Early intervention in psychosis: a new evidence based paradigm

2002 ◽  
Vol 11 (4) ◽  
pp. 237-247 ◽  
Author(s):  
Patrick D. McGorry ◽  
Eoin J. Killackey
Keyword(s):  
Mental Illness ◽  
Early Intervention ◽  
Evidence Based ◽  
Major Health ◽  
Indicated Prevention ◽  
The Individual ◽  
Early Intervention In Psychosis ◽  
New Evidence ◽  
Major Health Issue

SUMMARYObjective – Even in countries whose mental health services are comparatively well resourced, the care offered to those in the early stages of psychotic illnesses is not what it could be. Patients often have to progress to chronicity before receiving adequate interventions, by which stage there has been great potential for harm, not only through the psychosis, but also to the quality of life of the individual who has often missed or not completed adequately, several important developmental tasks. Further, evidence indicates that delay in treatment is positively associated with poorer outcome. This paper puts the case for early intervention in psychosis. Method – Based on the experience of the Early Psychosis Prevention and Intervention Centre in Melbourne, the paper reviews the evidence for and the criticisms of, early intervention. Using the concept of indicated prevention, it suggests ways in which clinicians can improve the interventions available to those experiencing the onset of psychosis and suggests that prepsychotic intervention may be possible. Results – Evidence discussed in this paper indicates that the development of mental illness is a major health issue in young people; that there is a positive correlation between duration of untreated psychosis and outcome; that it is possible to identify a proportion of those at high risk of developing mental illness; that through intervention it may be possible to reduce the transition rate to illness. Conclusion – Primary prevention is beyond the capacity of our present knowledge. Indicated prevention in the form of early intervention and optimal, sustained treatment is a paradigm for which there is increasing supportive evidence. It is a paradigm which is appealing to clinicians, patients, families and which has the potential to reduce the secondary impact of serious mental illness such as suicide, stigma, isolation and reduction in social status.

Detection and early intervention for psychosis

2018 ◽  
Vol 12 (2) ◽  
pp. 67-71 ◽  
Author(s):  
Anup Pradhan ◽  
Hena Joshi
Keyword(s):  
Mental Illness ◽  
Early Intervention ◽  
Social Isolation ◽  
Young Patients ◽  
Evidence Based ◽  
Specific Change ◽  
Evidence Based Treatment ◽  
Patient Behaviour ◽  
Early Intervention In Psychosis ◽  
Early Features

Psychosis is an example of severe mental illness; 80% of first psychotic episodes occur in patients between 16 and 30 years in age. The use of an early intervention in psychosis (EIP) team aims to improve outcomes and provide evidence-based treatment for young patients in the community. GPs are often the first clinicians consulted by patients with early features of psychosis, the symptoms of which are often non-specific. Change in patient behaviour and social isolation may be indicators of psychosis. These patients will need prompt referral to the EIP services. This article will outline the early clinical features of psychosis and the GP’s role in management.

Acupuncture in Neurological Disorders: An Evidence-Based Overview

2020 ◽  
pp. 449-494
Author(s):  
Alexandra Dimitrova
Keyword(s):  
Neurological Disorders ◽  
Large Scale ◽  
Healthcare Providers ◽  
Evidence Based ◽  
Tunnel Syndrome ◽  
Meta Analyses ◽  
New Evidence ◽  
Common Misconceptions

Over the past 20 years acupuncture has been rapidly gaining in popularity both in clinical practice and in research. New evidence for the benefits of acupuncture in various disorders is emerging seemingly every week, and recent large-scale systematic reviews and meta-analyses have suggested that acupuncture’s benefits in pain conditions can be maintained long term. At present the strongest evidence for acupuncture in the treatment of neurological disorders is in the fields of migraine, tension headaches, diabetic neuropathy, carpal tunnel syndrome, and Bell’s palsy. Recent trials suggest that acupuncture may be used as an adjunct in stroke rehabilitation and in improving the quality of life in patients with Parkinson’s disease and dementia. Despite recent mechanistic research advances, much remains unknown about acupuncture’s mechanism of action and there are common misconceptions about the origins of modern-day acupuncture. As acupuncture is being rapidly integrated into mainstream medical practice and increasingly being sought by patients, healthcare providers and neurologists in particular need to be educated about its applications and benefits for various neurological disorders. Our hope is that this chapter will serve toward this educational goal.

scholarly journals Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Lessons Learned ◽  
Evidence Based ◽  
Cranial Neuralgia ◽  
The Individual ◽  
Meta Analyses ◽  
Based Medicine ◽  
Over Time

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.

Posttraumatic Stress Disorder, Supported Employment, and Outcomes in People with Severe Mental Illness

CNS Spectrums ◽  
2004 ◽  
Vol 9 (12) ◽  
pp. 913-925 ◽  
Author(s):  
Kim T. Mueser ◽  
Susan M. Essock ◽  
Michael Haines ◽  
Rosemarie Wolfe ◽  
Haiyi Xie
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
Supported Employment ◽  
Stress Disorder ◽  
Work Outcomes ◽  
Individual Placement And Support ◽  
Rehabilitation Programs ◽  
The Individual ◽  
Individual Placement

AbstractObjective: To evaluate whether posttraumatic stress disorder (PTSD) is related to outcomes in persons with severe mental illness (SMI) participating in a study of vocatinal rehabilitation programsBackground: PTSD is a common comorbid disorder in people with SMI, but it is unknown whether PTSD interferes with the ability to benefit from rehabilitation programs such as supported employment.Methods: The relationships between PTSD and symptoms, health, quality of life, and work outcomes was examined in 176 clients with SMI participating in a 2-year randomized controlled trial of three vocational rehabilitation programs: supported employment based on the Individual Placement and Support model, a psychosocial rehabilitation program based on transitional employment, and standard services.Results: The overall rate of current PTSD in the sample was 16%. Compared with clients without PTSD, clients with PTSD had more severe psychiatric symptoms, worse reported health, lower self-esteem, and lower subjective quality of life. Clients with PTSD who participated in the Individual Placement and Support model (the most effective vocational model of the three studied) also had worse employment outcomes over the 2-year study period than clients without PTSD, with lower rates of compeitive work, fewer hours worked, and fewer wages earned. Employment outcomes did not differ between clients with PTSD versus without PTSD in the other two vocational rehabilitation approaches.Conclusion: The findings suggest that PTSD may contribute to worse work outcomes in clients participating in supported employment programs. Effective treatment of these clients with PTSD may improve their ability to benefit from supported employment.

Interrater Reliability of the New Sport-Specific Evidence-Based Classification System for Para Va'a

2020 ◽  
Vol 37 (3) ◽  
pp. 241-252
Author(s):  
Johanna S. Rosén ◽  
Victoria L. Goosey-Tolfrey ◽  
Keith Tolfrey ◽  
Anton Arndt ◽  
Anna Bjerkefors
Keyword(s):  
Classification System ◽  
Interrater Reliability ◽  
Intraclass Correlation ◽  
Test Battery ◽  
Evidence Based ◽  
Water Test ◽  
The Individual ◽  
New Evidence ◽  
Test Level ◽  
Total Agreement

The purpose of this study was to examine the interrater reliability of a new evidence-based classification system for Para Va'a. Twelve Para Va'a athletes were classified by three classifier teams each consisting of a medical and a technical classifier. Interrater reliability was assessed by calculating intraclass correlation for the overall class allocation and total scores of trunk, leg, and on-water test batteries and by calculating Fleiss’s kappa and percentage of total agreement in the individual tests of each test battery. All classifier teams agreed with the overall class allocation of all athletes, and all three test batteries exhibited excellent interrater reliability. At a test level, agreement between classifiers was almost perfect in 14 tests, substantial in four tests, moderate in four tests, and fair in one test. The results suggest that a Para Va'a athlete can expect to be allocated to the same class regardless of which classifier team conducts the classification.

scholarly journals O1.3. BACK TO THE FUTURE: PREDICTING POPULATION NEED FOR PSYCHOSIS CARE BASED ON THE EPIDEMIOLOGY OF PSYCHOTIC DISORDERS IN ENGLAND, AN APPLIED BAYESIAN METHODOLOGY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S1-S2
Author(s):  
Keltie McDonald ◽  
Tao Ding ◽  
Rebecca Dliwayo ◽  
David Osborn ◽  
Pia Wohland ◽  
...  
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Small Area ◽  
Psychotic Disorders ◽  
Population Projections ◽  
First Episode ◽  
Evidence Based ◽  
Psychosis Risk ◽  
Small Area Level ◽  
Early Intervention In Psychosis

Abstract Background Providing timely, adequate and appropriately-resourced care to people experiencing their first episode of psychosis needs to be informed by evidence-based models of future need in the population. We sought to develop a validated prediction model of need for provision of early intervention in psychosis [EIP] services at the small area level in England up to 2025, based on current epidemiological evidence and demographic projections of the at-risk population. Methods We developed a Bayesian population-level prediction tool. First, we obtained small area incidence data on first episode psychoses, aged 16–64 years, from three major empirical studies of psychosis risk (ÆSOP, ELFEP and SEPEA). Second, we identified suitable prior information from the published literature on variation in psychosis risk by age, sex, ethnicity, deprivation and cannabis use. Third, we combined this empirical data with prior beliefs in six Bayesian Poisson regression models to obtain a full characterisation of the underlying uncertainty in the form of suitable posterior distributions for the relative risks for different permutations of covariate data. Fourth, model coefficients were applied to population projections for 2017 to predict the expected incidence of psychotic disorders, aggregated to Commissioning Group [CCG] and national levels. Fifth, we compared these predictions to observed national FEP data from the NHS Mental Health Services Data Set in 2017 to establish the most valid model. Sixth, we used the best-fitting model to predict three nested indicators of need for psychosis care: (i) total annual referrals to early intervention in psychosis [EIP] for “suspected” FEP (ii) total annual cases accepted onto EIP service caseloads, and (iii) total annual new cases of probable FEP in England up until 2025, using small area population projections. Results A model with an age-sex interaction, ethnicity, small area-level deprivation, social fragmentation and regional cannabis use provided best internal and apparent validity, predicting 8112 (95% Credible Interval 7623 to 8597) individuals with FEP in England in 2017, compared with 8038 observed cases (difference: n=74; 0.94%). Apparent validity was acceptable at CCG level, and by sex and ethnicity, although we observed greater-than-expected need before 35 years old. Predicted new referrals, caseloads and probable incidences of FEP rose over the forecast period by 6.2% to 25,782, 23,187 and 9,541 new cases in 2025, respectively. Discussion Our translational epidemiological tool provides an accurate, validated method to inform planners, commissioners and providers about future population need for psychosis care at different stages of the referral pathway, based on individual and small area level determinants of need. Such tools can be used to underpin evidence-based decision-making in public mental health and resource allocation in mental health systems.

Reconsidering the Moralization of Health: Practices Versus Concepts, and What We Can Learn from Evidence-based Research

2019 ◽  
Vol 28 (02) ◽  
pp. 215-224 ◽  
Author(s):  
S. JOSHUA THOMAS
Keyword(s):  
Evidence Based ◽  
Conceptual Level ◽  
Competing Values ◽  
Free Standing ◽  
Health States ◽  
Concept Of Health ◽  
The Individual ◽  
Individual Healthcare ◽  
Practical Level

Abstract:This article aims to do two things. First, it argues that moralization of health occurs not only at the practical level of individual healthcare choices and health states, but also at the conceptual level of health itself. This is most evident in cases where the concept of health is presumed to possess the property of “overridingness” when compared to competing values and norms, that is, when it is treated as taking precedence over other values and norms it may come into conflict with. Second, the article makes a case for being critically skeptical of specific deployments of the concept of health when it has been moralized in this way. In such cases, what typically results is that some other personal value/norm, or set of values/norms, held by the individual is treated as intrinsically at odds with the concept of health, which is presumed, uncritically, to be superior, often because it is taken to be free-standing and self-justifying. Yet, a growing body of evidence-based research suggests that the role played by dimensions of personal meaningfulness in the quality of individuals’ overall health is quite underappreciated. It is useful to think of these dimensions of personal meaning and significance as representing the individual’s values. Thus, taking these data more seriously ought to lead to a reevaluation of the moralization of health at the conceptual level. In the first place, it is not obvious that if the concept of health runs afoul of other values/norms held by an individual, the latter should automatically yield. In the second place, they suggest that other values/norms held by an individual are not necessarily intrinsically opposed to the concept of health, but in fact may go a good distance in support of it.

The Care Triangle: Determining the Gaps in the Management of Atopic Dermatitis

2013 ◽  
Vol 17 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Ashley O'Toole ◽  
Bjorn Thomas ◽  
Richard Thomas
Keyword(s):  
Atopic Dermatitis ◽  
Response To Treatment ◽  
Care Process ◽  
Evidence Based ◽  
Previous Response ◽  
Children And Young Adults ◽  
The Individual ◽  
Evidence Based Guidelines ◽  
Based Medicine

Background: Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic dermatosis that usually affects infants, children, and young adults. The treatment of AD entails an individualized regimen that depends on the age of the patient, the stage and variety of lesions present, the sites and extent of involvement, the presence of infection, and the previous response to treatment. Objectives: To identify the evidence surrounding potential strategies for closing these gaps—ultimately improving the quality of care, the care process itself, and patient outcomes—and to encourage discussions that help develop tools to bridge the gap between suggested therapy and what is done by the patient. Methods: Review of the literature including searches on PubMed Central and Medline and in seminal dermatology texts. Results: There are several disconnections between the evidence-based guidelines in the management of AD, what the individual dermatologist recommends, and what the patient does. Conclusion: Applying the concept of the care triangle requires a balance of evidence-based medicine, the physician's experiences and the patient's needs and expectations in the decisions surrounding appropriate management of the disease.

Improving quality of cancer care by rapid adoption of new scientific evidence.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 62-62
Author(s):  
Joanne Schottinger ◽  
Violeta Rabrenovich ◽  
David Campen ◽  
Dean Fredriks
Keyword(s):  
Cancer Care ◽  
Scientific Evidence ◽  
Care Program ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Chemotherapy Administration ◽  
Inpatient Settings ◽  
New Evidence

62 Background: The goal of the Kaiser Permanente (KP) Cancer Care Program is to provide patient-centered, evidence-based, safe care for all KP oncology patients. Multiple processes and information technology tools support KP’s clinicians in delivering the best care to our patients. Prior to 2008, chemotherapy ordering and administration across KP was paper-based, and the standardization of chemotherapy regimens was driven by prescribers’ preferences. KP Oncologists used more than 1,400 chemotherapy protocols. Pharmacy had varying systems for dosing alerts, and reliable chemotherapy administration data was not available for clinical quality improvement. Methods: By 2012, all KP regions had implemented the KP HealthConnect Beacon (KPHCB) system, which incorporates chemotherapy ordering, alerting, verifying, dispensing, and administration in ambulatory and inpatient settings. Important outcomes of the KPHCB implementation include: 1) our success in gaining agreements on standardization of chemotherapy protocols across the Program, and 2) implementation of a rapid process for adoption of new scientific evidence. Our approach includes an evaluation of the quality of the relevant scientific literature and an assessment of a particular treatment. The KP multidisciplinary team discusses and integrates the scientific evidence and clinical expertise of KP clinicians into KPHCB chemotherapy protocols. The new evidence-based protocols with supporting literature references are imbedded as a web link at the end of the each protocol and are available to clinicians within days following the publishing of new evidence. Results: An example of a rapid dissemination and adoption of evidence is the 2010 Pfizer’s and FDA’s announcement that the sale of Mylotarg would be voluntarily discontinued due to a fatal liver veno-occlusive disease. Within 48 hours, we identified 12 patients who received Mylotarg in 2010, and the treating oncologists were individually contacted and provided with the new information to discuss with patients, as appropriate. Conclusions: The benefits of KP’s rapid adoption of new evidence methodology are reaching over 40,000 cancer patients, receiving over 250,000 chemotherapy treatments annually.

Quality Assurance in Evidence-Based Medicine

2010 ◽  
pp. 86-99
Author(s):  
Ioannis Apostolakis ◽  
Periklis Valsamos ◽  
Iraklis Varlamis
Keyword(s):  
Quality Assurance ◽  
Evidence Based Medicine ◽  
Medical Information ◽  
Building Blocks ◽  
Careful Examination ◽  
Evidence Based ◽  
The Individual ◽  
Based Medicine ◽  
Critical Overview

Evidence-based medicine (EBM) refers to the careful examination of all the available evidence when making decisions about the care of the individual patient. It assumes that well known medical practices and solutions are combined with the patient’s preferences and necessities in order to provide the most appropriate solution per case. The abundance of medical information in the web, the expansion of Semantic Web and the evolution of search services allowed the easier retrieval of scientific articles. Although the available infrastructure exists and continuously improves in performance, EBM still remains a complicated and sensitive process of high importance and has a need for Quality Assurance (QA). The purpose of this chapter is twofold: first, to provide an introduction on the concepts of Evidence-based Medicine, and second, to stress the necessity for structured methodologies that will assure the quality of the EBM process and ameliorate the final recommendations therapy. Since evidences are the building blocks of EBM, we capitalize on their quality and provide a critical overview of the existing methodologies in Quality Assurance of evidences.

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