scholarly journals Green care in first-episode psychosis: short report of a mixed-methods evaluation of a ‘woodland group’ in an early intervention service

2021 ◽  
pp. 1-3
Author(s):  
Sharon Cuthbert ◽  
Harriet Sharp ◽  
Clio Berry
Keyword(s):  
Mixed Methods ◽  
Early Intervention ◽  
Group Analysis ◽  
Well Being ◽  
First Episode ◽  
Short Report ◽  
Specific Patient ◽  
Mixed Methods Evaluation ◽  
Patient Reported ◽  
Early Intervention In Psychosis

Aims and method In the context of increasing recognition of the role of nature in well-being, but limited evidence for specific patient groups, we describe a mixed-methods evaluation of a 10-week green care intervention (a woodland group) for 18- to 30-year-olds who had experienced a first episode of psychosis. Data were collected using the Questionnaire on the Process of Recovery (QPR), semi-structured service evaluation questionnaires, the NHS Friends and Family Test (FFT), and focus group analysis. Results All participants present at week 10 (n = 5) would recommend this group to others; 4/8 participants showed reliable improvement on QPR outcome measures. Thematic analysis identified themes of connection with nature and others, development of a sense of well-being and ‘peacefulness’ and new perspectives on psychotic experience. Clinical implications This small retrospective evaluation describes patient-reported benefits, feasibility and acceptability of green care interventions within early intervention in psychosis services (EIS).

scholarly journals Working in the woodlands: a mixed methods evaluation of Green Care in first episode psychosis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S51-S51
Author(s):  
Harriet Sharp ◽  
Sharon Cuthbert ◽  
Clio Berry
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Thematic Analysis ◽  
Small Sample Size ◽  
Small Sample ◽  
First Episode ◽  
Psychotic Experience ◽  
Care Programme ◽  
Patient Reported ◽  
Early Intervention In Psychosis

AimsRecognition of the essential role of nature-based activities for general wellbeing is expanding. Previous evaluation of nature-based activities has shown that those with greater mental health needs may benefit proportionally more compared to the general population. Currently, there is limited evidence of the benefits of green care for those with severe and enduring mental illness, including psychosis.We aim to establish benefits and difficulties encountered during a 10-session green care programme for 18-30 year olds who have experienced first episode of psychosis (FEP) using a mixed methods approach.MethodThis was a service evaluation of the Woodland Group, run by Circle of Life Rediscovery (CLR) and commissioned by Sussex Partnership NHS Foundation Trust in Autumn 2019 for 10 half-day sessions. All participants were aged 18–30 years, referred from Early Intervention in Psychosis service and had experienced FEP. Patients were supported by EIS staff with a ratio of at least 3:1. Sessions consisted of a welcome and agenda setting, ice-breaking activity, core nature-based activity (such as roasting chestnuts, maintaining the woodland area) and a ‘sense meditation’.Quantitative data for this evaluation were collected through routinely collected 15-item Questionnaire on the Process of Recovery (QPR), and a semi-structured intervention experience questionnaire. Qualitative data were collected via a focus group within the final session of the Woodlands Group. Thematic analysis was performed by the three co-authors.ResultSession attendance ranged between 3-15. 4/8 patients showed reliable improvement on QPR outcome measures, 1 showed deterioration and 3 showed no change. Mean QPR scores showed modest increase from average 3.4 (week 1) to 3.8 (week 10). 100% of respondents would recommend this group to others. Thematic analysis identified themes of connection with nature and others, development of a sense of wellbeing and ‘peacefulness’ and new perspectives on psychotic experience.ConclusionThis small, retrospective evaluation is the first to investigate green care interventions for young people experiencing FEP. Our results reflect the positive informal feedback from participants and supporting staff following attendance at the Woodlands Group. Limitations include small sample size, incomplete data, and reliance on patient-reported outcomes. These findings show promise for green care activities within EIS and represents a sustainable intervention in mental health care.

Programma 2000: Celebrating 10 Years of Activity of an Italian Pilot Programme on Early Intervention in Psychosis

2008 ◽  
Vol 42 (12) ◽  
pp. 1003-1012 ◽  
Author(s):  
Angelo Cocchi ◽  
Anna Meneghelli ◽  
Antonio Preti
Keyword(s):  
Early Intervention ◽  
High Risk ◽  
Rating Scale ◽  
Young Patients ◽  
Skills Training ◽  
First Episode ◽  
Global Functioning ◽  
Adult Intelligence Scale ◽  
Cognitive Behavioural ◽  
Early Intervention In Psychosis

Objective: This paper describes the structure and the organization of the single Italian programme specifically targeted at the early detection of and interventions for subjects at onset of or at high risk of psychosis, Programma 2000. Methods: Programma 2000 is a comprehensive multi-modal protocol of early intervention in psychosis, set up in Milan in 1999. The service has been very active since its opening, and at the time of writing (spring (April) 2008), more than 300 young patients have been evaluated through a detailed protocol that embraces Health of the Nation Outcome Scale (HoNOS), Brief Psychiatric Rating Scale (BPRS), Cognitive Behavioural Assessment 2.0, Disability Assessment Schedule, Camberwell Family Interview, Wechsler Adult Intelligence Scale and the Early Recognition Inventory Retrospective Assessment of Symptoms. The treatment includes psychoeducation, cognitive behavioural therapy (CBT), both structured and unstructured psychosocial interventions and pharmacotherapy, when necessary. Results: The programme focuses on young people aged 17–30 years: to date, a total of 132 subjects with definite psychosis or within the high-risk category have been enrolled in treatment after assessment. Patients with first-episode psychosis were, on average and expectedly, more severe than those in the at-risk group, and were more likely to be prescribed antipsychotic drugs. A large majority of patients in both groups received tailored CBT; individual sessions of skills training were provided to two-thirds of patients. In both groups, improvement was found in both the BPRS and HoNOS, and in the level of global functioning as assessed on Global Assessment of Functioning at 6 month and 1 year follow up. Global functioning was more sensitive to change than symptom severity, reflecting the intensive and personalized efforts to improve social and role functioning in patients. Conclusions: Programma 2000 is still in development but it has already gained the support of therapists and other relevant people involved in the life of subjects at onset, or at high risk of psychosis.

scholarly journals Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting

2010 ◽  
Vol 41 (5) ◽  
pp. 949-958 ◽  
Author(s):  
F. Cheng ◽  
J. B. Kirkbride ◽  
B. R. Lennox ◽  
J. Perez ◽  
K. Masson ◽  
...  
Keyword(s):  
Early Intervention ◽  
Urban Areas ◽  
Clinical Epidemiology ◽  
Population Based ◽  
Service Planning ◽  
Urban Setting ◽  
First Episode ◽  
Urban Settings ◽  
Rural And Urban ◽  
Early Intervention In Psychosis

BackgroundEarly Intervention in Psychosis Services (EIS) for young people in England experiencing first-episode psychosis (FEP) were commissioned in 2002, based on an expected incidence of 15 cases per 100 000 person-years, as reported by schizophrenia epidemiology in highly urban settings. Unconfirmed reports from EIS thereafter have suggested higher than anticipated rates. The aim of this study was to compare the observed with the expected incidence and delineate the clinical epidemiology of FEP using epidemiologically complete data from the CAMEO EIS, over a 6-year period in Cambridgeshire, for a mixed rural–urban population.MethodA population-based study of FEP (ICD-10, F10–39) in people aged 17–35 years referred between 2002 and 2007; the denominator was estimated from mid-year census statistics. Sociodemographic variation was explored by Poisson regression. Crude and directly standardized rates (for age, sex and ethnicity) were compared with pre-EIS rates from two major epidemiological FEP studies conducted in urban English settings.ResultsA total of 285 cases met FEP diagnoses in CAMEO, yielding a crude incidence of 50 per 100 000 person-years [95% confidence interval (CI) 44.5–56.2]. Age- and sex-adjusted rates were raised for people from black ethnic groups compared with the white British [incidence rate ratio (IRR) 2.1, 95% CI 1.1–3.8]. Rates in our EIS were comparable with pre-EIS rates observed in more urban areas after age, sex and ethnicity standardization.ConclusionsOur findings suggest that the incidence observed in EIS is far higher than originally anticipated and is comparable to rates observed in more urban settings prior to the advent of EIS. Sociodemographic variation due to ethnicity and other factors extend beyond urban populations. Our results have implications for psychosis aetiology and service planning.

scholarly journals First-episode psychosis: primary care experience and implications for service development

2009 ◽  
Vol 33 (5) ◽  
pp. 165-168 ◽  
Author(s):  
Mamdouh El-Adl ◽  
John Burke ◽  
Karen Little
Keyword(s):  
Primary Care ◽  
Early Intervention ◽  
General Practitioners ◽  
Psychiatric Service ◽  
First Episode Psychosis ◽  
Health Clinic ◽  
First Episode ◽  
Care Experience ◽  
Episode Psychosis ◽  
Early Intervention In Psychosis

Aim and MethodsTo capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service. A survey of Northamptonshire general practitioners (GPs) using a confidential questionnaire was carried out.ResultsOut of 284 GPs, 123 (43%) responded. General practitioners are unlikely to start treatment before referring to a specialist service: 63 GPs (51% of responders) start treatment in 10% or less of individuals with first-episode psychosis and 19 (15.5%) GPs start treatment in 75% or more before referring them to psychiatric service; 42 GPs (34%) refer those who request/accept a referral and 66 GPs (53%) refer all even if they refuse. Overall, 92 GPs (74%) agreed that an early intervention in psychosis service is needed and 77 (63%) GPs welcome having a mental health clinic in their surgery.Clinical ImplicationsIndividuals are more likely to accept referral to a psychiatric service if offered than to ask for it. People disengaging, stigma, the service being difficult to access/inappropriate and carers' lack of knowledge about mental illness are the likely causes for delayed referral.

First-episode psychosis intervention – description of our early intervention model

2017 ◽  
Vol 41 (S1) ◽  
pp. s823-s823
Author(s):  
B. Melo ◽  
C. Alves Pereira ◽  
R. Cajão ◽  
J. Ribeiro Silva ◽  
S. Pereira ◽  
...  
Keyword(s):  
Early Intervention ◽  
Relapse Rate ◽  
First Episode Psychosis ◽  
First Episode ◽  
Child Psychiatrist ◽  
Duration Of Untreated Psychosis ◽  
Intervention Model ◽  
Episode Psychosis ◽  
Clinical Records ◽  
Early Intervention In Psychosis

IntroductionThe research about the benefits of early diagnosis and treatment of first-episode psychosis had significantly increased in last decades. There have been several early intervention programs in psychotic disease, implemented worldwide, in order to improve the prognosis of these psychotic patients.ObjectivesTo present a brief description of the first-episode psychosis intervention team of Tondela-Viseu Hospital Centre–Portugal and its model. We aim to further characterize our population and describe its evolution since 2008.AimsWe aim to clarify the benefits of an early intervention in psychosis.MethodsWe conducted a retrospective cohort study of patients being followed by our team from November 2008 to September 2016. Demographic and medical data were collected (such as diagnosis, duration of untreated psychosis, treatments and its clinical effectiveness, relapse rate and hospital admissions) in patient's clinical records. The intervention model protocol of this team was also described and analyzed.ResultsThis multidisciplinary team consists of three psychiatrists, one child Psychiatrist, one psychologist and five reference therapists (areas of nursing, social service and occupational therapy). It includes patients diagnosed with first-episode psychosis, aged 16 to 42 years old, followed for five years. The team followed, since its foundation, 123 patients, mostly male. The most prevalent diagnosis are schizophrenia and schizophreniform psychosis. The team is currently following 51 patients.ConclusionsThis team's intervention have progressively assumed a more relevant importance in the prognosis of patients with first-episode psychosis, by reducing the duration of untreated psychosis, the relapse rate and by promoting social reintegration.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Impulsivity in early psychosis: A complex link with violent behaviour and a target for intervention

2018 ◽  
Vol 49 ◽  
pp. 30-36 ◽  
Author(s):  
V. Moulin ◽  
P. Golay ◽  
J. Palix ◽  
P.S. Baumann ◽  
M-M. Gholamrezaeec ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Early Intervention ◽  
Psychotic Disorders ◽  
Interaction Analysis ◽  
Early Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Violent Behaviour ◽  
Increased Risk ◽  
Early Intervention In Psychosis

AbstractBackgroundViolent behaviour (VB) occurs in first episode of schizophrenia and can have devastating impact both on victims and patients themselves. A better knowledge of the underlying mechanisms of VB may pave the way to preventive treatments.Objectives1) To explore the nature of the link between impulsivity and VB in early psychosis (EP) patients; 2) To explore the interactions between impulsivity and substance abuse, insight, and positive symptoms, the main dynamic risk factors of VB described to date.Design and methodsPost hoc analysis of data acquired in the frame of a 36-months EP cohort study. A total of 265 EP patients, aged 18 to 35, treated at TIPP (Treatment and early Intervention in Psychosis Program), at the Department of Psychiatry in Lausanne, Switzerland, were included in the study. Logistic regression analyzes were performed as well as mediation analysis and interaction analysisResultsOur data suggest that impulsivity is a predictor of VB when analyzed independently and as part of a multi-factorial model. Impulsivity continues to differentiate violent patients from non-violent ones at the end of the program. In addition, the relationship between impulsivity and VB is not mediated by substance abuse. Finally, the effect of impulsivity on the probability of VB is potentiated by the interaction of different levels of insight and positive symptoms.ConclusionsEarly intervention strategies in psychotic disorders should include evaluation of impulsivity considering it is linked to increased risk of VB and may respond to treatment.

scholarly journals O1.3. BACK TO THE FUTURE: PREDICTING POPULATION NEED FOR PSYCHOSIS CARE BASED ON THE EPIDEMIOLOGY OF PSYCHOTIC DISORDERS IN ENGLAND, AN APPLIED BAYESIAN METHODOLOGY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S1-S2
Author(s):  
Keltie McDonald ◽  
Tao Ding ◽  
Rebecca Dliwayo ◽  
David Osborn ◽  
Pia Wohland ◽  
...  
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Small Area ◽  
Psychotic Disorders ◽  
Population Projections ◽  
First Episode ◽  
Evidence Based ◽  
Psychosis Risk ◽  
Small Area Level ◽  
Early Intervention In Psychosis

Abstract Background Providing timely, adequate and appropriately-resourced care to people experiencing their first episode of psychosis needs to be informed by evidence-based models of future need in the population. We sought to develop a validated prediction model of need for provision of early intervention in psychosis [EIP] services at the small area level in England up to 2025, based on current epidemiological evidence and demographic projections of the at-risk population. Methods We developed a Bayesian population-level prediction tool. First, we obtained small area incidence data on first episode psychoses, aged 16–64 years, from three major empirical studies of psychosis risk (ÆSOP, ELFEP and SEPEA). Second, we identified suitable prior information from the published literature on variation in psychosis risk by age, sex, ethnicity, deprivation and cannabis use. Third, we combined this empirical data with prior beliefs in six Bayesian Poisson regression models to obtain a full characterisation of the underlying uncertainty in the form of suitable posterior distributions for the relative risks for different permutations of covariate data. Fourth, model coefficients were applied to population projections for 2017 to predict the expected incidence of psychotic disorders, aggregated to Commissioning Group [CCG] and national levels. Fifth, we compared these predictions to observed national FEP data from the NHS Mental Health Services Data Set in 2017 to establish the most valid model. Sixth, we used the best-fitting model to predict three nested indicators of need for psychosis care: (i) total annual referrals to early intervention in psychosis [EIP] for “suspected” FEP (ii) total annual cases accepted onto EIP service caseloads, and (iii) total annual new cases of probable FEP in England up until 2025, using small area population projections. Results A model with an age-sex interaction, ethnicity, small area-level deprivation, social fragmentation and regional cannabis use provided best internal and apparent validity, predicting 8112 (95% Credible Interval 7623 to 8597) individuals with FEP in England in 2017, compared with 8038 observed cases (difference: n=74; 0.94%). Apparent validity was acceptable at CCG level, and by sex and ethnicity, although we observed greater-than-expected need before 35 years old. Predicted new referrals, caseloads and probable incidences of FEP rose over the forecast period by 6.2% to 25,782, 23,187 and 9,541 new cases in 2025, respectively. Discussion Our translational epidemiological tool provides an accurate, validated method to inform planners, commissioners and providers about future population need for psychosis care at different stages of the referral pathway, based on individual and small area level determinants of need. Such tools can be used to underpin evidence-based decision-making in public mental health and resource allocation in mental health systems.

Sign in / Sign up

Export Citation Format

Share Document