The role of relatives in pathways to care of patients with a first episode of psychosis

Vecchio, Valeria Del; Luciano, Mario; Sampogna, Gaia; Rosa, Corrado De; Giacco, Domenico; Tarricone, Ilaria; Catapano, Francesco; Fiorillo, Andrea

doi:10.1177/0020764014568129

Cited by 51 publications

(46 citation statements)

References 53 publications

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“…The three additional articles considered descriptive survey data on stigma-related experiences (de Haan et al 2002;Kapur et al 2014;Del Vecchio et al 2015).…”

Section: Quantitative Synthesismentioning

confidence: 99%

Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review

et al. 2017

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Background. Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigmarelated influences on pathways to care in the early stages of psychotic disorders have not been systematically examined.Method. This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results.Results. The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: 'sense of difference', 'characterizing difference negatively', 'negative reactions (anticipated and experienced)', 'strategies', 'lack of knowledge and understanding', and 'service-related factors'. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups.Conclusions. Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.

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“…The three additional articles considered descriptive survey data on stigma-related experiences (de Haan et al 2002;Kapur et al 2014;Del Vecchio et al 2015).…”

Section: Quantitative Synthesismentioning

confidence: 99%

Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review

et al. 2017

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“…The National Institute for Health and Care Excellence [5] advocates development of specific psychosocial interventions to meet the needs of African-Caribbean people diagnosed with schizophrenia. Recent research also highlights the significance of ethnicity and the crucial role relatives play in pathways to mental health care, in particular for patients with first episode psychosis [16]. Family intervention is one approach which may improve African-Caribbean service users’ engagement with mainstream services, encourage more timely access to care (via less coercive pathways), and improve risk management; thereby enabling better care experiences and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

Edge

Degnan

Cotterill

et al. 2016

Pilot Feasibility Stud

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BackgroundAfrican-Caribbeans in the UK have the highest schizophrenia incidence and greatest inequity in access to mental health services of all ethnic groups. The National Institute for Health and Care Excellence (NICE) highlights this crisis in care and urgent need to improve evidence-based mental healthcare, experiences of services and outcomes for this group. Family intervention (FI) is clinically and cost-effective for the management of schizophrenia but it is rarely offered. Evidence for FI with minority ethnic groups generally, and African-Caribbeans in particular, is lacking. This study aims to test the feasibility and acceptability of delivering Culturally-adapted Family Intervention (CaFI) to African-Caribbean service users diagnosed with schizophrenia.Methods/DesignThis is a feasibility cohort design study. Over a 12-month intervention period, 30 service users and their families, recruited from hospital and community settings, will receive ten one-hourly sessions of CaFI. Where biological families are absent, access to the intervention will be optimised through ‘family support members’; trusted individuals nominated by service users or study volunteers.We shall collect data on eligibility, uptake, retention and attrition and assess the utility and feasibility of collecting various outcome measures including readmission, service engagement, working alliance, clinical symptoms and functioning, perceived criticism, psychosis knowledge, familial stress and economic costs. Measures will be collected at baseline, post-intervention and at 3-month follow-up using validated questionnaires and standardised interviews. Admission rates and change in care management will be rated by independent case note examination. Variability in the measures will inform sample size estimates for a future trial. Independent raters will assess fidelity to the intervention in 10 % of sessions. Feedback at the end of each session along with thematically-analysed qualitative interviews will examine CaFI’s acceptability to service users, families and healthcare professionals.DiscussionThis innovative response to inequalities in mental healthcare experienced by African-Caribbeans diagnosed with schizophrenia might improve engagement in services, access to evidence-based interventions and clinical outcomes. Successful implementation of CaFI in this group could pave the way for better engagement and provision across marginalised groups and therefore has potentially important implications for commissioning and service delivery in ethnically diverse populations. This study will demonstrate whether the approach is feasible and acceptable and can be implemented with fidelity in different settings.

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“…The following information was collected from all patients: (1) sociodemographic and clinical characteristics, explored by the Socio-Demographic and Clinical Schedule; (2) pathways to psychiatric care, investigated by the Pathways to Care Form (Del Vecchio et al, 2015); (3) duration of untreated psychosis assessed by the Nottingham Onset Schedule (Singh et al, 2005). Diagnoses were confirmed by use of Structured Clinical Interview for DSM-IV Axis I Disorders (First, Spitzer, Gibbon, & Williams, 1997).…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, a longer DUP is associated with a poor quality of life (Volpe, Mihai, Jordanova, & Sartorius, 2015). In turn, DUP is influenced by several clinical and social factors (Del Vecchio et al, 2015); among them, the most important are male gender (O' Callaghan et al, 2010), early onset (Tomassini et al, 2012), substance abuse (Austin et al, 2015) and a gradual onset of the illness .…”

Section: Introductionmentioning

confidence: 99%

“…The delay between onset of psychosis and first adequate psychiatric treatment is still particularly high, being on average one year (Melle et al, 2004), and it is strongly influenced by sociocultural context (Del Vecchio et al, 2015). A study carried out in Australia pointed out that almost half of patients with schizophrenia had at least a care contact with general practitioners before referring to specialized care, hypothesizing a possible crucial role of these medical professionals in the early detection of psychoses (Lincoln, Harrigan, & McGorry, 1998).…”

Section: Introductionmentioning

confidence: 99%

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Pathways to care and duration of untreated psychosis in patients with a first episode of psychosis in Italy

Luciano

Sampogna

Vecchio

et al. 2016

International Journal of Culture and Mental Health

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This study aimed to examine the pathways to care and the duration of untreated psychosis (DUP) in first-episode psychosis patients in Italy. Sociodemographic and clinical characteristics of patients were collected using an ad-hoc schedule. Pathways to care of patients were evaluated by the Nottingham Onset Schedule, administered to patients, key-relatives and key-workers. Forty patients from the Department of Psychiatry of University of Naples were recruited. Mean duration of untreated illness (DUI) was 135.9±145.9 weeks, main DUP was 27.4±26.7 weeks. First helpseeking contact, often mediated by close relatives, took place after 21.6 ±43.8 weeks from symptoms onset and was with general practitioners, neurologists or psychologists. Only 25% immediately referred to psychiatrists. Patients had 1.8±0.8 contacts with non-psychiatric medical professionals before referring to the mental health service, and the mean time between first contact and adequate psychiatric treatments (referral delay) was 26.6±64.1 weeks. The DUI and DUP was longer in patients with less education (p < .05) and in those with an insidious onset of symptoms (p < .01). Targeted interventions and information campaigns on at-risk populations, such as young people and their relatives, could reduce the DUP, thus improving the long-term outcome of psychotic disorders. ARTICLE HISTORY

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The role of relatives in pathways to care of patients with a first episode of psychosis

Cited by 51 publications

References 53 publications

Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review

Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

Pathways to care and duration of untreated psychosis in patients with a first episode of psychosis in Italy

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