Outreach and support in South-London (OASIS) 2001—2020: Twenty years of early detection, prognosis and preventive care for young people at risk of psychosis

Fusar‐Poli, Paolo; Spencer, Tom; Micheli, Andrea De; Curzi, Victoria; Nandha, Sunil; McGuire, Philip

doi:10.1016/j.euroneuro.2020.08.002

Cited by 43 publications

(65 citation statements)

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“…These findings do not support the current pediatric-adult bifurcation of mental health services (cut at the age of 15 or 18) in Italy, where young people may fall into institutional gaps when they are most liable to mental disorders [29]. By overcoming this limitation, the ITAPP represents a promising template for transitional mental health services [4] aimed at early detection and intervention [3]. In line with these considerations, ITAPP services were enriched with multidisciplinary teams and approaches.…”

Section: Discussionmentioning

confidence: 80%

ITAlian Partnership for Psychosis Prevention (ITAPP): improving the mental health of young people

et al. 2021

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Background. The European impact of the clinical high risk for psychosis (CHR-P) paradigm is constrained by the lack of critical mass (detection) to power prognostic and preventive interventions.Methods. An ITAlian partnership for psychosis prevention (ITAPP) was created across CHR-P centers, which were surveyed to describe: (a) service, catchment area, and outreach; (b) service users; and (c) interventions and outcomes. Descriptive statistics and Kaplan-Meier failure function complemented the analyses. Results. The ITAPP included five CHR-P clinical academic centers established from 2007 to 2018, serving about 13 million inhabitants, with a recruitment capacity of 277 CHR-P individuals (mean age: 18.7 years, SD: 4.8, range: 12-39 years; 53.1% females; 85.7% meeting attenuated psychotic symptoms; 85.8% without any substance abuse). All centers were multidisciplinary and included adolescents and young adults (transitional) primarily recruited through healthcare services. The comprehensive assessment of at-risk mental state was the most widely used instrument, while the duration of follow-up, type of outreach, and preventive interventions were heterogeneous. Across 205 CHR-P individuals with follow up (663.7 days AE 551.7), the cumulative risk of psychosis increased from 8.7% (95% CI 5.3-14.1) at 1 year to 15.9% (95% CI 10.6-23.3) at 2 years, 21.8% (95% CI 14.9-31.3) at 3 years, 34.8% (95% CI 24.5-47.9) at 4 years, and 51.9% (95% CI 36.3-69.6) at 5 years. Conclusions. The ITAPP is one of the few CHR-P clinical research partnerships in Europe for fostering detection, prognosis, and preventive care, as well as for translating research innovations into practice.

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Section: Discussionmentioning

confidence: 80%

ITAlian Partnership for Psychosis Prevention (ITAPP): improving the mental health of young people

et al. 2021

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“…An alternative approach may be to enhance the transdiagnostic potential of current preventive (e.g., CHR-P) services, implementing the detection of emerging bipolar and depressive (and anxiety) disorders and better integrating them with primary care to facilitate the prevention of physical health burden 3 . Such initiatives are emerging 232 .…”

Section: Synergically Preventing Common and Infrequent Mental Disordersmentioning

confidence: 99%

“…Furthermore, the needs‐based support and the public health campaigns routinely offered by CHR‐P services could be expanded to better address the social determinants of psychotic and common mental disorders at the population level 233 . CHR‐P services also represent a successful global template for transitional mental health services and applied clinical research 232 that fully integrate between adolescence and young adulthood 67 . This overcomes the historical paediatric‐adult bifurcation, in which children and adolescent mental health services are usually cut at the age of 15 or 18 (the transitional period), when young people are most liable to mental disorders.…”

Section: Future Directions Of Research and Practicementioning

confidence: 99%

Preventive psychiatry: a blueprint for improving the mental health of young people

et al. 2021

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Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally‐sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high‐risk for psychosis paradigm has received the most empirical validation, while clinical high‐risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non‐genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi‐endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence‐based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost‐effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.

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“…For example, young people with attenuated symptoms for psychosis [10][11][12][13] and functional impairments accumulate several risk factors and have a 25% probability of developing the disorder over 3 years [14]. Clinical care for these individuals is typically implemented in specialised clinical services [15][16][17][18] and has the potential to delay or impede the transition to psychosis, although the efficacy of preventive interventions awaits more robust evidence [19][20][21]. Targeted preventive approaches involve screening programmes in asymptomatic individuals who have significant risk factors for certain psychiatric disorders [7,22,23] (primary selective prevention [7,8]) or public health campaigns in the general population (primary universal prevention) [7,8,24].…”

Section: Introductionmentioning

confidence: 99%

Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

et al. 2021

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Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11–34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7–16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9–25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14–29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15–23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17–48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20–41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20–34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20–33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21–46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18.

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Outreach and support in South-London (OASIS) 2001—2020: Twenty years of early detection, prognosis and preventive care for young people at risk of psychosis

Cited by 43 publications

References 43 publications

ITAlian Partnership for Psychosis Prevention (ITAPP): improving the mental health of young people

ITAlian Partnership for Psychosis Prevention (ITAPP): improving the mental health of young people

Preventive psychiatry: a blueprint for improving the mental health of young people

Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

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