Early Intervention In Psychotic Disorders Research Articles

Effect of early intervention for early-stage psychotic disorders on suicidal behaviours - a systematic review protocol.

The early stages of psychotic disorders correspond to the early phases of the disease and include the prodromal phase and first-episode psychosis; they constitute a period at high risk of suicidal behaviour. A long duration of untreated psychosis (DUP) is among the risk factors of suicidal behaviour identified in this early period. Many studies have shown the effectiveness of early interventions on the overall prognosis of psychotic disorders in the early stages, and early intervention strategies have been developed and tested worldwide. Several authors reported an improvement in suicidal behaviours; however, all these data have not been systematically analysed yet. The main objective of this systematic review was to collect evidence on the effect on suicidal behaviour of early interventions for patients in the early stages of psychotic disorders. We will carry out a systematic review of the literature according to the PRISMA criteria by searching articles in five databases (PubMed, Cochrane, PsycINFO, Scopus, EMBASE), without restriction on the publication date. The selection criteria are: articles (any type; e.g. prospective, retrospective, controlled or uncontrolled, and literature reviews) on early interventions for psychotic disorders in the early stages with data on suicide attempts, death by suicide, suicidal ideation; articles written in English or French. Exclusion criteria are: articles on suicidal behaviours in patients with psychotic disorders in the early stages, but without early intervention, and articles on early-stage psychotic disorders without data on suicidal behaviours. If this review confirms the effectiveness on suicidal behaviours of early interventions for young patients with psychotic disorders, the development/implementation of such intervention programmes should be better promoted. https://www.crd.york.ac.uk/prospero/, identifier CRD42021237833.

"Real-world" first-episode psychosis care in Massachusetts: Lessons learned from a pilot implementation of harmonized data collection.

Increasing evidence points to the value of coordinated specialty care (CSC) for early intervention in psychotic disorders. This report characterizes clinical and socio-demographic features of patients at CSC programs in Massachusetts (MA), assessed by a standardized battery incorporated into "real-world" clinical care. The MA psychosis network for early treatment developed a pilot battery to coordinate assessments across six CSC clinics. Programs reported baseline, 6-month, and 12-month data from a sample of 287 patients with intake dates ranging from April 2015 to December 2020. Patients showed improvements in functioning, emergency service use and several symptom domains at 6 and 12 months. Missing data proved to be a limitation. Patients improved on several meaningful domains within the first year of CSC treatment. Future implementation efforts in cross-program data collection should consider strategies to circumvent limitations related to heterogeneity between clinics, patient discharge and clinics' capacity for data collection.

International application of standards for health care quality, access and evaluation of services for early intervention in psychotic disorders.

Standards for health care quality, access and evaluation of early intervention in psychosis services are required to assess implementation, provide accountability to service users and funders and support quality assurance. The aim of this article is to review the application of standards in Europe and North America. Descriptive methods will be used to illustrate the organizational context in which standards are being applied and used, specific measures being applied and results so far. Both fidelity scales and quality indicators of health care are being used. Fidelity scales are being applied in Australia, Canada, Denmark, Italy and United States. In England, quality indicators derived from the National Institute for Health and Care Excellence guidance are being used. In the last 4 years, significant progress has been made in the development and application of measures that assess quality and access to evidence-based practices for early intervention in psychosis services. This represents an important step towards providing accountability, improving outcomes and service user experience. The methods used allow for comparison between the services that are assessed with the same methods, but there is a need to compare the different methods. Further research is also required to explore links between quality of care and outcomes for community mental health services that deliver early intervention in psychotic disorders.

Klasifikacija psihotičnih poremećaja - aktuelnosti

Two decades after the World Health Organization released the Tenth Revision of the International Classification of Diseases (ICD-10) and the American Psychiatric Association published the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), mental health professionals were presented with the newest revisions of the aforementioned classification systems (ICD-11 and DSM-5). The present review summarizes the major changes of ICD-11 and DSM-5 regarding the categorization and diagnostic criteria for psychosis spectrum disorders, emphasizing the most important similarities and differences between the two classification systems. The main changes brought by the newest ICD and DSM revisions are elimination of the clinical subtypes of schizophrenia, modifications in the diagnostic criteria for schizophrenia and schizoaffective disorder, and reconceptualization of catatonia. Moreover, the newest ICD and DSM revisions highlight the importance of the dimensional assessment of key psychopathology domains, whereby the significance of evaluation of (impaired) cognitive functioning has been formally recognized for the first time among these domains. The DSM-5's inclusion of attenuated psychosis syndrome under chapter Conditions for further study (appendix), reflects partial acknowledgment of the concept of early detection and early intervention in psychotic disorders, aimed to promote further research in this area. ICD-11 and DSM-5 did not bring fundamental changes concerning classification of psychotic disorders, in comparison to their previous versions - ICD-10 and DSM-IV. A major source of criticism in the latest revisions of the classification systems was that they had not been based on the up-to-date scientific data and neurobiological foundation of psychiatric disorders. Search for valid biomarkers for psychotic disorders is still a research priority in this area, and their integration into DSM and ICD. This remains a challenging task for future revisions of the classification systems.

T122. UNMET NEEDS IN PATIENTS WITH ACUTE TRANSIENT PSYCHOTIC DISORDERS (ATPD): ANALYSIS OF PATHWAYS TO CARE: AN 8 YEARS FOLLOW-UP STUDY

BackgroundAcute and transient psychotic disorders (ATPDs) constitute a highly heterogeneous category of brief psychotic disorders. The long-term course and outcomes of ATPDs is not completely clear, with more than half of patients initially diagnosed with ATPDs shifting towards other psychotic spectrum diagnoses. Uncertainties in the real-world clinical care of these patients is further complicated by the diagnostic overlap with the Brief Limited Intermittent Psychotic Symptoms (BLIPS). Thus, patients with similar diagnostic features may either be recommended conventional antipsychotic treatment (if diagnosed with ATPD and according to the current guidelines for first episode psychosis - FEP) or be contraindicated antipsychotic treatment and receive psychological therapies (recommended for BLIPS cases).Given the complexity of the clinical presentation, admission to highly specialized services for early intervention in psychotic disorders (EIP) should represent the best therapeutic pathway for these patients. However, it is not known how many individuals with ATPDs are effectively detected and treated by EIP services.This study aims at overcoming such a gap in knowledge by describing the pathways to care of patients with ATPDs and the treatments received across eight follow-up time-points (3, 6, 12, 18, 24, 48, 72, and 96 months).MethodsElectronic health record-based retrospective cohort study including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1st April 2006 and 15th June 2017. Sociodemographic and clinical characteristics were analyzed using one-way ANOVA and Tukey post-hoc tests for continuous variables and chi square test for categorical variables. Logistic regression analyses were used to investigate the association between sociodemographic characteristics and detection/treatment by EIP.ResultsA total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed schizophrenia (23.8%), affective-spectrum psychoses (4.8%), and other psychotic disorders.Only 7.5 % of ATPDs was detected and treated by Early intervention in Psychosis services (EIP). The remaining quote of patients were treated with general mental health services (91.5%).Active treatment by EIS was more common among males, caucasian, and younger individuals (odds ratio (OR) = 1.35, 95% CI 1.01–1.7, P<0.001; OR = 0.6, 95% CI 0.46–0.78, P<0.001; and OR = 0.91, 95% CI 0.90–0.92, P<0.001, respectively).Almost half of the total sample (48.5%) was in treatment with antipsychotic medications after 1 year of follow-up. This proportion dropped to 25% after 3 years of active treatment.Less than 1% of ATPDs were offered psychotherapy interventions at any of the 8 time points of interest.DiscussionThe present study shows that the largest majority of individuals with ATPD (91.5%) is never detected and treated by the EIP services, which should be the best clinical option for these patients.This suggests that they are receiving neither the best first-episode care nor the best preventative care. Efforts should be done to promote outreach campaigns in general mental health services to persuade clinicians referring these patients to local EIP services, with the aim of providing the best possible care.

T83. PROCESSING SPEED PERFORMANCE AND FUNCTIONING IN YOUNG ADOLESCENTS EXPERIENCING AUDITORY HALLUCINATIONS

BackgroundNeurocognitive impairments are a prevalent aspect of psychosis which, on average, begin in early adolescents, with particular impairment apparent in speed of processing and nonverbal working memory in early stages (Kelleher et al., 2012). It is important to understand the impact of cognitive impairment on functional ability, particularly in early stages of illness which may assist in the development of targeted therapeutic strategies.MethodsA population sample of 212 school going adolescents aged 11–13 years partook in the study, which included community-based adolescents who report experiencing psychotic symptoms but who were not clinically diagnosed. Psychotic symptoms were assessed using the psychosis section of the Schedule for Affective Disorders and Schizophrenia. Six cognitive domains were assessed using the MATRICS consensus cognitive battery. Functioning was assessed using the Children’s Global Assessment Scale. Six separate linear regression analyses were performed to test if each cognitive domain of the MATRICS battery predicted functioning.ResultsIn the entire sample (including those who experienced psychotic experiences and those who did not) (n=211), speed of processing significantly explained 8% of the variance in functioning (F(1, 76) = 6.61, p = .0012, R-squared = 0.08.), (Beta = 0.39, p = 0.012). When the sample was subdivided into those who ever experienced auditory hallucinations (AH) (n=62) versus those that did not (n=149), speed of processing significantly predicted 18% of the variance in functioning in the group experiencing AHs (F(2, 33) = 3.82, p =0.032, R-squared = 0.18), (Beta = 0.43, p = 0.06). However, no effect was found in the group without AVs (F(1,40) = 1.19, p =0.28). No other cognitive domain predicted functioning.DiscussionSpeed of processing appears to be a core cognitive deficit in psychosis which impacts on functioning in young adolescents particularly in those experiencing psychotic symptoms such as auditory hallucinations, however the variance predicted by processing speed is relatively low. This research highlights the potential of speed of processing as a possible viable target for early intervention in psychotic disorders.

The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders

The duration of untreated psychosis (DUP) has been shown to have an effect on outcome after first-episode psychosis. The premise of specialized early intervention (SEI) services is that intervention in the early years of illness can affect long-term outcomes. In this study, we investigate whether DUP affects treatment response after 5 years of SEI treatment compared to 2 years of SEI treatment. As part of a randomized controlled trial testing the effect of prolonged SEI treatment 400 participants diagnosed within the schizophrenia spectrum were recruited. For this specific study participants were dichotomized based on DUP, treatment delay, and time from first symptom until start of SEI treatment. The groups were analyzed with regard to treatment response on psychopathology, level of functioning, and cognitive functioning. The participants with a short DUP had a tendency to respond better to the prolonged treatment with regards to disorganized and negative dimension. For participants with short duration from first symptom until start of SEI treatment there was a significant difference on the negative dimension favoring the prolonged OPUS treatment. The finding of an effect of prolonged treatment for participants with a short total treatment delay could mean that prolonged SEI treatment is more beneficial than treatment as usual (TAU) so long as it is provided in the early years of illness and not just in the early years after diagnosis.

Building Early Intervention Services for Psychotic Disorders: A Primer for Early Adopters in the U.S.

Recent developments in the U.S. healthcare policy signal a growing commitment to early intervention for psychotic disorders. A growing international and U.S. research database supports the effectiveness of specialty team-based models adapted to care for young individuals with recent onset psychosis. The RAISE (Recovery After an Initial Schizophrenia Episode) initiative, sponsored by the NIMH (National Institute of Mental Health), has defined such Coordinated Specialty Care (CSC) services as a new benchmark for care across the U.S., and published a variety of resources to support dissemination. Funding initiatives led by the center for Substance Abuse and Mental Health Services (SAMHSA), and support from other national organizations, have catalyzed interest in community agencies across the country. We offer guidance to such early adopters and supplement extant resources with a focus on the process of setting up such programs. Adopters have numerous decisions to make. These include determining admission criteria, structuring care processes to maximize impact, choosing from several empirically based interventions, and resourcing workforce development. We provide a guide to salient resources, and lessons learned from a decade old CSC, to aid in these complex decisions. We end with a discussion of limitations in the current knowledge base, and the need for responsive research. Early intervention services can engender application of demonstrably effective treatment, while also providing platforms for research to improve and develop new treatments. Collaborations between a wide variety of government, academic and commercial stakeholders will be essential to realize the transformative public health impact of early intervention for psychotic disorders. Keywords: Psychosis, early intervention, first episode, schizophrenia, coordinated specialty care.

Preventive strategies for severe mental disorders

Since the 1990s, there has been a tremendous upsurge in research on early intervention in psychotic disorders. The neurodevelopmental hypothesis enabled the development of clinical staging models of schizophrenia, which in turn demonstrated that early intervention is possible before the onset of psychosis. Such intervention relied on early detection using prodromal vulnerability indicators and on targeted and stage-specific treatments. Initial efforts were focused on reducing the duration of untreated psychosis to improve outcome. As these efforts were not always successful, research moved on to the examination of prodromes and high-risk states. The “at-risk mental state” strategy based on principles of indicated prevention consisted of the “ultra-high risk” and the “basic symptoms” approaches. A large body of evidence indicated that about 30% of the patients who met criteria for either approach went on to develop full-blown psychosis in the next 2–3 years. Several early psychosis detection programs have been set up worldwide, and controlled trials have shown efficacy of early intervention in first-episode psychosis as well as prodromal or at-risk states. However, several issues regarding identifying and managing such patients still need to be sorted out before prevention of severe mental disorders becomes a reality.

Early Intervention for Psychotic Disorders: Building Population Health Systems.

Early Intervention for Psychotic Disorders: Building Population Health Systems.

Prevention and Early Intervention Program for Psychoses (PEPP)

The Prevention and Early Intervention Program for Psychoses (PEPP) was established in 1997 for individuals with first-episode non-affective psychotic disorder. The objectives of PEPP are to improve outcomes for clients by providing a prompt, comprehensive, coordinated and effective treatment program as well as to advance research concerning early intervention for psychotic disorders. This article describes the clinical and research program and the lessons learned.

From early intervention in psychosis to youth mental health reform: a review of the evolution and transformation of mental health services for young people.

The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy. The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the UK and Canada) currently active in the youth mental health field. Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front-line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front-line services (Jigsaw) which are being implemented across different jurisdictions; in the UK, a limited regional response has addressed mostly problems with transition from child-adolescent to adult mental health services; and in Canada, a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples. There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.

Future Looks Promising for Mental Illness Prevention

Research over the last decade shows that depression and anxiety are preventable, and psychiatrists are optimistic that advances in averting these and other mental illnesses are on the horizon.

Early intervention for psychotic disorders: Real-life implementation in Hong Kong

Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education.

Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Should Attenuated Psychosis Syndrome Be a DSM-5 Diagnosis?

The best hope for early intervention in psychotic disorders resides in public health measures for the population as a whole rather than in attempts to diagnose risk in individuals for what will be a low incidence of future psychosis. Making services more accessible, providing general diagnostic training to primary care workers, and creating community awareness will make the filters on the pathway to mental health treatment more permeable for people with early psychotic symptoms in need of care. Individual treatment should be initiated early but when it is indicated, as when criteria are first met for psychotic disorder not otherwise specified. Creating a diagnostic class that does not unambiguously define a specific group, treatment, or outcome does not add value for patients and their families. —Jim van Os

Early intervention in psychotic disorders: Challenges and relevance in the Indian context.

Over the last two decades, there has been an increasing interest in the concept of early intervention (EI) in psychotic disorders, notably schizophrenia. Several lines of research underlie this emerging paradigm shift: (a) an increasingly well-established association between the duration of prolonged untreated illness and poor outcome; (b) evidence of progressive neurobiological changes in the early course of schizophrenia both in the pre-psychotic and psychotic phases, as evidenced by brain imaging studies in schizophrenia; and (c) emerging data, albeit preliminary, suggesting the efficacy and effectiveness of EI programs in improving the outcome in these patients. Mental health service systems across the globe, including Asian countries, have been incorporating specialized early intervention programs. However, literature on EI in the Indian setting is relatively sparse. In this article, we will review the rationale and approaches to EI and the application of these approaches to the Indian context, in light of the available literature. We also examine the constraints in the implementation of EI. Controlled data are needed to evaluate EI and the roadblocks to them, in order to implement EI in the resource-strapped mental health service settings in India.

Public-Academic Partnerships: Early Intervention for Psychotic Disorders in a Community Mental Health Center

Public-Academic Partnerships: Early Intervention for Psychotic Disorders in a Community Mental Health Center

Public-Academic Partnerships: Early Intervention for Psychotic Disorders in a Community Mental Health Center

Early intervention may improve long-term outcomes for psychotic illnesses. Early-intervention services in other countries have focused on reducing the duration of untreated illness and adapting interventions for younger patients. This column describes the process of building such a service, called specialized treatment early in psychosis (STEP), at the Connecticut Mental Health Center. This effort is rooted in a long-standing collaborative relationship between the Connecticut Department of Mental Health and Addiction Services and Yale. The authors describe the critical contribution of such partnerships in evaluating the cost-effectiveness of early intervention in a "real-world" U.S. setting.

Early intervention in psychotic disorders: faith before facts?

This paper reviews the literature on early intervention in psychotic disorders, weighs the cons of this approach, and makes suggestions for clinicians and researchers regarding how to interpret and respond to what is still an embryonic evidence-base, notably in terms of any long-term benefits.