Scale for Assessment of Positive Symptoms (SAPS)/ Scale for assessment of negative symptoms (SANS) scales, cognitive difficulties using Montreal Cognitive Assessment (MOCA)/Rowland Universal Dementia Scale (RUDAS), and Frontal Assessment Battery(FAB), disability using World Health Organization - Disability assessment Scale (WHO-DAS) and psychosocial factors using a semi-structured proforma. The groups were compared using t-tests and chi-square for continuous and categorical variables respectively. Results Women with schizophrenia and homelessness were found to have significantly higher scores on measures of psychopathology, significantly lower cognitive functioning, and much higher disability, and were also on higher doses of antipsychotics. The mean scores on measures of psychopathology, cognition and disability for women with schizophrenia and homelessness differed by 2-3 standard deviations with the mean for women living with family (i.e. z scores) suggesting that they represented an extreme phenotype. Rates of past employment were higher among women with schizophrenia and homelessness. Hence these differences were not accounted for by premorbid functioning. Conclusions The study raises the possibility of an extreme phenotype of schizophrenia with severe and persistent psychopathology non-responsive to dopamine blocking drugs, cognitive impairment, and disability, which needs further exploration.
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14
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Lemonde AC, Iyer SN, Malla A, Rangaswamy T, Padmavati R, Mohan G, Taksal A, Gariepy G, Joober R, Boksa P, Shah JL. Differential Trajectories of Delusional Content and Severity Over 2 Years of Early Intervention for Psychosis: Comparison Between Chennai, India, and Montréal, Canada. Schizophr Bull 2023; 49:1032-1041. [PMID: 36897303 PMCID: PMC10318872 DOI: 10.1093/schbul/sbad007] [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: 03/11/2023]
Abstract
BACKGROUND There exist few direct studies of delusional content in psychosis across geo-cultural contexts, especially those in which treatment protocols and measures are comparable. To directly examine an illness outcome that is potentially culturally mediated, this study investigated the baseline presentation and longitudinal trajectory of delusions in first-episode psychosis (FEP) across 2 similar treatment settings in Montréal (Canada) and Chennai (India). STUDY DESIGN Patients entering an early intervention program for FEP in Chennai (N = 168) and Montréal (N = 165) were compared on site-level differences in the presentation of delusions across specific time points over 2 years of treatment. Delusions were measured using the Scale for Assessment of Positive Symptoms. Chi-square and regression analyses were conducted. STUDY RESULTS At baseline, delusions were more frequent in Montréal than in Chennai (93% vs 80%, respectively; X2(1) = 12.36, P < .001). Thematically, delusions of grandiosity, religiosity, and mind reading were more common in Montréal than in Chennai (all P < .001); however, these baseline differences did not persist over time. Regression revealed a significant time-by-site interaction in the longitudinal course of delusions, which differs from the trajectory of other FEP-positive symptom domains. CONCLUSIONS To the best of our knowledge, this is the first direct comparison of delusions in similar programs for FEP across 2 different geo-cultural contexts. Our findings support the notion that delusion themes follow consistent ordinal patterns across continents. Future work is needed to unpack the differences in severity that present at baseline and minor differences in content.
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Affiliation(s)
- Ann-Catherine Lemonde
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | | | | | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | | | - Ridha Joober
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Patricia Boksa
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Canada
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
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15
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Iyer SN, Taksal A, Malla A, Martin H, Levasseur MA, Pope MA, Rangaswamy T, Ramachandran P, Mohan G. Show me you care: A patient- and family-reported measure of care experiences in early psychosis services. Early Interv Psychiatry 2023; 17:662-669. [PMID: 36200407 PMCID: PMC10076446 DOI: 10.1111/eip.13360] [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: 02/27/2022] [Revised: 07/15/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
AIM Despite their emphasis on engagement, there has been little research on patients' and families' experiences of care in early intervention services for psychosis. We sought to compare patients' and families' experiences of care in two similar early psychosis services in Montreal, Canada and Chennai, India. Because no patient- or family-reported experience measures had been used in a low- and middle-income context, we created a new measure, Show me you care. Here we present its development and psychometric properties. METHODS Show me you care was created based on the literature and stakeholder inputs. Its patient and family versions contain the same nine items (rated on a 7-point scale) about various supportive behaviours of treatment providers towards patients and families. Patients (N = 293) and families (N = 237) completed the measure in French/English in Montreal and Tamil/English in Chennai. Test-retest reliability, internal consistency, convergent validity, and ease of use were evaluated. RESULTS Test-retest reliability (intra-class correlation coefficients) ranged from excellent (0.95) to good (0.66) across the patient and family versions, in Montreal and Chennai, and in English, French, and Tamil. Internal consistency estimates (Cronbach's alphas) were excellent (≥0.87). The measure was reported to be easy to understand and complete. CONCLUSION Show me you care fills a gap between principles and practice by making engagement and collaboration as central to measurement in early intervention as it is to its philosophy. Having been co-designed and developed in three languages and tested in a low-and-middle-income and a high-income context, our tool has the potential for global application.
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Affiliation(s)
- Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal; and Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Helen Martin
- Department of Psychiatry, McGill University, Montreal; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | | | - Megan A. Pope
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | | | | | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
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16
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Mustafa S, Malla A, Mohan G, Padmavati R, Rangaswamy T, Joober R, Schmitz N, Margolese H, Iyer SN. Subjective quality of life among first-episode psychosis patients in Chennai, India and Montreal, Canada. Schizophr Res 2023; 257:41-49. [PMID: 37276816 DOI: 10.1016/j.schres.2023.05.008] [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: 08/16/2022] [Revised: 03/03/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023]
Abstract
Differences in subjective quality of life among persons receiving early intervention for psychosis in varying geo-sociocultural contexts have rarely been examined. Our prospective longitudinal study compared the quality of life of persons with first-episode psychosis receiving two years of similar early intervention in Chennai, India and Montreal, Canada. We hypothesized that general life satisfaction would be higher in Chennai compared to Montreal, and that social relations (a specific quality of life component) would also be higher in Chennai and positively contribute to general life satisfaction. Participants completed the general satisfaction and social relations domains of the Wisconsin Quality of Life Index at baseline, months 12 and 24. Baseline weighted mean general satisfaction and social relations scores were in the low to moderate range. Generalized estimating equation analyses showed that general satisfaction scores increased with time [Wald χ2 (1) = 125.28, p < 0.001] and were higher in Chennai than in Montreal [Wald χ2 (1) = 7.50, p = 0.006]. Social relations scores showed the highest association with general satisfaction scores (B = 0.52), followed by positive symptom remission (B = 0.24) and gender (B = 0.18) with Chennai males having the highest general satisfaction scores. Social relations weighted mean scores increased with time [Wald χ2 (1) = 87.30, p < 0.001] and were positively associated with years of education [Wald χ2 (1) = 4.76, p = 0.029] and early negative symptom remission [Wald χ2 (1) = 7.38, p = 0.007]. Our results suggest that subjective quality of life may improve following early intervention for psychosis across contexts. Our findings advance knowledge about the role of sociocultural (e.g., gender) and clinical factors in influencing subjective outcomes in psychosis, and point to social support networks and symptom remission as avenues to boost quality of life.
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Affiliation(s)
- Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | | | | | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Norbert Schmitz
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada; Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Howard Margolese
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-MUHC), McGill University Health Centre, Montreal, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
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MacDonald K, Mohan G, Pawliuk N, Joober R, Padmavati R, Rangaswamy T, Malla A, Iyer SN. Comparing treatment delays and pathways to early intervention services for psychosis in urban settings in India and Canada. Soc Psychiatry Psychiatr Epidemiol 2023; 58:547-558. [PMID: 36571623 PMCID: PMC10088896 DOI: 10.1007/s00127-022-02414-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Although extensively studied in high-income countries (HICs) and less so in low- and middle-income countries (LMICs), pathways to care and treatment delays in early psychosis have not been compared across contexts. We compared pathways to early intervention for psychosis in an HIC (Montreal, Canada) and an LMIC (Chennai, India). We hypothesised that the duration of untreated psychosis (DUP) would be longer in Chennai. METHODS The number of contacts preceding early intervention, referral sources, first contacts, and DUP and its referral and help-seeking components of first-episode psychosis patients at both sites were similarly measured and compared using chi-square analyses and t tests/one-way ANOVAs. RESULTS Overall and help-seeking DUPs of Chennai (N = 168) and Montreal (N = 165) participants were not significantly different. However, Chennai patients had shorter referral DUPs [mean = 12.0 ± 34.1 weeks vs. Montreal mean = 13.2 ± 28.7 weeks; t(302.57) = 4.40; p < 0.001] as the early intervention service was the first contact for 44% of them (vs. 5% in Montreal). Faith healers comprised 25% of first contacts in Chennai. Those seeing faith healers had significantly shorter help-seeking but longer referral DUPs. As predicted, most (93%) Montreal referrals came from medical sources. Those seeing psychologists/counsellors/social workers as their first contact had longer DUPs. CONCLUSION Differences in cultural views about mental illnesses and organizational structures shape pathways to care and their associations with treatment delays across contexts. Both formal and informal sources need to be targeted to reduce delays. Early intervention services being the first portal where help is sought can reduce DUP especially if accessed early on in the illness course.
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Affiliation(s)
- Kathleen MacDonald
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, 600 101, India
| | - Nicole Pawliuk
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, 600 101, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, 600 101, India
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Pathways to care in first-episode psychosis in low-resource settings: Implications for policy and practice. Asian J Psychiatr 2023; 81:103463. [PMID: 36645973 DOI: 10.1016/j.ajp.2023.103463] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Developing countries such as India face a major mental health care gap. Delayed or inadequate care can have a profound impact on treatment outcomes. We compared pathways to care in first episode psychosis (FEP) between North and South India to inform solutions to bridge the treatment gap. METHODS Cross-sectional observation study of 'untreated' FEP patients (n = 177) visiting a psychiatry department in two sites in India (AIIMS, New Delhi and SCARF, Chennai). We compared duration of untreated psychosis (DUP), first service encounters, illness attributions and socio-demographic factors between patients from North and South India. Correlates of DUP were explored using logistic regression analysis (DUP ≥ 6 months) and generalised linear models (DUP in weeks). RESULTS Patients in North India had experienced longer DUP than patients in South India (β = 17.68, p < 0.05). The most common first encounter in North India was with a faith healer (45.7%), however, this contact was not significantly associated with longer DUP. Visiting a faith healer was the second most common first contact in South India (23.6%) and was significantly associated with longer DUP (Odds Ratio: 6.84; 95% Confidence Interval: 1.77, 26.49). Being in paid employment was significantly associated with shorter DUP across both sites. CONCLUSIONS Implementing early intervention strategies in a diverse country like India requires careful attention to local population demographics; one size may not fit all. A collaborative relationship between faith healers and mental health professionals could help with educational initiatives and to provide more accessible care.
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Grunfeld G, Lemonde AC, Gold I, Iyer SN, Malla A, Lepage M, Joober R, Boksa P, Shah JL. "The more things change…"? Stability of delusional themes across 12 years of presentations to an early intervention service for psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:35-41. [PMID: 35907013 DOI: 10.1007/s00127-022-02324-9] [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: 09/12/2021] [Accepted: 06/20/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE While the prevalence of delusional themes appears to be consistent across geographic contexts, little is known about the relative prevalence of such themes within a given setting over periods of time. We therefore investigated delusional themes across 12 years of presentation to a catchment-based early intervention service for first episode psychosis (FEP). METHODS Systematically collected data from 500 patients at an early intervention service for FEP were analyzed. Four cohorts of 3 years each, from 2006 to 2017, were used to compare the frequency of delusion themes across cohorts. We also integrated into the analysis baseline sociodemographic factors such as gender, age, and highest level of education and clinical factors such as anxiety, depression, suicidality, hallucinations, and primary diagnosis (affective or non-affective psychosis). RESULTS Sex and education level were stable across cohorts, while patient age varied (p = 0.047). Clinical anxiety, depression, and suicidality at entry were also stable. Across cohorts, the proportion of patients with affective versus non-affective diagnosis differed (p = 0.050), with no differences in global rating of delusion severity or theme prevalence except for delusions of guilt or sin (p = 0.001). This single theme difference was not correlated with age or diagnosis. CONCLUSION Our study suggests relatively stable prevalence of delusion themes across cohorts of individuals experiencing FEP. This demonstrates the potential utility of studying thematic content both for understanding delusions in clinical populations and in research. Future explorations of the relationships between delusion themes and across individual patient episodes should be conducted.
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Affiliation(s)
- Gil Grunfeld
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ann-Catherine Lemonde
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ian Gold
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Department of Philosophy, Faculty of Arts, McGill University, Montréal, QC, Canada
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Martin Lepage
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ridha Joober
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Patricia Boksa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada. .,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada.
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20
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An observational study of antipsychotic medication discontinuation in first-episode psychosis: clinical and functional outcomes. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1329-1340. [PMID: 35041015 DOI: 10.1007/s00127-022-02230-0] [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: 07/28/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To study the impact of supervised antipsychotic medication discontinuation on clinical and functional outcomes in first-episode psychosis (FEP) in two different cultural environments. METHOD FEP patients(N = 253), treated in two early intervention services (Montreal, Canada and Chennai, India) for 2 years, were assessed for medication use, positive and negative symptom remission and social-occupational functioning at regular intervals. RESULTS Between months 4 and 24 of treatment, 107 patients discontinued medication ('Off'group) as compared to 146 who stayed on medication ('On'group). Medication discontinuation was higher in Chennai as compared to Montreal (n = 80, 49.07% vs n = 27, 16.87%; χ2 37.80, p < 0.001), with no difference in time to discontinuation [Means(SDs) = 10.64(6.82) and 10.04(5.43), respectively, p = 0.71). At month 24 (N = 235), there were no differences in the rate of positive symptom remission between the on and Off groups (81.5 vs 88.0%, respectively) at both sites. The rate of negative symptom remission was lower among patients in the On compared to the Off group (63.2 vs 87.9%, respectively, χ2 = 17.91, p < 0.001), but only in Montreal (55.4% vs 80.0%, respectively, χ2 = 4.12, p < 0.05). Social and Occupational Functioning Assessment Scale scores were equally high in both Off and On medication groups in Chennai [Means (SDs) = 79.43(12.95) and 73.59(17.63), respectively] but higher in the Off compared to the On group in Montreal Means (SDs) = 77.47(14.97) and 64.94(19.02), respectively; Time × site interaction F = 3.96(1,217), p < 0.05]. Medication status (On-Off) had no impact on the outcomes, independent of other variables known to influence outcomes. CONCLUSION Certain cultural environments and patient characteristics may facilitate supervised discontinuation of antipsychotic medication following treatment of an FEP without negative consequences.
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21
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Pawliuk N, Malla A, Mohan G, Taksal A, Pope MA, Birchwood M, Mangala R, Ramachandran P, Loohuis H, Schmitz N, Joober R, Shah J, Rangaswamy T, Iyer SN. Adapting, updating and translating the Social Functioning Scale to assess social, recreational and independent functioning among youth with psychosis in diverse sociocultural contexts. Early Interv Psychiatry 2022; 16:812-817. [PMID: 34747136 PMCID: PMC9076754 DOI: 10.1111/eip.13231] [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: 04/10/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To compare social, recreational and independent functioning among persons with psychosis across two geo-cultural contexts, we adapted the well-established Social Functioning Scale (SFS) and translated it into French and Tamil. We present the development and psychometric testing of this adaptation, the SFS-Early Intervention. METHODS Sixteen items were added to reflect contemporary youth activities (e.g., online games) and 31 items adapted to enhance applicability and/or include context-specific examples (e.g., 'church activity' replaced with 'religious/spiritual activity'). Psychometric properties and participant feedback were evaluated. RESULTS Test-retest reliability (ICCs) ranged from 0.813 to 0.964. Internal consistency (Cronbach's α) ranged from .749 to .936 across sites and languages. Correlations with original subscales were high. The scale was rated easy to complete and understand. CONCLUSIONS The SFS-Early Intervention is a promising patient-reported measure of social, recreational and independent functioning. Our approach shows that conceptually sound existing measures are adaptable to different times and contexts.
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Affiliation(s)
- Nicole Pawliuk
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Megan A Pope
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | | | | | | | - Heleen Loohuis
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | | | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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22
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Iyer SN, Malla A, Taksal A, Maraj A, Mohan G, Ramachandran P, Margolese HC, Schmitz N, Joober R, Rangaswamy T. Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada. Psychol Med 2022; 52:1538-1547. [PMID: 32981550 DOI: 10.1017/s0033291720003359] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. METHODS Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). RESULTS The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = -1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81-0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). CONCLUSIONS This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.
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Affiliation(s)
- Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Anika Maraj
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
| | | | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis- McGill University Health Centre (PEPP-MUHC), Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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23
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Iyer SN, Malla A, Pope M, Mustafa S, Mohan G, Rangaswamy T, Schmitz N, Joober R, Shah J, Margolese HC, Ramachandran P. Whose responsibility? Part 2 of 2: views of patients, families, and clinicians about responsibilities for addressing the needs of persons with mental health problems in Chennai, India and Montreal, Canada. Int J Ment Health Syst 2022; 16:2. [PMID: 35000588 PMCID: PMC8744303 DOI: 10.1186/s13033-021-00511-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Individuals with mental health problems have many insufficiently met support needs. Across sociocultural contexts, various parties (e.g., governments, families, persons with mental health problems) assume responsibility for meeting these needs. However, key stakeholders' opinions of the relative responsibilities of these parties for meeting support needs remain largely unexplored. This is a critical knowledge gap, as these perceptions may influence policy and caregiving decisions. METHODS Patients with first-episode psychosis (n = 250), their family members (n = 228), and clinicians (n = 50) at two early intervention services in Chennai, India and Montreal, Canada were asked how much responsibility they thought the government versus persons with mental health problems; the government versus families; and families versus persons with mental health problems should bear for meeting seven support needs of persons with mental health problems (e.g., housing; help covering costs of substance use treatment; etc.). Two-way analyses of variance were conducted to examine differences in ratings of responsibility between sites (Chennai, Montreal); raters (patients, families, clinicians); and support needs. RESULTS Across sites and raters, governments were held most responsible for meeting each support need and all needs together. Montreal raters assigned more responsibility to the government than did Chennai raters. Compared to those in Montreal, Chennai raters assigned more responsibility to families versus persons with mental health problems, except for the costs of substance use treatment. Family raters across sites assigned more responsibility to governments than did patient raters, and more responsibility to families versus persons with mental health problems than did patient and clinician raters. At both sites, governments were assigned less responsibility for addressing housing- and school/work reintegration-related needs compared to other needs. In Chennai, the government was seen as most responsible for stigma reduction and least for covering substance use services. CONCLUSIONS All stakeholders thought that governments should have substantial responsibility for meeting the needs of individuals with mental health problems, reinforcing calls for greater government investment in mental healthcare across contexts. The greater perceived responsibility of the government in Montreal and of families in Chennai may both reflect and influence differences in cultural norms and healthcare systems in India and Canada.
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Affiliation(s)
- Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Megan Pope
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | | | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Canada
- Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), Montreal, Canada
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Iyer SN, Pope M, Taksal A, Mohan G, Rangaswamy T, Loohuis H, Shah J, Joober R, Schmitz N, Margolese HC, Padmavati R, Malla A. Whose responsibility? Part 1 of 2: A scale to assess how stakeholders apportion responsibilities for addressing the needs of persons with mental health problems. Int J Ment Health Syst 2022; 16:1. [PMID: 35000602 PMCID: PMC8744233 DOI: 10.1186/s13033-021-00510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with mental health problems have multiple, often inadequately met needs. Responsibility for meeting these needs frequently falls to patients, their families/caregivers, and governments. Little is known about stakeholders' views of who should be responsible for these needs and there are no measures to assess this construct. This study’s objectives were to present the newly designed Whose Responsibility Scale (WRS), which assesses how stakeholders apportion responsibility to persons with mental health problems, their families, and the government for addressing various needs of persons with mental health problems, and to report its psychometric properties. Methods The 22-item WRS asks respondents to assign relative responsibility to the government versus persons with mental health problems, government versus families, and families versus persons with mental health problems for seven support needs. The items were modelled on a World Values Survey item comparing the government’s and people’s responsibility for ensuring that everyone is provided for. We administered English, Tamil, and French versions to 57 patients, 60 family members, and 27 clinicians at two early psychosis programs in Chennai, India, and Montreal, Canada, evaluating test–retest reliability, internal consistency, and ease of use. Internal consistency estimates were also calculated for confirmatory purposes with the larger samples from the main comparative study. Results Test–retest reliability (intra-class correlation coefficients) generally ranged from excellent to fair across stakeholders (patients, families, and clinicians), settings (Montreal and Chennai), and languages (English, French, and Tamil). In the standardization and larger confirmatory samples, internal consistency estimates (Cronbach’s alphas) ranged from acceptable to excellent. The WRS scored average on ease of comprehension and completion. Scores were spread across the 1–10 range, suggesting that the scale captured variations in views on how responsibility for meeting needs should be distributed. On select items, scores at one end of the scale were never endorsed, but these reflected expected views about specific needs (e.g., Chennai patients never endorsed patients as being substantially more responsible for housing needs than families). Conclusions The WRS is a promising measure for use across geo-cultural contexts to inform mental health policies, and to foster dialogue and accountability among stakeholders about roles and responsibilities. It can help researchers study stakeholders’ views about responsibilities, and how these shape and are shaped by sociocultural contexts and mental healthcare systems. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-021-00510-x.
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Affiliation(s)
- Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - Megan Pope
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | | | - Heleen Loohuis
- McGill University Student Services, McGill University, Montreal, QC, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-MUHC), McGill University Health Centre, Montreal, Canada
| | | | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
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25
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Vaitheswaran S, Currie G, Dhandapani VR, Mohan G, Rangaswamy T, Preet Singh S. Implementation of first episode psychosis intervention in India - A case study in a low-and middle-income country. SSM - MENTAL HEALTH 2021; 1:None. [PMID: 34957426 PMCID: PMC8654684 DOI: 10.1016/j.ssmmh.2021.100018] [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: 02/26/2021] [Revised: 08/11/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
First Episode Psychosis (FEP) is a serious mental illness affecting adolescents and young persons. While many effective interventions are available, there has not been much research to understand the implementation of such interventions in India and other low- and middle-income countries (LMIC). We studied the implementation of an FEP intervention program in a specialist mental health facility in Chennai, India, using a well-established framework for doing so, the Consolidated Framework for Implementation Research (CFIR). We conducted 27 in-depth interviews with the service users (15 persons with FEP and 12 family caregivers of persons with FEP). We also conducted a focus group discussion with 8 service providers and in-depth interviews with 7 other service providers including those in the service management. A thematic analysis approach was used to identify emerging themes. First, we found CFIR effectively accommodated implementation challenges evident in LMICs; that is, it is transferable to LMIC settings. Second, we highlight barriers to implementation that include cost, limited human resources, cultural and professional hierarchy, divergence from evidence-based guidelines, and lack of awareness and stigma in the wider community. Third, we highlight facilitators for implementation such as, leadership engagement, the need for change that was recognized within the service, cosmopolitan perspectives derived from clinicians’ local and international collaborative experiences and expertise, compatibility of the intervention with the existing systems within the organization, accommodating the needs of the service users, and rapport developed by the service with the service users. Fourth, we propose a model of service delivery incorporating a task-sharing approach for first episode psychosis in resource restricted settings based on the feedback from the stakeholders. Implementation of interventions for First Episode Psychosis in India is explored systematically. Resource constraints, cultural factors, lack of awareness, and stigma are the main barriers to the implementation. Buy-in from the service providers, accommodating the needs and developing rapport with the service users are the facilitators.
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Affiliation(s)
- Sridhar Vaitheswaran
- Schizophrenia Research Foundation (SCARF), R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Vijaya Raghavan Dhandapani
- Schizophrenia Research Foundation (SCARF), R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - Swaran Preet Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Singh SP, Mohan M, Giacco D. Psychosocial interventions for people with a first episode psychosis: between tradition and innovation. Curr Opin Psychiatry 2021; 34:460-466. [PMID: 34282104 DOI: 10.1097/yco.0000000000000726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Assessing recent evidence on psychosocial interventions for people with first episode psychosis (FEP). RECENT FINDINGS Family interventions (FI) reduce relapse rates, whilst cognitive behavioural therapy (CBT) shows a moderate effect in improving positive psychotic symptoms. Vocational interventions (VI) appear to be worthy of implementation within early intervention for psychosis (EIP) teams, but it is still unclear what is the most cost-effective strategy for their delivery. Promising interventions, which need more careful evaluation, focus on substance misuse, physical health comorbidities, improvement of social participation, peer support and the potential of new technologies. SUMMARY The first five years after the onset of psychotic symptoms are a 'critical period' in which psychosocial interventions can be particularly influential in determining prognosis. Traditional EIP interventions have different effectiveness profiles, i.e., FI reduce relapse rates, CBT has a moderate effectiveness on overall and positive symptoms and VI can improve educational and employment-related functioning. Newer interventions show promise on important targets for FEP treatment but require higher-quality evaluations. Decisions on which interventions to implement within EIP teams should be informed by high-quality evidence, but difficult choices will have to be made based on costs, professionals and technologies available, and local priorities.
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Affiliation(s)
- Swaran P Singh
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Mohapradeep Mohan
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick
| | - Domenico Giacco
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick
- Coventry and Warwickshire Partnership Trust, Coventry, UK
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Singh SP, Mohan M, Iyer SN, Meyer C, Currie G, Shah J, Madan J, Birchwood M, Sood M, Ramachandran P, Chadda RK, Lilford RJ, Rangaswamy T, Furtado V. Warwick-India-Canada (WIC) global mental health group: rationale, design and protocol. BMJ Open 2021; 11:e046362. [PMID: 34117045 PMCID: PMC8202113 DOI: 10.1136/bmjopen-2020-046362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The primary aim of the National Institute of Health Research-funded global health research group, Warwick-India-Canada (WIC), is to reduce the burden of psychotic disorders in India. India has a large pool of undetected and untreated patients with psychosis and a treatment gap exceeding 75%. Evidence-based packages of care have been piloted, but delivery of treatments still remains a challenge. Even when patients access treatment, there is minimal to no continuity of care. The overarching ambition of WIC programme is to improve patient outcomes through (1) developing culturally tailored clinical interventions, (2) early identification and timely treatment of individuals with mental illness and (3) improving access to care by exploiting the potential of digital technologies. METHODS AND ANALYSIS This multicentre, multicomponent research programme, comprising five work packages and two cross-cutting themes, is being conducted at two sites in India: Schizophrenia Research Foundation, Chennai (South India) and All India Institute of Medical Sciences, New Delhi (North India). WIC will (1) develop and evaluate evidence-informed interventions for early and first-episode psychosis; (2) determine pathways of care for early psychosis; (3) investigate the efficacy and cost-effectiveness of community care models, including digital and mobile technologies; (4) develop strategies to reduce the burden of mental illnesses among youth; (5) assess the economic burden of psychosis on patients and their carers; and (6) determine the feasibility of an early intervention in psychosis programme in India. ETHICS AND DISSEMINATION This study was approved by the University of Warwick's Biomedical and Scientific Research Ethics Committee (reference: REGO-2018-2208), Coventry, UK and research ethics committees of all participating organisations. Research findings will be disseminated through peer-reviewed scientific publications, presentations at learnt societies and visual media.
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Affiliation(s)
- Swaran P Singh
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Mohapradeep Mohan
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Max Birchwood
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Rakesh K Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Vivek Furtado
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Malla A, Roy MA, Abdel-Baki A, Conus P, McGorry P. Intervention précoce pour les premiers épisodes psychotiques d’hier à demain : comment relever les défis liés à son déploiement pour en maximiser les bénéfices ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088190ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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