Early Intervention Centre Research Articles

The Bern Early Recognition and Intervention Centre for mental crisis (FETZ Bern)-An 8-year evaluation.

Early detection of, and intervention for, psychosis during its prodromal phase has the potential to alter the course of the disease and has therefore become a major objective of modern clinical psychiatry. An increasing number of early detection and intervention services have been established in Europe and worldwide. This study aims to describe and evaluate an early detection and intervention service for children, adolescents and adults (FETZ Bern) aged from eight to 40 years with a population catchment area of 1.035 million in Bern, Switzerland. Routine demographic, diagnostic and service usage data were collected upon admission to the service. Using a retrospective, descriptive and naturalistic study design, data was analysed for different age groups (children, adolescents and adults) and where available, outcome data after 12 and 24 months was evaluated. The FETZ Bern has received 827 referrals with full diagnostic data available for 353 patients. The majority of the assessed patients were young males. While 40% met criteria for a clinical high-risk state of psychosis, 20% were diagnosed with fully manifest psychosis at time of admission, and another 40% had one or more non-psychotic axis-I diagnoses. The FETZ Bern is the first early detection centre worldwide assessing children aged younger than 12 years, as well as adolescents and young adults in one service. Given that developmental peculiarities are important in understanding and ultimately treating psychosis, the FETZ Bern, with its emphasis on developmental peculiarities, should be considered as a model for other similar services.

Is there a diagnosis-specific influence of childhood trauma on later educational attainment? A machine learning analysis in a large help-seeking sample

BackgroundChildhood adversities and trauma (CAT) are associated with poor functional outcome. However, the influence of the single CAT aspects on the risk of a poor functional outcome within different mental disorders has not been investigated so far. Our aims were (i) to predict individual functional outcome based on CAT (ii) to examine whether the prediction power differs within different diagnostic groups (clinical high-risk for psychosis (CHR), psychosis, affective disorders, anxiety disorders) (iii) to compare the specific patterns of CAT experiences, influencing functional outcomes in these groups. MethodClinical data of 707 patients (mean age: 25.09 years (SD = 5.6), 65.5% male) of the Cologne Early Recognition and Intervention Center were assessed with the Trauma And Distress Scale. Functional outcome was estimated by the Social and Occupational Functioning Assessment Scale and school educational attainment. Using machine learning, we generated individualized models to predict functional outcome and to identify specific CAT patterns. ResultsAcross the entire sample, the best prediction for the functional outcome achieved a balanced accuracy (BAC) of 0.6. After splitting into the single diagnostic groups, an improvement with best results in the psychosis group (BAC = 0.70) was observed. Considering specific CAT patterns, the most predictive items depicted a positive and caring environment – or the absence of these, a positive self-image and experiences of bullying. ConclusionsOur results indicated that CAT was differentially associated with functional outcome in the various mental disorders. Thus, the importance of mediating variables, that might explain the interindividual differences in the vulnerability to CAT, like resilience factors, appeared to be crucial.

Working with Families Using a Family-Centered Approach for Improved Development Outcomes in High-Risk Children

Introduction: Around the world, almost half of all deaths in children under five occur in the newborn period. Ninety-nine percent of newborn deaths are in low- and middle-income countries and prematurity, intrapartumrelated neonatal deaths (‘birth asphyxia’), sepsis and meningitis account for 75% of these1. Developmental disability is a diverse group of chronic conditions that are due to mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in “language, mobility, learning, self-help, and independent living”2. Aim of Study: To analyze the impact of family centered-approach on child’s development outcomes. To quantify and validate the advantages of family-centered- approach for parents and children. Method: A low-cost, family-centered intervention programme to promote child and family wellbeing is provided at an Early Intervention Centre in Latika Roy Foundation, Dehradun, India. It follows a familycentered approach of empowering families through respect, collaboration, information, training and support. The effectiveness of this methodology is evaluated in this study. Discussion: This study evaluates the effectiveness of this family-centred interventions programme, provided by early intervention Centre, for improving development outcomes of high-risk infants. This study explores, for the first time in a resource limited country, the relationship between the reduction of family stress achieved through a family empowerment programme and improvement in development outcomes of high-risk children. Families of High-risk infants enrolled at the Centre during January 2015 through July 2017, who were in NICU for 5 or >5 days are partners in the study. Conclusion: The importance of family-centred care cannot be over-emphasized. Early intervention services and support to families can significantly improve quality of life of high-risk children. Intervention studies for children with disability state that the best way of improving children’s outcomes is by empowering parents through a structured learning programme. Given the scope and potential of such programs, this study quantifies and validates the advantages of the family-centred approach.

A Qualitative Account of Young People's Experiences Seeking Care from Emergency Departments for Self-Harm.

Many young people who engage in self-harm do not seek help from health services. For those that do, emergency departments (EDs) are a key point of contact. Substantial gaps remain in current knowledge related to young consumers’ experiences and views on optimal treatment of self-harm in the ED. In this study, semi-structured interviews were conducted with thirteen young people (Mage = 21.2 years), who were engaged with care at headspace early intervention centers and had presented to an ED with a self-inflicted physical injury. Participants were asked to describe their experience in the ED and the care they received. Data were analyzed thematically. Three inter-related themes were identified: 1. The ED was experienced through a lens of significant distress, 2. The ED environment and processes were counter-therapeutic, and 3. Staff were perceived to be disinterested, dismissive, and lacking in knowledge. The study highlights the overwhelmingly negative nature of participants’ experiences, and presents recommendations for service and practice improvements, such as the provision of staff training and increased aftercare.

The utility of a fidelity measure to monitor implementation of new early psychosis services across Australia

Early psychosis delivery models have proliferated worldwide, but there is limited research into establishing model fidelity. In this context, this article aims to describe the development and implementation of a fidelity tool in a national network of early psychosis services across Australia-the headspace Early Psychosis program. Following a detailed consultation process, and based on the Australian Early Psychosis model, an 80-item Early Psychosis Prevention and Intervention Centre Model Integrity Tool (EMIT) was developed along with predefined thresholds for fidelity. The tool was used to assess adherence to the model in six clusters of service sites across Australia. Ratings on the EMIT were informed by interviews with site staff and young people receiving the service, routinely collected data and site policies and procedures. All six clusters of headspace Early Psychosis programs participated in five fidelity assessments across a period of two and a half years. In the initial two visits, the average fidelity score was in the 'low' fidelity range (i.e., <75%). By the fifth fidelity visit, the network average improved to 92.35%, reflecting 'superior' fidelity. Results of the longitudinal fidelity assessments indicate the successful implementation of the Australian Early Psychosis model across the headspace Early Psychosis program. Utilisation of ongoing fidelity assessments has proved an effective method to improve and maintain adherence to the model.

Psychometric properties of the Spanish version of the Family Centred Practice Scale for use with families with children with Autism Spectrum Disorder

BackgroundThe Family-Centered Practices Scale assesses the degree to which staff in Early Childhood Intervention and Development Centers use this approach. However, there is no adaptation of this scale to families of children with Autism Spectrum Disorder in early intervention in Spain. Objectives: To validate and analyze the psychometric properties of the Family-Centered Practices scale in Spanish parents with children with Autism Spectrum Disorder. Methods: Descriptive analyses, exploratory factor analysis (n1 = 211), confirmatory factor analysis (n2 = 236), and scale reliability analyses were performed. In addition, the invariance of the scale by parents’ age and gender was assessed, and a longitudinal analysis of the scores was performed. Results: A scale with a two-factor structure was obtained, similar to the original version, where the goodness-of-fit indices were excellent (RMSEA [95%CI] = 02[0.01; 0.03]; CFI = 0.97; TLI = 0.98; RMR = 0.02; GFI = 0.96). However, the measure was not invariant in gender, with differences between fathers and mothers. Additionally, the internal consistency of the full scale (α = 0.94, ω = 0.90) and of the two dimensions showed high values in this sample and comparing the means between the two measurement time points showed no differences, the test was powerful had a large effect size. Discussion: The psychometric properties of this scale are adequate, which makes it faster to apply and gives it better clinical applicability. Conclusions: This version of scale in Spanish is a valid, reliable tool for evaluating family-centered practices in families with children with Autism Spectrum Disorder.

Symptomatic, functional and service utilization outcomes of migrants with a first episode of psychosis.

Certain migrant groups have been identified as being at increased risk of developing a psychotic disorder, but there is limited research on the outcomes for migrants who develop a first episode of psychosis (FEP). We investigated symptomatic outcomes (remission and relapse rates), functional outcomes (occupational status and relationships) and service utilization (hospital admission and engagement). Young people, aged between 15 and 24, who presented with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen between 01.01.11 and 31.12.16 were included. Place of birth was recorded at the time of presentation. To determine remission, symptoms were scored at three-month intervals using the short-form Scale for the Assessment of Positive Symptoms. A total of 1220 young people presented with FEP over the six-year period (mean age = 19.6 ± 2.8). Of these, 58.1% were male and 24.0% were first-generation migrants. While there was no difference in overall rates of admission after presentation, migrants were more likely to have an involuntary admission after presentation (31.4% vs. 24.6%, aHR = 1.54, 95% CI [1.19, 2.01]) and this risk was greatest for African migrants (HR = 1.98, 95% C.I. [1.37, 2.86]. The rates of remission and relapse were similar in migrants and those born in Australia and there was no difference in functional outcomes, such as employment rates at follow-up. The outcomes for migrants who experience FEP appear to be largely similar to those for the Australian-born population. Our finding that a greater rate of involuntary admission for migrants at presentation supports existing literature and needs further exploration to improve clinical care.

A study to assess the effectiveness of awareness programme on knowledge regarding district early intervention centre among mothers of selected areas of north Gujarat

A study to assess the effectiveness of awareness programme on knowledge regarding district early intervention centre among mothers of selected areas of north Gujarat

Rapid assessment of Rashtriya Bal Swasthya Karyakram program implementation and beneficiary feedback at two district early intervention centers in Chhattisgarh State in India

Background: The Government of India launched the child health screening and early Intervention programme called Rashtriya Bal Swasthya Karyakram in 2014 to screen children from 0 to 18 years for the early detection of 4 D's (Defects, Diseases, Deficiency, and Developmental Delays including disabilities). Under this program, district early intervention centers (DEICs) are set up as nodal centers at the district level to manage the cases of 4Ds. There are few studies published evaluating the functioning of DEICs or reflecting the feedback from beneficiaries. Aims: The aim of this study is to assess the functioning and infrastructure of DEIC and beneficiary feedback. Methods: One good performing district (Raigarh) and one poor performing district (Raipur) were selected for rapid assessment. Observational check list according to norms was used for assessment of facilities, staffing pattern, and semi-structured questionnaire used for beneficiary feedback. Data were entered in Microsoft excel for the analysis. Results: DEIC Raipur was deficient in staff and infrastructure. Among all the referred cases, only 38.9% and 31.5% reached DEIC Raipur and Raigarh, respectively. DEIC Raigarh deserves special mention. It has special Orthotics unit, “Sensory garden,” and Disability Rehabilitation Center. Beneficiaries face many difficulties at DEIC despite having necessary referral forms. 73.4% parents said loss of daily wages was a deterrent to go to DEIC repeatedly for follow-up. Conclusion: There was a deficiency of staff and infrastructure in DEIC Raipur. DEIC Raigarh had a well-equipped rehabilitation center. It should be developed as “Model DEIC” for Chhattisgarh and explore the possibility of telemedicine to provide services to neighboring underserved districts. Beneficiary feedback was below satisfaction.

Mindlink: A stigma-free youth-friendly community-based early-intervention centre in Korea.

AimIn many Asian countries, youth mental health services are not well‐developed and access to treatment is generally delayed. Here, we present a community‐based service model based on our experience with Mindlink, the first early‐intervention centre of its kind in Korea.MethodsWe describe the history of this mental health early‐intervention service and the characteristics of users, as well as its intervention programmes and research directions. We also propose ways to further develop youth mental health services.ResultsA community‐based early‐intervention service for youth was first introduced in 2012, when a special team was formed in a community mental health centre of Korea. As the numbers of young clients increased, a youth‐friendly, early‐intervention centre called Mindlink was opened in 2016. Mindlink targets those aged 15–30 years with mental illness less than 5 years in duration. Its goal is to detect mental illness in young people early and provide comprehensive multidisciplinary interventions. It provides intensive case management and group programmes including cognitive‐behavioural therapy, family intervention, psychoeducation, behavioural activation and physical health promotion. The Korean government has officially announced that the Mindlink model is effective and is currently in the process of scaling it up on a national level.ConclusionAn accessible, youth‐friendly, stigma‐free, community mental health centre such as Mindlink allows early detection and appropriate management of mental illness in young patients.

Efficiency of scanning and attention to faces in infancy independently predict language development in a multiethnic and bilingual sample of 2-year-olds

Efficient visual exploration in infancy is essential for cognitive and language development. It allows infants to participate in social interactions by attending to faces and learning about objects of interest. Visual scanning of scenes depends on a number of factors, and early differences in efficiency are likely contributing to differences in learning and language development during subsequent years. Predicting language development in diverse samples is particularly challenging, as additional multiple sources of variability affect infant performance. In this study, we tested how the complexity of visual scanning in the presence or absence of a face at 6 to 7 months of age is related to language development at 2 years of age in a multiethnic and predominantly bilingual sample from diverse socioeconomic backgrounds. We used Recurrence Quantification Analysis to measure the temporal and spatial distribution of fixations recurring in the same area of a visual scene. We found that in the absence of a face the temporal distribution of re-fixations on selected objects of interest (but not all) significantly predicted both receptive and expressive language scores, explaining 16% to 20% of the variance. Also, lower rate of re-fixations recurring in the presence of a face predicted higher receptive language scores, suggesting larger vocabulary in infants that effectively disengage from faces. Altogether, our results suggest that dynamic measures, which quantify the complexity of visual scanning, can reliably and robustly predict language development in highly diverse samples. They suggest that selective attending to objects predicts language independently of attention to faces. As eye-tracking and language assessments were carried out in early intervention centres, our study demonstrates the utility of mobile eye-tracking setups for early detection of risk in attention and language development.

What families really think about the quality of early intervention centers: a perspective from mixed methods.

BackgroundFamilies are a fundamental aspect in the current perspective of Early Intervention, and knowing their opinion with quantitative and qualitative research is necessary for its improvement. The objective of this research was to evaluate the quality of the service perceived in Early Intervention Centers and its relationship with satisfaction and future intention, as well as to identify factors that are associated with the perception of users.MethodsA measurement model of 50 items and an open question to gather qualitative information was used in a sample of 233 participants. A confirmatory factor analysis and a regression analysis were conducted. Regarding the qualitative data, the information was subjected to a thematic content analysis in order to delve into the perception of the participants.ResultsThe model showed a satisfactory fit and the regression analysis indicated that treatment rooms (β = − 0.28) and adaptation of activities (β = 0.27) have greater weight with respect to satisfaction, whereas for future intention, the factors of greater weight were adaptation of activities (β = 0.23) and location (β = 0.20). The qualitative analysis showed three themes: facilitators, barriers and suggestions for improvement. Within facilitators, the participants were satisfied with the Early Intervention professionals, and they made improvement suggestions for the detected barriers to improve the facilities and the follow-up of the child.ConclusionsThe study offers a wide perspective of the perception of the service with an active participation of families in the treatment within the Early Intervention service. This will allow professionals in Early Intervention, service providers and researchers to consider the families as intervention agents capable of providing their opinion and making decisions, and not only as passive elements.

Association Between Symbolic Play and Language: A Comparison Between Typically Developing Children and Children with Down Syndrome.

Language and symbolic play require the same underlying symbolic ability and develop parallel to one another. The aim of this study was to determine the association between symbolic play and vocabulary in typically developing children and children with Down syndrome in Malaysia. Twenty-five typically developing children and 25 children with Down syndrome aged between 12 and 36 months were involved in this study. They were recruited from an early intervention center and various kindergartens from the West Coast of Peninsular Malaysia. Their play skills were assessed using the Symbolic Play Test Second Edition, and information about their vocabulary was obtained through the MacArthur Bates Communicative Development Inventories that was filled out by their parents. There was a significant difference in the vocabulary and symbolic play scores of children with Down syndrome compared with typically developing children. There was also a positive correlation between symbolic play scores and receptive and expressive vocabulary scores for both groups of children. When providing intervention, speech-language pathologists need to promote the development of symbolic play in addition to language, given the association between the two. They should also look into introducing an augmentative and alternative communication system to the children who demonstrate age-appropriate symbolic play skills but have trouble with symbolic language production.

Cultural Influences on Early Intervention Services

This survey-based, quantitative research investigated Early Intervention teachers' perception about Early Intervention services in Mecca Region in The Kingdom of Saudi Arabia. This research focused on the cultural influences in the provision of services by professionals. Two options were offered to subjects to complete the survey: 1) an online survey and 2) a hard copy of the survey which was distributed to teachers in Early Intervention Centers. The majority of the participants completed the online survey. Data was collected and analyzed. The results showed that the teachers in Mecca Region in Saudi Arabia indicated that they considered the culture of the children and families when determining curriculum and services in their programs.

Activity Participation and Sensory Processing Patterns of Preschool-Age Children With Autism Spectrum Disorder.

A dearth of information is available on the relationship between activity participation and sensory processing patterns in preschool-age children with autism spectrum disorder (ASD). To investigate differences in activity participation and sensory processing patterns between preschool-age children with ASD and typically developing (TD) children. Cross-sectional. Clinics, hospitals, early intervention centers, and preschools in Tainan, Taiwan. Forty children with ASD and 40 TD children (ages 36-71 mo). The Childhood Autism Rating Scale (2nd ed., Standard Version), Assessment of Preschool Children's Participation, and Short Sensory Profile 2 (SSP-2). Compared with TD children, children with ASD had significantly lower scores on participation diversity in activities across areas of play, physical recreation, and social activities and higher scores in each of the four sensory quadrants. For children with ASD, participation in social activities was significantly negatively correlated with SSP-2 quadrant scores. These findings have implications for how preschool-age children with ASD typically engage in daily activities and suggest that some sensory processing patterns may be associated with participation in social activities. Occupational therapy practitioners can facilitate activity participation for preschool-age children with ASD by using their strengths and the activities that they find interesting; practitioners should consider the role of sensory systems to promote activity participation in natural settings.

Trapped in a Glass Bell Jar: Neural Correlates of Depersonalization and Derealization in Subjects at Clinical High-Risk of Psychosis and Depersonalization-Derealization Disorder.

BackgroundDepersonalization (DP) and derealization (DR) are symptoms of a disruption of perceptual integration leading to an altered quality of subjective experiences such as feelings of unreality and detachment from the self (DP) or the surroundings (DR). Both DP and DR often occur in concert with other symptoms, for example in subjects at clinical high-risk (CHR) for psychosis, but also appear isolated in the form of DP/DR disorder. Despite evidence that DP/DR causes immense distress, little is known about their neurobiological underpinnings. Therefore, we investigated the neural correlates of DP/DR using pseudo-continuous arterial spin labeling MRI.MethodsWe evaluated the frequency of DP/DR symptoms in a clinical sample (N = 217) of help-seeking individuals from the Early Detection and Intervention Centre for Mental Crisis (CHR, n = 97; clinical controls (CC), n = 91; and first-episode psychosis (FEP), n = 29). Further, in a subsample of those CHR subjects who underwent MRI, we investigated the resting-state regional cerebral blood flow (rCBF). Here, individuals with (n = 21) and without (n = 23) DP/DR were contrasted. Finally, rCBF was measured in a small independent second sample of patients with DP/DR disorder (n = 6) and healthy controls (HC, n = 6).ResultsIn the complete clinical sample, significantly higher frequency of DP/DR was found in CHR compared to CC (50.5 vs. 16.5%; χ2 (2) = 24.218, p ≤ 0.001, Cramer’s V = 0.359) as well as in FEP compared to CC (37.9 vs. 16.5%; χ2 (2) = 5.960, p = 0.015, Cramer’s V = 0.223). In MRI, significantly lower rCBF was detected in the left orbitofrontal cortex in CHR with vs. without DP/DR (x/y/z = −16/42/−22, p < 0.05, FWE corrected). In patients with DP/DR disorder, significantly higher rCBF was detected in the left caudate nucleus (x/y/z = −18/−32/18, p < 0.05) compared to HC.ConclusionsThis study shows that DP/DR symptoms are frequently found in CHR subjects. Investigating two separate DP/DR populations with an identical neuroimaging technique, our study also indicates that there may be divergent pathophysiological mechanisms—decreased neuronal activity in the orbitofrontal cortex, but increased activity within the caudate nucleus—leading to a final common pathway with similar psychopathological symptoms. This suggests that both top-down (orbitofrontal cortex) and bottom-up (caudate nucleus) mechanisms could contribute to the emergence of DP/DR.

Initial 6-month quality review of a percutaneous endovascular arteriovenous fistula program.

Percutaneous arteriovenous fistulas have recently proven successful alternatives to surgical arteriovenous fistulas with encouraging initial results. The Ellipsys Endovascular Arteriovenous Fistula System utilizing ultrasound and thermal energy has recently received approval for use in the United States. At the University of New Mexico, we developed an integrated service between Vascular Surgery, Interventional Radiology, and Interventional Nephrology for percutaneous arteriovenous fistulas utilizing Ellipsys. We performed a retrospective chart review of the initial 6 months (January 1st 2019 to July 1st 2019) of 18 percutaneous arteriovenous fistula placements to evaluate our initial technical success rate, the number of arteriovenous fistulas meeting maturation characteristics or use in dialysis, and to identify areas for quality improvement. Initial technical success was achieved in 17 out of 18 arteriovenous fistulas (94.4%). Three patients did not report for any follow-up at the end of the initial 6 months. Of the remaining patients, 7 out of 15 were using their arteriovenous fistulas or meeting maturation characteristics at the end of the study (46.7%). Patient loss to follow-up/no-show (16.7%), patient not yet requiring hemodialysis (27.8%), and poor post-surgical maturation and/or need for additional maturation procedures (55.6%) were the predominate reasons for non-use. We identified improved coordination of care, early intervention, and outpatient dialysis center education as the primary areas of focus for quality improvement. Initial technical success rate of percutaneous arteriovenous fistulas placement was comparable to published studies. Early and aggressive secondary angiographic interventions of arteriovenous fistulas failing to meet cannulation requirements, improved coordination of post-operative care, and outpatient dialysis center education appear to be the primary targets for quality improvement.

Smartphone-Enhanced Symptom Management In Psychosis: Open, Randomized Controlled Trial.

BackgroundImproving recovery from acute symptoms and preventing relapse are two significant challenges in severe mental illness. We developed a personalized smartphone-based app to monitor symptoms in real time and validated its acceptance, reliability, and validity.ObjectiveTo assess (i) acceptability of continuous monitoring to SMI patients and health professionals over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; and (iii) the feasibility of detecting early warning signs of relapse.MethodsThe active symptom monitoring smartphone app was built into an end-to-end system in two NHS Trusts to enable real-time symptom self-monitoring and detection by the clinical team of early signs of relapse in people with severe mental illness. We conducted an open randomized controlled trial of active symptom monitoring compared to usual management to assess: (i) acceptability and safety of continuous monitoring over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; (iii) feasibility of detecting early warning signs of relapse communicated to the healthcare staff via an app streaming data to the electronic health record. Eligible participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of schizophrenia and related disorders, and a history of relapse within the previous two years were enrolled from an early intervention team and a community mental health team.ResultsOf 181 eligible patients, 81 (45%) consented and were randomized to either active symptom monitoring or management as usual. At 12 weeks, 90% (33/36) of those in the active monitoring group continued to use the system and exhibited an adherence rate (defined as responding to >33% of alerts) of 84% (30/36}. Active symptom monitoring was associated with no difference on the empowerment scale in comparison to the usual management group at 12 weeks. The pre-planned intent-to-treat analysis of the primary outcome, a positive score on the Positive and Negative Syndrome Scale (PANSS) scale, showed a significant reduction in the active symptom monitoring group over 12 weeks in the early intervention center. Alerts for personalized early warning signs of relapse were built into the workflows of both NHS Trusts, and 100% of health professional staff used the system in a new digital workflow. Qualitative analyses supported the acceptability of the system to participants and staff.ConclusionsThe active smartphone monitoring system is feasible and was accepted by users in a 3-month study of people with severe mental illness, with surprisingly high levels of adherence. App use was associated with psychotic symptom improvement in recent-onset participants, but not those with longstanding illness, supporting the notion of improved self-management. When built into clinical management workflows to enable personalized alerts of symptom deterioration, the app has demonstrated utility in promoting earlier intervention for relapse.Trial RegistrationISRCTN Registry ISRCTN88145142; http://www.isrctn.com/ISRCTN88145142

Prediction of clinical outcomes beyond psychosis in the ultra-high risk for psychosis population.

Several prediction models have been introduced to identify young people at greatest risk of transitioning to psychosis. To date, none has examined the possibility of developing a clinical prediction model of outcomes other than transition. The aims of this study were to examine the association between baseline clinical predictors and outcomes including, but not limited to, transition to psychosis in young people at risk for psychosis, and to develop a prediction model for these outcomes. Several evidence-based variables previously associated with transition to psychosis and some important clinical comorbidities experienced by ultra-high risk (UHR) individuals were identified in 202 UHR individuals. Secondary analysis of the Neurapro clinical trial were conducted to investigate the associations between these variables and favourable (remission and recovery) or unfavourable (transition to psychosis, no remission, any recurrence and relapse) clinical outcomes. Logistic regression, best subset selection, Akaike Information Criterion and receiver operating characteristic curves were used to seek the best prediction model for clinical outcomes from all combinations of possible predictors. When considered individually, only higher general psychopathology levels (P = .023) was associated with the unfavourable outcomes. Prediction models suggest that general psychopathology and functioning are predictive of unfavourable outcomes. The predictive performance of the resulting models was modest and further research is needed. Nonetheless, when designing early intervention centres aiming to support individuals in the early phases of a mental disorder, the proper assessment of general psychopathology and functioning should be considered in order to inform interventions and length of care provided.

Quality of Life in Children with Epilepsy

Abstract Objective The main aim of this study was to assess quality of life in children with epilepsy. Materials and Methods A prospective observational study was conducted in Regional Early Intervention Centre of the Department of Pediatrics Tertiary Care Hospital in central India. This study included 120 children with epilepsy aged between 2 and 18 years. In this study, we assessed the quality of life in children with epilepsy with the help of Pediatric Quality of Life Inventory (PedsQL). We further analyzed the quality of life in various dimensions. For the statistical analyses for SPSS version, 20 was used, chi-squared and Fisher's exact test was used for categorical variables, and Student's t-test was used for quantitative variables. Linear regression analysis was done for multivariate analysis. Result Mean total PedsQL score for total cohort was 70.96. The cognitive dimension of epileptic children was more affected than physical, social, and emotional dimensions. Factors associated with lower PedsQL scores in epilepsy patients were associated with long duration of epilepsy, polytherapy, male gender, low head circumference, presence of intellectual disability, and refractory epilepsy. Conclusion Epilepsy affects the quality of life in children across all age groups. Among epilepsy indicators, polytherapy, refractory epilepsy, and duration of epilepsy were the most important factors associated with poor quality of life. We can conclude that every effort should be made to decrease the duration of treatment and minimize the number of drugs for improving the quality of life in this patient cohort.