Early Intervention in Psychiatry最新文献

Objective

Many individuals with psychosis consider themselves religious or spiritual and report using religion as a means of coping with their illness. However, research exploring the impact of religiosity and spirituality on the experience of psychosis is sparse, with most studies focusing on delusions or hallucinations with religious content.

Methods

A systematic review examined the evidence regarding the role of religiosity/spirituality in the maintenance and recovery of psychosis.

Results

A total of 35 studies were eligible for inclusion. In terms of maintenance, religiosity and spirituality were positively correlated with positive symptoms of psychosis. Individualised religious practice was associated with more severe delusions, while high intrinsic religiosity was associated with an increased severity of auditory and visual hallucinations. In terms of recovery, Positive Religious Coping (PRC) was found to improve wellbeing, quality of life, treatment expectancy, and medication adherence, while Negative Religious Coping (NRC) increased suicidality, positive symptom severity, and illness duration, and reduced social functioning. Holding religious/spiritual explanatory models was correlated with increased psychosis symptom severity and delayed recovery, while holding a bio-psychosocial explanatory model assisted with recovery.

Conclusions

Religiosity/spirituality appears to play a significant role in the maintenance and recovery of positive symptoms of psychosis. CBTp could be enhanced by integrating religiosity and spirituality into assessment, formulation, and the development of targeted interventions. This approach would promote more culturally adapted CBTp and improved engagement with clients from diverse cultural backgrounds in Early Intervention Services.

Background

A majority of patients with psychosis have experienced trauma, but trauma-focused (TF) treatment is not routinely offered. The current systematic review set out to examine the effect of TF treatments in patients with a psychotic disorder and comorbid trauma symptoms on symptoms of (1) trauma, (2) psychosis and (3) anxiety, depression and psychosocial functioning.

Methods

A systematic search following the PRISMA guideline yielded 17 studies reported in 19 records.

Results

Overall, results indicated positive effects of TF treatment on trauma symptoms (87.5% of the studies), especially for TF CBT, EMDR and PE for psychosis, with indications of improvements to be stable over time. Positive outcomes were also reported for psychosis symptoms (72.2% of the studies). Results were inconclusive for depression (56% of the studies), anxiety (44.4% of the studies) and functioning (66.7% of the studies), which also were less frequently reported as outcomes in the included studies.

Discussion

The present findings give preliminary support for the effect of TF treatment on trauma and psychosis symptoms, but there is more uncertainty for anxiety, depression and psychosocial functioning, which need more research. Support was found for treatments delivered both individually and by group. The current evidence base on TF treatment in psychosis is, however, still at an early stage and is challenged by methodological issues.

Introduction

This study examined the prevalence of psychiatric medication discontinuation amongst perinatal women with depressive symptoms and describes characteristics of those who discontinued compared to those who continued medications in pregnancy.

Methods

We conducted a cross-sectional analysis using baseline data from the PRogram In Support of Moms study. Amongst 98 women prescribed psychiatric medication, we descriptively assessed sociodemographic characteristics of participants who discontinued versus continued medications. A logistic regression model evaluated the association between depressive symptoms and medication discontinuation.

Results

Approximately 65% reported medication discontinuation in pregnancy (95% CI: 55%–74%). Those who discontinued had a median Edinburgh Postnatal Depression Scale (EPDS) score that was 1 point higher than those who continued (p = 0.12). Of those who discontinued medications, 27% were never married, 52% reported annual incomes < $60 000, and 56% were Medicaid-insured.

Conclusion

Most participants prescribed psychiatric medications before pregnancy discontinued them in pregnancy. Adequately powered studies are needed to validate findings and to explore mediating factors.

Trial Registration: NCT02760004

Background

Despite evidence for early interventions for bipolar disorder (BD), there are relatively few accessible treatment models. We developed a digitally augmented model of care termed BLEND (BipoLar early interventions using New Digital technologies) which aims to improve mood symptoms in BD. BLEND includes: (a) guideline-concordant pharmacotherapy; (b) in-person psychological therapies blended with digital therapeutic content and (c) digital relapse monitoring. The aim of this study was twofold: (i) describe the acceptability, safety and feasibility of delivering BLEND and (ii) examine the feasibility of an efficacy trial of BLEND compared with enhanced standard care (ESC).

Method

We conducted a parallel-group, open-label, 2:1 randomised pilot trial within a youth mental-health outpatient service in Melbourne, Australia. We included youth aged 15–25 years with BD I or II, who had not previously accessed multidisciplinary care. All participants received similar background care. BLEND differed from ESC in having manualised blended digital and in-person psychological therapies and digital relapse monitoring.

Results

We randomised 21 young people over a 12-month recruitment period, predominantly female participants (71.4%) with BD Type II (85.7%). Both treatment models were acceptable and safe, but the BLEND group had greater reductions in suicidal ideation. Among components of BLEND, in-person psychological therapy and psychopharmacological interventions could be delivered with fidelity. Digital therapy engagement was high, but participants used digital relapse monitoring variably.

Conclusions

The BLEND model was safe and acceptable and may lead to improvements in suicidality compared with ESC. Concordant with the aims of a pilot study, there is scope for the content to be rationalised based on feedback to improve feasibility of the digital therapy. Relapse monitoring may usefully be extended to depressive symptoms. The next step is to confirm the efficacy of BLEND compared with standard care.

Background

Family peer workers form connections with family members of young people attending mental health services and can offer emotional support, relevant information, and referrals based on their own lived experience. Although an increasing number of family peer support programs exist in the youth mental health sector, they are rarely described or reported on. There is a need for greater documentation of the experiences of family peer workers operating in the sector to raise awareness of issues currently facing the workforce and support organisations to make positive changes. We present a detailed description of the factors that impact effective program implementation and delivery from the perspectives of four family peer workers and two supervisors.

Conclusions

Organisations should encourage self-care and social connections between family peer workers to reduce the impacts of ongoing mental health challenges, work-related burnout, and isolation. Colleagues should be educated about the field of family peer support to improve role clarity and foster a positive team environment. Within the field, it is vital to develop comprehensive position descriptions, training programs, and onboarding procedures to ensure new employees are adequately equipped. To improve staff retention and compensate those with further education, experience, and skills, organisations may consider offering increased remuneration, negotiating longer-term contracts with a potential for a greater number of workdays, and should create senior lived experience positions. Further research is needed to formally investigate barriers and facilitating factors of program implementation in mental health settings.

Introduction

The aim of this study was to compare the multidisciplinary vocational intervention, Morpheus, with standard vocational rehabilitation for young adults with incident schizophrenia undergoing the OPUS specialised early intervention programme. The study evaluated whether the type of vocational intervention was related to attachment to the labour market and educational system, outpatient contacts, hospital admissions and psychotropic drug use.

Methods

This retrospective cohort study included patients of the OPUS programme in the period from January 1, 2014, to December 31, 2019. Patients at Aarhus University Hospital Psychiatry (Aarhus) were offered the Morpheus intervention, while patients at Aalborg University Hospital (Aalborg) received standard vocational rehabilitation. The study used register and clinical data. The analyses involved logistic and linear regression presented as crude and adjusted models.

Results

Of the 404 OPUS patients from Aarhus and 246 OPUS patients from Aalborg, patients participating in the Morpheus intervention (n = 116) were more likely to be employed or enrolled in education 2 and 4 years after diagnosis compared with patients undergoing standard vocational intervention (n = 130). Specifically, the adjusted odds ratio for employment was 1.14 (0.37; 3.45) and 1.51 (0.70; 3.27) at 2 and 4 years, respectively. Morpheus patients were less likely to attend somatic outpatient contacts, which involve consultations or treatment for physical health conditions, as well as psychiatric outpatient contacts. Furthermore, they were less likely to be admitted to somatic departments or to redeem antipsychotic medication. However, Morpheus patients had a higher likelihood of being admitted to psychiatric departments during the periods 0–2 and 2–4 years after diagnosis.

Conclusion

Young adults with incident schizophrenia receiving the Morpheus intervention within the OPUS treatment did not show statistically significant increased odds of employment or education enrolment compared to those in standard vocational rehabilitation.

Introduction

The primary objective was to analyse the prescribing and discontinuation rates of long-acting injectable (LAI) antipsychotics among child and adolescent populations. The secondary objective was to assess if racial/ethnic differences existed between LAI antipsychotics and discontinuation rates.

Methods

Children and adolescents (2–17 years old) with schizophrenia or related disorders who received LAI antipsychotics between January 1, 2017 and December 31, 2021 were identified using Merative MarketScan Multi-State Medicaid Database. Descriptive statistics summarised the rates of LAI antipsychotic use. Kaplan–Meier survival curves were examined, and Cox regression analyses conducted to compare the hazard of discontinuation across LAI antipsychotics (p < 0.05).

Results

A total of 1277 out of 67 502 patients were included in the final analysis. The average age was 15.4 ± 1.7 years (range 7–17 years). Approximately 59% were male, with the most common races identified being Black (48%) and White (38%). Prescribing of LAI second-generation antipsychotics occurred in about 94% of the population. The most common LAI antipsychotics prescribed included paliperidone palmitate 1 month (40%) and aripiprazole formulations (48%). When controlling for age group, gender and plan type, the discontinuation rate for paliperidone and aripiprazole formulations did not differ. However, LAI paliperidone palmitate was associated with a 46% lower hazard of discontinuation for White compared to Black populations (HR = 0.54; p = 0.01).

Conclusion

Despite the limited sample, this study explored the frequency of prescribing and discontinuation rates between LAI antipsychotics in children. Future studies may further explain the unique challenges (e.g., reasons for discontinuation) and economic impact LAI antipsychotics present.

Purpose

Previous literature suggests that sleep disturbance is linked to Internet addiction, however, there was not sufficient empirical evidence to validate the causal relationships connecting these two variables. Our research intended to investigate these bidirectional associations in an adolescent population.

Methods

In all, 27 260 adolescents were assessed from December 17 to 26, 2021 and again 6 months later from May 17 to June 5, 2022. To evaluate Internet addiction, researchers employed the Revised Chinese Internet Addiction Scale (CIAS-R), while sleep disturbance was assessed through a four-item questionnaire addressing issues such as: difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and poor sleep quality.

Results

Sleep disturbance at baseline was linked to a higher probability of developing Internet addiction within 6 months, even after adjusting for relevant covariates. Similarly, individuals with Internet addiction at baseline exhibited a markedly increased risk of developing new-onset disturbance at the six-month follow-up.

Conclusion

This study highlights the bidirectional prospective links between sleep disturbance and Internet addiction among adolescents. The findings hold significant educational and clinical value, offering insights for managing Internet addiction alongside addressing sleep-related issues.