“Real‐world” first‐episode psychosis care in Massachusetts: Lessons learned from a pilot implementation of harmonized data collection

2021 ◽  
Author(s):  
Emily R. Kline ◽  
Kelsey A. Johnson ◽  
Alejandro Szmulewicz ◽  
Beshaun J. Davis ◽  
Aliyah S. Sanders ◽  
...  
Keyword(s):  
Data Collection ◽  
Real World ◽  
First Episode Psychosis ◽  
Lessons Learned ◽  
First Episode ◽  
Episode Psychosis ◽  
Pilot Implementation

scholarly journals Time for a change of practice: the real-world value of testing for neuronal autoantibodies in acute first-episode psychosis

BJPsych Open ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 262-264 ◽  
Author(s):  
Thomas A. Pollak ◽  
Belinda R. Lennox
Keyword(s):  
Lumbar Puncture ◽  
Real World ◽  
Culture Change ◽  
Autoimmune Encephalitis ◽  
First Episode Psychosis ◽  
Acute Onset ◽  
First Episode ◽  
The Real ◽  
Episode Psychosis ◽  
Neuronal Autoantibodies

SummaryIt is time that all patients with acute-onset psychosis are screened for autoimmune encephalitis, that lumbar puncture becomes a routine psychiatric investigation and that immunotherapy is available in indicated cases. We call for a culture change in the management of psychosis by psychiatry.Declaration of interestNone.

scholarly journals Adaptation of a Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Services for First-Episode Psychosis: Results From the Horyzons-Canada Phase 1 Study (Preprint)

2020 ◽  
Author(s):  
Shalini Lal ◽  
John Gleeson ◽  
Lysanne Rivard ◽  
Simon D'Alfonso ◽  
Ridha Joober ◽  
...  
Keyword(s):  
Digital Health ◽  
First Episode Psychosis ◽  
Lessons Learned ◽  
Mobile Technologies ◽  
Rural Setting ◽  
First Episode ◽  
Health Innovation ◽  
Episode Psychosis ◽  
Support Recovery ◽  
Age Range

BACKGROUND Developing a digital health innovation can require a substantial amount of financial and human resource investment before it can be scaled for implementation across geographical, cultural, and health care contexts. As such, there is an increased interest in leveraging eHealth innovations developed and tested in one country or jurisdiction and using these innovations in local settings. However, limited knowledge exists on the processes needed to appropriately adapt digital health innovations to optimize their transferability across geographical, cultural, and contextual settings. OBJECTIVE We report on the results of an adaptation study of Horyzons, a digital health innovation originally developed and tested in Australia. Horyzons is designed to prevent relapses and support recovery in young people receiving services for first-episode psychosis (FEP). The aim of this study is to assess the initial acceptability of Horyzons and adapt it in preparation for pilot testing in Canada. METHODS This research took place in 2 specialized early intervention clinics for FEP, located in 1 urban and 1 urban-rural setting, in 2 Canadian provinces. A total of 26 participants were recruited: 15 clinicians (age range 26-56 years) and 11 patients (age range 19-37 years). Following the digital health adaptation framework developed by our team, we used a mixed methods approach, combining descriptive quantitative and qualitative methods across 3 stages of data collection (focus groups, interviews, and consultations), analysis, and adaptations. RESULTS Overall, patients and clinicians appreciated the strengths-based approach and social media features of Horyzons. However, participants expressed concerns related to implementation, especially in relation to capacity (eg, site moderation, crisis management, internet speed in rural locations). They also provided suggestions for adapting content and features, for example, in relation to community resources, volume of text, universal accessibility (eg, for individuals with limitations in vision), and optimization of platform accessibility through mobile devices. Additional aspects of the innovation were flagged for adaptation during the final stages of preparing it for live implementation. These included terms of use, time zone configuration to reflect local time and date, safety and moderation protocols, the <i>need help now</i> feature, and the list of trigger words to flag posts indicative of potential risk. CONCLUSIONS In the context of the COVID-19 pandemic and public health guidelines for social distancing, there is an increasing interest and need to leverage the internet and mobile technologies for delivering youth mental health services. As countries look to one another for guidance on how to navigate changing social dynamics, knowledge on how to utilize and adapt existing innovations across contexts is now more important than ever. Using a systematic approach, this study illustrates the methods, processes, results, and lessons learned on adapting a digital health innovation to enhance its local acceptability. INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.8810

scholarly journals A comparison of neurocognition and functioning in first episode psychosis populations: do research samples reflect the real world?

2018 ◽  
Vol 54 (3) ◽  
pp. 291-301 ◽  
Author(s):  
Emily Kline ◽  
Victoria Hendel ◽  
Michelle Friedman-Yakoobian ◽  
Raquelle I. Mesholam-Gately ◽  
Ann Findeisen ◽  
...  
Keyword(s):  
Real World ◽  
First Episode Psychosis ◽  
First Episode ◽  
The Real ◽  
Episode Psychosis

First-episode psychosis: What does it mean?

2016 ◽  
Vol 33 (S1) ◽  
pp. s258-s258
Author(s):  
S. Marques ◽  
F. Godinho ◽  
A.L. Melo ◽  
D. Barrocas
Keyword(s):  
Real World ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Real World Setting ◽  
Episode Psychosis ◽  
Competing Interest ◽  
Disorganized Speech ◽  
Psychotic Features

IntroductionFirst-Episode Psychosis (FEP) is a variable condition, characterized by the emergence of new psychotic features for a period of at least 1 week. The majority of existing studies about FEP only address schizophrenia spectrum psychosis (SSP), which may limit the capacity to fully characterize this entity.Objectives/AimsReport the clinical and socio-demographic characteristics of patients with FEP in real-world setting, and compare the differences among SSP and affective FEP.MethodsRetrospective analysis of clinical files of patients admitted to our hospital unit with FEP diagnosis from January/2012 to April/2015. Clinician-rated dimensions of psychosis symptom severity scales (DSM-5) were applied.ResultsAnnual incidence of FEP was 11,3/100,000. From a total of 755 patients, 57 (7,5%) corresponded to FEP; 38 (66,7%) were diagnosed with SSP, 11 (19,3%) affective psychosis, 3 (5,2%) toxic psychosis and 5 (8,8%) organic psychosis. Most were female (61,4%), with a mean age of 49 years. The majority were unemployed (66,7%), lived with family (57,9%), and presented with moderate-severe delusions (80,1%), but without hallucinations (57,8%), disorganized speech (59,6%) or negative symptoms (85,9%). Affective FEP patients were older (61 vs 45 years), presented with less severe psychotic symptoms (7,2 vs 8,3 points), but with higher hospital admission (26,1 vs 21,1 days).ConclusionsRegardless the growing interest concerning FEP, its conceptualization and characterization remains controversial. Our results differ from pre-existing literature data, especially concerning gender and age. By including all the possible etiologies of FEP, we aimed to obtain a more realistic characterization of this entity in a real-world setting.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Psychosis, Telehealth, and COVID-19: Successes and Lessons Learned from the First Wave of the Pandemic

2021 ◽  
pp. 1-12
Author(s):  
Serena Chaudhry ◽  
Ashley Weiss ◽  
Grinasha Dillon ◽  
Ariana O’Shea ◽  
Tonya Cross Hansel
Keyword(s):  
Service Provision ◽  
First Episode Psychosis ◽  
Lessons Learned ◽  
First Episode ◽  
Telemental Health ◽  
Supportive Services ◽  
Client Engagement ◽  
Episode Psychosis ◽  
Provision Of Services ◽  
Second Wave

ABSTRACT Objective: This brief report analyzes a first-episode psychosis (FEP) clinic’s shift from in-person treatment to the provision of services through telemental health during the COVID-19 pandemic. The feasibility of using this technology was examined by assessing client engagement. Methods: The authors created and implemented procedures for the clinic’s transition to telemental health. Once clients’ consent was obtained, a HIPAA compliant platform was used to continue service provision. Results: Client engagement during this period improved compared to the same quarter the previous year. Telemental health was also practical for providing groups and other supportive services to meet clients’ needs. Conclusion: Telemental health is an effective approach to providing care at an FEP clinic during a pandemic. Successes and lessons learned from the first wave of the pandemic can be used to prevent an uptick in symptoms and sustain engagement for this vulnerable population during the anticipated second wave.

scholarly journals Adaptation of a Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Services for First-Episode Psychosis: Results From the Horyzons-Canada Phase 1 Study

10.2196/19887 ◽  
2020 ◽  
Vol 4 (10) ◽  
pp. e19887
Author(s):  
Shalini Lal ◽  
John Gleeson ◽  
Lysanne Rivard ◽  
Simon D'Alfonso ◽  
Ridha Joober ◽  
...  
Keyword(s):  
Digital Health ◽  
First Episode Psychosis ◽  
Lessons Learned ◽  
Mobile Technologies ◽  
Rural Setting ◽  
First Episode ◽  
Health Innovation ◽  
Episode Psychosis ◽  
Support Recovery ◽  
Age Range

Background Developing a digital health innovation can require a substantial amount of financial and human resource investment before it can be scaled for implementation across geographical, cultural, and health care contexts. As such, there is an increased interest in leveraging eHealth innovations developed and tested in one country or jurisdiction and using these innovations in local settings. However, limited knowledge exists on the processes needed to appropriately adapt digital health innovations to optimize their transferability across geographical, cultural, and contextual settings. Objective We report on the results of an adaptation study of Horyzons, a digital health innovation originally developed and tested in Australia. Horyzons is designed to prevent relapses and support recovery in young people receiving services for first-episode psychosis (FEP). The aim of this study is to assess the initial acceptability of Horyzons and adapt it in preparation for pilot testing in Canada. Methods This research took place in 2 specialized early intervention clinics for FEP, located in 1 urban and 1 urban-rural setting, in 2 Canadian provinces. A total of 26 participants were recruited: 15 clinicians (age range 26-56 years) and 11 patients (age range 19-37 years). Following the digital health adaptation framework developed by our team, we used a mixed methods approach, combining descriptive quantitative and qualitative methods across 3 stages of data collection (focus groups, interviews, and consultations), analysis, and adaptations. Results Overall, patients and clinicians appreciated the strengths-based approach and social media features of Horyzons. However, participants expressed concerns related to implementation, especially in relation to capacity (eg, site moderation, crisis management, internet speed in rural locations). They also provided suggestions for adapting content and features, for example, in relation to community resources, volume of text, universal accessibility (eg, for individuals with limitations in vision), and optimization of platform accessibility through mobile devices. Additional aspects of the innovation were flagged for adaptation during the final stages of preparing it for live implementation. These included terms of use, time zone configuration to reflect local time and date, safety and moderation protocols, the need help now feature, and the list of trigger words to flag posts indicative of potential risk. Conclusions In the context of the COVID-19 pandemic and public health guidelines for social distancing, there is an increasing interest and need to leverage the internet and mobile technologies for delivering youth mental health services. As countries look to one another for guidance on how to navigate changing social dynamics, knowledge on how to utilize and adapt existing innovations across contexts is now more important than ever. Using a systematic approach, this study illustrates the methods, processes, results, and lessons learned on adapting a digital health innovation to enhance its local acceptability. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8810

scholarly journals Lessons Learned in Clinical Research Recruitment of Immigrants and Minority Group Members with First-Episode Psychosis

2018 ◽  
Vol 21 (1) ◽  
pp. 123-128 ◽  
Author(s):  
Mercedes Hernandez ◽  
Richard Franco ◽  
Alex Kopelowicz ◽  
Maria Y. Hernandez ◽  
Yesenia Mejia ◽  
...  
Keyword(s):  
Clinical Research ◽  
Minority Group ◽  
First Episode Psychosis ◽  
Lessons Learned ◽  
First Episode ◽  
Research Recruitment ◽  
Episode Psychosis ◽  
Group Members

scholarly journals Rates of treatment-resistant schizophrenia from first-episode cohorts: systematic review and meta-analysis

2021 ◽  
pp. 1-6
Author(s):  
Dan Siskind ◽  
Stacy Orr ◽  
Surabhi Sinha ◽  
Ou Yu ◽  
Bhavna Brijball ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Collection ◽  
First Episode Psychosis ◽  
Drop Out ◽  
Continuous Treatment ◽  
Sensitivity Analyses ◽  
First Episode ◽  
Treatment Resistant ◽  
Episode Psychosis

Background Treatment-resistant schizophrenia (TRS) is associated with high levels of functional impairment, healthcare usage and societal costs. Cross-sectional studies may overestimate TRS rates because of selection bias. Aims We aimed to quantify TRS rates by using first-episode cohorts to improve resource allocation and clozapine access. Method We undertook a systematic review of TRS rates among people with first-episode psychosis and schizophrenia, with a minimum follow-up of 8 weeks. We searched PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews, and meta-analysed TRS rates from included studies. Results Twelve studies were included, totalling 11 958 participants; six studies were of high quality. The rate of TRS was 22.8% (95% CI 19.1–27.0%, P < 0.001) among all first-episode cohorts and 24.4% (95% CI 19.5–30.0%, P < 0.001) among first-episode schizophrenia cohorts. Subgroup sensitivity analyses by location of recruitment, TRS definition, study quality, time of data collection and retrospective versus prospective data collection did not lead to statistically significant differences in heterogeneity. In a meta-regression, duration of follow-up and percentage drop-out did not significantly affect the overall TRS rate. Men were 1.57 times more likely to develop TRS than women (95% CI 1.11–2.21, P = 0.010). Conclusions Almost a quarter of people with first-episode psychosis or schizophrenia will develop TRS in the early stages of treatment. When including people with schizophrenia who relapse despite initial response and continuous treatment, rates of TRS may be as high as a third. These high rates of TRS highlight the need for improved access to clozapine and psychosocial supports.

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