The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse.
To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset Team) on clinical and social outcomes, and on service user satisfaction.
One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately.
Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups.
The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.
"Research findings support a number of key elements of early intervention programs, yet there is variability in their implementation (Catts et al., 2010; Ghio et al., 2012; McGorry et al., 2008; Srihari et al., 2012). Some programs stress the importance of case management, while others focus on medication or social and functional recovery (Garety et al., 2006; Spencer et al., 2001). Although variation exists, most studies indicate key components such as: pharmacological interventions , cognitive-behavioral treatment, family interventions, and vocational services (Allott et al., 2011; De Masi et al., 2008; Hill et al., 2012; Spencer et al., 2001). "
"The outcomes were also better in satisfaction (Verona Service Satisfaction Scale), quality of life (MANSA), and pharmacological adherence. In addition, the patients maintained educational or work activities for a longer period of time than the control group (6.9 vs. 4.2 months) (11). Patients receiving specialized care reported a greater average number of significant others in their social network (2.40 ± 1.20 vs. 1.71 ± 1.06), which linear regression analysis correlated with significant improvement in total PANNS and GAF (β = 2.95, SE = 1.04), showing the importance of social network in clinical improvement (12). "
[Show abstract][Hide abstract] ABSTRACT: Background: In Chile, the clinical guidelines “For the Treatment of People from First Episode of Schizophrenia” aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals. Objectives: This study compiles and synthesizes available scientific evidence from the last 14 years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders. Methodology: An electronic search was carried out using PUBMED, LILACS and Science-Direct as databases. Criteria of inclusion: i: randomized clinical trials, ii. Community-based interventions, iii. diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10). Exclusion Criteria: i. treatments exclusively pharmacological, ii. Interventions carried out in inpatient settings, ii. bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). Results: 66 articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status. Conclusions: Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia.
Frontiers in Psychiatry 10/2013; 4:116. DOI:10.3389/fpsyt.2013.00116
"However, it is interesting to note at this point that, in both countries, there is a gap between the mental health needs of adolescents and the services available to them. Some researchers in the United Kingdom have claimed that help for adolescents is often not available or effective (Garety et al., 2006). Others have pointed out that many of the major mental health disorders begin in adolescence, but that this is where service provision is weakest (Gunn, 2004). "
[Show abstract][Hide abstract] ABSTRACT: Estimates of the mental health needs of adolescents far outstrip the resources of traditional mental health. The field of adventure therapy has the potential to help meet these unmet needs. It is argued that particularly in the United States and the United Kingdom, for adventure therapy to become a formal part of the mental health delivery service and thereby secure funding for innovative programs, the field will have to conform to the standards of other ancillary health care providers. In this way, high standards of staff training and credentials will be required, as will an evidence base that is consistent with models used by, among other organizations, the National Health Service. Advances have been made through the research efforts of groups like the Outdoor Behavioral Research Cooperative. Training and competency standards have also been developed. In addition to continued training and research, project RE-AIM offers a promising model to implement adventure therapy as a component of a comprehensive mental health delivery system.
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