Faculty Opinions recommendation of Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review.

2019 ◽  
Author(s):  
Vijay Mittal
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
At Risk ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Episode Psychosis ◽  
Related Stigma ◽  
Health Related

scholarly journals Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review

2017 ◽  
Vol 47 (11) ◽  
pp. 1867-1879 ◽  
Author(s):  
P. C. Gronholm ◽  
G. Thornicroft ◽  
K. R. Laurens ◽  
S. Evans-Lacko
Keyword(s):  
At Risk ◽  
Help Seeking ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Current Evidence ◽  
Pathways To Care ◽  
First Episode ◽  
Early Stages ◽  
Episode Psychosis ◽  
Service Contact

BackgroundStigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined.MethodThis review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results.ResultsThe meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: ‘sense of difference’, ‘characterizing difference negatively’, ‘negative reactions (anticipated and experienced)’, ‘strategies’, ‘lack of knowledge and understanding’, and ‘service-related factors’. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups.ConclusionsOur findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.

Improving outcomes: Factors influencing help-seeking behaviors in immigrants and ethnic minorities with first-episode psychosis

2016 ◽  
Vol 13 (03) ◽  
pp. 152-157
Author(s):  
A. O. Berg ◽  
K. Leopold ◽  
S. Zarafonitis-Müller ◽  
M. Nerhus ◽  
L. H. Stouten ◽  
...  
Keyword(s):  
Mental Health ◽  
Help Seeking ◽  
Service Use ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Factors Influencing ◽  
Increased Risk ◽  
Episode Psychosis ◽  
The Hague

Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.

scholarly journals Circulating lipids associate with future weight gain in individuals with an at-risk mental state and in first-episode psychosis

2020 ◽  
Author(s):  
Santosh Lamichhane ◽  
Alex M. Dickens ◽  
Partho Sen ◽  
Heikki Laurikainen ◽  
Jaana Suvisaari ◽  
...  
Keyword(s):  
At Risk ◽  
Weight Gain ◽  
High Risk ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Molecular Signature ◽  
First Episode ◽  
Baseline Serum ◽  
Average Life Span ◽  
Episode Psychosis

AbstractPatients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic co-morbidities. Identification of individuals with psychotic disorders with a high risk of rapid weight gain, and the associated development of metabolic complications, is an unmet need as regards public health. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 controls (CTR), 44 first-episode psychosis (FEP) patients and 22 individuals at clinical-high-risk (CHR) for psychosis, from two study centers (Turku/Finland and London/UK). Baseline serum samples were analyzed by lipidomics, while body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols with low double bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of two triacylglycerols (TG(48:0) and TG(45:0)), was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60–0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61–0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals, and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic co-morbidities.

The pathways to mental health care of first-episode psychosis patients: a systematic review

2010 ◽  
Vol 40 (10) ◽  
pp. 1585-1597 ◽  
Author(s):  
K. K. Anderson ◽  
R. Fuhrer ◽  
A. K. Malla
Keyword(s):  
Mental Health ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Psychotic Episode ◽  
First Psychotic Episode ◽  
Episode Psychosis ◽  
First Contact ◽  
Pathway To Care ◽  
Delay In Treatment

BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

scholarly journals Association Between Circulating Lipids and Future Weight Gain in Individuals With an At-Risk Mental State and in First-Episode Psychosis

2020 ◽  
Author(s):  
Santosh Lamichhane ◽  
Alex M Dickens ◽  
Partho Sen ◽  
Heikki Laurikainen ◽  
Faith Borgan ◽  
...  
Keyword(s):  
At Risk ◽  
Weight Gain ◽  
High Risk ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Molecular Signature ◽  
First Episode ◽  
Baseline Serum ◽  
Average Life Span ◽  
Episode Psychosis

Abstract Patients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic comorbidities. There is an unmet public health need to identify individuals with psychotic disorders who have a high risk of rapid weight gain and who are at risk of developing metabolic complications. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 healthy controls (CTR), 44 first-episode psychosis (FEP) patients, and 22 individuals at clinical high risk (CHR) for psychosis, from 2 study centers (Turku, Finland and London, UK). Baseline serum samples were analyzed using lipidomics, and body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols (TGs) with low double-bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of 2 TGs (TG[48:0] and TG[45:0]) was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60–0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61–0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic comorbidities.

scholarly journals First-episode psychosis: factors associated with delayed access to care in a rural Egyptian setting

2008 ◽  
Vol 5 (4) ◽  
pp. 95-97 ◽  
Author(s):  
Mamdouh El-Adl ◽  
Mohammed El-Mahdy ◽  
Musheera Anis
Keyword(s):  
Help Seeking ◽  
Psychotic Disorders ◽  
Clinical Care ◽  
Cost Effective ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Early Results ◽  
Episode Psychosis ◽  
Early Intervention In Psychosis

Over the past few decades there has been a growing interest in first-episode psychosis (FEP), help-seeking behaviour and pathways to care. Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care (Yung & McGorry, 2007). FEP studies show that the average time between onset of symptoms and first effective treatment is often 1 year or more (McGlashan, 1987). This long duration of untreated psychosis (DUP) is undesirable. Early treatment helps minimise the risk of the serious consequences of untreated psychosis, in terms of changes in mental state and behaviour (Larsen et al, 1998; Wyatt et al, 1998) and can reduce suffering (Ho et al, 2003). Some early results suggested that an ‘early intervention in psychosis’ (EIP) service is more cost-effective than generic services (Mihalopoulos et al, 1999).

Platform for systems medicine research and diagnostic applications in psychotic disorders—The METSY project

2018 ◽  
Vol 50 ◽  
pp. 40-46 ◽  
Author(s):  
Elisabeth Frank ◽  
Dieter Maier ◽  
Juha Pajula ◽  
Tommi Suvitaival ◽  
Faith Borgan ◽  
...  
Keyword(s):  
At Risk ◽  
Lipid Metabolism ◽  
Psychotic Disorders ◽  
Clinical Decision Making ◽  
Endocannabinoid System ◽  
First Episode Psychosis ◽  
First Episode ◽  
Glucose And Lipid Metabolism ◽  
Episode Psychosis ◽  
Patients At Risk

AbstractPsychotic disorders are associated with metabolic abnormalities including alterations in glucose and lipid metabolism. A major challenge in the treatment of psychosis is to identify patients with vulnerable metabolic profiles who may be at risk of developing cardiometabolic co-morbidities. It is established that both central and peripheral metabolic organs use lipids to control energy balance and regulate peripheral insulin sensitivity. The endocannabinoid system, implicated in the regulation of glucose and lipid metabolism, has been shown to be dysregulated in psychosis. It is currently unclear how these endocannabinoid abnormalities relate to metabolic changes in psychosis. Here we review recent research in the field of metabolic co-morbidities in psychotic disorders as well as the methods to study them and potential links to the endocannabinoid system. We also describe the bioinformatics platforms developed in the EU project METSY for the investigations of the biological etiology in patients at risk of psychosis and in first episode psychosis patients. The METSY project was established with the aim to identify and evaluate multi-modal peripheral and neuroimaging markers that may be able to predict the onset and prognosis of psychiatric and metabolic symptoms in patients at risk of developing psychosis and first episode psychosis patients. Given the intrinsic complexity and widespread role of lipid metabolism, a systems biology approach which combines molecular, structural and functional neuroimaging methods with detailed metabolic characterisation and multi-variate network analysis is essential in order to identify how lipid dysregulation may contribute to psychotic disorders. A decision support system, integrating clinical, neuropsychological and neuroimaging data, was also developed in order to aid clinical decision making in psychosis. Knowledge of common and specific mechanisms may aid the etiopathogenic understanding of psychotic and metabolic disorders, facilitate early disease detection, aid treatment selection and elucidate new targets for pharmacological treatments.

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