Early Intervention in Psychiatry最新文献_第2页

Adaptation of Narrative Enhancement and Cognitive Therapy for Youth Receiving Services for a First Episode of Psychosis 初次精神病青少年接受服务的叙事增强与认知治疗的适应。

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2026-01-06 DOI: 10.1111/eip.70130

Philip T. Yanos, Evan J. Myers, Joseph S. DeLuca, Sheharyar Hussain, Courtney N. Wiesepape, Lorelei Wilkey, Bethany L. Leonhardt

Purpose

There is evidence that anticipated and self-stigma are associated with decreased engagement in first episode psychosis (FEP) treatment. It is therefore plausible that addressing stigma in FEP treatment could potentially improve treatment engagement and facilitate outcomes related to recovery. Narrative Enhancement and Cognitive Therapy (NECT) is a structured group-based intervention that has been found to be effective at reducing self-stigma among persons diagnosed with severe mental illnesses in multiple RCTs; however, a review of the manual determined that it was not appropriate for use with people with FEP in its standard form. The purpose of the present study was to adapt NECT for FEP youth and determine its acceptability/feasibility.

Basic Procedures

We discuss the process of manual adaptation, including: optimising fidelity, optimising fit, balancing fidelity and fit, and pilot testing. Acceptability and feasibility were assessed as a function of treatment fidelity, attendance, and treatment satisfaction in an initial implementation (using a modified version of the Narrative Evaluation of Intervention Interview [NEII]). A case example of a group implementation is also presented.

Main Findings

Mean overall fidelity ratings were good (4.33 on a 1–5 scale); among the three participants who attended at least one session, attendance was acceptable, with 77.8% of scheduled meetings attended. Findings from the NEII revealed that all participants perceived benefit from the intervention.

Principal Conclusions

Findings supported the potential acceptability and feasibility of the adapted form of NECT geared towards youth who have experienced FEP (NECT-YA).

目的：有证据表明，预期和自我耻辱与首次发作精神病（FEP）治疗的参与度下降有关。因此，解决FEP治疗中的耻辱感可能会潜在地提高治疗参与度，并促进与康复相关的结果，这是合理的。叙事增强和认知疗法（NECT）是一种结构化的基于群体的干预措施，在多个随机对照试验中被发现可有效减少严重精神疾病患者的自我耻辱感；然而，对手册的审查确定它不适合以标准形式与FEP患者一起使用。本研究的目的是使NECT适用于FEP青年，并确定其可接受性/可行性。基本程序：我们讨论了人工适应的过程，包括：优化保真度，优化拟合，平衡保真度和拟合，以及试点测试。可接受性和可行性被评估为治疗保真度、出勤率和初始实施治疗满意度的函数（使用干预访谈叙事评估[NEII]的修改版本）。并给出了一个组实现的实例。主要发现：平均整体保真度评分良好（1-5评分为4.33）；在至少参加过一次会议的三名参与者中，出席率是可以接受的，77.8%的预定会议出席了会议。NEII的研究结果显示，所有参与者都从干预中获益。主要结论：研究结果支持了针对经历过FEP的青年（NECT- ya）的适应形式的NECT的潜在可接受性和可行性。

{"title":"Adaptation of Narrative Enhancement and Cognitive Therapy for Youth Receiving Services for a First Episode of Psychosis","authors":"Philip T. Yanos, Evan J. Myers, Joseph S. DeLuca, Sheharyar Hussain, Courtney N. Wiesepape, Lorelei Wilkey, Bethany L. Leonhardt","doi":"10.1111/eip.70130","DOIUrl":"10.1111/eip.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>There is evidence that anticipated and self-stigma are associated with decreased engagement in first episode psychosis (FEP) treatment. It is therefore plausible that addressing stigma in FEP treatment could potentially improve treatment engagement and facilitate outcomes related to recovery. Narrative Enhancement and Cognitive Therapy (NECT) is a structured group-based intervention that has been found to be effective at reducing self-stigma among persons diagnosed with severe mental illnesses in multiple RCTs; however, a review of the manual determined that it was not appropriate for use with people with FEP in its standard form. The purpose of the present study was to adapt NECT for FEP youth and determine its acceptability/feasibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Basic Procedures</h3>\u0000 \u0000 <p>We discuss the process of manual adaptation, including: optimising fidelity, optimising fit, balancing fidelity and fit, and pilot testing. Acceptability and feasibility were assessed as a function of treatment fidelity, attendance, and treatment satisfaction in an initial implementation (using a modified version of the Narrative Evaluation of Intervention Interview [NEII]). A case example of a group implementation is also presented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Findings</h3>\u0000 \u0000 <p>Mean overall fidelity ratings were good (4.33 on a 1–5 scale); among the three participants who attended at least one session, attendance was acceptable, with 77.8% of scheduled meetings attended. Findings from the NEII revealed that all participants perceived benefit from the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Conclusions</h3>\u0000 \u0000 <p>Findings supported the potential acceptability and feasibility of the adapted form of NECT geared towards youth who have experienced FEP (NECT-YA).</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910962","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}

引用次数: 0

A Longitudinal Study of Bidirectional Relationships Between Multiple Unhealthy Lifestyles and Psychotic-Like Experiences in Adolescents 青少年多种不健康生活方式与类精神病经历双向关系的纵向研究。

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2026-01-06 DOI: 10.1111/eip.70128

Dan Chen, Yifan Zhang, Haoxian Ye, Luowei Bu, Yukai Li, Huanhuan Chen, Dongfang Wang, Fang Fan

Purpose

Unhealthy lifestyles often co-occur and are associated with psychotic-like experiences (PLEs). Nevertheless, longitudinal research simultaneously incorporating multiple unhealthy lifestyles to explore their associations with PLEs remains limited.

Methods

The longitudinal survey was conducted at baseline from December 17 to 12, 2021 (Time 1, T1) and 6 months later from May 17 to June 5, 2022 (Time 2, T2), including 27 260 adolescents (M_age = 14.3 [1.5] years; 47.8% of females). The 8-item Positive Subscale of the Community Assessment of Psychic Experiences was used to assess PLE. Five lifestyles (i.e., sleep duration, physical activity, smoking, alcohol use, and BMI) were included, each classified as healthy or unhealthy, and the number of unhealthy lifestyles was summed into cumulative unhealthy lifestyles (at each assessment). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Baseline unhealthy lifestyles, including poor sleep duration, physical inactivity, smoking, alcohol use, and abnormal BMI, significantly increased the risk of PLEs 6 months later. Conversely, baseline PLEs also affect the four unhealthy lifestyles 6 months later, excluding abnormal BMI. Moreover, cumulative unhealthy lifestyles were associated with PLEs 6 months later, with the impact increasing as the cumulative lifestyle numbers increased. Conversely, individuals with PLEs would be most likely to experience more unhealthy lifestyles 6 months later.

Conclusion

The relationships between multiple unhealthy lifestyles and PLEs among adolescents were bidirectional, even after adjusting for confounders. Therefore, it is essential to promote healthy lifestyles and prevent PLEs simultaneously, so as to break the potential vicious cycle between the two.

目的：不健康的生活方式经常同时发生，并与类精神病经历（ple）相关。然而，同时纳入多种不健康生活方式以探索其与ple之间关系的纵向研究仍然有限。方法：于基线时间2021年12月17日至12日（时间1，T1）和6个月后的2022年5月17日至6月5日（时间2，T2）进行纵向调查，包括27 260名青少年（年龄14.3[1.5]岁，女性占47.8%）。采用社区心理体验评估的8项积极分量表对PLE进行评估。包括五种生活方式（即睡眠时间、身体活动、吸烟、饮酒和BMI），每种生活方式被分类为健康或不健康，不健康生活方式的数量被汇总为累积的不健康生活方式（每次评估）。Logistic回归模型用于估计优势比（ORs）和95%置信区间（ci）。结果：基线不健康的生活方式，包括睡眠时间不足、缺乏身体活动、吸烟、饮酒和BMI异常，在6个月后显著增加了ple的风险。相反，基线ple在6个月后也会影响四种不健康的生活方式，不包括异常的BMI。此外，累积的不健康生活方式与6个月后的ple相关，且随着累积生活方式数量的增加，其影响越来越大。相反，有ple的人在6个月后最有可能经历更不健康的生活方式。结论：多种不健康生活方式与青少年生命周期的关系是双向的，即使在调整混杂因素后也是如此。因此，提倡健康的生活方式和预防ple是必要的，以打破两者之间潜在的恶性循环。

{"title":"A Longitudinal Study of Bidirectional Relationships Between Multiple Unhealthy Lifestyles and Psychotic-Like Experiences in Adolescents","authors":"Dan Chen, Yifan Zhang, Haoxian Ye, Luowei Bu, Yukai Li, Huanhuan Chen, Dongfang Wang, Fang Fan","doi":"10.1111/eip.70128","DOIUrl":"10.1111/eip.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Unhealthy lifestyles often co-occur and are associated with psychotic-like experiences (PLEs). Nevertheless, longitudinal research simultaneously incorporating multiple unhealthy lifestyles to explore their associations with PLEs remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The longitudinal survey was conducted at baseline from December 17 to 12, 2021 (Time 1, T1) and 6 months later from May 17 to June 5, 2022 (Time 2, T2), including 27 260 adolescents (M<sub>age</sub> = 14.3 [1.5] years; 47.8% of females). The 8-item Positive Subscale of the Community Assessment of Psychic Experiences was used to assess PLE. Five lifestyles (i.e., sleep duration, physical activity, smoking, alcohol use, and BMI) were included, each classified as healthy or unhealthy, and the number of unhealthy lifestyles was summed into cumulative unhealthy lifestyles (at each assessment). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline unhealthy lifestyles, including poor sleep duration, physical inactivity, smoking, alcohol use, and abnormal BMI, significantly increased the risk of PLEs 6 months later. Conversely, baseline PLEs also affect the four unhealthy lifestyles 6 months later, excluding abnormal BMI. Moreover, cumulative unhealthy lifestyles were associated with PLEs 6 months later, with the impact increasing as the cumulative lifestyle numbers increased. Conversely, individuals with PLEs would be most likely to experience more unhealthy lifestyles 6 months later.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The relationships between multiple unhealthy lifestyles and PLEs among adolescents were bidirectional, even after adjusting for confounders. Therefore, it is essential to promote healthy lifestyles and prevent PLEs simultaneously, so as to break the potential vicious cycle between the two.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910967","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}

引用次数: 0

Adjunct Contingency Management for Youth With Substance Use and Psychosis Engaged in Community-Based Coordinated Specialty Care 青少年物质使用和精神病参与社区协调专科护理辅助应急管理

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2026-01-06 DOI: 10.1111/eip.70126

Sarosh Khan, Agata Bereznicka, Hannah E. Brown, Anne Berrigan, Christian Wulff, Ellen Reagan, Amy M. Yule

Aim

To examine the feasibility of contingency management (CM) within a community-based coordinated specialty care (CSC) program for youth with psychosis and substance use.

Methods

A modified form of CM, targeting treatment engagement and prosocial behaviour, was offered as a points-based rewards program. In phase 1, youth could earn up to 15 points (equivalent to $15) per week for activities which promoted greater treatment engagement or pro-social activities. After reaching $75 in rewards, participants entered a phase 2 raffle program.

Results

In the first 6 months of adjunct CM, 12 out of 31 youth (39%) agreed to participate in it. Most of the youth (N = 10) earned points in phase 1, and 2 youth reached phase 2.

Conclusion

CM is feasible to implement in a community based-CSC program for youth with psychosis and substance use, although further work is needed to identify strategies to increase participation and engagement with this intervention.

目的探讨在以社区为基础的协调专科护理（CSC）计划中对青少年精神病和物质使用的应急管理（CM）的可行性。方法一种改良的CM形式，针对治疗参与和亲社会行为，作为基于积分的奖励计划提供。在第一阶段，青少年每周可以通过促进更多的治疗参与或亲社会活动获得最多15分（相当于15美元）。在获得75美元的奖励后，参与者进入第二阶段的抽奖活动。结果在辅助CM治疗的前6个月，31名青少年中有12名（39%）同意参加辅助CM治疗。大部分青年（N = 10）在阶段1中获得积分，2名青年进入阶段2。结论：CM在以社区为基础的青少年精神病和药物使用csc项目中实施是可行的，尽管需要进一步的工作来确定增加参与和参与这种干预的策略。

{"title":"Adjunct Contingency Management for Youth With Substance Use and Psychosis Engaged in Community-Based Coordinated Specialty Care","authors":"Sarosh Khan, Agata Bereznicka, Hannah E. Brown, Anne Berrigan, Christian Wulff, Ellen Reagan, Amy M. Yule","doi":"10.1111/eip.70126","DOIUrl":"https://doi.org/10.1111/eip.70126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To examine the feasibility of contingency management (CM) within a community-based coordinated specialty care (CSC) program for youth with psychosis and substance use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A modified form of CM, targeting treatment engagement and prosocial behaviour, was offered as a points-based rewards program. In phase 1, youth could earn up to 15 points (equivalent to $15) per week for activities which promoted greater treatment engagement or pro-social activities. After reaching $75 in rewards, participants entered a phase 2 raffle program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the first 6 months of adjunct CM, 12 out of 31 youth (39%) agreed to participate in it. Most of the youth (<i>N</i> = 10) earned points in phase 1, and 2 youth reached phase 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CM is feasible to implement in a community based-CSC program for youth with psychosis and substance use, although further work is needed to identify strategies to increase participation and engagement with this intervention.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909357","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}

引用次数: 0

Preliminary Findings From an Augmented Reality (AR) App Delivering Recovery-Oriented Cognitive Therapy for Negative Symptoms in Schizophrenia 增强现实（AR）应用程序为精神分裂症阴性症状提供康复导向的认知治疗的初步发现。

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2026-01-06 DOI: 10.1111/eip.70119

Sunny X. Tang, Moein Foroughi, Aaron P. Brinen, Michael L. Birnbaum, Sarah A. Berretta, Leily M. Behbehani, John M. Kane, Edward Yoon, William F. Cronin

Background

NST-SPARK is a novel digital therapeutic targeting negative symptoms in schizophrenia spectrum disorders (SSD). It is a smartphone application delivering recovery-oriented cognitive therapy (CT-R), via gamified augmented reality (AR) experiences. The primary objective was to determine the acceptability and feasibility of a single-session prototype. Secondary objectives were to generate descriptive findings for changes in defeatist beliefs, self-esteem and attitudes toward goal-oriented activities.

Methods

Twenty participants with schizophrenia or schizoaffective disorder enrolled. Participants completed self-reports on the acceptability and feasibility of NST-SPARK v.1.5 and provided open-ended feedback. Self-report scales on defeatist beliefs, self-esteem and attitudes toward goal-oriented activities were completed before and after participants were introduced to NST-SPARK, and at 1-week follow-up.

Results

Participants found NST-SPARK to be feasible and acceptable, with an average response of ‘Agree’, indicating that the intervention met with the participants' approval and seemed implementable. Almost all participants (19 of 20) used the app on their own prior to the 1-week follow up despite not being incentivised. We also observed changes in defeatist beliefs, self-esteem and attitudes toward goal attainment consistent with intended improvements in these targeted areas. Participants made substantive progress toward identified goals in 90% of cases. The most common positive feedback was appreciation that the app got them going, and the most common negative feedback pointed out technical aspects that did not function properly.

Conclusions

This preliminary, single-arm, unblinded study of a single-module prototype for NST-SPARK found that the approach is generally acceptable and feasible for people with SSD and negative symptoms.

背景：NST-SPARK是一种针对精神分裂症谱系障碍（SSD）阴性症状的新型数字治疗方法。这是一款智能手机应用程序，通过游戏化的增强现实（AR）体验，提供以康复为导向的认知治疗（CT-R）。主要目标是确定单会话原型的可接受性和可行性。次要目标是对失败主义信念、自尊和对目标导向活动的态度的变化产生描述性的发现。方法：纳入20名精神分裂症或分裂情感性障碍患者。参与者完成关于NST-SPARK v.1.5的可接受性和可行性的自我报告，并提供开放式反馈。失败主义信念、自尊和对目标导向活动的态度的自我报告量表在参与者引入NST-SPARK之前和之后以及一周的随访中完成。结果：参与者认为NST-SPARK是可行和可接受的，平均回答为“同意”，表明该干预措施得到了参与者的认可，似乎是可以实施的。几乎所有的参与者（20人中有19人）在1周的随访前都自己使用了这款应用，尽管没有得到奖励。我们还观察到失败主义信念、自尊和对目标实现的态度的变化，这些变化与这些目标领域的预期改善相一致。在90%的情况下，参与者在实现既定目标方面取得了实质性进展。最常见的正面反馈是对应用的赞赏，而最常见的负面反馈则是指出技术方面的问题。结论：这项针对NST-SPARK单模块原型的初步、单臂、非盲法研究发现，该方法对于SSD和阴性症状患者通常是可接受和可行的。

{"title":"Preliminary Findings From an Augmented Reality (AR) App Delivering Recovery-Oriented Cognitive Therapy for Negative Symptoms in Schizophrenia","authors":"Sunny X. Tang, Moein Foroughi, Aaron P. Brinen, Michael L. Birnbaum, Sarah A. Berretta, Leily M. Behbehani, John M. Kane, Edward Yoon, William F. Cronin","doi":"10.1111/eip.70119","DOIUrl":"10.1111/eip.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>NST-SPARK is a novel digital therapeutic targeting negative symptoms in schizophrenia spectrum disorders (SSD). It is a smartphone application delivering recovery-oriented cognitive therapy (CT-R), via gamified augmented reality (AR) experiences. The primary objective was to determine the acceptability and feasibility of a single-session prototype. Secondary objectives were to generate descriptive findings for changes in defeatist beliefs, self-esteem and attitudes toward goal-oriented activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty participants with schizophrenia or schizoaffective disorder enrolled. Participants completed self-reports on the acceptability and feasibility of NST-SPARK v.1.5 and provided open-ended feedback. Self-report scales on defeatist beliefs, self-esteem and attitudes toward goal-oriented activities were completed before and after participants were introduced to NST-SPARK, and at 1-week follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants found NST-SPARK to be feasible and acceptable, with an average response of ‘Agree’, indicating that the intervention met with the participants' approval and seemed implementable. Almost all participants (19 of 20) used the app on their own prior to the 1-week follow up despite not being incentivised. We also observed changes in defeatist beliefs, self-esteem and attitudes toward goal attainment consistent with intended improvements in these targeted areas. Participants made substantive progress toward identified goals in 90% of cases. The most common positive feedback was appreciation that the app got them going, and the most common negative feedback pointed out technical aspects that did not function properly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This preliminary, single-arm, unblinded study of a single-module prototype for NST-SPARK found that the approach is generally acceptable and feasible for people with SSD and negative symptoms.</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.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910970","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}

引用次数: 0

Neurodevelopmental, Pharmacological and Substance Use Factors in the Association Between ADHD and First-Episode Non-Affective Psychosis: A Systematic Review 神经发育、药理学和物质使用因素在ADHD和首发非情感性精神病之间的关联：一项系统综述。

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2026-01-06 DOI: 10.1111/eip.70123

Valerio Ricci, Marialuigia Barresi, Gabriele Di Salvo, Giuseppe Maina

Objective

This systematic review investigates the complex relationship between attention deficit hyperactivity disorder (ADHD) and first-episode non-affective psychosis (FEP), focusing on neurodevelopmental, pharmacological and substance use factors that may influence this association.

Methods

Following PRISMA guidelines, we conducted a comprehensive literature search across PubMed, Scopus, Web of Science and PsycINFO databases for studies published between January 2001 and June 2024. We included experimental and observational studies examining ADHD and FEP in participants aged ≥ 16 years. Quality assessment was performed using standardised tools specific to each study design.

Results

From 1243 initially identified records, 13 studies met inclusion criteria. Five studies addressing neurodevelopmental factors revealed shared neurobiological vulnerabilities between ADHD and psychosis, including impaired cortical inhibition, neurophysiological markers and cognitive deficits. Five pharmacological studies demonstrated that whilst stimulant-induced psychosis can occur, the absolute risk appears low, with amphetamines carrying a 1.65-fold higher risk than methylphenidate. Three studies on substance use patterns showed that ADHD patients with FEP had significantly higher rates of substance use disorders, particularly cannabis use, which was associated with earlier psychosis onset and poorer outcomes.

Conclusions

Individuals with ADHD, particularly those with persistent symptoms from childhood and neurocognitive deficits, may have an elevated risk of developing FEP. Substance use appears to be an important mediating factor in this relationship. Regarding pharmacological treatment, recent epidemiological evidence provides a more nuanced perspective on stimulant safety, though the evidence remains mixed and requires further investigation. These findings highlight the importance of comprehensive assessment, substance use prevention and individualised risk stratification when managing ADHD patients at risk for psychosis.

目的：本系统综述探讨了注意缺陷多动障碍（ADHD）与首发非情感性精神病（FEP）之间的复杂关系，重点探讨了可能影响这种关联的神经发育、药物和物质使用因素。方法：根据PRISMA指南，我们对2001年1月至2024年6月期间发表的研究进行了PubMed， Scopus， Web of Science和PsycINFO数据库的综合文献检索。我们纳入了年龄≥16岁参与者中ADHD和FEP的实验和观察性研究。使用特定于每个研究设计的标准化工具进行质量评估。结果：从1243个最初确定的记录中，13个研究符合纳入标准。五项针对神经发育因素的研究揭示了ADHD和精神病之间共同的神经生物学脆弱性，包括皮层抑制功能受损、神经生理标志物和认知缺陷。五项药理学研究表明，虽然兴奋剂引起的精神病可能发生，但绝对风险似乎很低，安非他明的风险比哌醋甲酯高1.65倍。三项关于药物使用模式的研究表明，患有FEP的ADHD患者的药物使用障碍率明显更高，特别是大麻使用，这与早期精神病发作和较差的预后有关。结论：患有ADHD的个体，特别是那些从儿童时期就有持续症状和神经认知缺陷的个体，可能有较高的发生FEP的风险。在这种关系中，物质使用似乎是一个重要的中介因素。关于药物治疗，最近的流行病学证据对兴奋剂的安全性提供了更细致的看法，尽管证据仍然混杂，需要进一步调查。这些发现强调了在管理有精神病风险的ADHD患者时，综合评估、药物使用预防和个体化风险分层的重要性。

{"title":"Neurodevelopmental, Pharmacological and Substance Use Factors in the Association Between ADHD and First-Episode Non-Affective Psychosis: A Systematic Review","authors":"Valerio Ricci, Marialuigia Barresi, Gabriele Di Salvo, Giuseppe Maina","doi":"10.1111/eip.70123","DOIUrl":"10.1111/eip.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review investigates the complex relationship between attention deficit hyperactivity disorder (ADHD) and first-episode non-affective psychosis (FEP), focusing on neurodevelopmental, pharmacological and substance use factors that may influence this association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we conducted a comprehensive literature search across PubMed, Scopus, Web of Science and PsycINFO databases for studies published between January 2001 and June 2024. We included experimental and observational studies examining ADHD and FEP in participants aged ≥ 16 years. Quality assessment was performed using standardised tools specific to each study design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1243 initially identified records, 13 studies met inclusion criteria. Five studies addressing neurodevelopmental factors revealed shared neurobiological vulnerabilities between ADHD and psychosis, including impaired cortical inhibition, neurophysiological markers and cognitive deficits. Five pharmacological studies demonstrated that whilst stimulant-induced psychosis can occur, the absolute risk appears low, with amphetamines carrying a 1.65-fold higher risk than methylphenidate. Three studies on substance use patterns showed that ADHD patients with FEP had significantly higher rates of substance use disorders, particularly cannabis use, which was associated with earlier psychosis onset and poorer outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals with ADHD, particularly those with persistent symptoms from childhood and neurocognitive deficits, may have an elevated risk of developing FEP. Substance use appears to be an important mediating factor in this relationship. Regarding pharmacological treatment, recent epidemiological evidence provides a more nuanced perspective on stimulant safety, though the evidence remains mixed and requires further investigation. These findings highlight the importance of comprehensive assessment, substance use prevention and individualised risk stratification when managing ADHD patients at risk for psychosis.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910883","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}

引用次数: 0

Correction to ‘Beyond Symptom Reduction: A Call to Integrate Well-Being in Psychosis Research and Early Intervention’ 更正“超越症状减轻：呼吁在精神病研究和早期干预中整合福祉”。

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2025-12-21 DOI: 10.1111/eip.70118

Blasco-Belled, A., K. K. Sarasjärvi, C. Alsinet, and B. Nelson. 2025. “Beyond Symptom Reduction: A Call to Integrate Well-Being in Psychosis Research and Early Intervention.” Early Intervention in Psychiatry 19, no. 11: e70115. https://doi.org/10.1111/eip.70115.

The following information is missing from the funding statement:

“Ana Blasco-Belled was supported by the Ministry of Science, Innovation and Universities (Spain) for mobility stays at foreign higher education and research institutions.”

The second affiliation (Orygen) was incorrect and should have read:

“Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.”

The affiliation in the online version of this article has been corrected accordingly.

We apologize for these errors.

Blasco-Belled， A， K. K. Sarasjärvi， C. Alsinet和B. Nelson, 2025。“超越症状减轻：在精神病研究和早期干预中整合健康的呼吁。”《精神病学早期干预》第19期，第2期。11: e70115。https://doi.org/10.1111/eip.70115.The资助声明中缺少以下信息：“Ana blasco - bell得到了科学、创新和大学（西班牙）部的支持，用于在外国高等教育和研究机构的流动停留。”第二个隶属关系（Orygen）是不正确的，应该是这样写的：“Orygen，国家青少年心理健康卓越中心，Parkville, Victoria, Australia。”本文在线版本中的从属关系已相应更正。我们为这些错误道歉。

引用次数: 0

Social Cognition and Social Inclusion in Young People With First-Episode Psychosis: A Brief Report 青少年首发精神病患者的社会认知和社会包容：一个简短的报告。

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2025-12-14 DOI: 10.1111/eip.70113

Molly Butler, Kate Filia, Jacqueline Anderson, Sean Murrihy, Sue M. Cotton, Amity E. Watson

Aim

First-episode psychosis (FEP) is a disabling illness associated with poor social inclusion, a critical determinant of mental health. Social cognitive impairment, a core feature of psychosis, may have implications for social inclusion.

Method

This cross-sectional study investigated relationships between social inclusion and social cognition in 56 young people with FEP (aged 16–25, M = 20.4; SD = 2.8 years) receiving treatment at Orygen's Early Psychosis Prevention and Intervention Centre in Melbourne, Australia. Social inclusion was assessed alongside social cognition (domains including theory of mind, emotion recognition, social perception and attributional bias), and psychopathology.

Results

Social inclusion was significantly lower when compared to data from a same-aged non-clinical sample (p < 0.001). Multiple regression analysis found no significant associations between social cognition and social inclusion (all p > 0.05).

Discussion

Findings highlight social challenges experienced in early psychosis, particularly building and maintaining relationships. Future research should examine how interventions targeting broader social and functional factors might enhance social inclusion in early psychosis.

目的：首发精神病（FEP）是一种与社会包容不良相关的致残疾病，是心理健康的关键决定因素。社会认知障碍是精神病的一个核心特征，可能对社会包容产生影响。方法：本横断面研究调查了在澳大利亚墨尔本Orygen早期精神病预防和干预中心接受治疗的56名FEP青年（16-25岁，M = 20.4, SD = 2.8岁）的社会包容与社会认知的关系。社会包容与社会认知（包括心理理论、情感识别、社会知觉和归因偏见）和精神病理学一起被评估。结果：与同年龄非临床样本的数据相比，社会包容显著降低（p 0.05）。讨论：研究结果强调了早期精神病患者所经历的社会挑战，特别是建立和维持关系。未来的研究应该研究针对更广泛的社会和功能因素的干预措施如何增强早期精神病患者的社会包容。

{"title":"Social Cognition and Social Inclusion in Young People With First-Episode Psychosis: A Brief Report","authors":"Molly Butler, Kate Filia, Jacqueline Anderson, Sean Murrihy, Sue M. Cotton, Amity E. Watson","doi":"10.1111/eip.70113","DOIUrl":"10.1111/eip.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>First-episode psychosis (FEP) is a disabling illness associated with poor social inclusion, a critical determinant of mental health. Social cognitive impairment, a core feature of psychosis, may have implications for social inclusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This cross-sectional study investigated relationships between social inclusion and social cognition in 56 young people with FEP (aged 16–25, <i>M</i> = 20.4; SD = 2.8 years) receiving treatment at Orygen's Early Psychosis Prevention and Intervention Centre in Melbourne, Australia. Social inclusion was assessed alongside social cognition (domains including theory of mind, emotion recognition, social perception and attributional bias), and psychopathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Social inclusion was significantly lower when compared to data from a same-aged non-clinical sample (<i>p</i> < 0.001). Multiple regression analysis found no significant associations between social cognition and social inclusion (all <i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Findings highlight social challenges experienced in early psychosis, particularly building and maintaining relationships. Future research should examine how interventions targeting broader social and functional factors might enhance social inclusion in early psychosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"19 12","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755627","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}

引用次数: 0

Characteristics of Youth With Recent Substance Use With and Without Substance Use Disorder Presenting for Primary Mental Healthcare in Australia: Baseline Findings From the INTEGRATE Trial 最近有物质使用的青少年的特征，有或没有物质使用障碍，呈现在澳大利亚的初级精神卫生保健：来自INTEGRATE试验的基线结果。

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2025-11-30 DOI: 10.1111/eip.70106

Ellie Ahounbar, Alexandre A. Guerin, Leanne Hides, Sarah Bendall, Andrew Chanen, Sarah Clarke, Amelia Quinn, Shelley Baird, Eóin Killackey, Patrick McGorry, Gillinder Bedi

Aims

Both substance use and mental illness commonly onset during adolescence or young adulthood, and rates of substance use in young people with mental illness are disproportionately high. This baseline data paper from a clinical trial testing an integrated early intervention for substance use and mental health problems aims to (1) describe the characteristics of participants enrolled and (2) compare young people with a current and without a lifetime diagnosis of substance use disorder (SUD) in terms of psychiatric symptoms, functioning, and substance use.

Methods

Seventy-nine participants aged 12–25 years with high prevalence mental illness (e.g., depression, anxiety) and substance use seeking mental healthcare were recruited from headspace primary mental health centres in North-Western Melbourne. At baseline, they completed self-report and interview measures of psychiatric diagnoses and symptoms, functioning, and substance use. We compared those with a current (n = 51) and without a lifetime (n = 21) SUD on these measures. This is a secondary data analysis of baseline data for the INTEGRATE clinical trial.

Results

Youth with an SUD endorsed more severe depressive and anxiety symptoms, and lower quality of life and role functioning than those who used substances without a lifetime SUD. They also had more alcohol-related problems and higher frequency cannabis use and higher risk scores for alcohol, tobacco, cannabis, cocaine, amphetamine-type stimulants and hallucinogen use. There were no group differences in social and occupational functioning or subjectively rated sleep quality.

Conclusions

Findings highlight the need for early identification and integrated care models within youth mental health services to address the high prevalence and impact of substance use, potentially reducing adverse effects of co-occurring SUD and mental illness on youth development and functioning.

Trial Registration

The study was preregistered (ACTRN12619001522101)

目的：物质使用和精神疾病通常发生在青春期或青年期，并且患有精神疾病的年轻人的物质使用率高得不成比例。这篇基线数据论文来自一项临床试验，旨在测试药物使用和精神健康问题的综合早期干预措施，旨在(1)描述入组参与者的特征，(2)比较目前和没有终身诊断为药物使用障碍（SUD）的年轻人在精神症状、功能和药物使用方面的差异。方法：从墨尔本西北部的headspace初级精神卫生中心招募了79名年龄在12-25岁、患有高患病率精神疾病（如抑郁、焦虑）和物质使用寻求精神卫生保健的参与者。在基线时，他们完成了自我报告和精神诊断、症状、功能和物质使用的访谈测量。我们比较了目前（n = 51）和没有终身（n = 21） SUD的患者的这些措施。这是对INTEGRATE临床试验基线数据的二次数据分析。结果：与没有终生SUD的青少年相比，有SUD的青少年有更严重的抑郁和焦虑症状，生活质量和角色功能更低。他们也有更多与酒精有关的问题，使用大麻的频率更高，使用酒精、烟草、大麻、可卡因、安非他明类兴奋剂和致幻剂的风险评分更高。在社会和职业功能或主观评价睡眠质量方面没有组间差异。结论：研究结果强调了在青少年心理健康服务中早期识别和综合护理模式的必要性，以解决药物使用的高患病率和影响，潜在地减少共同发生的SUD和精神疾病对青少年发展和功能的不利影响。试验注册：该研究已预注册（ACTRN12619001522101）。

{"title":"Characteristics of Youth With Recent Substance Use With and Without Substance Use Disorder Presenting for Primary Mental Healthcare in Australia: Baseline Findings From the INTEGRATE Trial","authors":"Ellie Ahounbar, Alexandre A. Guerin, Leanne Hides, Sarah Bendall, Andrew Chanen, Sarah Clarke, Amelia Quinn, Shelley Baird, Eóin Killackey, Patrick McGorry, Gillinder Bedi","doi":"10.1111/eip.70106","DOIUrl":"10.1111/eip.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Both substance use and mental illness commonly onset during adolescence or young adulthood, and rates of substance use in young people with mental illness are disproportionately high. This baseline data paper from a clinical trial testing an integrated early intervention for substance use and mental health problems aims to (1) describe the characteristics of participants enrolled and (2) compare young people with a current and without a lifetime diagnosis of substance use disorder (SUD) in terms of psychiatric symptoms, functioning, and substance use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventy-nine participants aged 12–25 years with high prevalence mental illness (e.g., depression, anxiety) and substance use seeking mental healthcare were recruited from headspace primary mental health centres in North-Western Melbourne. At baseline, they completed self-report and interview measures of psychiatric diagnoses and symptoms, functioning, and substance use. We compared those with a current (<i>n</i> = 51) and without a lifetime (<i>n</i> = 21) SUD on these measures. This is a secondary data analysis of baseline data for the INTEGRATE clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Youth with an SUD endorsed more severe depressive and anxiety symptoms, and lower quality of life and role functioning than those who used substances without a lifetime SUD. They also had more alcohol-related problems and higher frequency cannabis use and higher risk scores for alcohol, tobacco, cannabis, cocaine, amphetamine-type stimulants and hallucinogen use. There were no group differences in social and occupational functioning or subjectively rated sleep quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings highlight the need for early identification and integrated care models within youth mental health services to address the high prevalence and impact of substance use, potentially reducing adverse effects of co-occurring SUD and mental illness on youth development and functioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The study was preregistered (ACTRN12619001522101)</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"19 12","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647530","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}

引用次数: 0

Adverse Short-Term Cardiometabolic Outcomes in Psychosis Early Intervention Services: Which Risk Prediction Algorithm? 精神病早期干预服务的短期不良心脏代谢结果：哪种风险预测算法？

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2025-11-26 DOI: 10.1111/eip.70116

James Hughes, Ashwin Moothedath Asok, Mao Fong Lim, Liliana Galindo, Benjamin Ian Perry

Introduction

Weight gain and other adverse cardiometabolic changes occur early in severe mental illness (SMI) but may be preventable. It is unknown whether existing cardiometabolic risk prediction algorithms can be repurposed to predict early cardiometabolic changes after first-episode psychosis, especially in younger populations.

Methods

Data from newly enrolled patients (16–65 years) to the Cambridgeshire and Peterborough CAMEO Early Intervention Service for Psychosis (EIS) (March 2022–Feb 2024) were used to explore the accuracy of population-based (QRISK3, QDIABETES) and SMI-specific (PsyMetRiC-full, PsyMetRiC-partial, PRIMROSE) cardiometabolic risk prediction algorithms for early cardiometabolic changes (weight, total cholesterol, triglycerides). Risk scores were calculated using baseline clinic data, and outcomes assessed at three-monthly follow-up. Multiple imputation was used where appropriate. Predictive accuracy was assessed using the coefficient of determination (R²) and root mean squared error (RMSE). Sensitivity analysis was conducted in younger (16–35 years) patients.

Results

We included n = 74 participants (male = 50%, white European = 75%, mean age = 32.0, median follow-up = 112 days). Mean body weight increased by 3.58 kg, total cholesterol by 0.64 mmol/L, and triglycerides by 0.84 mmol/L. PsyMetRiC-full was the best predictor of weight (R² = 0.54, 95% C.I., 0.36–0.69, p < 0.001; RMSE = 1.91; 95% C.I., 1.58–2.37); and triglyceride changes (R² = 0.36; 95% C.I. 0.12–0.56, p = 0.004; RMSE = 1.98; 95% C.I., 1.43–2.63). No algorithm accurately predicted total cholesterol changes. General population-based algorithms performed poorly. Sensitivity analysis results were more extreme in favour of the PsyMetRiC algorithms.

Conclusion

PsyMetRiC is likely to be better than alternatives at predicting short-term cardiometabolic changes in early psychosis, particularly in patients aged 16–35. Stakeholder engagement is now required to co-decide ‘high-risk’ thresholds and intervention strategies to reduce the cardiometabolic impacts of psychosis and its treatment.

体重增加和其他不良的心脏代谢变化发生在严重精神疾病（SMI）的早期，但可能是可以预防的。目前尚不清楚现有的心脏代谢风险预测算法是否可以重新用于预测首发精神病后的早期心脏代谢变化，特别是在年轻人群中。方法利用剑桥郡和彼得伯勒CAMEO精神病早期干预服务（EIS）（2022年3月- 2024年2月）新入组患者（16-65岁）的数据，探讨基于人群（QRISK3、QDIABETES）和smi特异性（PsyMetRiC-full、PsyMetRiC-partial、PRIMROSE）的心脏代谢风险预测算法对早期心脏代谢变化（体重、总胆固醇、甘油三酯）的准确性。使用基线临床数据计算风险评分，并在三个月随访时评估结果。在适当的情况下使用多重插入。采用决定系数（R2）和均方根误差（RMSE）评估预测准确性。对年龄较小（16-35岁）的患者进行敏感性分析。我们纳入了74名参与者（男性= 50%，欧洲白人= 75%，平均年龄= 32.0，中位随访= 112天）。平均体重增加3.58 kg，总胆固醇增加0.64 mmol/L，甘油三酯增加0.84 mmol/L。PsyMetRiC-full是体重的最佳预测因子（R2 = 0.54, 95% ci, 0.36-0.69, p < 0.001; RMSE = 1.91; 95% ci, 1.58-2.37）；和甘油三酯的变化(R2 = 0.36; 95% C.I. 0.12 - -0.56, p = 0.004; RMSE = 1.98; 95% C.I。,1.43 - -2.63)。没有任何算法能准确预测总胆固醇的变化。一般基于群体的算法表现不佳。灵敏度分析结果更极端地支持PsyMetRiC算法。结论PsyMetRiC在预测早期精神病的短期心脏代谢变化方面可能比其他方法更好，特别是在16-35岁的患者中。现在需要利益相关者参与共同决定“高风险”阈值和干预策略，以减少精神病及其治疗对心脏代谢的影响。

{"title":"Adverse Short-Term Cardiometabolic Outcomes in Psychosis Early Intervention Services: Which Risk Prediction Algorithm?","authors":"James Hughes, Ashwin Moothedath Asok, Mao Fong Lim, Liliana Galindo, Benjamin Ian Perry","doi":"10.1111/eip.70116","DOIUrl":"https://doi.org/10.1111/eip.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Weight gain and other adverse cardiometabolic changes occur early in severe mental illness (SMI) but may be preventable. It is unknown whether existing cardiometabolic risk prediction algorithms can be repurposed to predict early cardiometabolic changes after first-episode psychosis, especially in younger populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from newly enrolled patients (16–65 years) to the Cambridgeshire and Peterborough CAMEO Early Intervention Service for Psychosis (EIS) (March 2022–Feb 2024) were used to explore the accuracy of population-based (QRISK3, QDIABETES) and SMI-specific (PsyMetRiC-full, PsyMetRiC-partial, PRIMROSE) cardiometabolic risk prediction algorithms for early cardiometabolic changes (weight, total cholesterol, triglycerides). Risk scores were calculated using baseline clinic data, and outcomes assessed at three-monthly follow-up. Multiple imputation was used where appropriate. Predictive accuracy was assessed using the coefficient of determination (<i>R</i><sup>2</sup>) and root mean squared error (RMSE). Sensitivity analysis was conducted in younger (16–35 years) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included <i>n</i> = 74 participants (male = 50%, white European = 75%, mean age = 32.0, median follow-up = 112 days). Mean body weight increased by 3.58 kg, total cholesterol by 0.64 mmol/L, and triglycerides by 0.84 mmol/L. PsyMetRiC-full was the best predictor of weight (<i>R</i><sup>2</sup> = 0.54, 95% C.I., 0.36–0.69, <i>p</i> < 0.001; RMSE = 1.91; 95% C.I., 1.58–2.37); and triglyceride changes (<i>R</i><sup>2</sup> = 0.36; 95% C.I. 0.12–0.56, <i>p</i> = 0.004; RMSE = 1.98; 95% C.I., 1.43–2.63). No algorithm accurately predicted total cholesterol changes. General population-based algorithms performed poorly. Sensitivity analysis results were more extreme in favour of the PsyMetRiC algorithms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PsyMetRiC is likely to be better than alternatives at predicting short-term cardiometabolic changes in early psychosis, particularly in patients aged 16–35. Stakeholder engagement is now required to co-decide ‘high-risk’ thresholds and intervention strategies to reduce the cardiometabolic impacts of psychosis and its treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"19 12","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601138","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}

引用次数: 0

Motivating the Motivators: Clinician Motivation and Communication Style for Physical Health Intervention With Young People Experiencing First-Episode Psychosis 激励动机：临床医生对青少年首发精神病身体健康干预的动机与沟通方式

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry

Pub Date : 2025-11-26 DOI: 10.1111/eip.70117

Jesse Gates, Lisa Phillips, Mario Alvarez-Jimenez, Eóin Killackey

Introduction

People with psychotic disorders face a significant disparity in life expectancy, primarily due to preventable health conditions. Mental health clinicians play a vital role in addressing these issues, yet barriers such as a lack of training, low confidence, and unclear role responsibilities impede effective interventions. This study explores the motivation, perceived competence, and communication styles of clinicians addressing physical health for young people with first-episode psychosis, using Self-Determination Theory as a framework.

Methods

A mixed-methods design was employed, involving semi-structured interviews with six case managers and five psychiatrists at a specialised early intervention service. Thematic analysis identified key themes, and quantitative ratings assessed attitudes, perceived competence, and communication styles. Results were synthesised into Self-Determination Theory constructs.

Results

Quantitative ratings highlighted gaps in training, resources and prioritisation of physical health. Seven themes emerged from clinician interviews: (1) role responsibility, (2) constrained autonomy, (3) autonomous motivation, (4) clinician competence, (5) perceived young person's competence, (6) domain-dependent communication and (7) the centrality of relatedness for treatment. Clinicians reported a more directive approach for weight-related issues compared to substance use.

Conclusion

Clinicians face significant systemic and individual barriers to addressing physical health in first-episode psychosis. Enhancing autonomy-supportive environments, clarifying role responsibilities and providing targeted training could improve engagement and outcomes. Integrating physical health within mental healthcare must be prioritised to reduce disparities.

精神障碍患者在预期寿命方面存在显著差异，主要是由于可预防的健康状况。精神卫生临床医生在解决这些问题方面发挥着至关重要的作用，但缺乏培训、信心不足和角色责任不明确等障碍阻碍了有效的干预措施。本研究以自我决定理论为框架，探讨临床医生为首发精神病患者处理身体健康问题的动机、感知能力和沟通方式。方法采用混合方法设计，对一家专门的早期干预服务机构的6名病例管理人员和5名精神科医生进行半结构化访谈。专题分析确定了关键主题，定量评分评估了态度、感知能力和沟通风格。结果被合成为自决理论构念。结果定量评分突出了培训、资源和身体健康优先级方面的差距。从临床医生访谈中出现了七个主题：(1)角色责任，(2)受约束的自主性，(3)自主动机，(4)临床医生能力，(5)感知到的年轻人能力，(6)领域依赖的沟通和(7)治疗关系的中心地位。与药物使用相比，临床医生报告了一种更直接的方法来解决与体重相关的问题。结论临床医生在处理首发精神病患者的身体健康时面临着显著的系统和个体障碍。加强支持自主的环境，明确角色职责，提供有针对性的培训，可以提高参与度和成果。必须优先考虑将身体健康纳入精神保健，以减少差距。

{"title":"Motivating the Motivators: Clinician Motivation and Communication Style for Physical Health Intervention With Young People Experiencing First-Episode Psychosis","authors":"Jesse Gates, Lisa Phillips, Mario Alvarez-Jimenez, Eóin Killackey","doi":"10.1111/eip.70117","DOIUrl":"https://doi.org/10.1111/eip.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with psychotic disorders face a significant disparity in life expectancy, primarily due to preventable health conditions. Mental health clinicians play a vital role in addressing these issues, yet barriers such as a lack of training, low confidence, and unclear role responsibilities impede effective interventions. This study explores the motivation, perceived competence, and communication styles of clinicians addressing physical health for young people with first-episode psychosis, using Self-Determination Theory as a framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A mixed-methods design was employed, involving semi-structured interviews with six case managers and five psychiatrists at a specialised early intervention service. Thematic analysis identified key themes, and quantitative ratings assessed attitudes, perceived competence, and communication styles. Results were synthesised into Self-Determination Theory constructs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Quantitative ratings highlighted gaps in training, resources and prioritisation of physical health. Seven themes emerged from clinician interviews: (1) role responsibility, (2) constrained autonomy, (3) autonomous motivation, (4) clinician competence, (5) perceived young person's competence, (6) domain-dependent communication and (7) the centrality of relatedness for treatment. Clinicians reported a more directive approach for weight-related issues compared to substance use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinicians face significant systemic and individual barriers to addressing physical health in first-episode psychosis. Enhancing autonomy-supportive environments, clarifying role responsibilities and providing targeted training could improve engagement and outcomes. Integrating physical health within mental healthcare must be prioritised to reduce disparities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"19 12","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601140","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}

引用次数: 0