scholarly journals Developing services for first-episode psychosis and the critical period

2005 ◽  
Vol 187 (S48) ◽  
pp. s91-s97 ◽  
Author(s):  
Jane Edwards ◽  
Meredith G. Harris ◽  
Swagata Bapat
Keyword(s):  
Evaluation Studies ◽  
Complex Interventions ◽  
Clinical Work ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
Current Evidence ◽  
First Episode ◽  
Episode Psychosis ◽  
Assessment And Treatment ◽  
Recent Evaluation

BackgroundProviding specialised services to individuals experiencing first-episode psychosis (FEP) is a relatively new endeavour.AimsTo overview developing services for newly diagnosed cases of FEP and the context in which they develop.MethodThis paper describes five model multi-element FEP programmes, outlines recent evaluation studies of FEP services, discusses current evidence gaps relating to the evaluation of complex interventions and specific interventions for FEP and illustrates attempts to examine aspects of clinical work practised at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.ResultsConsiderable progress has been made in terms of influencing practice in the assessment and treatment of early psychosis.ConclusionsThere is need for quality clinical and research efforts to inform and accelerate progress in this burgeoning field.

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

2003 ◽  
Vol 37 (4) ◽  
pp. 414-420 ◽  
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.

scholarly journals The Implementation and Review of Cognitive Remediation Training for First Episode Psychosis in Singapore

2021 ◽  
Vol 12 ◽  
Author(s):  
Nigel Ian Ming Chong ◽  
Yogeswary Maniam ◽  
Yi Chian Chua ◽  
Charmaine Tang
Keyword(s):  
Verbal Memory ◽  
Cognitive Abilities ◽  
Statistical Significance ◽  
Real Life ◽  
Cognitive Remediation ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
First Episode ◽  
Educational Approach ◽  
Episode Psychosis

Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed.Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05.Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding.Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.

scholarly journals The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Nicholas J. K. Breitborde ◽  
Emily K. Bell ◽  
David Dawley ◽  
Cindy Woolverton ◽  
Alan Ceaser ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
Clinical Service ◽  
Early Psychosis ◽  
First Episode ◽  
Episode Psychosis

scholarly journals Using Machine Learning and Structural Neuroimaging to Detect First Episode Psychosis: Reconsidering the Evidence

2019 ◽  
Vol 46 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Sandra Vieira ◽  
Qi-yong Gong ◽  
Walter H L Pinaya ◽  
Cristina Scarpazza ◽  
Stefania Tognin ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cortical Thickness ◽  
Gray Matter Volume ◽  
Diagnostic Value ◽  
First Episode Psychosis ◽  
Current Evidence ◽  
First Episode ◽  
Structural Neuroimaging ◽  
Individual Level ◽  
Episode Psychosis

Abstract Despite the high level of interest in the use of machine learning (ML) and neuroimaging to detect psychosis at the individual level, the reliability of the findings is unclear due to potential methodological issues that may have inflated the existing literature. This study aimed to elucidate the extent to which the application of ML to neuroanatomical data allows detection of first episode psychosis (FEP), while putting in place methodological precautions to avoid overoptimistic results. We tested both traditional ML and an emerging approach known as deep learning (DL) using 3 feature sets of interest: (1) surface-based regional volumes and cortical thickness, (2) voxel-based gray matter volume (GMV) and (3) voxel-based cortical thickness (VBCT). To assess the reliability of the findings, we repeated all analyses in 5 independent datasets, totaling 956 participants (514 FEP and 444 within-site matched controls). The performance was assessed via nested cross-validation (CV) and cross-site CV. Accuracies ranged from 50% to 70% for surfaced-based features; from 50% to 63% for GMV; and from 51% to 68% for VBCT. The best accuracies (70%) were achieved when DL was applied to surface-based features; however, these models generalized poorly to other sites. Findings from this study suggest that, when methodological precautions are adopted to avoid overoptimistic results, detection of individuals in the early stages of psychosis is more challenging than originally thought. In light of this, we argue that the current evidence for the diagnostic value of ML and structural neuroimaging should be reconsidered toward a more cautious interpretation.

scholarly journals Disparities in Access to Early Psychosis Intervention Services: Comparison of Service Users and Nonusers in Health Administrative Data

2018 ◽  
Vol 63 (6) ◽  
pp. 395-403 ◽  
Author(s):  
Kelly K. Anderson ◽  
Ross Norman ◽  
Arlene G. MacDougall ◽  
Jordan Edwards ◽  
Lena Palaniyappan ◽  
...  
Keyword(s):  
Administrative Data ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
Primary Data ◽  
First Episode ◽  
Health Administrative Data ◽  
Lower Odds ◽  
Factors Associated ◽  
Episode Psychosis ◽  
Incident Cases

Objective: There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. Methods: Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. Results: Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. Conclusions: We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.

Gender differences in patients with first-episode psychosis in the Singapore Early Psychosis Intervention Programme

2015 ◽  
Vol 10 (6) ◽  
pp. 528-534 ◽  
Author(s):  
Shirlene Pang ◽  
Mythily Subramaniam ◽  
Edimansyah Abdin ◽  
Lye Yin Poon ◽  
Siow Ann Chong ◽  
...  
Keyword(s):  
Gender Differences ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
First Episode ◽  
Intervention Programme ◽  
Episode Psychosis

scholarly journals S102. DIAGNOSTIC CHALLENGES AT TIME OF INPATIENT ADMISSION: DIAGNOSTIC SHIFTS IN PATIENTS WITH FIRST EPISODE PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S73-S73
Author(s):  
Marlene Koch ◽  
Melanie Trimmel ◽  
Josef Baumgartner ◽  
Barbara Hinterbuchinger ◽  
Zsuzsa Litvan ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
Inpatient Unit ◽  
Early Psychosis ◽  
First Episode ◽  
Organic Psychosis ◽  
Affective Psychosis ◽  
Clinical Phenotypes ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
Time Of Admission

Abstract Background First episode psychoses (FEP) may present with diffuse symptoms and a broad range of clinical phenotypes, leading to difficulties in the early detection of the different pluripotent trajectories and consequently to instability of the diagnoses. The aim of this study was to assess the stability of diagnoses at time of admission compared to discharge in patients with FEP at a newly established early psychosis inpatient unit within a general psychiatric service in a general hospital. Methods Charts of all patients admitted to the early psychosis inpatient unit of the Clinical Division of Social Psychiatry of the Medical University of Vienna between 01.01.2016 and 31.03.2017 were reviewed. FEP was defined as a first presentation of affective, schizophreniform, acute polymorphic, organic or substance-related psychosis according to ICD-10. Results 127 patients were admitted during the said period, among whom 92 (72,4%) were diagnosed with a psychotic disorder at time of admission. 39,1% (n=36) of those had a FEP, whereof 58,3% (n=21) were diagnosed with schizophrenia spectrum psychosis, 27,8% (n=10) with affective psychosis, 11,1% (n=4) with substance-related psychosis and 2,8% (n=1) with organic psychosis as main diagnosis at time of discharge. In 50% (n=18) of FEP patients, diagnosis at time of admission was not maintained. 54,2% (n=13) of FEP patients who were admitted with a schizophrenia spectrum diagnosis had a shift in diagnosis at time of discharge, whereof 46,2% (n=6) were adjusted to another diagnosis of the same spectrum and 53,8% (n=7) to a diagnosis of either affective spectrum, substance-related psychosis or organic psychosis. 100% (n=2) of those with a persistent delusional disorder had a different diagnosis at discharge, as well as 56,3% (n=9=) of those admitted with a diagnosis of acute and transient psychotic disorders. Changes in the admission diagnoses of affective psychosis were necessary in 44,4% (n=4), whereof one half was adjusted to another diagnosis of the same spectrum and the other half to a diagnosis of the schizophrenia spectrum. Discussion The diagnostic instability in this study underlines the concept of the highly dynamic and changeable nature of psychopathology in the early stages and the pluripotent trajectories of psychosis. Furthermore, inadequate information available for specific diagnosis at time of admission as well as diagnostic uncertainty at the onset of psychosis could be implicated in the described diagnostic instability. The broad range of clinical phenotypes of early psychosis and the limitations of current diagnostic risk and identification approaches for the assessment of first episode psychosis indicate psychopathology conformed to a more dimensional rather than categorical model, as well as the need of a more dynamic model of prediction, such as the clinical staging model.

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