Research and practice for ultra‐high risk for psychosis: A national survey of early intervention in psychosis services in England

Mawn, Lauren; Common, Stephanie; Pilton, Marie; Thompson, Andrew

doi:10.1111/eip.12443

Cited by 16 publications

(22 citation statements)

References 26 publications

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“…We note the UHR phase represents a unique opportunity to intervene to prevent future ill‐health (Carney et al, , ). The review by Stain et al () showing that a high number of UHR services utilize antipsychotic medication strengthens our argument that there is a failed opportunity to prevent serious physical health problems in an already vulnerable group.…”

supporting

confidence: 67%

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mentioning

confidence: 99%

“…According to the National Institute for Health and Care Excellence (NICE, ) in the United Kingdom, the primary recommended treatment for this group are psychological therapies such as cognitive behavioural therapy (CBT) and family therapies, both of which were offered in only half of services surveyed (Stain et al, ). Due to the serious metabolic side‐effects of antipsychotic medication, pharmacological interventions are not recommended as a first‐line treatment for this group.…”

mentioning

confidence: 99%

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Ultra‐high risk phase: A missed opportunity for physical health care

Carney

Bradshaw

Yung

2017

Early Intervention Psych

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We read with interest the paper by Stain, Mawn, Common, Pilton, and Thompson (2017) published online for "Early Intervention in Psychiatry." The paper provides important findings and carries implications for future service development. Despite evidence for the importance of early intervention, the authors found that the current service provision in England falls substantially below standard for young people at ultra-high risk (UHR) for psychosis.According to the National Institute for Health and Care Excellence (NICE, 2013) in the United Kingdom, the primary recommended treatment for this group are psychological therapies such as cognitive behavioural therapy (CBT) and family therapies, both of which were offered in only half of services surveyed (Stain et al., 2017). Due to

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supporting

confidence: 67%

“…

…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Ultra‐high risk phase: A missed opportunity for physical health care

Carney

Bradshaw

Yung

2017

Early Intervention Psych

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“…Another recent appraisal of the standard confirmed that it is unclear how adopting the recommended extended age range and treating CHR-P cases could impact on the positive outcomes already associated with 14 to 35 years age range (40). A further independent survey of CHR-P services in the UK concluded that current provision for CHR-P in England does not match clinical guidelines (41). Fourth, concerning illicit substance misuse, only a minority of CHR-P individuals reported using them.…”

Section: Discussionmentioning

confidence: 99%

Pan-London Network for Psychosis-Prevention (PNP)

Fusar‐Poli¹,

Estradé²,

Spencer³

et al. 2019

Front. Psychiatry

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Background: The empirical success of the Clinical High Risk for Psychosis (CHR-P) paradigm is determined by the concurrent integration of efficient detection of cases at-risk, accurate prognosis, and effective preventive treatment within specialized clinical services. The characteristics of the CHR-P services are relatively under-investigated. Method: A Pan-London Network for psychosis prevention (PNP) was created across urban CHR-P services. These services were surveyed to collect the following: description of the service and catchment area, outreach, service users, interventions, and outcomes. The results were analyzed with descriptive statistics and Kaplan Meier failure function. Results: The PNP included five CHR-P services across two NHS Trusts: Outreach and Support In South-London (OASIS) in Lambeth and Southwark, OASIS in Croydon and Lewisham, Tower Hamlets Early Detection Service (THEDS), City & Hackney At-Risk Mental State Service (HEADS UP) and Newham Early Intervention Service (NEIS). The PNP serves a total population of 2,318,515 Londoners (830,889; age, 16–35 years), with a yearly recruitment capacity of 220 CHR-P individuals (age, 22.55 years). Standalone teams (OASIS and THEDS) are more established and successful than teams that share their resources with other mental health services (HEADS UP, NEIS). Characteristics of the catchment areas, outreach and service users, differ across PNP services; all of them offer psychotherapy to prevent psychosis. The PNP is supporting several CHR-P translational research projects. Conclusions: The PNP is the largest CHR-P clinical network in the UK; it represents a reference benchmark for implementing detection, prognosis, and care in the real-world clinical routine, as well as for translating research innovations into practice.

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“…In line with the International Early Psychosis Association recommendations that interventions are provided flexibly and in low stigmatising environments, sessions are held in the patient's home or local health service clinic. 54 At the final session, participants will be asked to complete a self-report questionnaire to assess the acceptability of the intervention (AARP 55 ).…”

Section: The Sleepwell Interventionmentioning

confidence: 99%

Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell)

et al. 2020

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BackgroundEffective interventions, targeting key contributory causal factors, are needed to prevent the emergence of severe mental health problems in young people. Insomnia is a common clinical issue that is problematic in its own right but that also leads to the development and persistence of psychotic experiences. The implication is that treating sleep problems may prevent the onset of psychosis. We collected initial case series data with 12 young people at ultra-high-risk of psychosis. Post-intervention, there were improvements in sleep, depression and psychotic experiences. Now we test the feasibility of a randomised controlled trial, with a clinical aim to treat sleep problems and hence reduce depression, psychotic experiences, and prevent transition to psychosis.Methods and analysisA randomised controlled feasibility trial will be conducted. Forty patients aged 14 to 25 years who are at ultra-high-risk of psychosis and have sleep disturbance will be recruited from National Health Service (NHS) mental health services. Participants will be randomised to receive either a novel, targeted, youth-focussed sleep intervention in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 9 months (follow-up). The eight-session psychological intervention will target the key mechanisms which disrupt sleep: circadian rhythm irregularities, low sleep pressure, and hyperarousal. To gain an in-depth understanding of participants’ views on the acceptability of the intervention and study procedures, 16 participants (n=10 intervention, n=6 control) will take part in qualitative interviews. Analyses will focus on feasibility outcomes (recruitment, retention, and treatment uptake rates) and provide initial CI estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention and trial procedures.Ethics and disseminationThe trial has received ethical approval from the NHS Health Research Authority. Findings will be disseminated through peer-reviewed publications, conference presentations, and lay networks.Trial registration numberISRCTN85601537.

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Research and practice for ultra‐high risk for psychosis: A national survey of early intervention in psychosis services in England

Cited by 16 publications

References 26 publications

Ultra‐high risk phase: A missed opportunity for physical health care

Ultra‐high risk phase: A missed opportunity for physical health care

Pan-London Network for Psychosis-Prevention (PNP)

Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell)

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