The rationale for early intervention in schizophrenia and related disorders

ArticleinEarly Intervention in Psychiatry 3 Suppl 1(s1):S3-7 · September 2009with32 Reads
DOI: 10.1111/j.1751-7893.2009.00123.x · Source: PubMed
To examine the rationale and evidence supporting an early intervention approach in schizophrenia. A selective literature review was conducted. During the onset of schizophrenia, there is often a significant delay between the emergence of psychotic symptoms and the initiation of treatment. The average duration of untreated psychosis is around 1-2 years. During this period, brain function may continue to deteriorate and social networks can be irreversibly damaged. Studies have consistently linked longer duration of untreated psychosis with poorer outcomes and this relationship holds even after controlling for the potential confounding variable of premorbid functioning. In Norway, the early Treatment and Intervention in PSychosis study demonstrated that duration of untreated psychosis is amenable to intervention with the combination of educational campaigns and specialized early detection units substantially decreasing the period from onset of symptoms to treatment initiation. Furthermore, recent evidence from the randomized controlled OPUS and the Lambeth Early Onset trial studies have linked phase-specific early interventions to improved outcomes spanning symptoms, adherence to treatment, comorbid drug abuse, relapse and readmission. Some benefits persist after cessation of the intervention. Early intervention in schizophrenia is justified to reduce the negative personal and social impact of prolonged periods of untreated symptoms. Furthermore, phase-specific interventions are associated with improved outcomes, at least in the short term. Further research is needed to establish the optimum duration of such programmes.
    • "However, the tradeoff for using a small sample size in Stage 1 was that we were able to very quickly evaluate the feasibility of the app and refine the platform for use in Stage 2. Another limitation of this feasibility study is that our participants were all in the early phase of schizophrenia and therefore the results of the study are likely not representative of the larger population of those with persistent schizophrenia. We decided to focus on designing the intervention to treat young patients early in their course of illness based on numerous findings promoting the benefits of early intervention [39,40]. By designing an intervention specifically for use with this population we are aiming to significantly improve the course of illness by improving functional outcome during a critical period. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Despite improvements in treating psychosis, schizophrenia remains a chronic and debilitating disorder that affects approximately 1% of the US population and costs society more than depression, dementia, and other medical illnesses across most of the lifespan. Improving functioning early in the course of illness could have significant implications for long-term outcome of individuals with schizophrenia. Yet, current gold-standard treatments do not lead to clinically meaningful improvements in outcome, partly due to the inherent challenges of treating a population with significant cognitive and motivational impairments. The rise of technology presents an opportunity to develop novel treatments that may circumvent the motivational and cognitive challenges observed in schizophrenia. Objective: The purpose of this study was two-fold: (1) to evaluate the feasibility and acceptability of implementing a Personalized Real-Time Intervention for Motivation Enhancement (PRIME), a mobile app intervention designed to target reward-processing impairments, enhance motivation, and thereby improve quality of life in recent onset schizophrenia, and (2) evaluate the empirical benefits of using an iterative, user-centered design (UCD) process. Methods: We conducted two design workshops with 15 key stakeholders, followed by a series of in-depth interviews in collaboration with IDEO, a design and innovation firm. The UCD approach ultimately resulted in the first iteration of PRIME, which was evaluated by 10 RO participants. Results from the Stage 1 participants were then used to guide the next iteration that is currently being evaluated in an ongoing RCT. Participants in both phases were encouraged to use the app daily with a minimum frequency of 1/week over a 12-week period. Results: The UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community "moments feed" to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform. Conclusions: These results indicate that the neuroscience-informed mobile app, PRIME, is a feasible and acceptable intervention for young people with schizophrenia.
    Full-text · Article · Apr 2016
  • [Show abstract] [Hide abstract] ABSTRACT: This article aims to review Latin America's early intervention services in psychosis and to shed light into their challenges and particularities. An internet-based search comprising medical societies' websites, published articles, and major universities' websites was conducted and the results were critically discussed. Latin American countries are profoundly deficient in specialized early intervention services. Our search found seven target services, four of which are based in urban areas of Brazil, inside tertiary hospitals or universities. Among the initiatives advanced by these centers, there are partnerships with the public educational system and other community-based efforts toward knowledge transfer. On the other hand, several challenges remain to be overcome, especially in relation to their expansion, which is necessary to match the existing demand.
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