Help-Seekers in an Early Detection of Psychosis Service: The Non-cases

Purpose: Enhancing early help-seeking is important for early intervention in psychosis. However, knowledge is limited about those help-seekers who are not initially found to have psychotic symptoms when assessed in services aiming at psychosis detection and, thus, deemed ineligible for early intervention of psychosis programs. We aimed to examine clinical diagnostic and socioeconomic pathways of help-seekers accessing an early detection of psychosis service with referral-free access. Specific focus was on the help-seekers initially assessed not to have psychotic symptoms, considered the non-cases, and to examine potential differences and similarities between non-cases and cases (i.e., those initially assessed to have psychotic symptoms).Methods: We followed 450 help-seekers assessed by a free-of-referral early detection of psychosis team in national registers for up to 4 years. We examined clinical diagnoses and status of not in education, employment, or training (NEET) before and after contact with the team.Results: Of the non-cases, 46% were referred to mental health services by the early detection of psychosis team for evaluation of other mental disorders, and 15% of these were subsequently diagnosed with a non-affective psychotic disorder during follow-up of 12–52 months. Prior to current help-seeking, 39% (n = 174) of the help-seekers had had contact with other mental health services. Nearly a quarter of help-seekers were NEETs at the time of assessment; the number increased during follow-up, both for cases and non-cases. Of the cases, 58% were subsequently clinically diagnosed by mental health services. Those seeking help who had no previous contact with mental health services were more frequently diagnosed with a non-affective psychotic disorder during follow-up (p = 0.05).Conclusion: Referral-free services to promote early detection of psychosis seem a valuable add-on to established pathways, allowing early intervention in psychosis. Our results point to an unmet mental health service need among non-cases; overall, in our sample, independent of case status, social functioning was markedly affected. Our results have implications for future focus in early detection of psychosis. Offering intervention to non-cases within the service has the potential to be cost effective, e.g., if a timely and targeted intervention reduces repeated contacts in other mental health services and social services.

Evaluation of a collaborative care program for patients with treatment-resistant schizophrenia: Protocol for a multiple case-study. (Preprint)

UNSTRUCTURED Background Around one-third of all patients with schizophrenia are classified as "treatment-resistant". Across the globe, there is under-treatment with clozapine and other effective treatment options for people with treatment-resistant schizophrenia (TRS). In this respect, it appears that regular healthcare models do not optimally fit this particular patient group. The Collaborative Care model (CC) has proven to be effective for patients with severe mental illness, both in primary care and in specialized mental healthcare facilities. The key principles of the CC model is that both patients and informal caregivers are part of the treatment team, that a structured treatment plan is put in place with planned evaluations by the team, and that the treatment approach is both multidisciplinary in nature and uses evidence-based interventions. We have developed a tailored CC-program for patients with TRS (CC-TRS). In this paper, we provide an overview of the research design for a potential study that seeks to gain insight into both the process of implementation and the preliminary effects of CC-TRS. Moreover, we will aim to gain insight into the experiences of professionals, patients and informal caregivers with the program. Methods The study will be underpinned by a multiple case-study design (N = 20) that utilizes a mixed-methods approach. These case studies will focus on one Early Intervention in Psychosis Team (EIT) and two Flexible Assertive Community treatment (FACT) teams in the Netherlands. Data will be collected from patients’ records as well as through questionnaires, individual interviews and focus groups. We began the process of recruiting patients in October 2020. Discussion The research design is discussed in line with the aims of the study, which are framed within the process of developing and testing innovative interventions. The limitations in clinical practice as well as their specific consequences for this study are explained. Trial registration AsPredicted (#62738), pre-registration titled 'Collaborative care for patients with treatment-resistant schizophrenia', registered 13 April 2021. https://aspredicted.org/gk958.pdf.

Through COVID-19 and beyond: developing a multidisciplinary telehealth family intervention in first episode psychosis

The COVID-19 pandemic presents unique challenges to high quality, safe Early Intervention in Psychosis (EIP) service provision. Due to the necessity to ensure EIP continues despite this, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of first episode psychosis service users: PERCEPTION. This perspective article aims to: describe PERCEPTION; offer reflections on our experience of delivering it; make recommendations for future research; and synthesise key learning to assist the integration of similar interventions in other EIP services. We provide a descriptive account of PERCEPTION’s development and implementation, with reflections from the clinicians involved, on supporting families using this approach. We experienced telehealth as patient-focused, safe, and efficient and believe the intervention’s blended nature augmented families’ engagement. The approach adopted can assist service providers to attain balance between protecting public health and offering a meaningful, therapeutic intervention to support families in the current epoch.

Late ‘Early Intervention in Psychosis’: A Family School for Learning How to Live with Schizophrenia

The paper describes a family school for learning how to live with schizophrenia, which was founded in 1986 in Vienna, Austria, and is still running today. It was established in cooperation between professionals and the Austrian self-help association HPE of the relatives of persons with mental disorders. It addresses the needs of 10 families at a time, in cases where a son or a daughter was diagnosed with schizophrenia and had already experienced one or several episodes of the illness. The course lasts one and a half years and is organized according to the model of a weekly boarding school, where 10 children, the residents, stay in the school overnight from Sunday evening to Friday and take part in a structured program on cognitive, social and practical life skills. Ambulatory psychiatric treatment is taking place concurrently outside the school through local routine services. On weekends residents stay with their parents since the school is closed. Parents visit the school regularly to take part in joint activities with the residents. They also undertake night shifts in the school and attend a weekly parents group. In the regular encounters during everyday activities in the school, learning by doing occurs parents get to know the daughters and sons of other families and can learn to distinguish between disease-related and personality-related behavior. Residents can have similar learning experiences in relation to the parents of other residents. The main aim of the school is that parents learn to provide protected autonomy for the daughters or sons in question, in order to assist them after the end of the course in leading a life characterized by as much autonomy as possible after the end of the school.