Functional deficits in attenuated psychosis syndrome and related conditions: Current and future treatment options

Harvey, Philip D.; Jones, Mackenzie T.

doi:10.1016/j.scog.2019.100152

Cited by 5 publications

(3 citation statements)

References 47 publications

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“…The recruitment of individuals for undergoing a CHR-P assessment is primarily based on unstructured and heterogeneous selection and sampling strategies based on the clinicians’ suspicion of psychosis risk (33) and help-seeking behavior (37). These recruitment processes determine the extent to which individuals at CHR-P would accumulate several risk factors for psychosis ( Figure 3 ) (22, 38); in turn, the accumulation of risk factors determines the level of functional impairment (39, 40) and associated attenuated psychotic symptoms ( Figure 4 ) (8). Broadly speaking, individuals are generally recruited from secondary mental health care, primary care, or the community and represent different populations on the basis of clinical and functional characteristics.…”

Section: Resultsmentioning

confidence: 99%

Improving the Detection of Individuals at Clinical Risk for Psychosis in the Community, Primary and Secondary Care: An Integrated Evidence-Based Approach

et al. 2019

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Background: The first rate-limiting step for improving outcomes of psychosis through preventive interventions in people at clinical high risk for psychosis (CHR-P) is the ability to accurately detect individuals who are at risk for the development of this disorder. Currently, this detection power is sub-optimal. Methods: This is a conceptual and nonsystematic review of the literature, focusing on the work conducted by leading research teams in the field. The results will be structured in the following sections: understanding the CHR-P assessment, validity of the CHR-P as a universal risk state for psychosis, and improving the detection of at-risk individuals in secondary mental health care, in primary care, and in the community. Results: CHR-P instruments can provide adequate prognostic accuracy for the prediction of psychosis provided that they are employed in samples who have undergone risk enrichment during recruitment. This substantially limits their detection power in real-world settings. Furthermore, there is initial evidence that not all cases of psychosis onset are preceded by a CHR-P stage. A transdiagnostic individualized risk calculator could be used to automatically screen secondary mental health care medical notes to detect those at risk of psychosis and refer them to standard CHR-P assessment. Similar risk estimation tools for use in primary care are under development and promise to boost the detection of patients at risk in this setting. To improve the detection of young people who may be at risk of psychosis in the community, it is necessary to adopt digital and/or sequential screening approaches. These solutions are based on recent scientific evidence and have potential for implementation internationally. Conclusions: The best strategy to improve the detection of patients at risk for psychosis is to implement a clinical research program that integrates different but complementary detection approaches across community, primary, and secondary care. These solutions are based on recent scientific advancements in the development of risk estimation tools and e-health approaches and have the potential to be applied across different clinical settings.

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Section: Resultsmentioning

confidence: 99%

Improving the Detection of Individuals at Clinical Risk for Psychosis in the Community, Primary and Secondary Care: An Integrated Evidence-Based Approach

et al. 2019

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“…it does not require relaxation) are important. Experiences such as suspiciousness were discussed for their potential to interact with learning, particularly in a group settingechoing research showing a close relationship between attenuated psychotic symptoms and functioning (Cadenhead et al 2010;Harvey & Jones 2019). Similarly, greater social anxiety, a common experience for at-risk cohorts, has been found to correlate with higher negative symptoms and poorer social functioning (Kuhney et al 2021).…”

Section: Discussionmentioning

confidence: 99%

Stakeholder views on mindfulness for youth at risk for psychosis

Reich

Evans

O’Shea

2022

Int J Mental Health Nurs

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Interventions incorporating mindfulness for youth identified to be at risk for psychosis show promise for symptom management yet to be addressed by other approaches. Important questions remain as to how to safely and effectively implement these interventions with this cohort. The aim of this research was to collaboratively identify with stakeholders of such interventions, namely youth at risk for psychosis, and practitioners with experience working with youth at risk for psychosis – attitudes towards mindfulness and potential intervention adaptations to ensure the safety, uptake, and effectiveness of mindfulness interventions used with youth at risk for psychosis. Consolidated criteria for reporting qualitative studies were adopted. Eight practitioners and six at risk for psychosis individuals were interviewed. Both groups identified significant potential benefits of mindfulness, for stress and relaxation, managing difficult thoughts and emotions, increasing positive emotions, improving functioning, and patient empowerment within treatment participation. Stakeholders identified the helpfulness of including compassion‐based practices, emphasizing experiential and concrete material, shorter and guided exercises, the targeting of anxiety and attenuated psychotic symptomology, and making the goals or intent of practice youth relevant. Significant barriers were identified – poor functioning and low motivation, high self‐criticism, concurrent medication and substance use, and perceptions of mindfulness that may impact uptake (e.g. it requires relaxation to work). Formulation of and research into comprehensive clinical guidelines will help ensure the safe and effective use of future mindfulness and compassion‐based practices with at risk for psychosis individuals.

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“…Family psychoeducation and peer support are recognised as essential components of early intervention services for psychosis,34 with the former shown possibly to produce improvements in attenuated positive symptoms of psychosis35 36 and the latter potentially leading to improvements in empowerment and recovery 37. Finally, difficulties in cognitive abilities38–40 and social and role functioning41–43 are common among individuals at CHR-P and may represent key treatment targets given their possible association with increased risk for transition to psychosis 40 44 45…”

Section: Methods and Analysismentioning

confidence: 99%

The Ohio State University Early Psychosis Intervention Center (EPICENTER) step-based care programme for individuals at clinical high risk for psychosis: study protocol for an observational study

et al. 2020

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IntroductionIn October 2018, the Substance Abuse and Mental Health Services Administration funded 21 sites throughout the USA to develop, implement and evaluate specialised care programmes for individuals at clinical high risk for developing a psychotic disorder (CHR-P). Per the funding requirements, such programmes were required to provide ‘step-based care’—a model in which individuals are initially provided with low-intensity, non-psychosis-specific and more benign (ie, least side effects) interventions and only progress onto higher-intensity, psychosis-specific interventions with a greater risk of more severe side effects should they not meet a priori criteria for clinical response to such lower-intensity interventions. Here, we outline the evaluation component of the step-based care programme for individuals at CHR-P at The Ohio State University Early Psychosis Intervention Center (EPICENTER).Methods and analysesThe EPICENTER CHR-P programme provides a step-based care model comprising psychotherapy, medication management, family support/education, peer support and vocational/educational support. All participants who opt to receive care at the EPICENTER will complete a standardised assessment battery as part of usual care. This battery will be administered on enrolment and will be re-administered at 6-month intervals throughout individuals’ participation in EPICENTER clinical services. Participants will have the opportunity to allow for data from these usual care assessments to be used as part of an evaluation project for this new clinical service. The primary outcome for this evaluation project is time to remission of symptomatic and functional deficits commonly experienced by individuals at CHR-P. Participants will also have the opportunity to participate in a supplemental research project designed to further evaluate treatment outcomes and patient characteristics among individuals participating in EPICENTER clinical services.Ethics and disseminationThis project was approved by The Ohio State University Institutional Review Board. Results from this project will be disseminated through publications and presentations.Trial registration numberNCT03970005.

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Functional deficits in attenuated psychosis syndrome and related conditions: Current and future treatment options

Cited by 5 publications

References 47 publications

Improving the Detection of Individuals at Clinical Risk for Psychosis in the Community, Primary and Secondary Care: An Integrated Evidence-Based Approach

Improving the Detection of Individuals at Clinical Risk for Psychosis in the Community, Primary and Secondary Care: An Integrated Evidence-Based Approach

Stakeholder views on mindfulness for youth at risk for psychosis

The Ohio State University Early Psychosis Intervention Center (EPICENTER) step-based care programme for individuals at clinical high risk for psychosis: study protocol for an observational study

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