scholarly journals Psychosocial Intervention With or Without Antipsychotic Medication for First-Episode Psychosis: A Randomized Noninferiority Clinical Trial

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Shona M Francey ◽  
Brian O’Donoghue ◽  
Barnaby Nelson ◽  
Jessica Graham ◽  
Lara Baldwin ◽  
...  
Keyword(s):  
Early Intervention ◽  
Antipsychotic Medication ◽  
Psychosocial Intervention ◽  
First Episode Psychosis ◽  
Functional Improvement ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Free Treatment ◽  
Intervention Service ◽  
Episode Psychosis

Abstract This triple-blind (participants, clinicians, and researchers) randomized controlled noninferiority trial examined whether intensive psychosocial intervention (cognitive-behavioral case management, CBCM) for first-episode psychosis (FEP) in 15–25 year-olds managed in a specialized early intervention for psychosis service was noninferior to usual treatment of antipsychotic medication plus CBCM delivered during the first 6 months of treatment. To maximize safety, participants were required to have low levels of suicidality and aggression, a duration of untreated psychosis (DUP) of less than 6 months, and be living in stable accommodation with social support. The primary outcome was level of functioning as assessed by the Social and Occupational Functioning Scale (SOFAS) at 6 months. Ninety young people were randomized by computer, 46 to placebo, and 44 antipsychotic medication and 33% of those who commenced trial medication completed the entire 6-month trial period. On the SOFAS, both groups improved, and group differences were small and clinically trivial, indicating that treatment with placebo medication was no less effective than conventional antipsychotic treatment (mean difference = −0.2, 2-sided 95% confidence interval = −7.5 to 7.0, t = 0.060, P = .95). Within the context of a specialized early intervention service, and with a short DUP, the immediate introduction of antipsychotic medication may not be required for all cases of FEP in order to see functional improvement. However, this finding can only be generalized to a very small proportion of FEP cases at this stage, and a larger trial is required to clarify whether antipsychotic-free treatment can be recommended for specific subgroups of those with FEP. Trial Registration: ACTRN12607000608460 (www.anzctr.org.au).

Cognitive remediation combined with an early intervention service in first episode psychosis

2014 ◽  
Vol 130 (4) ◽  
pp. 300-310 ◽  
Author(s):  
T. Østergaard Christensen ◽  
L. Vesterager ◽  
G. Krarup ◽  
B. B. Olsen ◽  
M. Melau ◽  
...  
Keyword(s):  
Early Intervention ◽  
Cognitive Remediation ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Service ◽  
Intervention Service ◽  
Episode Psychosis

Structural Neuroimaging in First-Episode Psychosis: a review of neuroimaging practice in an early intervention service

2011 ◽  
Vol 26 (S2) ◽  
pp. 947-947
Author(s):  
S. Otero ◽  
R. Mehrotra
Keyword(s):  
Early Intervention ◽  
Statistical Significance ◽  
First Episode Psychosis ◽  
First Episode ◽  
Analysis Tool ◽  
Early Intervention Service ◽  
Structural Neuroimaging ◽  
Intervention Service ◽  
Episode Psychosis ◽  
Significant Difference

IntroductionThe UK NICE technology guidance “Structural Neuroimaging in First-Episode Psychosis” concludes that CT/MRI is not routinely recommended as an initial investigation for first-episode psychosis.ObjectivesTo evaluate the use of CT/MRI in a group of Early Intervention Service (EIS) patients with a first-episode psychosis aged 18–35 years at presentation.AimsTo develop practice guidelines for use of neuroimaging in first-episode psychosis.MethodsAll 107 patients registered with the EIS in Hounslow, London, UK, were eligible for inclusion in this review. Data was collected from the medical records and the Picture Archiving and Communications System. Data was analysed using a microsoft excel data analysis tool. Additionally, comparisons were made between the group of patients with normal scans and that with abnormal scans. Statistical significance was determined using the chi-squared method with a significance of P < 0.05.Results17 patients had documented neuroimaging results. 4 scans were abnormal. There was no significant difference between the group with normal and abnormal scans in terms of gender, abnormalities of physical/neurological health, blood tests and whether the patient had any additional medical conditions. Abnormal scan results did not influence treatment or outcome for any patient.ConclusionsThe abnormal scans were not correlated to clinical indices of history, examination and laboratory tests. Abnormal scans appear to have a low yield in terms of clinical effectiveness. The findings support selective use of neuroimaging in this cohort of patients. The indications for it usage would appear to rely on clinical judgement as well clinical findings.

scholarly journals COVID and early intervention: the impact of COVID-19 on referrals to an early intervention service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S112-S112
Author(s):  
Adam Whyte ◽  
Alastair Reid
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Mental Health Services ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Intervention Service ◽  
Number Of Patients ◽  
Episode Psychosis ◽  
The Impact

AimsCOVID-19 has a demonstratable impact on the population's mental health and is associated with an increased incidence of psychiatric disorders, including patients experiencing psychotic presentations. The aim of this study was to explore whether referral rates within a county-wide Early Intervention (EI) service changed in response to the COVID-19 pandemic. The EI service provides NICE approved treatments and support for patients experiencing a First Episode Psychosis (FEP).MethodData were collected from all referrals to the EI service between March–December 2019 and March–December 2020. Clinical notes were reviewed to ascertain whether the referred patient was assessed and if they were subsequently accepted on to the team's caseload.ResultDuring the March–December 2019 period 147 referrals were made to the EI service, with 66 patients being accepted for treatment by the service (44.9% of referrals). In March–December 2020, 127 referrals were made, a 13.6% reduction compared to the same period in 2019, however 70 referrals were accepted (55.1% of referrals).Whilst the overall referrals declined during the COVID-19 period, there were notable increases in both April and August 2020, by 25.0% and 70.0% respectively.ConclusionAlthough overall referrals to the EI service reduced during the COVID-19 pandemic compared similarly to the previous year, there was a noteworthy increase in the proportion of patients accepted onto the team's caseload.Potential explanations for this finding include the possibility of an increased incidence of first episode psychosis during this period, or that restrictions in accessing primary care and secondary mental health services during the COVID-19 pandemic reduced the number of patients being referred whose symptoms were not representative of First Episode Psychosis (FEP).This study highlights that mental health services, such as EI teams, have experienced a persistent level of need over the past year and that ongoing investment in psychiatric services is warranted to meet this sustained requirement for support and interventions.

scholarly journals Understanding Pathways to Care of Individuals Entering a Specialized Early Intervention Service for First-Episode Psychosis

2018 ◽  
Vol 69 (6) ◽  
pp. 648-656 ◽  
Author(s):  
Leopoldo J. Cabassa ◽  
Sarah Piscitelli ◽  
Morgan Haselden ◽  
Rufina J. Lee ◽  
Susan M. Essock ◽  
...  
Keyword(s):  
Early Intervention ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Early Intervention Service ◽  
Intervention Service ◽  
Episode Psychosis

scholarly journals What are the benefits of evidence-based supported employment for patients with first-episode psychosis?

2004 ◽  
Vol 28 (8) ◽  
pp. 281-284 ◽  
Author(s):  
Miles Rinaldi ◽  
Karen Mcneil ◽  
Mike Firn ◽  
Marsha Koletsi ◽  
Rachel Perkins ◽  
...  
Keyword(s):  
Early Intervention ◽  
Supported Employment ◽  
First Episode Psychosis ◽  
Educational Activity ◽  
First Episode ◽  
Evidence Based ◽  
Early Intervention Service ◽  
Model Fidelity ◽  
Intervention Service ◽  
Episode Psychosis

Aims and MethodTo examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.ResultsFollowing vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying ‘good implementation’.Clinical ImplicationsThe results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service.

scholarly journals T154. WHITE MATTER INTEGRITY, DURATION OF UNTREATED PSYCHOSIS, AND ANTIPSYCHOTIC TREATMENT RESPONSE IN MEDICATION-NAïVE FIRST EPISODE PSYCHOSIS PATIENTS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S289-S289
Author(s):  
Nina Kraguljac ◽  
Anthony Thomas ◽  
Charity Morgan ◽  
Ripu Jindal ◽  
Adrienne Lahti
Keyword(s):  
Early Intervention ◽  
White Matter ◽  
Treatment Response ◽  
First Episode Psychosis ◽  
White Matter Integrity ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Duration Of Untreated Psychosis ◽  
Phase Encoding ◽  
Episode Psychosis

Abstract Background It is becoming increasingly clear that longer duration of untreated psychosis (DUP) is associated with adverse clinical outcomes in patients with psychosis spectrum disorders. Especially because this association is often cited when justifying early intervention efforts, it is imperative to better understand underlying biological mechanisms. Methods We recruited 74 antipsychotic-naïve first episode psychosis (FEP) patients and 45 matched healthy controls in this trial. At baseline, we used a human connectome style diffusion weighted imaging (DWI) sequence to quantify white matter integrity in both groups. Patients then received 16 weeks of treatment with risperidone. DWI scans were acquired with opposite phase encoding directions [TR/TE: 3230ms/ 89.20ms; multiband acceleration factor 4, Flip angle: 84°; slice thickness 1.5mm, 92 slices, voxel size 1.5mm3, 92 diffusion weighted images distributed equally over 2 shells with b-values of ̴ 1500s/mm2 and ̴ 3000s/mm2, as well as 7 interspersed b= ̴ 0s/mm2 images]). Preprocessing of DWI images was performed in TORTOISE (version 3.1.2). This included correction for thermal noise, Gibbs-ringing, high b-value based bulk motion and eddy-current distortions using a MAP-MRI model, resampling of images to 1mm3, and rotation of gradient tables independently for each DWI phase encoding direction. Then, DR-BUDDI was used to correct EPI distortions with input from the anatomical image and to combine the two datasets using geometric averaging to generate the final corrected dataset. Tensors were computed with DIFF_CALC using a linear fitting algorithm. To spatially normalize images to the Illinois Institute of Technology atlas (IIT4) space, we implemented an optimized non-linear image registration procedure using a modified version of 3dQwarp in AFNI. We compared whole brain fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD) and radial diffusivity between groups. To test if structural white matter integrity mediates the relationship between longer DUP and poorer treatment response, we fit a mediator model and estimated indirect effects. Results Groups did not differ in age (FEP: 23.83+/-6.21 years; HC: 24.78+/-6.24 years), sex (FEP: 65.2% male; HC: 64.4% male), or parental socioeconomic status (FEP: 5.95+/-4.83; HC: 4.22+/-4.06). We found decreased whole brain FA and AD in medication-naive FEP compared to controls. In patients, lower FA was correlated with longer DUP (r= -0.32; p= 0.03) and poorer subsequent response to antipsychotic treatment (r= 0.40; p= 0.01). Importantly, we found a significant mediation effect for FA (indirect effect: -2.70; p= 0.03), indicating that DUP exerts its effects on treatment response through affecting white matter integrity. Discussion To our knowledge, this is the first study to examine a putative role of white matter integrity in the observed association between DUP and clinical outcomes in first episode psychosis. Our data provide empirical support to the idea the DUP may have fundamental pathogenic effects on the natural history of psychosis, suggest a biological mechanism underlying this phenomenon, and underscore the importance of early intervention efforts in this disabling neuropsychiatric syndrome.

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