Early Intervention for Psychosis: The Calgary Early Psychosis Treatment and Prevention Program

Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.

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Prediction of self-stigma in early psychosis: 3-Year follow-up of the randomized-controlled trial on extended early intervention

Schizophrenia Research ◽

10.1016/j.schres.2017.09.004 ◽

2018 ◽

Vol 195 ◽

pp. 463-468 ◽

Cited By ~ 11

Author(s):

Ryan Wui Hang Ho ◽

Wing Chung Chang ◽

Vivian Wing Yan Kwong ◽

Emily Sin Kei Lau ◽

Gloria Hoi Kei Chan ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Early Intervention ◽

Controlled Trial ◽

Early Psychosis ◽

Randomized Controlled

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Loneliness in early psychosis: A qualitative study exploring the views of mental health practitioners in early intervention services

10.21203/rs.3.rs-45913/v1 ◽

2020 ◽

Author(s):

Theodora Stefanidou ◽

Jingyi Wang ◽

Nicola Morant ◽

Brynmor Lloyd-Evans ◽

Sonia Johnson

Keyword(s):

Mental Health ◽

Early Intervention ◽

Public Health Problem ◽

Early Psychosis ◽

Mental Health Practitioners ◽

First Episode ◽

Physical And Mental Health ◽

Early Intervention Services ◽

Health Practitioners ◽

Intervention Services

Abstract Background: Loneliness is an important public health problem with established adverse effects on physical and mental health. Although, people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions.Methods: Semi-structured face-to-face interviews were conducted with mental health practitioners (n=20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted.Results: Participants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development. Conclusions: This study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions.

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Impulsivity in early psychosis: A complex link with violent behaviour and a target for intervention

European Psychiatry ◽

10.1016/j.eurpsy.2017.12.003 ◽

2018 ◽

Vol 49 ◽

pp. 30-36 ◽

Cited By ~ 11

Author(s):

V. Moulin ◽

P. Golay ◽

J. Palix ◽

P.S. Baumann ◽

M-M. Gholamrezaeec ◽

...

Keyword(s):

Substance Abuse ◽

Early Intervention ◽

Psychotic Disorders ◽

Interaction Analysis ◽

Early Psychosis ◽

First Episode ◽

Positive Symptoms ◽

Violent Behaviour ◽

Increased Risk ◽

Early Intervention In Psychosis

AbstractBackgroundViolent behaviour (VB) occurs in first episode of schizophrenia and can have devastating impact both on victims and patients themselves. A better knowledge of the underlying mechanisms of VB may pave the way to preventive treatments.Objectives1) To explore the nature of the link between impulsivity and VB in early psychosis (EP) patients; 2) To explore the interactions between impulsivity and substance abuse, insight, and positive symptoms, the main dynamic risk factors of VB described to date.Design and methodsPost hoc analysis of data acquired in the frame of a 36-months EP cohort study. A total of 265 EP patients, aged 18 to 35, treated at TIPP (Treatment and early Intervention in Psychosis Program), at the Department of Psychiatry in Lausanne, Switzerland, were included in the study. Logistic regression analyzes were performed as well as mediation analysis and interaction analysisResultsOur data suggest that impulsivity is a predictor of VB when analyzed independently and as part of a multi-factorial model. Impulsivity continues to differentiate violent patients from non-violent ones at the end of the program. In addition, the relationship between impulsivity and VB is not mediated by substance abuse. Finally, the effect of impulsivity on the probability of VB is potentiated by the interaction of different levels of insight and positive symptoms.ConclusionsEarly intervention strategies in psychotic disorders should include evaluation of impulsivity considering it is linked to increased risk of VB and may respond to treatment.

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Toward Effective Early Intervention and Prevention Strategies for Major Affective Disorders: A Review of Antecedents and Risk Factors

The Canadian Journal of Psychiatry ◽

10.1177/070674370004500402 ◽

2000 ◽

Vol 45 (4) ◽

pp. 340-348 ◽

Cited By ~ 20

Author(s):

Anne Duffy

Keyword(s):

Risk Factors ◽

Early Intervention ◽

Family History ◽

Mood Disorder ◽

Mood Disorders ◽

Relevant Literature ◽

Positive Family History ◽

Prevention Strategies ◽

Sociological Factors ◽

Treatment And Prevention

Objective: To review critically the literature pertaining to riskfactors and antecedent symptoms and syndromes in order to determine an empirically based strategy for early treatment and prevention of major mood episodes. Method: The relevant literature is summarized, with particular emphasis on early-onset (child and adolescent) mood disorders. Results: A complex interaction between biological, psychological, and sociological factors contributes to the development of a major mood disorder. Having a positive family history of mood disorder (bipolar and unipolar) and being female (unipolar) are the strongest, most reliable risk factors. There is continuity between adolescent and adult mood disorders, and subsyndromal mood disturbance in adolescents has clinical and public health significance. However, more longitudinal study is required to reliably map the course and predictive importance of mood disorders in very young children. Conclusions: Substantial evidence supports the effectiveness of early intervention and prevention efforts in children at risk for mood disorders (identified as having affected family members) and in adolescents manifesting significant mood symptoms and syndromes (especially if associated with a positive family history). However, the current level of understanding regarding the etiological significance and mechanism of risk factors associated with mood disorders does not support broad community-based primary prevention strategies in unselected populations.

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T33. EARLY INTERVENTION FOR EARLY PSYCHOSIS IN FRANCE, MAPPING OF PROGRAMS

Schizophrenia Bulletin ◽

10.1093/schbul/sby016.309 ◽

2018 ◽

Vol 44 (suppl_1) ◽

pp. S125-S126 ◽

Cited By ~ 1

Author(s):

Sophie Meunier-Cussac ◽

Guy Gozlan ◽

Laurent Lecardeur ◽

Anne Duburcq ◽

Laurène Courouve

Keyword(s):

Early Intervention ◽

Early Psychosis

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Facilitating treatment engagement for early psychosis through peer-delivered decision support: intervention development and protocol for pilot evaluation

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00927-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Elizabeth C. Thomas ◽

John Suarez ◽

Alicia Lucksted ◽

Laura A. Siminoff ◽

Irene Hurford ◽

...

Keyword(s):

Decision Making ◽

Decision Support ◽

Early Intervention ◽

Emerging Adults ◽

Pilot Trial ◽

Intervention Development ◽

Early Psychosis ◽

Coaching Intervention ◽

Service Engagement ◽

The Impact

Abstract Background Emerging adults with early psychosis demonstrate high rates of service disengagement from critical early intervention services. Decision support interventions and peer support have both been shown to enhance service engagement but are understudied in this population. The purposes of this article are to describe the development of a novel peer-delivered decision coaching intervention for this population and to report plans for a pilot study designed to gather preliminary data about its feasibility, acceptability, and potential impact. Methods The intervention was developed based on formative qualitative data and in collaboration with a diverse team of researchers, key stakeholders, and expert consultants. The pilot trial will utilize a single-group (N = 20), pre-post, convergent mixed-methods design to explore whether and how the intervention addresses decision-making needs (the primary intervention target). The impact of the intervention on secondary outcomes (e.g., engagement in the program) will also be assessed. Additionally, through observation and feedback from the peer decision coach and study participants, we will evaluate the feasibility of research and intervention procedures, and the acceptability of information and support from the peer decision coach. Discussion The peer-delivered decision coaching intervention holds promise for assisting young people with making informed and values-consistent decisions about their care, and potentially enhancing service engagement within this traditionally difficult-to-engage population. If the intervention demonstrates feasibility and acceptability, and pilot data show its potential for improving treatment decision-making, our work will also lay the foundation for a new evidence base regarding roles for peer specialists on early intervention teams. Trial registration This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034) on 28 August 2020 as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis.

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