Prevention and Recovery in Early Psychosis (PREP®): Building a public-academic partnership program in Massachusetts, United States

Caplan, Brina; Zimmet, Suzanna V.; Meyer, Eric C.; Friedman‐Yakoobian, Michelle; Monteleone, Thomas; Leung, Y. Jude; Guyer, Margaret; Rood, Laura Logue; Keshavan, Matcheri S.; Seidman, Larry J.

doi:10.1016/j.ajp.2012.10.009

Cited by 23 publications

(22 citation statements)

References 66 publications

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“…In comparison, STEP is more generalizable to U.S. community settings, with average patient: clinician ratios of 50:1 and office-based care. While the long history of public-academic collaboration makes CMHC a somewhat unique environment for service innovation (35), reports from Massachusetts, California and North Carolina (36–38) support the feasibility of implementing similar publicly funded FES across distinct and heterogeneous U.S. healthcare ecologies.…”

Section: Discussionmentioning

confidence: 99%

First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial

et al. 2015

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Objective This study seeks to determine the effectiveness of a comprehensive first-episode service (the clinic for Specialized Treatment Early in Psychosis, STEP) based in an urban U.S. community mental health center, compared to treatment as usual. Methods This pragmatic randomized controlled trial enrolled 120 ‘first-episode psychosis’ patients within 5 years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from area inpatient psychiatric units and enrollees were randomly allocated to STEP or referral to routine care (TU). Main outcomes included hospital utilization (primary), ability to work, attend age-appropriate schooling or actively seek these opportunities (‘vocational engagement’), and general functioning. Analysis was by modified intent to treat (excluding only 3 who withdrew consent) for hospitalization and completers for other outcomes. Results After one year, STEP effected reductions on all measures of inpatient utilization vs. usual treatment: not psychiatrically hospitalized (77% vs. 56%, RR 1.38, 95% confidence interval (CI) 1.08–1.58); mean hospitalizations (0.33±0.70 vs. 0.68±0.92, p=0.02) and mean bed days (5.34±13.53 vs. 11.51±15.04, p=0.05). For every 5 patients allocated in STEP vs. usual treatment, one additional patient avoided psychiatric hospitalization over the first year (NNT = 5, CI 2.7–26.5). STEP also delivered better vocational engagement (91.7% vs. 66.7%, RR 1.40, 95% CI 1.18–1.48) and salutary trends in measures of global functioning. Conclusions This trial demonstrates the feasibility and effectiveness of a U.S. public sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses. Trial registration www.ClinicalTrials.gov: NCT00309452.

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Section: Discussionmentioning

confidence: 99%

First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial

et al. 2015

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“…All clients were engaged in treatment with an outpatient psychiatrist and were taking antipsychotic medication. Seven of 10 also received individual psychotherapy, and three were attending an early psychosis program that included two afternoons per week of specialized group programming, case management, and multi-family group support (Caplan et al, 2012). …”

Section: Methodsmentioning

confidence: 99%

Family-directed cognitive adaptation pilot: Teaching cognitive adaptation to families of individuals with schizophrenia

Friedman-Yakoobian

Mueser

Giuliano

et al. 2016

American Journal of Psychiatric Rehabilitation

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Cognitive deficits are a major determinant of functional outcome in schizophrenia. A promising treatment involves teaching individuals to use cognitive adaptation strategies to minimize the functional impact of cognitive difficulties. We developed Family Directed Cognitive Adaptation (FCA) to train caregivers to help their relatives with schizophrenia use cognitive adaptations to improve living skills. The goal of this open pilot trial was to examine the feasibility of FCA. Ten adults with schizophrenia, each with at least one relative, participated in FCA and were evaluated at baseline, post-treatment, and 6-month follow-up. Domains assessed included adaptive functioning, psychiatric symptoms, school/work involvement, hospitalizations, family burden, and treatment satisfaction. Participants reported high levels of satisfaction with FCA, and all families completed the 16-session intervention. Relatives reported reduced burden at termination and follow-up. No participants were hospitalized during the treatment or follow-up period, and rates of work/school involvement increased from 30% at baseline to 50% at the end of treatment and follow-up. Individuals improved in negative symptoms and adaptive functioning over the course of treatment, but these gains were not maintained. This pilot provides preliminary support for the acceptability and feasibility of FCA, and points to the need to address the maintenance of treatment gains after termination.

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“…This study describes the clinical and demographic characteristics of the population in Boston's Prevention and Recovery in Early Psychosis (PREP R ) program, an intensive outpatient EP service (see Caplan and Zimmet et al, 2013 for a description of the PREP R treatment model). Our primary aim was to investigate whether clinician-rated social and role functioning, along with several clinician-rated and self-reported clinical variables, and neurocognitive functioning, improved following six months of treatment in PREP R .…”

Section: Objectives and Hypothesesmentioning

confidence: 99%

“…Based on prior research, we expected a model consisting of premorbid adjustment in adolescence, baseline neurocognition, and reduction in depression to account for significant variance in social and role functioning change. Caplan and Zimmet et al, 2013). The current study includes a mixed diagnostic EP sample; research designs using mixed samples often contain considerable heterogeneity and are an efficient method for describing populations commonly seen in community mental health clinics (Verdoux et al, 2002).…”

Section: Objectives and Hypothesesmentioning

confidence: 99%

“…Specialized clinical programs for early psychosis (EP) have been emerging over the past decade (Caplan and Zimmet et al, 2013) and it is important to evaluate outcomes of those programs. Several studies have assessed change in functioning in EP outside of specialized treatment programs (Austin et al, 2013;Goulding et al, 2010), whereas others have compared changes in functioning between samples receiving EP specific interventions with those receiving treatment as usual (Baksheev et al, 2012;Petersen et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

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The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program

Minor

Friedman‐Yakoobian

Leung

et al. 2015

Aust N Z J Psychiatry

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Objective: Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP R , Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement. Method:The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP R (n = 46 with social functioning and 47 with role functioning measures at both time points).Results: Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not. Conclusions:Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings.

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Prevention and Recovery in Early Psychosis (PREP®): Building a public-academic partnership program in Massachusetts, United States

Cited by 23 publications

References 66 publications

First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial

First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial

Family-directed cognitive adaptation pilot: Teaching cognitive adaptation to families of individuals with schizophrenia

The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program

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