Telepsychotherapy with youth at clinical high risk for psychosis: Clinical issues and best practices during the COVID-19 pandemic.

Abstract

Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis—those at clinical high risk for psychosis (CHR)—given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the coronavirus 2019 (COVID-19) pandemic and its subsequent physical isolation measures, as a result of heightened stress sensitivity and comorbid mental health problems. Telepsychotherapy holds promise for reaching this population, especially during the current COVID-19 outbreak. However, there are limited evidence-based guidelines or interventions for use of telepsychotherapy with this population. In this article, we review common clinical issues for individuals at CHR and how they might be exacerbated by the COVID-19 pandemic. We then review best practices for treatment and adaptations for telepsychotherapy for individuals at CHR, and highlight real clinical issues that we are currently experiencing in a United States–based specialized CHR clinic as we conduct telepsychotherapy via videoconferencing. We conclude with questions for those in the field to contemplate, as well as potential challenges and benefits in using telepsychotherapy with individuals at CHR and their families.

Psychotherapy During COVID-19: How the Clinical Practice of Italian Psychotherapists Changed During the Pandemic

“…For example, people with anxiety-related or mood disorders resulted in being significantly affected than others, reporting greater fear about the danger of contamination, socioeconomic consequences, xeno-phobia, and traumatic stress symptoms (Asmundson et al, 2020). Similarly, individuals at high clinical risk for psychosis may be prone to exacerbate psychological distress (DeLuca et al, 2020), as a result of heightened stress sensitivity and comorbid mental health problems (Boldrini et al, 2019). efficacious alternative to physical treatment during the pandemic (Swartz, 2020;Wind et al, 2020).…”

The impact of the COVID-19 pandemic on negative symptoms in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia

“…Clinical case reports and commentaries have posited that the COVID-19 pandemic will lead to widespread reductions in service utilization and subsequent increases in acute symptom exacerbations in those who had already been diagnosed with a psychotic disorder prior to the pandemic [35,40,44]. There is also fear that reduced access to healthcare, social isolation, and reduced physical activity may lead those at clinical high risk (CHR) for developing psychosis to transition to illness onset [6,14,17]. Although clinical reports are alarming, empirical evidence for the detrimental effects of the COVID-19 pandemic on schizophrenia-spectrum symptoms in SZ and CHR populations has yet to be demonstrated relative to prepandemic data.…”

Schizophrenia and the Family Burden During the Pandemic

“…The caregivers of an individual with schizophrenia are required to find out from reliable sources about the vulnerability of the loved one suffering from schizophrenia, given that the classic medical consultation has been replaced by telemedicine (DeLuca et al, 2020).…”