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Elizabeth Kuipers - One of the best experts on this subject based on the ideXlab platform.
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family interventions in Early Psychosis specificity and effectiveness
Epidemiology and Psychiatric Sciences, 2011Co-Authors: Juliana Onwumere, Paul Bebbington, Elizabeth KuipersAbstract:The first episode of Psychosis frequently occurs during adolescence and Early adulthood, and is associated with high levels of trauma, affective disturbance and suicide. The social networks of service users often decrease significantly following the first onset, although many will remain in close contact with some family members particularly during the Early phases. However, the negative impact of Psychosis on families and their relationship with the identified service user are well documented. Family intervention is a recommended and evidence-based treatment in later Psychosis. In this paper, we review the literature on family interventions in Early Psychosis in the context of new evidence for its efficacy and its routine incorporation in Early intervention services for Psychosis.
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Early intervention services cognitive behavioural therapy and family intervention in Early Psychosis systematic review
British Journal of Psychiatry, 2010Co-Authors: Victoria Bird, Preethi Premkumar, Tim Kendall, Craig Whittington, Jonathan Mitchell, Elizabeth KuipersAbstract:Background Early intervention services for Psychosis aim to detect emergent symptoms, reduce the duration of untreated Psychosis, and improve access to effective treatments. Aims To evaluate the effectiveness of Early intervention services, cognitive–behavioural therapy (CBT) and family intervention in Early Psychosis. Method Systematic review and meta-analysis of randomised controlled trials of Early intervention services, CBT and family intervention for people with Early Psychosis. Results Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission. Conclusions For people with Early Psychosis, Early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with Early and established Psychosis need further research.
Andor E Simon - One of the best experts on this subject based on the ideXlab platform.
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The Swiss Early Psychosis Project SWEPP: a national network.
Early intervention in psychiatry, 2012Co-Authors: Andor E Simon, Anastasia Theodoridou, Benno G. Schimmelmann, Roland Schneider, Philippe ConusAbstract:Aim: The study aims to describe the activities of the Swiss Early Psychosis Project (SWEPP) which was founded in 1999 as a national network to further and disseminate knowledge on Early Psychosis (EP) and to enhance collaboration between healthcare groups. Methods: The present paper is a detailed account of the initiation and the development of the Swiss network. We describe all activities such as the several educational campaigns that were addressed to primary and secondary care groups since the Early days. We also provide an overview of the current status of EP services throughout the country. Results: Today, most regions in Switzerland provide specialized EP inpatient and/or outpatient services with a clinical or combined clinical research approach that targets at-risk and/or first-episode populations. Some more recently initiated EP services have been launched as collaborative models between several local or regional psychiatric services. Conclusions: The increasing number of EP services and experts in Switzerland may mirror the catalyzing contribution of the Swiss Early Psychosis Project in this important field of health care. The country's small size and the increasing density of specialized services provide excellent bases for larger-scale networking activities in the future, both in clinical and research areas.
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The International Study on General Practitioners and Early Psychosis (IGPS).
Schizophrenia research, 2008Co-Authors: Andor E Simon, Helen Lester, Lynda Tait, Emanuel Stip, Paul Roy, Gretchen Conrad, Jennifer Hunt, Irvin Epstein, Tor K Larsen, Paul AmmingerAbstract:In much of the world, general practitioners (GPs) are the health professionals most frequently initially contacted when a young person is developing Psychosis. However little is known about their expertise in assessing Psychosis and its risk. To assess the diagnostic patterns and treatment practices related to Psychosis of GPs working in a range of health care systems, questionnaires were mailed to 12,516 randomly selected GPs in seven countries: Canada, Australia, New Zealand, England, Norway, Austria and the Czech Republic. Sites were defined as gatekeeping or non-gatekeeping, based on the primary care health system in effect at each site. A gatekeeping system (GK) is one which mandates that patients see a GP before in order to be referred to a specialist. By contrast, in a non-gatekeeping (nGK) system, individuals can seek help directly from specialists without authorization by a GP. Twenty-two percent (n=2784) GPs responded to the mailed questionnaire. They reported low prevalence of Early Psychosis seen in general practice. Using awareness of functional decline as a prognostic sign as a proxy, gatekeeping (GK) GPs were found to be superior in their knowledge of the signs and symptoms of Early Psychosis than were non-gatekeeping GPs. GP's with less knowledge as to Early Psychosis were more likely to refer individuals with suspected Psychosis to specialists. GP's reported a preference for access to specialized outpatient services as compared with obtaining continuous medical education relevant to Early Psychosis. The duration of maintenance treatment recommended by GP's was less than that recommended in international guidelines. GP's also underestimated the risk for relapse after a first episode of Psychosis. As GPs were largely unaware of features of Early Psychosis, such as functional decline, this should be the target of educational programs for GP's. However, the incidence of Psychosis is low and GP's express a preference for access to appropriate referral over continuing medical education. Therefore, the development of specialized services for the assessment and care of patients who are in the Early stages of developing schizophrenia may be warranted.
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The International Study on General Practitioners and Early Psychosis (IGPS)
Schizophrenia Research, 2008Co-Authors: Andor E Simon, Helen Lester, Lynda Tait, Emanuel Stip, Paul Roy, Gretchen Conrad, Irvin Epstein, Tor K Larsen, Jennifer C. Hunt, Paul AmmingerAbstract:Abstract Background In much of the world, general practitioners (GPs) are the health professionals most frequently initially contacted when a young person is developing Psychosis. However little is known about their expertise in assessing Psychosis and its risk. Methods To assess the diagnostic patterns and treatment practices related to Psychosis of GPs working in a range of health care systems, questionnaires were mailed to 12,516 randomly selected GPs in seven countries: Canada, Australia, New Zealand, England, Norway, Austria and the Czech Republic. Sites were defined as gatekeeping or non-gatekeeping, based on the primary care health system in effect at each site. A gatekeeping system (GK) is one which mandates that patients see a GP before in order to be referred to a specialist. By contrast, in a non-gatekeeping (nGK) system, individuals can seek help directly from specialists without authorization by a GP. Results Twenty-two percent (n = 2784) GPs responded to the mailed questionnaire. They reported low prevalence of Early Psychosis seen in general practice. Using awareness of functional decline as a prognostic sign as a proxy, gatekeeping (GK) GPs were found to be superior in their knowledge of the signs and symptoms of Early Psychosis than were non-gatekeeping GPs. GP's with less knowledge as to Early Psychosis were more likely to refer individuals with suspected Psychosis to specialists. GP's reported a preference for access to specialized outpatient services as compared with obtaining continuous medical education relevant to Early Psychosis. The duration of maintenance treatment recommended by GP's was less than that recommended in international guidelines. GP's also underestimated the risk for relapse after a first episode of Psychosis. Conclusions As GPs were largely unaware of features of Early Psychosis, such as functional decline, this should be the target of educational programs for GP's. However, the incidence of Psychosis is low and GP's express a preference for access to appropriate referral over continuing medical education. Therefore, the development of specializ ed services for the assessment and care of patients who are in the Early stages of developing schizophrenia may be warranted.
Paul Amminger - One of the best experts on this subject based on the ideXlab platform.
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The International Study on General Practitioners and Early Psychosis (IGPS).
Schizophrenia research, 2008Co-Authors: Andor E Simon, Helen Lester, Lynda Tait, Emanuel Stip, Paul Roy, Gretchen Conrad, Jennifer Hunt, Irvin Epstein, Tor K Larsen, Paul AmmingerAbstract:In much of the world, general practitioners (GPs) are the health professionals most frequently initially contacted when a young person is developing Psychosis. However little is known about their expertise in assessing Psychosis and its risk. To assess the diagnostic patterns and treatment practices related to Psychosis of GPs working in a range of health care systems, questionnaires were mailed to 12,516 randomly selected GPs in seven countries: Canada, Australia, New Zealand, England, Norway, Austria and the Czech Republic. Sites were defined as gatekeeping or non-gatekeeping, based on the primary care health system in effect at each site. A gatekeeping system (GK) is one which mandates that patients see a GP before in order to be referred to a specialist. By contrast, in a non-gatekeeping (nGK) system, individuals can seek help directly from specialists without authorization by a GP. Twenty-two percent (n=2784) GPs responded to the mailed questionnaire. They reported low prevalence of Early Psychosis seen in general practice. Using awareness of functional decline as a prognostic sign as a proxy, gatekeeping (GK) GPs were found to be superior in their knowledge of the signs and symptoms of Early Psychosis than were non-gatekeeping GPs. GP's with less knowledge as to Early Psychosis were more likely to refer individuals with suspected Psychosis to specialists. GP's reported a preference for access to specialized outpatient services as compared with obtaining continuous medical education relevant to Early Psychosis. The duration of maintenance treatment recommended by GP's was less than that recommended in international guidelines. GP's also underestimated the risk for relapse after a first episode of Psychosis. As GPs were largely unaware of features of Early Psychosis, such as functional decline, this should be the target of educational programs for GP's. However, the incidence of Psychosis is low and GP's express a preference for access to appropriate referral over continuing medical education. Therefore, the development of specialized services for the assessment and care of patients who are in the Early stages of developing schizophrenia may be warranted.
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The International Study on General Practitioners and Early Psychosis (IGPS)
Schizophrenia Research, 2008Co-Authors: Andor E Simon, Helen Lester, Lynda Tait, Emanuel Stip, Paul Roy, Gretchen Conrad, Irvin Epstein, Tor K Larsen, Jennifer C. Hunt, Paul AmmingerAbstract:Abstract Background In much of the world, general practitioners (GPs) are the health professionals most frequently initially contacted when a young person is developing Psychosis. However little is known about their expertise in assessing Psychosis and its risk. Methods To assess the diagnostic patterns and treatment practices related to Psychosis of GPs working in a range of health care systems, questionnaires were mailed to 12,516 randomly selected GPs in seven countries: Canada, Australia, New Zealand, England, Norway, Austria and the Czech Republic. Sites were defined as gatekeeping or non-gatekeeping, based on the primary care health system in effect at each site. A gatekeeping system (GK) is one which mandates that patients see a GP before in order to be referred to a specialist. By contrast, in a non-gatekeeping (nGK) system, individuals can seek help directly from specialists without authorization by a GP. Results Twenty-two percent (n = 2784) GPs responded to the mailed questionnaire. They reported low prevalence of Early Psychosis seen in general practice. Using awareness of functional decline as a prognostic sign as a proxy, gatekeeping (GK) GPs were found to be superior in their knowledge of the signs and symptoms of Early Psychosis than were non-gatekeeping GPs. GP's with less knowledge as to Early Psychosis were more likely to refer individuals with suspected Psychosis to specialists. GP's reported a preference for access to specialized outpatient services as compared with obtaining continuous medical education relevant to Early Psychosis. The duration of maintenance treatment recommended by GP's was less than that recommended in international guidelines. GP's also underestimated the risk for relapse after a first episode of Psychosis. Conclusions As GPs were largely unaware of features of Early Psychosis, such as functional decline, this should be the target of educational programs for GP's. However, the incidence of Psychosis is low and GP's express a preference for access to appropriate referral over continuing medical education. Therefore, the development of specializ ed services for the assessment and care of patients who are in the Early stages of developing schizophrenia may be warranted.
Donald Addington - One of the best experts on this subject based on the ideXlab platform.
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A Pilot Study of Cognitive Behavior Therapy for Depression in Early Psychosis
Cognitive and Behavioral Practice, 2014Co-Authors: Alisa R. Singer, Donald Addington, Keith S. Dobson, Caitlin A. WrightAbstract:Abstract Depression is a significant problem in Early Psychosis, yet there are few effective treatments available. The purpose of this open clinical trial was to examine the feasibility of cognitive behavioral therapy for depression in a sample of 10 depressed patients with Early Psychosis. Patients received between 16 and 22 sessions of cognitive therapy delivered by a certified cognitive therapist. They completed baseline and posttreatment assessments on clinical rating scales and self-report questionnaires. Group results suggest that participants demonstrated significant reductions in depression, negative symptoms, and general psychopathology. They also reported less hopelessness, beliefs about loss, dysfunctional attitudes, and increased self-esteem. Clinical case descriptions are also discussed. Results demonstrate that CBT may be a feasible treatment for depression in psychotic disorders, but more rigorous research is needed. Clinical and research implications are discussed.
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Family Work in Early Psychosis
Journal of Family Psychotherapy, 2007Co-Authors: Jean Addington, Amanda Mccleery, April Collins, Donald AddingtonAbstract:Abstract Many individuals with schizophrenia have family members who are actively involved in their care. Often, these family members feel burdened and experience significant distress as a consequence of this increased responsibility. Family interventions have been shown to reduce relapse in individuals with Psychosis, highlighting the importance of the family component in Psychosis treatment programs. This paper describes how an optimal family intervention can be devised using a recovery framework, and used within an Early Psychosis treatment program. Three-year outcome data is presented demonstrating improvement in family well-being, and clinical implications are discussed.
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Relapse rates in an Early Psychosis treatment service.
Acta psychiatrica Scandinavica, 2007Co-Authors: Donald Addington, M. D. Jean Addington, Scott B. PattenAbstract:Objective: To examine the relapse rate achievable in a real-life Early Psychosis treatment service. Method: A 2-year longitudinal cohort study of consecutive admissions to an Early Psychosis programme which served the entire population in a catchment area. The primary outcome measure was relapse. Results: One hundred and forty-eight consecutive consenting admissions were recruited, 124 (83.8%) of whom were followed for 1 year and 116 (78.4%) for 2 years. Relapse was assessed by clinicians using structured criteria. The 2-year relapse rate among subjects with complete data collection was 34/95 (35.7%, 95% CI 26.2–46.3). A Kaplan–Meier life table censoring subjects lost to follow-up yielded a comparable estimate of the proportion not relapsing: 68% (95% CI 58–76%). Conclusion: These estimates compare favourably with a published range of 2-year relapse from 55% to 70% in the older literature and are comparable with the results in recent clinical trials.
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Insight in Early Psychosis: a 1-year follow-up.
Schizophrenia research, 2004Co-Authors: Alisa R Mintz, Jean Addington, Donald AddingtonAbstract:Insight was investigated in 180 individuals consecutively admitted to a comprehensive Early Psychosis treatment program. Insight was assessed on admission and after 3, 6 and 12 months. Insight improved significantly over 12 months, and was negatively correlated with both positive and negative symptoms, and positively correlated with depressive symptoms at admission. There were no associations with cognition.
Patrick D. Mcgorry - One of the best experts on this subject based on the ideXlab platform.
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The utility of a fidelity measure to monitor implementation of new Early Psychosis services across Australia.
Early intervention in psychiatry, 2021Co-Authors: Georgia Williams, Patrick D. Mcgorry, Simone Farrelly, Andrew Thompson, Heather Stavely, Dianne Albiston, Kristie Van Der El, Eoin KillackeyAbstract:AIM Early Psychosis delivery models have proliferated worldwide, but there is limited research into establishing model fidelity. In this context, this article aims to describe the development and implementation of a fidelity tool in a national network of Early Psychosis services across Australia-the headspace Early Psychosis program. METHODS Following a detailed consultation process, and based on the Australian Early Psychosis model, an 80-item Early Psychosis Prevention and Intervention Centre Model Integrity Tool (EMIT) was developed along with predefined thresholds for fidelity. The tool was used to assess adherence to the model in six clusters of service sites across Australia. Ratings on the EMIT were informed by interviews with site staff and young people receiving the service, routinely collected data and site policies and procedures. RESULTS All six clusters of headspace Early Psychosis programs participated in five fidelity assessments across a period of two and a half years. In the initial two visits, the average fidelity score was in the 'low' fidelity range (i.e.,
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australian Early Psychosis research network national collaboration international competitive advantage
The Medical Journal of Australia, 2015Co-Authors: Patrick D. McgorryAbstract:Patrick D McGorry, on behalf of the Australian Early Psychosis Research Network Writing Group
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At the heart of an Early Psychosis centre: the core components of the 2014 Early Psychosis Prevention and Intervention Centre model for Australian communities
Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, 2014Co-Authors: Frank Hughes, Heather Stavely, Raelene Simpson, Sherilyn Goldstone, Kerryn Pennell, Patrick D. McgorryAbstract:Objective:To describe the core components of the Early Psychosis Prevention and Intervention Centre service model as the template agreed with the Australian Federal Government for national upscalin...
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Forgotten family members: the importance of siblings in Early Psychosis.
Early intervention in psychiatry, 2013Co-Authors: Siann Bowman, Patrick D. Mcgorry, Mario Alvarez-jimenez, Darryl Wade, Linsey HowieAbstract:Objective This paper reviews the evidence on the significance of sibling inclusion in family interventions and support during Early Psychosis. Method This narrative review presents the current research related to the importance of family work during Early Psychosis, the needs and developmental significance of siblings during adolescence and Early adulthood, the protective effects of sibling relationships, and the characteristics of Early Psychosis relevant to the sibling experience. It will also review the evidence of the sibling experience in chronic physical illness and disability, as well as long-term psychotic illness. Conclusions Despite the evidence that working with families is important during Early Psychosis, siblings have been largely ignored. Siblings are an important reciprocal relationship of long duration. They play an important role in development during adolescence and Early adulthood. These relationships may be an underutilized protective factor due to their inherent benefits and social support. Developmental theories imply that Early Psychosis could negatively impact the sibling relationship and their quality of life, effecting personality development and health outcomes. The evidence shows that adolescent physical illness or disability has a significantly negative impact on the sibling's quality of life and increases the risk for the onset of mental health issues. Long-term psychotic illness also results in negative experiences for siblings. Current evidence shows that siblings in Early Psychosis experience psychological distress and changes in functional performance. Further research using standard measures is required to understand the impact Early Psychosis has on the sibling relationship and their quality of life.
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the recognition and management of Early Psychosis a preventive approach
2009Co-Authors: Henry J Jackson, Patrick D. McgorryAbstract:Dedication List of contributors Foreword Jan Olav Johannessen Acknowledgements Part I. Introduction: 1. Rationale for and overview of the 2nd edition of The Recognition and Management of Early Psychosis Henry J. Jackson, Patrick D. McGorry and Kelly Allott 2. Diagnosis and the staging model of Psychosis Patrick D. McGorry, Kelly Allott and Henry J. Jackson Part II. Risk and Vulnerability: 3. Genetic vulnerability Daniel Weinberger and Gregor Berger 4. Environmental vulnerability and genetic-environmental interactions Jim van Os and Richie Poulton 5. Neurobiological endophenotypes of Psychosis and schizophrenia: are there biological markers of illness onset? Christos Pantelis, Murat Yucel, Stephen J. Wood, Warrick J. Brewer, Alex Fornito, Gregor Berger, Tyrone Cannon and Dennis Velakoulis Part III. At Risk Mental State: 6. At risk mental state and prediction Alison R. Yung, Joachim Klosterkoetter, Barbara Cornblatt and Frauke Schultze-Lutter 7. At risk mental state: management Lisa J. Phillips, Jean Addington and Anthony P. Morrison Part IV. Access and Reducing Delay to Treatment: Reducing DUP: 8. Duration of untreated Psychosis: definition, measurement and association with outcome Max Marshall, Susy Harrigan and Shon Lewis 9. Improving the community's mental health literacy as a means of facilitating Early intervention Anthony F. Jorm and Annemarie Wright 10. Pathways to care and reducing treatment delay in Early Psychosis Ross M. G. Norman and Ashok K. Malla Part V. The First Episode: 11. Initial assessment and initial pharmacological treatment in the acute phase Martin Lambert 12. Complete and incomplete recovery from first-episode Psychosis Jean Addington, Tim Lambert and Peter Burnett 13. Preventive strategies in bipolar disorders: identifying targets for Early intervention Philippe Conus, Michael Berk, Nellie Lucas, Jose Luis Vazquez-Barquero and Craig Macneil Part VI. The Critical Period: Other Psychopathology and Comorbidity: 14. Substance misuse in first-episode Psychosis Darryl Wade, Leanne Hides, Amanda Baker and Dan Lubman 15. Suicide prevention in first-episode Psychosis Paddy Power and Jo Robinson 16. Emotional and personality dysfunctions in Early Psychosis Max Birchwood, John Gleeson, Andrew Chanen, Louise K. McCutcheon, Shona M. Francey and Maria Michail Part VII. The Critical Period: Specific Interventions: 17. Family intervention in Early Psychosis Catharine McNab and Don Linszen 18. Enhancing work functioning in Early Psychosis Eoin Killackey, Henry J. Jackson, David Fowler and Keith H. Nuechterlein 19. Relapse prevention in Early Psychosis John Gleeson, Don Linszen and Durk Wiersma 20. Treatment resistance in first-episode Psychosis Christian G. Huber and Martin Lambert Part VIII. Service Models: 21. Using research and evaluation to inform the development of Early Psychosis service models: international examples Meredith Harris, Thomas Craig, Robert B. Zipursky, Donald Addington, Merete Nordentoft and Paddy Power.
