The clinical and functional outcomes of a large naturalistic cohort of young people accessing national early psychosis services

Aims: Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported. Methods: We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as headspace between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time. Results: Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment. Conclusion: These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.

The Relationship Between Plasma Oxytocin and Executive Functioning in Huntington’s Disease: A Pilot Study

The role of oxytocin (OT) in social cognition of patients with Huntington’s disease (HD) has been studied, but its impact on executive functioning has not been explored yet. Healthy controls, premanifest HD, and manifest HD participants underwent executive functioning assessment and OT plasma measurement. There were no significant group differences in plasma OT levels. Higher OT levels were associated with better executive functioning in premanifest HD participants. Our findings revealed an association between OT levels and depressive symptoms in premanifest and manifest HD participants. The potential role of OT in HD deserves further investigation.

Family Functioning Assessment Instruments in Adults with a Non-Psychiatric Chronic Disease: A Systematic Review

There is little information on the evaluation of family functioning in adult patients with chronic non-psychiatric illness. The objective of this systematic review was to identify family functioning assessment instruments of known validity and reliability that have been used in health research on patients with a chronic non-psychiatric illness. We conducted a search in three biomedical databases (PubMed, Science Direct, and Web of Science), for original articles available in English or Spanish published between 2000 and 2019. The review was conducted in accordance with PRISMA guidelines. Fourteen articles were included in the review. The instruments Family Assessment Device, Family Adaptability and Cohesion Evaluation Scales, Family Functioning Health and Social Support, Family APGAR, Assessment of Strategies in Families-Effectiveness, Iceland Expressive Family Functioning, Brief Family Assessment Measure-III, and Family Relationship Index were identified. All of them are reliable instruments to evaluate family functioning in chronic patients and could be very valuable to help nurses identify families in need of a psychosocial intervention. The availability and clinical application of these instruments will allow nurses to generate knowledge on family health and care for non-psychiatric chronic conditions, and will eventually contribute to the health and wellbeing of adults with a non-psychiatric chronic disease and their families.

MO1053FACTORS INFLUENCING DROPOUT FROM PHYSICAL FUNCTION ASSESSMENT PROGRAMS AMONG PATIENTS RECEIVING MAINTENANCE HEMODIALYSIS

Background and Aims Continuing participation in physical function assessment programs is a critical component of treatment for patients undergoing hemodialysis (HD). Maintaining physical function through participation in a physical function assessment program is important to prevent adverse events in the clinical field of nephrology. Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care for patients receiving hemodialysis (HD). However, the factors related to patients’ continuation of a physical function assessment program while undergoing HD remain unknown. We aimed to investigate the predictors associated with dropout from a physical function assessment program among patients receiving outpatient HD. Method In 2016, Seirei Sakura Citizen Hospital initiated a physical function assessment program for patients receiving outpatient HD. This retrospective cohort study included 230 patients receiving HD who participated in the first physical function assessment program in 2016. Following the initial visit, all patients were invited to complete a physical function assessment once a year. We assessed self-efficacy (SE), short physical performance battery (SPPB), exercise habits, and hand grip and provided patients with appropriate feedback. These measures were performed before the hemodialysis session. Laboratory Data and dialysis status were also collected. Participants were tracked for three years after their first physical function assessment to determine their attendance rate. Patients were provided with four opportunities for participation, including the initial assessment. The program's participation rate was defined as the number of program sessions in which the patient actually participated and the percentage (%) of the four physical functioning assessment visits attended. Patients were then divided into a continuation group (> 50% participation, including the initial assessment) and a dropout group (≤ 50% participation, including the initial assessment). Multivariate logistic regression analyses were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the continuation group to determine the predictors of dropout from the physical function assessment program. Ethical approval was provided by Seirei Sakura Citizen Hospital,and written informed consent. Results A total of 230 patients receiving outpatient HD were invited to participate in the study. Among these, 78 patients refused to participate, 45 participants died or changed clinic within three years of obtaining baseline measurements, and six patients had missing data. Therefore, the final analysis included 101 patients undergoing HD. The continuation and dropout groups included 43 and 58 patients, respectively. SE (continuation: 13.0 ± 4.3 points; dropout: 9.8 ± 4.8 points) and age (continuation: 65.7 ± 10.4 years; dropout: 61.2 ± 12.2 years) were significantly higher in the continuation group than in the dropout group (p = 0.001, p = 0.047, respectively). Multivariate logistic regression analyses indicated that only SE (OR: 1.192, 95% CI: 1.088–1.319) remained a significant predictor after adjustment (p < 0.05). Conclusion Our data demonstrate that exercise-related SE and age significantly influenced dropout from the physical function assessment program; in particular, SE was a strong predictor of dropout, possibly because the patients with high SE may have had positive feelings about exercise based on previous experience. The older patients may have had a smaller social circle and more time to spare and been more aware of their health and desires. There is a need to evaluate SE to prevent dropout from physical functioning assessment programs. Interventions designed to enhance exercise-related SE may improve program retention among patients with HD.

Comparison of the Impact of Zika and Dengue Virus Infection, and Other Acute Illnesses of Unidentified Origin on Cognitive Functions in a Prospective Cohort in Chiapas Mexico

Zika has been associated with a variety of severe neurologic manifestations including meningitis and encephalitis. We hypothesized that it may also cause mild to subclinical neurocognitive alterations during acute infection or over the long term. In this observational cohort study, we explored whether Zika cause subclinical or mild neurocognitive alterations, estimate its frequency and duration, and compare it to other acute illnesses in a cohort of people with suspected Zika infection, in the region of Tapachula in Chiapas, Mexico during 2016–2018. We enrolled patients who were at least 12 years old with suspected Zika virus infection and followed them up for 6 months. During each visit participants underwent a complete clinical exam, including a screening test for neurocognitive dysfunction (Montreal Cognitive Assessment score). We enrolled 406 patients [37 with Zika, 73 with dengue and 296 with other acute illnesses of unidentified origin (AIUO)]. We observed a mild and transient impact over cognitive functions in patients with Zika, dengue and with other AIUO. The probability of having an abnormal MoCA score (<26 points) was significantly higher in patients with Zika and AIUO than in those with dengue. Patients with Zika and AIUO had lower memory scores than patients with dengue (Zika vs. Dengue: −0.378, 95% CI−0.678 to −0.078; p = 0.014: Zika vs. AIUO 0.264, 95% CI 0.059, 0.469; p = 0.012). The low memory performance in patients with Zika and AIUO accounts for most of the differences in the overall MoCA score when compared with patients with dengue. Our results show a decrease in cognitive function during acute illness and provides no evidence to support the hypothesis that Zika might cause neurocognitive alterations longer than the period of acute infection or different to other infectious diseases. While effects on memory or perhaps other cognitive functions over the long term are possible, larger studies using more refined tools for neurocognitive functioning assessment are needed to identify these.Trial Registration: NCT02831699.