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Jolley S, Grice S. State of the art in psychological therapies for psychosis: Family interventions for psychosis. Psychol Psychother 2024; 97:19-33. [PMID: 37515432 DOI: 10.1111/papt.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE It is a half-century since the coalescence of social psychiatry and systemic family therapy approaches started to inform condition-specific therapeutic work with families to reduce relapse and hospital readmission for people with schizophrenia. Today, family interventions are a cornerstone of international guidelines for the treatment of psychosis, and of workforce development initiatives. Effect sizes for clinical and economic outcomes are large, and the evidence base is robust and reliable, not only for outcomes but also for the underpinning theoretical models, which are coherent and consistent. Few, if any, psychological therapies, have so powerful a framework to drive widespread implementation. Nevertheless, delivery in clinical services is variable, often lagging behind that of individual cognitive behavioural therapy, notwithstanding its considerably weaker implementation framework. Our aim in this article is to formulate this translation failure and offer potential solutions. METHOD We summarise the model/intervention and supporting evidence, then consider why delivery remains problematic. RESULTS We highlight the inter-linked issues of conceptual confusion between and conflation of, different approaches to working with families; of addressing diagnostic uncertainty, complex comorbidity and adapting interventions for specific populations; and of translation from gold-standard research trial practice, through educational curricula and training programmes, to routine delivery in frontline services. CONCLUSION We present our view of clinical, research and workforce development priorities to address these issues and continue the collective effort, moving into the next half-century, to work more effectively with people with psychosis and their families, to further improve outcomes.
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Affiliation(s)
- Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - Sarah Grice
- South London and Maudsley NHS Foundation Trust, London, UK
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Miola A, Gardea-Reséndez M, Ortiz-Orendain J, Nunez NA, Ercis M, Coombes BJ, Salgado MF, Gruhlke PM, Michel I, Bostwick JM, McKean AJ, Ozerdem A, Frye MA. Factors associated with suicide attempts in the antecedent illness trajectory of bipolar disorder and schizophrenia. Int J Bipolar Disord 2023; 11:38. [PMID: 38063942 PMCID: PMC10709261 DOI: 10.1186/s40345-023-00318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Factors associated with suicide attempts during the antecedent illness trajectory of bipolar disorder (BD) and schizophrenia (SZ) are poorly understood. METHODS Utilizing the Rochester Epidemiology Project, individuals born after 1985 in Olmsted County, MN, presented with first episode mania (FEM) or psychosis (FEP), subsequently diagnosed with BD or SZ were identified. Patient demographics, suicidal ideation with plan, self-harm, suicide attempts, psychiatric hospitalizations, substance use, and childhood adversities were quantified using the electronic health record. Analyses pooled BD and SZ groups with a transdiagnostic approach given the two diseases were not yet differentiated. Factors associated with suicide attempts were examined using bivariate methods and multivariable logistic regression modeling. RESULTS A total of 205 individuals with FEM or FEP (BD = 74, SZ = 131) were included. Suicide attempts were identified in 39 (19%) patients. Those with suicide attempts during antecedent illness trajectory were more likely to be female, victims of domestic violence or bullying behavior, and have higher rates of psychiatric hospitalizations, suicidal ideation with plan and/or self-harm, as well as alcohol, drug, and nicotine use before FEM/FEP onset. Based on multivariable logistic regression, three factors remained independently associated with suicidal attempts: psychiatric hospitalization (OR = 5.84, 95% CI 2.09-16.33, p < 0.001), self-harm (OR = 3.46, 95% CI 1.29-9.30, p = 0.014), and nicotine use (OR = 3.02, 95% CI 1.17-7.76, p = 0.022). CONCLUSION Suicidal attempts were prevalent during the antecedents of BD and SZ and were associated with several risk factors before FEM/FEP. Their clinical recognition could contribute to improve early prediction and prevention of suicide during the antecedent illness trajectory of BD and SZ.
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Affiliation(s)
- Alessandro Miola
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Manuel Gardea-Reséndez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mete Ercis
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Brandon J Coombes
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Peggy M Gruhlke
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ian Michel
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Alastair J McKean
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
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Pinto D, Martins R, Macedo A, Castelo Branco M, Valente Duarte J, Madeira N. Brain Hemispheric Asymmetry in Schizophrenia and Bipolar Disorder. J Clin Med 2023; 12:jcm12103421. [PMID: 37240527 DOI: 10.3390/jcm12103421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND This study aimed to compare brain asymmetry in patients with schizophrenia (SCZ), bipolar disorder (BPD), and healthy controls to test whether asymmetry patterns could discriminate and set boundaries between two partially overlapping severe mental disorders. METHODS We applied a fully automated voxel-based morphometry (VBM) approach to assess structural brain hemispheric asymmetry in magnetic resonance imaging (MRI) anatomical scans in 60 participants (SCZ = 20; BP = 20; healthy controls = 20), all right-handed and matched for gender, age, and education. RESULTS Significant differences in gray matter asymmetry were found between patients with SCZ and BPD, between SCZ patients and healthy controls (HC), and between BPD patients and HC. We found a higher asymmetry index (AI) in BPD patients when compared to SCZ in Brodmann areas 6, 11, and 37 and anterior cingulate cortex and an AI higher in SCZ patients when compared to BPD in the cerebellum. CONCLUSION Our study found significant differences in brain asymmetry between patients with SCZ and BPD. These promising results could be translated to clinical practice, given that structural brain changes detected by MRI are good candidates for exploration as biological markers for differential diagnosis, besides helping to understand disease-specific abnormalities.
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Affiliation(s)
- Diogo Pinto
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
| | - Ricardo Martins
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - António Macedo
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
| | - Miguel Castelo Branco
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - João Valente Duarte
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Nuno Madeira
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
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