Early Intervention in Psychiatry最新文献

Aim: Accurate and appropriate cognitive screening can significantly enhance early psychosis care, yet no screening tools have been validated for the early psychosis population and little is known about current screening practices, experiences, or factors that may influence implementation. CogScreen is a hybrid type 1 study aiming to validate two promising screening tools with young people with first episode psychosis (primary aim) and to understand the context for implementing cognitive screening in early psychosis settings (secondary aim). This protocol outlines the implementation study, which aims to explore the current practices, acceptability, feasibility and determinants of cognitive screening in early psychosis settings from the perspective of key stakeholders.

Methods: Young people with first episode psychosis (n = 350), caregivers (minimum n = 10) and service providers (minimum n = 12) will be recruited from primary and specialist early psychosis services in Melbourne, Adelaide and Sydney, Australia. Two implementation science frameworks will inform data collection and analysis: the Theoretical Framework of Acceptability and the Consolidated Framework for Implementation Research. A mixed-methods design will be employed to collect and analyse data from questionnaires with young people, interviews with all stakeholder groups, and administrative processes. Quantitative data will be analysed using descriptive statistics. Qualitative data will be analysed through content analysis using deductive and inductive coding.

Results and discussion: This protocol paper presents the rationale and methods for the CogScreen implementation study.

Conclusion: Together with accuracy findings, results from the implementation study will provide insights about the practices, experiences, enablers and barriers to cognitive screening in early psychosis services.

Introduction: Research with integrated youth mental health services (IYMHS) has been criticised for low quality, with difficulties in recruiting and retaining participants in studies which can introduce bias. This feasibility study aimed to investigate the "real-world research" barriers and facilitators to recruitment and retention arising in a longitudinal study with Jigsaw, the National Centre for Youth Mental Health in Ireland, and to provide recommendations for conducting IYMHS research in future.

Methods: A qualitative study was conducted to investigate recruitment and retention difficulties. Participants were young people attending Jigsaw (n = 14) and members of clinical staff (n = 29), who provided feedback on facilitators and barriers to recruiting and retaining participants in a wider youth mental health intervention study. Data were collected via online surveys. Content analysis was conducted on the findings.

Results: Facilitators included the prosocial motivation of young people to support others through research, providing incentives for participants, clear communication and information sharing, and the supportive role of parents/guardians. Identified barriers included the timing of recruitment, communication difficulties, gatekeeping, and reluctance to participate in research. Suggestions provided to address barriers in future were integrating research teams into services, addressing communication difficulties, and timing the recruitment of youth participants appropriately.

Conclusion: Where possible, IYMHS should conduct research in person in services to improve communication and reduce gatekeeping. In addition, services should consider remunerating participating young people in research and involve parents/guardians when designing research in this context.

Background: It has been over 20 years since a review of early psychosis services in New Zealand was completed, and it is unclear if services now meet international best practice. Furthermore, significant disparities in psychosis experiences exist in New Zealand, and it is unclear whether service structure might contribute to such disparities. Given the current restructuring of the health system in New Zealand, now is the optimal time to understand strengths and weaknesses in early psychosis care provision.

Methods: All early psychosis services in New Zealand (n = 12) were surveyed. Leads from each service completed a survey on the general elements of their service, alongside the First-Episode Psychosis Services Fidelity Scale, which allows comparison with international early psychosis services.

Results: Specific services are provided across 11/20 districts, leaving 9 without any dedicated early psychosis care. Service strengths included short wait lists, comprehensive assessments, good provision of case managers, team managers and psychiatrists and good length of care. Relative weaknesses included provision of therapy, limited age ranges, high numbers of inpatient referrals, poor Clozapine usage and limited family participation. There was also a lack of services for people at risk for psychosis. Lack of cultural support staff, models and confidence in meeting cultural needs was also evident.

Conclusion: While New Zealand early psychosis services are relatively comparable to international services, certain areas of weakness need to be addressed by decreasing variability in service eligibility, increasing care for those at-risk, wider availability of therapy and family involvement and improved cultural services.

Aim: Studies have shown that people experiencing early phase psychosis (EPP) are at increased risk for criminal conviction and incarceration. However, there is limited data looking at overall legal burden. To address these gaps in the literature, the goal of this study was to categorise criminal charges and convictions using the United States Federal Bureau of Investigation (FBI) uniform crime reporting (UCR) program, assess frequency of incarcerations, and describe the frequency of substance use disorder (SUD) diagnoses and its relationship to criminal offending and incarceration in a well categorised EPP population.

Methods: A sample of 309 adults experiencing EPP were enrolled in a specialty care clinic. The research team expanded upon prior work and collected data from three public databases to identify legal burden in this population.

Results: Almost 50% (n = 155) of subjects had a history of a criminal charge, 34% (n = 104) of subjects had a history of criminal conviction, and 40% (n = 123) of subjects had at least one incarceration event. The most common typology of criminal offence were crimes against society. Lastly, a dual diagnosis was statistically associated with incarcerations (χ² = 10.152, p < 0.0011), crimes against society (χ² = 13.172, p < 0.0002), and crimes against persons (χ² = 9.136, p < 0.0023).

Conclusions: These data highlight the high legal burden people experiencing EPP face and the need for future work to examine the risks incarceration places on this population. This work also shows the need for specialty care clinics managing EPP to be proficient in treating a dual diagnosis or the need to partner with an appropriate clinic.

Objective: Early intervention in psychosis is associated with favourable outcomes. We investigated whether loved ones' illness duration moderated caregiver outcomes following a Cognitive Behavioural Therapy-informed Family Intervention for psychosis (FIp).

Methods: We conducted a secondary analysis of measures of FIp participants' depression and anxiety symptoms, caregiver appraisals, expressed emotion and foundational psychotherapeutic competencies at pre-, post- and 4-month follow-up. Our primary aim was to evaluate whether duration of illness moderated participant outcomes.

Results: Relative to pre-intervention, all caregivers reported lower depression, anxiety and expressed emotion, as well as higher positive attitudes and mastery of cognitive behavioural skills, at post-intervention and 4-month follow-up. Outcomes were not moderated by their loved one's illness duration.

Conclusion: Families may benefit equally from FIp regardless of illness duration. Although we recommend that FIp are offered as early as possible, modifications for families with lengthier illness courses are not implicated by our findings.

Introduction: A key factor influencing the duration of untreated psychosis is that young individuals typically do not seek help during their initial psychotic experiences. This online study aimed to explore the efficacy of preventive video interventions providing information on psychosis on the attitudes towards seeking mental health care among young adults from the general population.

Methods: Participants (N = 147) were randomised to one of the following online conditions: a short 3-min video of an empowered patient or of a psychiatrist describing different aspects of mental illness, a short control video or no video. Then, participants answered the Inventory of Attitudes to Seeking Mental Health Services (IARSSM) to measure attitudes towards seeking mental health.

Results: A Kruskal-Wallis one-way ANOVA on the total IARSSM score revealed no significant effect of the group on attitude towards mental health care (χ2₍₃₎ = 6.52, p = 0.09). A small but statistically significant effect was found for the IARSSM factor "indifference to stigma" (χ2₍₃₎ = 8.50, p = 0.04), with slightly lower levels of indifference to stigma in the patient video group (M = 20.5, SD = 6.50) compared to the psychiatry video group (M = 24.5, SD = 4.35).

Conclusion: Emphasising nonconformity with mental health stereotypes, portraying positive aspects and utilising short video formats on social media platforms can potentially reduce stigma in the short term. Long-term effectiveness and identification of specific factors optimising attitudes towards mental health help-seeking warrant further investigation.

We argue that while a substantial proportion of emerging adults are in post-secondary education, there is relatively little consideration of this context within research and policy around youth mental health. The unique challenges young adults face in post-secondary education overlay underlying risk factors experienced by emerging adults. While post-secondary education facilitates social mobility, it also introduces stressors such as academic demands, financial insecurity and social isolation. As we increasingly appreciate the social determinants of mental health and the influence of institutional systems, understanding the post-secondary context offers promise in transforming mental health in emerging adulthood. There are pockets of great practice. However, we argue that targeted efforts are now needed to bring together students, practitioners, policymakers and researchers to drive evidence-informed improvements in mental health within the post-secondary context.

Aims: Research on family functioning in psychosis has typically focused on specific family-related factors and their impact on symptomatology, finding strong associations between high expressed emotion and poor outcomes, especially in those with long-term illness. The objective of this review is to examine the impact of a broad range of family-related factors and their relationship with clinical, social, occupational and relational outcomes in first-episode psychosis (FEP).

Method: A systematic search of databases PsycInfo, Pubmed, Embase and CINHAL between 1990 and August 2023 was completed. In total, 1408 articles were screened, and study quality was assessed using the JBI critical appraisal checklists for analytical cross-sectional studies and cohort studies. A narrative synthesis approach was used to analyse the data.

Results: Of the 1408 identified articles, 80 full-text articles were screened. Fifteen studies were included for data extraction. The objectives and scope of the selected studies varied considerably. Studies consisted of cross-sectional and prospective cohort designs. Participants consisted of FEP patients and family members, with the patient age range varying from 15.9 to 30.8 (MD = 24.5). Significant associations were identified between family factors (high EE, family environment and carer burden) and symptom and social outcomes.

Discussion: While findings emphasised the significant impact of family factors on symptomatic and social outcomes, the literature had significant limitations due to the absence of underlying theoretical models and understanding of the dynamics of distress in families within FEP. Future research should seek to develop a model accounting for such processes.

Aim: This study aimed to examine patient perceived reasons for thinking about suicide among individuals with first-episode psychosis (FEP).

Methods: Participants completed a baseline assessment followed by 28 days of ecological momentary assessment (EMA). Baseline measures assessed lifetime suicidal ideation and reasons for thinking about suicide. EMA items assessed real-time suicidal ideation and reasons for thinking about suicide.

Results: The average number of lifetime reasons for thinking about suicide was 11.47 ± 5.99, with the most commonly endorsed reasons being to get away or escape (81.6%), to stop bad feelings (71.1%), and to relieve feelings of aloneness, emptiness or isolation (57.9%). Only 31.6% of participants endorsed positive symptoms as a lifetime reason for thinking about suicide. EMA results were consistent with lifetime data. Participants typically endorsed multiple reasons (2.15 ± 0.71), with the desire to escape and to stop bad feelings being the most commonly endorsed items. Psychosis was endorsed as a reason for thinking about suicide during 16.3% of instances of ideation during EMA.

Conclusion: These findings highlight the multi-faceted nature of suicide risk in psychosis. Interestingly, positive symptoms were not frequently endorsed as reasons for thinking about suicide from the patient's perspective. Further research is needed to identify when and for whom positive symptoms contribute to suicide risk. Additionally, our results identify important risk factors for further study, namely the desire to escape and/or stop bad feelings.

Introduction: Chronotypes and perceived stress can predict psychiatric symptoms and affect sleep quality, though the relationships between these factors are not completely described. This study explores the influence of chronotypes and perceived stress on sleep quality among undergraduates.

Methods: An online survey was administered to a convenience sample of 110 undergraduates aged 18-23 years (mean age 20.32 ± 1.00) at a university in southern Taiwan, predominantly women and senior students. Three self-reporting instruments were used: the Munich Chronotype Questionnaire, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index. Multivariate regression analysis was performed to investigate the influence of chronotype and perceived stress on sleep quality in undergraduates.

Results: Sixty-one per cent of the respondents were poor-quality sleepers. Moreover, 85.5% of the respondents were classified as "neither" chronotype, whereas 13.6% were "evening" chronotype. Sleep quality was associated with both chronotype and perceived stress level (r = 0.41, 0.43, p < 0.01). Multiple regression revealed higher MCTQ scores (continuous or categorical) and higher perceived stress were significantly associated with poorer sleep quality, explaining approximately 30% of the variance (p < 0.001).

Conclusions: The findings of this study showed evening-type undergraduates with higher perceived stress exhibited poorer sleep quality. Highlight the importance of considering chronotype in health promotion among individuals transitioning to adulthood. Early interventions may help align an individual's chronotype with their external time schedule, mitigate the negative impacts of misaligned later chronotypes, enhance sleep quality, and help to manage perceived stress levels in undergraduates.