Early detection of psychosis – Establishing a service for persons at risk

AbstractPurposeThe establishment phase of an early detection centre for prodromal psychosis is introduced and characterised, along with its detaining and promoting factors within a universal multi-payer health care system.MethodAcross the first six years (1998–2003), users' characteristics are compared between different diagnostic groups and to the local population statistics; and, for an exemplary 12-months period (3-1-2002 to 2-28-2003), the characteristics of telephone contacts with the service are studied.ResultsRising steadily in number across the first three years, 872 persons, predominately of German citizenship and higher education, consulted the service until 2003, 326 with first-episode psychosis and 144 not fulfilling criteria for a current or beginning psychosis. Of the 402 putatively prodromal patients, 94% reported predictive basic symptoms, 68.9% attenuated and 20.6% transient psychotic symptoms. Most contacts by persons meeting any prodromal criterion were initiated by mental health professionals (psychiatrists or psychologists) and counselling services.ConclusionSupported by public awareness campaigns, an early detection service is well received by its users and private practitioners as reflected by the large proportion of referrals from the latter. However, persons of non-German background as well as of lower education were underrepresented indicating that these sub-groups should be approached by tailored programmes.

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Initiatives to shorten duration of untreated psychosis: systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.075622 ◽

2011 ◽

Vol 198 (4) ◽

pp. 256-263 ◽

Cited By ~ 94

Author(s):

Brynmor Lloyd-Evans ◽

Michelle Crosby ◽

Sarah Stockton ◽

Stephen Pilling ◽

Lorna Hobbs ◽

...

Keyword(s):

Systematic Review ◽

Early Detection ◽

Public Awareness ◽

National Level ◽

First Episode ◽

Duration Of Untreated Psychosis ◽

Early Intervention Services ◽

Awareness Campaigns ◽

Poor Outcomes ◽

Practitioner Education

BackgroundLong duration of untreated psychosis (DUP) is common and associated with poor outcomes. Strategies to enhance early detection of first-episode psychosis have been advocated.AimsTo evaluate initiatives for early detection of psychosis.MethodSystematic review of available evidence on the effectiveness of early detection initiatives to reduce the DUP.ResultsThe review included 11 studies which evaluated 8 early detection initiatives. Evidence suggests that general practitioner education campaigns and dedicated early intervention services do not by themselves reduce DUP or generate more treated cases. Evidence for multifocus initiatives is mixed: intensive campaigns targeting the general public as well as relevant professionals may be needed. No studies evaluated initiatives targeting young people or professionals from non-health organisations.ConclusionsHow early detection can be achieved is not clear. Evidence is most promising for intensive public awareness campaigns: these require organisation and resourcing at a regional or national level. More good-quality studies are needed to address gaps in knowledge.

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Main Symptomatic Treatment Targets in Suspected and Early Psychosis: New Insights From Network Analysis

Schizophrenia Bulletin ◽

10.1093/schbul/sbz140 ◽

2020 ◽

Vol 46 (4) ◽

pp. 884-895 ◽

Cited By ~ 1

Author(s):

Natalia Jimeno ◽

Javier Gomez-Pilar ◽

Jesus Poza ◽

Roberto Hornero ◽

Kai Vogeley ◽

...

Keyword(s):

High Risk ◽

Network Analysis ◽

Early Detection ◽

Symptomatic Treatment ◽

Structured Interview ◽

Psychotic Symptoms ◽

First Episode ◽

Symptom Development ◽

Treatment Targets ◽

Symptom Criteria

Abstract The early detection and intervention in psychoses prior to their first episode are presently based on the symptomatic ultra-high-risk and the basic symptom criteria. Current models of symptom development assume that basic symptoms develop first, followed by attenuated and, finally, frank psychotic symptoms, though interrelations of these symptoms are yet unknown. Therefore, we studied for the first time their interrelations using a network approach in 460 patients of an early detection service (mean age = 26.3 y, SD = 6.4; 65% male; n = 203 clinical high-risk [CHR], n = 153 first-episode psychosis, and n = 104 depression). Basic, attenuated, and frank psychotic symptoms were assessed using the Schizophrenia Proneness Instrument, Adult version (SPI-A), the Structured Interview for Psychosis-Risk Syndromes (SIPS), and the Positive And Negative Syndrome Scale (PANSS). Using the R package qgraph, network analysis of the altogether 86 symptoms revealed a single dense network of highly interrelated symptoms with 5 discernible symptom subgroups. Disorganized communication was the most central symptom, followed by delusions and hallucinations. In line with current models of symptom development, the network was distinguished by symptom severity running from SPI-A via SIPS to PANSS assessments. This suggests that positive symptoms developed from cognitive and perceptual disturbances included basic symptom criteria. Possibly conveying important insight for clinical practice, central symptoms, and symptoms “bridging” the association between symptom subgroups may be regarded as the main treatment targets, in order to prevent symptomatology from spreading or increasing across the whole network.

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Early Warning Signs and Preventing a Relapse

The First Episode of Psychosis ◽

10.1093/oso/9780195372496.003.0019 ◽

2010 ◽

Author(s):

Michael T Compton ◽

Beth Broussard

Keyword(s):

Mental Health Professionals ◽

Early Warning ◽

Signs And Symptoms ◽

Warning Signs ◽

Psychotic Symptoms ◽

First Episode ◽

Prodromal Phase ◽

Early Warning Signs ◽

Short Period

In this chapter, we discuss early warning signs, which are signs and symptoms that often occur before an episode of psychosis. These signs and symptoms, though mild, may occur before the first episode of psychosis and also before later episodes. That is, some mild signs and symptoms may occur during the prodromal phase of the illness, before psychotic symptoms first develop. These same signs and symptoms often serve as warning signs before another episode of illness, or a relapse of psychosis, occurs. So, it is important to be familiar with early warning signs and what to do if they begin to develop. Many people who have had a first episode of psychosis will go on to have one or more relapses of their illness. A relapse happens when symptoms appear again. Some relapses may happen with little or no warning over a short period of time, such as a few days. However, most relapses develop slowly over longer periods, like a few weeks. A relapse may or may not require hospitalization, but it definitely calls for immediate attention, evaluation, and treatment. After a stay in the hospital or after outpatient stabilization, some people feel better quickly. Others take weeks, or even months, to function as well as they had before the relapse. One way of avoiding a relapse is to stay in treatment and attend all follow-up appointments (see Chapter 8 on Follow-up and Sticking with Treatment). Also, it is very important to become aware of one’s specific early warning signs, which are changes in thoughts, feelings, and behaviors that happen a few days or weeks before an episode (reappearance of symptoms). By carefully watching for these signs, patients, their families, and their mental health professionals can work together to help lessen the severity of any episode that may occur. Relapse prevention is the goal of preventing a relapse altogether, by sticking to treatment and watching for early warning signs. The first step in determining one’s specific early warning signs is to think back to the changes that occurred in the prodromal period of the illness, or the time just before the first episode of psychosis. While there are common early warning signs, they will show up slightly differently in each person. Early warning signs in one person may be clear and easy to detect, while in another person they may be trickier to figure out. Early warning signs are signals that symptoms are beginning again and that another episode of psychosis may happen.

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Medicines Used to Treat Psychosis

The First Episode of Psychosis ◽

10.1093/oso/9780195372496.003.0015 ◽

2010 ◽

Author(s):

Michael T Compton ◽

Beth Broussard

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Health Professionals ◽

Treatment Plan ◽

Psychotic Symptoms ◽

First Episode ◽

Psychosocial Treatments ◽

Conventional Antipsychotics ◽

Trade Name ◽

Trade Names

Mental health professionals treat nearly all psychiatric illnesses using two types of treatments: medicines and psychosocial treatments. This is true for psychosis as well. We describe medicines used to treat psychosis in this chapter and psychosocial treatments for psychosis in Chapter 7. Medicines are a crucial part of the treatment plan for people who experience a first episode of psychosis. In fact, many mental health professionals view medicines to be the most important aspect of the treatment of psychosis. This is because psychosocial treatments are usually more effective when medicines help to adequately control symptoms. We discuss a number of medicines in this chapter. When a specific medicine is mentioned, two names are given. The first is the generic name and the second (in parentheses) is the trade name in the United States. For example, Tylenol is the trade name of the generic pain medicine called acetaminophen. Anyone taking medicine should be familiar with both the generic and trade names of the medicine, even though the generic names are sometimes more difficult to spell or pronounce. This chapter begins with an overview of the class of medicines used to treat psychosis, called antipsychotic medicines, or just “antipsychotics.” Before explaining antipsychotics in further detail, we set the stage by defining how antipsychotics work and some side effects and other serious problems called adverse events that may occur when taking antipsychotics. We then describe in more detail the two main types of medicines used to treat psychosis, the so-called “conventional” antipsychotics, and the “atypical” antipsychotics. Some mental health professionals refer to these as “first-generation” and “second-generation” antipsychotics, respectively. Then, we discuss the sometimes difficult task of finding the right medicine. We end by addressing two commonly asked questions about antipsychotic medicines: “Why is it important to take the medicine?” and “How long should the medicine be taken?” As mentioned earlier, the main types of medicines used to treat psychosis are the antipsychotics. These medicines are “antipsychotics” because they fight against (“anti-”) psychotic symptoms. As discussed in Chapter 1 (What Is Psychosis?) and Chapter 2 (What Are the Symptoms of Psychosis?), psychosis is a state of not being well-grounded in reality, due to symptoms like hallucinations or delusions.

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Modelling the cost-effectiveness of public awareness campaigns for the early detection of non-small-cell lung cancer

British Journal of Cancer ◽

10.1038/bjc.2015.167 ◽

2015 ◽

Vol 113 (1) ◽

pp. 135-141 ◽

Cited By ~ 5

Author(s):

S Hinde ◽

C McKenna ◽

S Whyte ◽

M D Peake ◽

M E J Callister ◽

...

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Early Detection ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Public Awareness ◽

Small Cell ◽

Small Cell Lung ◽

Awareness Campaigns ◽

The Cost

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Environmental Degradation in the Ikorodu Sub-Urban Lagos - Lagoon Coastal Environment, Nigeria

Open Environmental Sciences ◽

10.2174/1876325101810010016 ◽

2018 ◽

Vol 10 (1) ◽

pp. 16-33 ◽

Cited By ~ 1

Author(s):

Shakirudeen Odunuga ◽

Samuel Udofia ◽

Opeyemi Esther Osho ◽

Olubunmi Adegun

Keyword(s):

Anthropogenic Activities ◽

Public Awareness ◽

Biodiversity Loss ◽

Policy Formulation ◽

Coastal Environment ◽

Resource Exploitation ◽

Average Growth ◽

Awareness Campaigns ◽

The Government ◽

State Of The Environment

Introduction:Human activities exert great pressures on the environment which in turn cause environmental stresses of various intensities depending on the factors involved and the sensitivity of the receiving environment.Objective:This study examines the effects of anthropogenic activities along the sub-urban lagoon fragile coastal ecosystem using DPSIR framework.Results:The results show that the study area has undergone a tremendous change between 1964 and 2015 with the built up area increasing to about 1,080 ha (17.87%) in 2015 from 224 ha (1.32%) in 1964 at an average growth rate of 16.78ha per annum. The nature of the degradation includes an increasing fragility of the ecosystem through the emergence and expansion of wetlands, flooding and erosion as well as a reduction in the benefits from the ecosystem services. Population growth, between 2006 and 2015 for Ikorodu LGA, estimated at 8.84% per annum serves as the most important driving force in reducing the quality of the environment. This is in addition to Pressures emanating from anthropogenic activities. The state of the environment shows continuous resource exploitation (fishing and sand mining) with the impacts of the pressures coming from water pollution, bank erosion, biodiversity loss and flooding. Although there has been a strong policy formulation response from the government, weak implementation is a major challenge.Recommendation:The study recommends public awareness campaigns and the implementation of existing policies to ensure a sustainable sub-urban lagoon coastal environment..

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Advance care planning: the future

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002304 ◽

2020 ◽

pp. bmjspcare-2020-002304

Author(s):

Judith Rietjens ◽

Ida Korfage ◽

Mark Taubert

Keyword(s):

Advance Care Planning ◽

Public Awareness ◽

Care Planning ◽

Decisional Capacity ◽

Best Interest ◽

Awareness Campaigns ◽

People With Dementia ◽

Future Care ◽

Advance Care ◽

Improve Patient

ObjectivesThere is increased global focus on advance care planning (ACP) with attention from policymakers, more education programmes, laws and public awareness campaigns.MethodsWe provide a summary of the evidence about what ACP is, and how it should be conducted. We also address its barriers and facilitators and discuss current and future models of ACP, including a wider look at how to best integrate those who have diminished decisional capacity.ResultsDifferent models are analysed, including new work in Wales (future care planning which includes best interest decision-making for those without decisional capacity), Asia and in people with dementia.ConclusionsACP practices are evolving. While ACP is a joint responsibility of patients, relatives and healthcare professionals, more clarity on how to apply best ACP practices to include people with diminished capacity will further improve patient-centred care.

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Medical dispatchers’ perception of the interaction with the caller during emergency calls - a qualitative study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00860-y ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Thea Palsgaard Møller ◽

Hejdi Gamst Jensen ◽

Søren Viereck ◽

Freddy Lippert ◽

Doris Østergaaard

Keyword(s):

Public Awareness ◽

Emergency Call ◽

Awareness Campaigns ◽

Emergency Calls ◽

Modifiable Factors ◽

Qualitative Interview Study ◽

Call Process ◽

Complex Procedure ◽

Call Handling ◽

Emergency Medical Dispatchers

Abstract Background Medical dispatching is a highly complex procedure and has an impact upon patient outcome. It includes call-taking and triage, prioritization of resources and the provision of guidance and instructions to callers. Whilst emergency medical dispatchers play a key role in the process, their perception of the process is rarely reported. We explored medical dispatchers’ perception of the interaction with the caller during emergency calls. Secondly, we aimed to develop a model for emergency call handling based on these findings. Methods To provide an in-depth understanding of the dispatching process, an explorative qualitative interview study was designed. A grounded theory design and thematic analysis were applied. Results A total of 5 paramedics and 6 registered nurses were interviewed. The emerging themes derived from dispatchers’ perception of the emergency call process were related to both the callers and the medical dispatchers themselves, from which four and three themes were identified, respectively. Dispatchers reported that for callers, the motive for calling, the situation, the perception and presentation of the problem was influencing factors. For the dispatchers the expertise, teamwork and organization influenced the process. Based on the medical dispatchers´ perception, a model of the workflow and interaction between the caller and the dispatcher was developed based on themes related to the caller and the dispatcher. Conclusions According to medical dispatchers, the callers seem to lack knowledge about best utilization of the emergency number and the medical dispatching process, which can be improved by public awareness campaigns and incorporating information into first aid courses. For medical dispatchers the most potent modifiable factors were based upon the continuous professional development of the medical dispatchers and the system that supports them. The model of call handling underlines the complexity of medical dispatching that embraces the context of the call beyond clinical presentation of the problem.

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