The access and waiting-time standard for first-episode psychosis: an opportunity for identification and treatment of psychosis risk states?

Whale, Richard; Thompson, Andrew; Fraser, Richard

doi:10.1192/pb.bp.116.054254

Cited by 3 publications

(3 citation statements)

References 11 publications

(19 reference statements)

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“…Recent guidelines in the UK stipulate the provision of services for young people at ultra-high risk of psychosis (NICE, 2013 ; NHS England, 2015 ). As services seek to define what is beneficial and achievable for this group (Whale et al, 2017 ), a brief, targeted intervention that may have wider benefits could be of value. These wider benefits may include social and educational function and potentially preventing exacerbation of, or development of more severe, psychotic-like experiences.…”

Section: Discussionmentioning

confidence: 99%

Treating Sleep Problems in Young People at Ultra-High Risk of Psychosis: A Feasibility Case Series

Bradley

Freeman

Chadwick

et al. 2017

Behav. Cogn. Psychother.

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Background: Our view is that sleep disturbance may be a contributory causal factor in the development and maintenance of psychotic experiences. A recent series of randomized controlled intervention studies has shown that cognitive-behavioural approaches can improve sleep in people with psychotic experiences. However, the effects of psychological intervention for improving sleep have not been evaluated in young people at ultra-high risk of psychosis. Improving sleep might prevent later transition to a mental health disorder. Aims: To assess the feasibility and acceptability of an intervention targeting sleep disturbance in young people at ultra-high risk of psychosis. Method: Patients were sought from NHS mental health services. Twelve young people at ultra-high risk of psychosis with sleep problems were offered an eight-session adapted CBT intervention for sleep problems. The core treatment techniques were stimulus control, circadian realignment, and regulating day-time activity. Participants were assessed before and after treatment and at a one month follow-up. Results: All eligible patients referred to the study agreed to take part. Eleven patients completed the intervention, and one patient withdrew after two sessions. Of those who completed treatment, the attendance rate was 89% and an average of 7.6 sessions (SD = 0.5) were attended. There were large effect size improvements in sleep. Post-treatment, six patients fell below the recommended cut-off for clinical insomnia. There were also improvements in negative affect and psychotic experiences. Conclusion: This uncontrolled feasibility study indicates that treating sleep problems in young people at ultra-high of psychosis is feasible, acceptable, and may be associated with clinical benefits.

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Section: Discussionmentioning

confidence: 99%

Treating Sleep Problems in Young People at Ultra-High Risk of Psychosis: A Feasibility Case Series

Bradley

Freeman

Chadwick

et al. 2017

Behav. Cogn. Psychother.

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“…The investigation of antipsychotic-naïve first-episode psychosis (FEP) patients is particularly helpful for understanding the biology at the onset of psychotic disorders. At this phase, before the intervention with antipsychotic medications, the potential to contribute to the evaluation of the disease before the influence of medication is recognized, and it may also allow the assessment of the pharmacotherapy effects in the follow-up studies ( Anderson et al, 2014 ; Ito et al, 2015 ; Elowe and Conus 2017 ; Gay et al, 2017 ; Whale et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

A Study in First-Episode Psychosis Patients: Does Angiotensin I-Converting Enzyme Activity Associated With Genotype Predict Symptom Severity Reductions After Treatment With Atypical Antipsychotic Risperidone?

Nani

Mas

Yonamine

et al. 2020

International Journal of Neuropsychopharmacology

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Background Our previous studies showed increased angiotensin I-converting enzyme (ACE) activity in chronic schizophrenia (SCZ) patients compared to healthy control (HC) volunteers, and the relevance of combining ACE genotype and activity for predicting SCZ was suggested. Methods ACE activity was measured in plasma of ACE insertion/deletion (I/D) genotyped HC volunteers (N = 53) and antipsychotic-naïve first-episode psychosis (FEP) patients (N = 45), assessed at baseline (FEB-B) and also after 2-months (FEP-2M) of treatment with the atypical antipsychotic risperidone. Results ACE activity measurements showed significant differences among HC, FEP-B and FEP-2M groups (F = 5.356, df = 2, p = 0.005), as well as between HC and FEP-2M (post-hoc Tukey's multiple comparisons test, p = 0.004). No correlation was observed for ACE activity increases and symptom severity reductions in FEP as assessed by total PANSS (r = -0.131, p = 0.434). FEP subgrouped by ACE I/D genotype showed significant ACE activity increases, mainly in the DD genotype subgroup. No correlation between ACE activity and age was observed in FEP or HC groups separately (r = 0.210, p = 0.392), but ACE activity levels differences observed between these groups were influenced by age. Conclusions The importance of measuring the ACE activity in blood plasma, associated to ACE I/D genotyping to support the follow-up of FEP patients did not show correlation with general symptoms amelioration in the present study. However, new insights into the influence of age and I/D genotype for ACE activity changes in FEP individuals upon treatment was demonstrated.

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“…In the absence of explicit communication on these touchpoints, healthcare professionals are likely to refer to internalised guidelines rather than official and explicit guidelines and codes of practice (Gabbay & le May, ). In addition, given the recent emphasis placed by the NHS on the inclusion of the ARMS population in the early intervention strategy, and considered the controversy regarding diagnostic thresholds and appropriate intervention in this preclinical population (see Whale, Thompson, & Fraser, ), a stronger focus on the procedural and substantive ethical dimensions of EIP may be essential to the ethical implementation of the early intervention strategy in England.…”

Section: Discussionmentioning

confidence: 99%

What constitutes ‘good practice’ in early intervention for psychosis? Analysis of clinical guidelines

Corsico

Griffin-Doyle

Singh

2017

Child Adoles Ment Health

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BackgroundEarly Intervention in Psychosis (EIP) services have been implemented with the dual aims of preventing harmful outcomes associated with early‐onset psychosis and improving prognosis. However, concerns have been raised regarding the ethical implications of involving young people in EIP services. One way to ensure high ethical standards and promote good practice in EIP delivery is through governance of clinical practice. This study aimed to investigate the normative dimensions of good practice in EIP through examination of clinical guideline documents published in England over the past 15 years.MethodsA total of 14 clinical guidelines and relevant policy documents for EIP were retrieved and analysed using a mixed inductive and deductive thematic approach. Themes were derived from the data itself, whereas the development of broader categories was performed through a constant comparison with the scientific literature describing ethical issues in EIP.ResultsEthical touchpoints of good practice in EIP included both procedural and substantive factors, which were seen to be interdependent and mutually constitutive. These ethical touchpoints were largely implicit in the documents analysed. Procedural requirements of EIP service delivery consisted of norms and rules pertaining to EIP service structure, adherence to codes of ethics, inclusivity, patient and family centredness and appropriate treatment provision. Substantive factors consisted of moral attributes that should be cultivated by healthcare professionals working in EIP: competency, empathy, sensitivity and trustworthiness.ConclusionsWe argue that, to ensure good practice in EIP, procedural and substantive ethical expectations embedded in EIP guideline documents should be made explicit in EIP service and care delivery. We suggest that the procedural and substantive factors highlighted in this paper contribute useful dimensions for the eventual evaluation of good practice in EIP services across England.

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The access and waiting-time standard for first-episode psychosis: an opportunity for identification and treatment of psychosis risk states?

Cited by 3 publications

References 11 publications

Treating Sleep Problems in Young People at Ultra-High Risk of Psychosis: A Feasibility Case Series

Treating Sleep Problems in Young People at Ultra-High Risk of Psychosis: A Feasibility Case Series

A Study in First-Episode Psychosis Patients: Does Angiotensin I-Converting Enzyme Activity Associated With Genotype Predict Symptom Severity Reductions After Treatment With Atypical Antipsychotic Risperidone?

What constitutes ‘good practice’ in early intervention for psychosis? Analysis of clinical guidelines

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