L. Hyam, L. M. Gallagher, G. Di Clemente, E. Killackey, D. Glennon, J. Griffiths, R. Mills, J. Wilkins, M. Ahmed, K. L. Allen, U. Schmidt
Introduction
First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention service model for young people with recent-onset eating disorders. This manuscript describes the development and pilot testing of an implementation fidelity tool for FREED or similar early intervention models, exploring feasibility of the tool and changes in fidelity over time.
Methods
An iterative consultation process within the FREED national team reviewed the core aims, functions, principles, and key components of FREED services. A set of items and a scoring rubric were drafted and pilot-tested via two assessments in a London-based FREED service with routine data and interviews with team members. Items were scored independently by two raters. Inter-rater reliability was assessed.
Results
The fidelity tool comprised 35 items across two components: (1) rapid access to the service and (2) adherence to the FREED care package (e.g., family involvement, attention to transitions). Overall fidelity scores were 63% at time 1% and 60% at time 2, indicating ‘lower’ fidelity. Component scores ranged from ‘not satisfactory’ for rapid access, to ‘medium fidelity’ for care package components. Weighted Cohen's kappa indicated almost perfect agreement across assessments.
Conclusion
This is the first fidelity measurement tool for early intervention eating disorders services. It demonstrated feasibility, simple administration, and time efficiency. Pilot testing suggested fidelity to some aspects of FREED, but further support is required to improve fidelity. Future work should focus on refining the tool (e.g., further psychometric evaluation) and testing it in more services to investigate whether ongoing assessments support fidelity.
{"title":"To Fidelity and Beyond: Development of an Implementation Fidelity Tool for Early Intervention for Eating Disorders Services","authors":"L. Hyam, L. M. Gallagher, G. Di Clemente, E. Killackey, D. Glennon, J. Griffiths, R. Mills, J. Wilkins, M. Ahmed, K. L. Allen, U. Schmidt","doi":"10.1111/eip.70132","DOIUrl":"10.1111/eip.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention service model for young people with recent-onset eating disorders. This manuscript describes the development and pilot testing of an implementation fidelity tool for FREED or similar early intervention models, exploring feasibility of the tool and changes in fidelity over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An iterative consultation process within the FREED national team reviewed the core aims, functions, principles, and key components of FREED services. A set of items and a scoring rubric were drafted and pilot-tested via two assessments in a London-based FREED service with routine data and interviews with team members. Items were scored independently by two raters. Inter-rater reliability was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The fidelity tool comprised 35 items across two components: (1) rapid access to the service and (2) adherence to the FREED care package (e.g., family involvement, attention to transitions). Overall fidelity scores were 63% at time 1% and 60% at time 2, indicating ‘lower’ fidelity. Component scores ranged from ‘not satisfactory’ for rapid access, to ‘medium fidelity’ for care package components. Weighted Cohen's kappa indicated almost perfect agreement across assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first fidelity measurement tool for early intervention eating disorders services. It demonstrated feasibility, simple administration, and time efficiency. Pilot testing suggested fidelity to some aspects of FREED, but further support is required to improve fidelity. Future work should focus on refining the tool (e.g., further psychometric evaluation) and testing it in more services to investigate whether ongoing assessments support fidelity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victoria C. Patterson, Bradley A. J. Gillis, Julia Sawers, Alissa Pencer, Maria Simmons, Rachel Church, G. Camelia Adams, Samantha Carley, Stephen Adams, Philip G. Tibbo
Background
Adverse events and substance misuse are rarely examined together among people in early phase psychosis, although both are frequently examined in isolation given their high prevalence in this population. As a result, the frequency of the three-way overlap is unclear. Moreover, adverse events are often limited to childhood abuse and rarely include illness-related events (e.g., threatening hallucinations). This study aims to explore the overlap between these variables and provide a more detailed understanding of adversity in this population and their desire to disclose experiences.
Methods
We surveyed 110 individuals aged 16–35 years with early phase psychosis about substance misuse, lifetime adverse events, disclosure of adverse events, and PTSD symptoms.
Results
Nearly all participants (97.2%) had experienced at least 1 adverse event, recalling an average of 8 adverse events over lifetime (SD = 3.8). Over 22% met the cutoff for a probable PTSD diagnosis on a validated measure. Substance misuse was present in 67% of participants, often involving multiple substances (M = 2.7 substances, SD = 1.5), most commonly alcohol, cannabis, and tobacco. There was an overlap between early phase psychosis, substance misuse, and a history of at least 1 adverse event in 66.4% of the sample. Most participants (78.7%) had disclosed their adverse events to someone, and 72.7% expressed interest in speaking to a mental health professional about their experiences.
Conclusion
Adverse events and substance misuse commonly co-occur in early phase psychosis, and these results have important clinical ramifications for assessment and treatment in an early phase psychosis population.
{"title":"Lifetime Adversity Among Individuals With Early Phase Psychosis and Comorbid Substance Misuse","authors":"Victoria C. Patterson, Bradley A. J. Gillis, Julia Sawers, Alissa Pencer, Maria Simmons, Rachel Church, G. Camelia Adams, Samantha Carley, Stephen Adams, Philip G. Tibbo","doi":"10.1111/eip.70122","DOIUrl":"10.1111/eip.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adverse events and substance misuse are rarely examined together among people in early phase psychosis, although both are frequently examined in isolation given their high prevalence in this population. As a result, the frequency of the three-way overlap is unclear. Moreover, adverse events are often limited to childhood abuse and rarely include illness-related events (e.g., threatening hallucinations). This study aims to explore the overlap between these variables and provide a more detailed understanding of adversity in this population and their desire to disclose experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We surveyed 110 individuals aged 16–35 years with early phase psychosis about substance misuse, lifetime adverse events, disclosure of adverse events, and PTSD symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nearly all participants (97.2%) had experienced at least 1 adverse event, recalling an average of 8 adverse events over lifetime (SD = 3.8). Over 22% met the cutoff for a probable PTSD diagnosis on a validated measure. Substance misuse was present in 67% of participants, often involving multiple substances (<i>M</i> = 2.7 substances, SD = 1.5), most commonly alcohol, cannabis, and tobacco. There was an overlap between early phase psychosis, substance misuse, and a history of at least 1 adverse event in 66.4% of the sample. Most participants (78.7%) had disclosed their adverse events to someone, and 72.7% expressed interest in speaking to a mental health professional about their experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Adverse events and substance misuse commonly co-occur in early phase psychosis, and these results have important clinical ramifications for assessment and treatment in an early phase psychosis population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa Elgie, Jennifer Yessis, Dillon T. Browne, Mark A. Ferro
Background
Children with chronic physical illness (CPI) are highly vulnerable to developing a co-occurring psychopathology, which is associated with compounding negative health effects throughout the life-course. Literature regarding psychopathology onset among children with CPI is sparse; studies are predominantly cross-sectional and illness-specific. This research examined the onset and correlates of internalising and externalising psychopathologies among children with CPI over 48 months.
Methods
Data come from a longitudinal study of 263 children with CPI, aged 2–16 years, and their parent. Child psychopathology was measured using the parent-reported Mini International Neuropsychiatric Interview for Children and Adolescents, which defined the events, internalising and externalising psychopathology onset. Kaplan–Meier survival analyses illustrated internalising and externalising psychopathology onset, and Cox regressions modelled predictors of onset.
Results
Overall, 64.1% of children met criteria for an internalising or externalising psychopathology at baseline and throughout follow-up. Average time-to-onset of internalising and externalising psychopathology was approximately 20.4 and 18.1 months, respectively. Children with greater disability (HR = 1.15, 1.00–1.31), were older (HR = 1.15, 1.05–1.27), and had younger parents (HR = 0.91, 0.85–0.97) were most susceptible to an internalising psychopathology. Male children (HR = 0.37, 0.20–0.70), and children exposed to greater parent psychopathology (HR = 1.29, 1.11–1.47) were most likely to develop an externalising psychopathology.
Conclusions
Many children with CPI developed psychopathology, and subgroups of children were identified as most at risk of internalising and externalising psychopathology. Findings support routine mental health screening of children with CPI to foster mental well-being among these vulnerable children.
{"title":"Onset of Psychopathology Among Children With Chronic Physical Illness","authors":"Melissa Elgie, Jennifer Yessis, Dillon T. Browne, Mark A. Ferro","doi":"10.1111/eip.70125","DOIUrl":"10.1111/eip.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Children with chronic physical illness (CPI) are highly vulnerable to developing a co-occurring psychopathology, which is associated with compounding negative health effects throughout the life-course. Literature regarding psychopathology onset among children with CPI is sparse; studies are predominantly cross-sectional and illness-specific. This research examined the onset and correlates of internalising and externalising psychopathologies among children with CPI over 48 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data come from a longitudinal study of 263 children with CPI, aged 2–16 years, and their parent. Child psychopathology was measured using the parent-reported Mini International Neuropsychiatric Interview for Children and Adolescents, which defined the events, internalising and externalising psychopathology onset. Kaplan–Meier survival analyses illustrated internalising and externalising psychopathology onset, and Cox regressions modelled predictors of onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 64.1% of children met criteria for an internalising or externalising psychopathology at baseline and throughout follow-up. Average time-to-onset of internalising and externalising psychopathology was approximately 20.4 and 18.1 months, respectively. Children with greater disability (HR = 1.15, 1.00–1.31), were older (HR = 1.15, 1.05–1.27), and had younger parents (HR = 0.91, 0.85–0.97) were most susceptible to an internalising psychopathology. Male children (HR = 0.37, 0.20–0.70), and children exposed to greater parent psychopathology (HR = 1.29, 1.11–1.47) were most likely to develop an externalising psychopathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many children with CPI developed psychopathology, and subgroups of children were identified as most at risk of internalising and externalising psychopathology. Findings support routine mental health screening of children with CPI to foster mental well-being among these vulnerable children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12790943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Music Therapy as a Preventive and Therapeutic Approach to Risky Sexual Behaviour Among Youth With and at Risk for Bipolar Disorder","authors":"Dominikus David Biondi Situmorang","doi":"10.1111/eip.70129","DOIUrl":"10.1111/eip.70129","url":null,"abstract":"","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isadora Espíndola Leite Borges, Gabriel dos Reis Stafuzza, Pedro Luis Freitas Tótolo, Mario Nicolau Silva Gomes, Eduardo Janotti Cavalcante, Paulo Jeng Chian Suen, Andreza Aparecida Miranda dos Santos, Pedro Mario Pan, Silvia Brasiliano, Patrícia Brunfentrinker Hochgraf, Pedro Starzynski Bacchi
Aim
Emerging adulthood is a critical period for health interventions. The gender gap in substance use disorder (SUD) prevalence between men and women has been consistently narrowing, particularly amongst emerging adults (EAs), yet women remain underrepresented in SUD research. This study aims to investigate pretreatment and treatment dropout rates and predictors in patients at a Women-Specific Outpatient Service in Brazil, across different age strata: emerging adults (EAs, 18–25), middle aged adults (MAAs, 26–59), and older adults (OAs, 60+).
Methods
An observational cohort study across 27 years. Pretreatment dropout was evaluated with multivariate logistic regression. Survival curves with dropout as event were estimated for each age stratum and log rank tests were performed. Survival probabilities and Cox proportional hazards models were used to gauge dropout risk and determine dropout risk factors.
Results
The 756 women were included, comprising 125 EAs, 585 MAAs, and 46 OAs. MAAs showed lower odds of pretreatment dropout than EAs (OR = 0.56, p = 0.025). EAs exhibited lowest treatment retention, with only 13% remaining in treatment at 104 weeks (p < 0.0001). Cox regression indicated that higher education was protective, with tertiary education reducing dropout risk (HR = 0.65, p = 0.038), whilst cocaine/crack use increased it (HR = 1.57, p = 0.017). Patients enrolled in more recent years had a higher risk of dropout whithin the first six months of treatment.
Conclusions
Emerging adulthood is a critical period for health interventions. The gender gap is narrowing amongst EAs, and women are still underrepresented in studies. We found very high pretreatment and treatment dropout rates amongst Emerging Adults in our sample. These findings underscore the necessity for early-stage risk stratification and intervention protocols for this subpopulation.
{"title":"Gone Too Soon: Higher Pretreatment and Treatment Dropout Among Emerging Adults in a Women-Specific Outpatient Treatment Service for Substance Use Disorders in Brazil","authors":"Isadora Espíndola Leite Borges, Gabriel dos Reis Stafuzza, Pedro Luis Freitas Tótolo, Mario Nicolau Silva Gomes, Eduardo Janotti Cavalcante, Paulo Jeng Chian Suen, Andreza Aparecida Miranda dos Santos, Pedro Mario Pan, Silvia Brasiliano, Patrícia Brunfentrinker Hochgraf, Pedro Starzynski Bacchi","doi":"10.1111/eip.70133","DOIUrl":"10.1111/eip.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Emerging adulthood is a critical period for health interventions. The gender gap in substance use disorder (SUD) prevalence between men and women has been consistently narrowing, particularly amongst emerging adults (EAs), yet women remain underrepresented in SUD research. This study aims to investigate pretreatment and treatment dropout rates and predictors in patients at a Women-Specific Outpatient Service in Brazil, across different age strata: emerging adults (EAs, 18–25), middle aged adults (MAAs, 26–59), and older adults (OAs, 60+).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An observational cohort study across 27 years. Pretreatment dropout was evaluated with multivariate logistic regression. Survival curves with dropout as event were estimated for each age stratum and log rank tests were performed. Survival probabilities and Cox proportional hazards models were used to gauge dropout risk and determine dropout risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 756 women were included, comprising 125 EAs, 585 MAAs, and 46 OAs. MAAs showed lower odds of pretreatment dropout than EAs (OR = 0.56, <i>p</i> = 0.025). EAs exhibited lowest treatment retention, with only 13% remaining in treatment at 104 weeks (<i>p</i> < 0.0001). Cox regression indicated that higher education was protective, with tertiary education reducing dropout risk (HR = 0.65, <i>p</i> = 0.038), whilst cocaine/crack use increased it (HR = 1.57, <i>p</i> = 0.017). Patients enrolled in more recent years had a higher risk of dropout whithin the first six months of treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emerging adulthood is a critical period for health interventions. The gender gap is narrowing amongst EAs, and women are still underrepresented in studies. We found very high pretreatment and treatment dropout rates amongst Emerging Adults in our sample. These findings underscore the necessity for early-stage risk stratification and intervention protocols for this subpopulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12791191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kim Laurendeau, Paquito Bernard, Florence Piché, Amal Abdel-Baki, Ahmed Jérôme Romain
Background and Hypothesis
In people with psychotic disorders, exercise is known to improve psychotic symptoms; however, the mechanisms underlying these effects are unclear. In the network approach, mental disorders are conceptualised as complex systems of interacting symptoms. In this context, exercise interventions could modify the dynamic of psychotic symptoms within the network. Using data from two independent clinical trials using exercise, the aim was to investigate the impact of exercise interventions on network connectivity, then compare the network structure pre and post intervention.
Study Design
Combined data from two clinical trials on exercise with a total of 106 participants with a diagnosis of psychotic disorder were included. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity using semi-structured interviews. Networks analyses were performed to compare before and after exercise.
Study Results
At baseline, the PANSS network was densely connected with several strong positive connections. Symptoms being most central were negative symptoms. After exercise, the network was less dense and less connected, and the connections were different. When the networks before and after exercise were compared, they were significantly different in terms of structure, but not global strength.
Conclusion
This study is the first to show that exercise seems to favour a disconnection between psychotic symptoms and could modify the network structure, providing a first mechanism of action which would require more investigation.
{"title":"The Impact of Exercise Interventions on the Network Structure of Psychotic Symptoms: Analysis From Two Clinical Trials","authors":"Kim Laurendeau, Paquito Bernard, Florence Piché, Amal Abdel-Baki, Ahmed Jérôme Romain","doi":"10.1111/eip.70124","DOIUrl":"10.1111/eip.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Hypothesis</h3>\u0000 \u0000 <p>In people with psychotic disorders, exercise is known to improve psychotic symptoms; however, the mechanisms underlying these effects are unclear. In the network approach, mental disorders are conceptualised as complex systems of interacting symptoms. In this context, exercise interventions could modify the dynamic of psychotic symptoms within the network. Using data from two independent clinical trials using exercise, the aim was to investigate the impact of exercise interventions on network connectivity, then compare the network structure pre and post intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Combined data from two clinical trials on exercise with a total of 106 participants with a diagnosis of psychotic disorder were included. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity using semi-structured interviews. Networks analyses were performed to compare before and after exercise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Results</h3>\u0000 \u0000 <p>At baseline, the PANSS network was densely connected with several strong positive connections. Symptoms being most central were negative symptoms. After exercise, the network was less dense and less connected, and the connections were different. When the networks before and after exercise were compared, they were significantly different in terms of structure, but not global strength.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study is the first to show that exercise seems to favour a disconnection between psychotic symptoms and could modify the network structure, providing a first mechanism of action which would require more investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Teya Petrova, Philippe Golay, Paul Klauser, Sandra Vieira, Inès Lepreux, Lora Bici, Boshra Razavi, Raoul Jenni, Nadir Mebdouhi, Martine Cleusix, Caroline Conchon, Lilith Abrahamyan Empson, Philippe Conus, Luis Alameda
Introduction
Early intervention services (EIS) in psychosis are the gold standard to treat patients after a first episode of psychosis (FEP). However, the understanding of the evolution and the long-term effects of such type of intervention is limited. This study aims to gain insight into the long-term evolution of physical and mental health, as well as the neurobiological outcomes of the patients treated for a FEP.
Methods
The Long-term Follow-up of TIPP (LOFT) is an up to 20-year study within a cohort of patients who completed a three-year EI treatment at Treatment and early Intervention in Psychosis Program (TIPP, in Lausanne, Switzerland) and went through a deep phenotyping prospective multimodal assessment. 720 patients will be contacted and asked to participate in LOFT. Once they are assessed they will be allocated to a timepoint at either 5 (+2), 10 (±2), 15 (±2), and 20 (−2) years after TIPP entry. A follow-up visit will be proposed every 5 years. All participants will be evaluated on psychopathological, functional, and physical health outcomes including metabolic disturbances. A subsample of the patients who previously took part in a biomarker research program (n = 168) whilst at TIPP will be invited to undergo additional assessments (cognition, brain imaging, biofluids collection). Both traditional group-level and machine learning analyses will be conducted.
Conclusion
Ethical approval has been obtained and recruitment started in 2024, and 111 participants have been recruited so far. LOFT will help reshape and redefine current interventions for subgroups of patients at risk of poorer long-term outcome and to understand the underlying neurobiological mechanisms influencing psychosis evolution.
{"title":"The Long-Term Follow-Up TIPP Project: LOFT Study Protocol, a 20-Year Prospective Study of Early Psychosis Patients","authors":"Teya Petrova, Philippe Golay, Paul Klauser, Sandra Vieira, Inès Lepreux, Lora Bici, Boshra Razavi, Raoul Jenni, Nadir Mebdouhi, Martine Cleusix, Caroline Conchon, Lilith Abrahamyan Empson, Philippe Conus, Luis Alameda","doi":"10.1111/eip.70127","DOIUrl":"10.1111/eip.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Early intervention services (EIS) in psychosis are the gold standard to treat patients after a first episode of psychosis (FEP). However, the understanding of the evolution and the long-term effects of such type of intervention is limited. This study aims to gain insight into the long-term evolution of physical and mental health, as well as the neurobiological outcomes of the patients treated for a FEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Long-term Follow-up of TIPP (LOFT) is an up to 20-year study within a cohort of patients who completed a three-year EI treatment at Treatment and early Intervention in Psychosis Program (TIPP, in Lausanne, Switzerland) and went through a deep phenotyping prospective multimodal assessment. 720 patients will be contacted and asked to participate in LOFT. Once they are assessed they will be allocated to a timepoint at either 5 (+2), 10 (±2), 15 (±2), and 20 (−2) years after TIPP entry. A follow-up visit will be proposed every 5 years. All participants will be evaluated on psychopathological, functional, and physical health outcomes including metabolic disturbances. A subsample of the patients who previously took part in a biomarker research program (<i>n</i> = 168) whilst at TIPP will be invited to undergo additional assessments (cognition, brain imaging, biofluids collection). Both traditional group-level and machine learning analyses will be conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ethical approval has been obtained and recruitment started in 2024, and 111 participants have been recruited so far. LOFT will help reshape and redefine current interventions for subgroups of patients at risk of poorer long-term outcome and to understand the underlying neurobiological mechanisms influencing psychosis evolution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12779809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel I. Shapiro, Rebecca E. Grattan, Jill R. Laquidara, Paula Wadell, Rachel S. Suk, Karina Muro, Ryan Shickman, Jessica Salmonsen, Valerie L. Tryon, Tyler Lesh, Rachel Loewy, Rebecca Canfield, Jessica Spark, Melissa J. Kerr, Barnaby Nelson, G. Paul Amminger, Patrick McGorry, Cameron Carter, Tara A. Niendam
Aim
This study assessed the feasibility of a stepped-care model for those at clinical high-risk for psychosis (CHRp) within a coordinated specialty care clinic in the United States.
Methods
Youth aged 12–30 completed a 12-month, three-step intervention where persistent or worsening symptoms received increasingly intensive treatment including Supportive Problem Solving, Cognitive Behavioural Case Management, and a Selective Serotonin Reuptake Inhibitor.
Results
Of 32 CHR youth admitted to the clinic over 18 months, 12 were eligible for the study, 10 consented (83.3% consent rate at 0.56 recruitment rate), eight participated, and five completed (62.5% completion rate). Reasons for ineligibility were mostly unrelated to the treatment, including disengagement before recruitment, pressing comorbid concerns that required other specialty care, and medication preferences. Those who completed treatment showed clinically significant improvements in social functioning, depression, and attenuated psychosis symptoms by 12-month follow-up, but sample size precluded statistical analysis. Three discontinued due to medication needs (more intensive care, perceived side effects).
Conclusions
This small preliminary study supports larger scale trials of stepped-care interventions for CHRp in the US, but also illuminates key features of the US healthcare system that must shape implementation. The stepped-care intervention appeared tolerable and feasible in those who were eligible and engaged; clinical outcomes were promising. Comorbid treatment needs in this heterogenous population, including medication needs/preferences, and disengagement during referral to psychosis specialty care precluded participation for many. Future studies should evaluate larger samples, account for needs and preferences for medication, and place screening and early steps in general outpatient mental health services to evaluate real-world effectiveness.
{"title":"Feasibility of a Stepped-Care Intervention for Those at Clinical High Risk for Psychosis in the United States","authors":"Daniel I. Shapiro, Rebecca E. Grattan, Jill R. Laquidara, Paula Wadell, Rachel S. Suk, Karina Muro, Ryan Shickman, Jessica Salmonsen, Valerie L. Tryon, Tyler Lesh, Rachel Loewy, Rebecca Canfield, Jessica Spark, Melissa J. Kerr, Barnaby Nelson, G. Paul Amminger, Patrick McGorry, Cameron Carter, Tara A. Niendam","doi":"10.1111/eip.70120","DOIUrl":"10.1111/eip.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study assessed the feasibility of a stepped-care model for those at clinical high-risk for psychosis (CHRp) within a coordinated specialty care clinic in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Youth aged 12–30 completed a 12-month, three-step intervention where persistent or worsening symptoms received increasingly intensive treatment including Supportive Problem Solving, Cognitive Behavioural Case Management, and a Selective Serotonin Reuptake Inhibitor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 32 CHR youth admitted to the clinic over 18 months, 12 were eligible for the study, 10 consented (83.3% consent rate at 0.56 recruitment rate), eight participated, and five completed (62.5% completion rate). Reasons for ineligibility were mostly unrelated to the treatment, including disengagement before recruitment, pressing comorbid concerns that required other specialty care, and medication preferences. Those who completed treatment showed clinically significant improvements in social functioning, depression, and attenuated psychosis symptoms by 12-month follow-up, but sample size precluded statistical analysis. Three discontinued due to medication needs (more intensive care, perceived side effects).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This small preliminary study supports larger scale trials of stepped-care interventions for CHRp in the US, but also illuminates key features of the US healthcare system that must shape implementation. The stepped-care intervention appeared tolerable and feasible in those who were eligible and engaged; clinical outcomes were promising. Comorbid treatment needs in this heterogenous population, including medication needs/preferences, and disengagement during referral to psychosis specialty care precluded participation for many. Future studies should evaluate larger samples, account for needs and preferences for medication, and place screening and early steps in general outpatient mental health services to evaluate real-world effectiveness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amelia Sim, Quek Mable Jing Ting, Yi Lun Tay, Suying Ang, Donald Addington, Charmaine Tang, Swapna Verma
Background
Fidelity assessments are crucial for ensuring evidence-based delivery of first episode psychosis (FEP) services. The First Episode Psychosis Services Fidelity Scale (FEPS-FS) is a validated tool for evaluating FEP programmes, but its application in Asian contexts remains unexplored. This study applies and adapts the FEPS-FS to evaluate Singapore's Early Psychosis Intervention Programme (EPIP) in 2024, examining its contextual applicability within Singapore's healthcare framework.
Methods
Fidelity was assessed at EPIP through programme data analysis, health record reviews, and interviews with staff, patients, and families. Three evaluators scored 37 items on a five-point scale, with ratings determined by consensus. Two items were selectively added from an earlier FEPS-FS version to address local contexts. Items rated ≤ 3 indicated areas needing attention. The FRAME methodology documented adaptations for local challenges, particularly in weight management and substance use interventions.
Results
EPIP demonstrated high fidelity to evidence-based FEP practices, particularly in programme structure and clinical processes. Twenty items achieved maximum ratings, including team integration, family engagement, and clozapine adherence. Lower ratings (≤ 3) identified gaps in participant ratios, psychiatrist caseload, and medication practices. Five items, primarily related to psychological and occupational therapies and substance use interventions, were unscored due to documentation differences, highlighting the need for tailored adaptations.
Conclusion
This study demonstrates EPIP's strong adherence to evidence-based practices while highlighting areas for improvement, particularly in resource allocation and documentation. The findings underscore the need for culturally sensitive adaptations of fidelity measures and innovative solutions to address challenges in early psychosis services within Asian healthcare systems. Future research should focus on developing structured documentation systems that balance standardisation with personalised care and explore strategies to enhance metabolic health interventions and substance use management in the local context.
{"title":"Adapting the First Episode Psychosis Services Fidelity Scale in Asia: A Comprehensive Evaluation of Singapore's Early Psychosis Intervention Programme","authors":"Amelia Sim, Quek Mable Jing Ting, Yi Lun Tay, Suying Ang, Donald Addington, Charmaine Tang, Swapna Verma","doi":"10.1111/eip.70131","DOIUrl":"https://doi.org/10.1111/eip.70131","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fidelity assessments are crucial for ensuring evidence-based delivery of first episode psychosis (FEP) services. The First Episode Psychosis Services Fidelity Scale (FEPS-FS) is a validated tool for evaluating FEP programmes, but its application in Asian contexts remains unexplored. This study applies and adapts the FEPS-FS to evaluate Singapore's Early Psychosis Intervention Programme (EPIP) in 2024, examining its contextual applicability within Singapore's healthcare framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fidelity was assessed at EPIP through programme data analysis, health record reviews, and interviews with staff, patients, and families. Three evaluators scored 37 items on a five-point scale, with ratings determined by consensus. Two items were selectively added from an earlier FEPS-FS version to address local contexts. Items rated ≤ 3 indicated areas needing attention. The FRAME methodology documented adaptations for local challenges, particularly in weight management and substance use interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>EPIP demonstrated high fidelity to evidence-based FEP practices, particularly in programme structure and clinical processes. Twenty items achieved maximum ratings, including team integration, family engagement, and clozapine adherence. Lower ratings (≤ 3) identified gaps in participant ratios, psychiatrist caseload, and medication practices. Five items, primarily related to psychological and occupational therapies and substance use interventions, were unscored due to documentation differences, highlighting the need for tailored adaptations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates EPIP's strong adherence to evidence-based practices while highlighting areas for improvement, particularly in resource allocation and documentation. The findings underscore the need for culturally sensitive adaptations of fidelity measures and innovative solutions to address challenges in early psychosis services within Asian healthcare systems. Future research should focus on developing structured documentation systems that balance standardisation with personalised care and explore strategies to enhance metabolic health interventions and substance use management in the local context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.70131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adolescents recruited from clinical samples with borderline personality disorder (BPD) often experience significant functional impairment across multiple domains. Evidence indicates that borderline personality features emerging before adulthood can predict long-term difficulties and may worsen over time. However, the role of assessment methods and the impact of psychological interventions on functional outcomes remain unclear.
Methods
A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to evaluate the impact of psychological interventions on functioning in adolescents and young adults with BPD features. Four databases (PsycINFO, Medline, Embase and CINAHL) were searched up to June 2023.
Results
From 1859 identified studies, seven trials (N = 657) met the inclusion criteria. Across studies, psychological interventions were associated with improvements in functioning from baseline to both post-treatment and final follow-up. However, when comparing specialised psychological interventions to generalist treatment as usual (TAU), differences were not statistically significant. Effect sizes were small at post-treatment (SMD = 0.13, 95% CI = [−0.05, 0.31]) and remained small at final follow-up (SMD = 0.12, 95% CI = [−0.08, 0.33]). Substantial heterogeneity was observed across studies, and risk of bias was noted in several trials, with only two studies rated as low risk.
Conclusions
The findings suggest that both specialised psychological interventions and generalist interventions yield similar outcomes in terms of functional improvement. These results have implications for clinical service design and underscore the importance of addressing the needs of this underrepresented population. More high-quality, large-scale trials are needed to strengthen the evidence base.
目的：从边缘型人格障碍（BPD）的临床样本中招募的青少年经常在多个领域经历显著的功能障碍。有证据表明，在成年之前出现的边缘性人格特征可以预测长期的困难，并可能随着时间的推移而恶化。然而，评估方法的作用和心理干预对功能结果的影响仍不清楚。方法对随机对照试验（RCTs）进行系统回顾和荟萃分析，评估心理干预对具有BPD特征的青少年和青壮年功能的影响。检索到2023年6月为止的四个数据库（PsycINFO、Medline、Embase和CINAHL）。结果在1859项纳入的研究中，有7项试验（N = 657）符合纳入标准。在所有研究中，心理干预与从基线到治疗后和最终随访的功能改善有关。然而，当比较专业心理干预与一般治疗（TAU）时，差异没有统计学意义。治疗后的效应量较小（SMD = 0.13, 95% CI =[−0.05,0.31]），在最终随访时仍然较小（SMD = 0.12, 95% CI =[−0.08,0.33]）。研究中观察到大量的异质性，并且在几个试验中注意到偏倚风险，只有两个研究被评为低风险。结论：研究结果表明，在功能改善方面，专业心理干预和通才干预的结果相似。这些结果对临床服务设计具有启示意义，并强调了解决这一代表性不足人群需求的重要性。需要更多高质量、大规模的试验来加强证据基础。
{"title":"The Impact of Psychological Interventions on Functioning in the Context of Borderline Personality Disorder Features for Adolescents and Young Adults: A Systematic Review and Meta-Analysis","authors":"Benjamin D. Brandrett, Ruchika Gajwani","doi":"10.1111/eip.70112","DOIUrl":"https://doi.org/10.1111/eip.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Adolescents recruited from clinical samples with borderline personality disorder (BPD) often experience significant functional impairment across multiple domains. Evidence indicates that borderline personality features emerging before adulthood can predict long-term difficulties and may worsen over time. However, the role of assessment methods and the impact of psychological interventions on functional outcomes remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to evaluate the impact of psychological interventions on functioning in adolescents and young adults with BPD features. Four databases (PsycINFO, Medline, Embase and CINAHL) were searched up to June 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1859 identified studies, seven trials (<i>N</i> = 657) met the inclusion criteria. Across studies, psychological interventions were associated with improvements in functioning from baseline to both post-treatment and final follow-up. However, when comparing specialised psychological interventions to generalist treatment as usual (TAU), differences were not statistically significant. Effect sizes were small at post-treatment (SMD = 0.13, 95% CI = [−0.05, 0.31]) and remained small at final follow-up (SMD = 0.12, 95% CI = [−0.08, 0.33]). Substantial heterogeneity was observed across studies, and risk of bias was noted in several trials, with only two studies rated as low risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggest that both specialised psychological interventions and generalist interventions yield similar outcomes in terms of functional improvement. These results have implications for clinical service design and underscore the importance of addressing the needs of this underrepresented population. More high-quality, large-scale trials are needed to strengthen the evidence base.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"20 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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