Peer‐driven family support services in the context of first‐episode psychosis: Participant perceptions from a Canadian early intervention programme

BackgroundNumerous early intervention services targeting young people with psychosis have been established, based on the premise that reducing treatment delay and providing intensive treatment in the initial phase of psychosis can improve long-term outcome.AimsTo establish the effect of extending a specialised early intervention treatment for first-episode psychosis by 1 year.MethodA randomised, single-blind controlled trial (NCT01202357) compared a 1-year extension of specialised early intervention with step-down care in patients who had all received a 2-year intensive early intervention programme for first-episode psychosis.ResultsPatients receiving an additional year of specialised intervention had better outcomes in functioning, negative and depressive symptoms and treatment default rate than those managed by step-down psychiatric care.ConclusionsExtending the period of specialised early intervention is clinically desirable but may not be feasible in lower-income countries.

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Sustainability of treatment effect of a 3-year early intervention programme for first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.117.198929 ◽

2017 ◽

Vol 211 (1) ◽

pp. 37-44 ◽

Cited By ~ 17

Author(s):

Wing Chung Chang ◽

Vivian Wing Yan Kwong ◽

Emily Sin Kei Lau ◽

Hon Cheong So ◽

Corine Sau Man Wong ◽

...

Keyword(s):

Early Intervention ◽

Service Use ◽

Controlled Trial ◽

First Episode Psychosis ◽

First Episode ◽

Intervention Programme ◽

Positive Effects ◽

Therapeutic Benefits ◽

Episode Psychosis ◽

Post Trial

BackgroundEvidence indicates that the positive effects of 2-year early intervention services for psychosis are not maintained after service withdrawal. Optimal duration of early intervention in sustaining initial improved outcomes remains to be determined.AimsTo examine the sustainability of the positive effects of an extended, 3-year, early intervention programme for patients with first-episode psychosis (FEP) after transition to standard care.MethodA total of 160 patients, who had received a 2-year early intervention programme for FEP, were enrolled to a 12-month randomised-controlled trial (ClinicalTrials.gov: NCT01202357) comparing a 1-year extension of the early intervention (3-year specialised treatment) with step-down care (2-year specialised treatment). Participants were followed up and reassessed 2 and 3 years after inclusion to the trial.ResultsThere were no significant differences between the treatment groups in outcomes on functioning, symptom severity and service use during the post-trial follow-up period.ConclusionsThe therapeutic benefits achieved by the extended, 3-year early intervention were not sustainable after termination of the specialised service.

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Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India

The British Journal of Psychiatry ◽

10.1192/bjp.2020.126 ◽

2020 ◽

Vol 217 (3) ◽

pp. 514-520 ◽

Cited By ~ 1

Author(s):

Ashok Malla ◽

Srividya N. Iyer ◽

Thara Rangaswamy ◽

Padmavati Ramachandran ◽

Greeshma Mohan ◽

...

Keyword(s):

Early Intervention ◽

Family Support ◽

Clinical Outcomes ◽

Negative Symptom ◽

Negative Symptoms ◽

First Episode Psychosis ◽

First Episode ◽

Early Intervention Services ◽

Episode Psychosis ◽

Intervention Services

BackgroundPurported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS).AimsTo compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences.MethodPatients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted.ResultsFour patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = −7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes.ConclusionsPatients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.

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Cost-effectiveness of treating first-episode psychosis: five-year follow-up results from an Italian early intervention programme

Early Intervention in Psychiatry ◽

10.1111/j.1751-7893.2011.00261.x ◽

2011 ◽

Vol 5 (3) ◽

pp. 203-211 ◽

Cited By ~ 30

Author(s):

Cocchi Angelo ◽

Mapelli Vittorio ◽

Meneghelli Anna ◽

Preti Antonio

Keyword(s):

Early Intervention ◽

Cost Effectiveness ◽

First Episode Psychosis ◽

First Episode ◽

Intervention Programme ◽

Episode Psychosis

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Becoming Family Centered: Child Welfare's Challenge

Families in Society The Journal of Contemporary Social Services ◽

10.1177/104438949507600304 ◽

1995 ◽

Vol 76 (3) ◽

pp. 163-172 ◽

Cited By ~ 15

Author(s):

Elizabeth S. Cole

Keyword(s):

Early Intervention ◽

Child Welfare ◽

Family Support ◽

Support Services ◽

Family Preservation ◽

Family Preservation Services ◽

Child Welfare Agencies ◽

Welfare Agencies ◽

Family Centered ◽

Family Support Services

The author discusses current challenges to increasing family-centered practice within child welfare agencies. The article focuses on two issues: (1) child welfare's collaboration with early-intervention and family-support services and (2) maintaining family-preservation services despite growing criticism of such services.

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Views of Young People in Early Intervention Services for First-Episode Psychosis in England

Psychiatric Services ◽

10.1176/ps.62.8.pss6208_0882 ◽

2011 ◽

Vol 62 (8) ◽

pp. 882-887 ◽

Cited By ~ 41

Author(s):

Helen Lester ◽

Max Marshall ◽

Peter Jones ◽

David Fowler ◽

Tim Amos ◽

...

Keyword(s):

Early Intervention ◽

Young People ◽

First Episode Psychosis ◽

First Episode ◽

Early Intervention Services ◽

Episode Psychosis ◽

Intervention Services

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Suicide Prevention in First Episode Psychosis: The Development of a Randomised Controlled Trial of Cognitive Therapy for Acutely Suicidal Patients With Early Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2003.01209.x ◽

2003 ◽

Vol 37 (4) ◽

pp. 414-420 ◽

Cited By ~ 94

Author(s):

P.J.R. Power ◽

R.J. Bell ◽

R. Mills ◽

T. Herrman-Doig ◽

M. Davern ◽

...

Keyword(s):

Early Intervention ◽

Treatment Group ◽

Young People ◽

Controlled Trial ◽

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Randomised Controlled ◽

Suicidal Patients

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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