Early Intervention In Psychosis

Question 1

What is the relationship between Duration of Untreated Psychosis (DUP) and negative symptom severity?

Answer 1

Longer DUP is associated with greater severity of negative symptoms.

Question 2

What is the current evidence regarding psychological interventions for At Risk Mental States (ARMS)?

Answer 2

Psychological interventions are promising but challenging to implement widely.

Question 3

What is the ethical concern regarding antipsychotic use in ARMS?

Answer 3

Antipsychotics can reduce transition rates but are ethically problematic since only 30% of individuals in ARMS transition to psychosis.

Question 4

How does a first-degree relative with psychosis affect the ARMS threshold?

Answer 4

It lowers the threshold for ARMS and is associated with a severe decline in functioning.

Question 5

Why is the period 3-5 years after the onset of psychosis critical?

Answer 5

Approximately two-thirds of individuals with psychosis may attempt suicide during this period.

Question 6

What is the effectiveness of Early Intervention Services (EIS) in improving psychosis outcomes?

Answer 6

EIS shows modest effects on outcomes including relapse rates and functioning.

Question 7

What are the key findings regarding community-based mental health interventions?

Answer 7

Case Management, EIS, and caregiver-directed interventions are superior to standard care in reducing hospital admissions.

Question 8

What evidence supports EIS’s impact on global functioning?

Answer 8

EIS has high-quality evidence showing a small positive effect on global functioning.

Question 9

How do EIS and self-management education affect quality of life?

Answer 9

Both show a small positive effect on quality of life with moderate-quality evidence.

Question 10

What notable gaps exist in community mental health research?

Answer 10

There are significant gaps in innovative community mental health strategies that have not been covered in meta-analyses.

Question 11

What has been observed about long-term outcomes despite early intervention initiatives?

Answer 11

Although remission from the first episode has increased, rates of full recovery may have declined over time.

Question 12

What challenges exist in detecting individuals with ARMS?

Answer 12

False positives and difficulties finding individuals who present only when developing psychosis hinder detection efforts.

Question 13

What percentage of individuals with psychosis/bipolar had prior CAMHS contact?

Answer 13

50.2% had a history of CAMHS contact before their diagnosis.

Question 14

What did Fusar-Poli et al.’s meta-analysis reveal about transition rates to psychosis for those assessed as having an ARMS?

Answer 14

The transition rate was found to be 32% at three years.

Question 15

What strategies are being researched to improve detection of ARMS?

Answer 15

Combining clinical screening tools with biomarkers, cognitive markers, and machine learning approaches.

Question 16

What does recent meta-analysis suggest about CBT for reducing incidence in ARMS?

Answer 16

CBT remains the most promising approach, showing a reduction in incidence at 12 months (RR = 0.52).

Question 17

What are some barriers to improving EIS effectiveness?

Answer 17

Limited focus on individualizing care, lack of trauma-informed approaches, and insufficient service user involvement.

Question 18

Which ethnic groups are less likely to receive CBT for psychosis within Early Intervention Services?

Answer 18

Bangladeshi and Pakistani individuals are less likely to receive CBT for psychosis.

Question 19

What challenges exist regarding maintaining benefits after discharge from EIS?

Answer 19

High relapse rates and mixed results regarding sustained benefits beyond discharge indicate challenges in continuity of care.

Question 20

What areas require further investigation to improve early intervention outcomes?

Answer 20

Research should focus on sustaining benefits post-discharge, individualizing interventions, and addressing societal barriers to engagement.

Question 21

What does DUP stand for in the context of psychosis?

Answer 21

Duration of Untreated Psychosis.

Question 22

How do early detection initiatives impact the duration of untreated psychosis (DUP)?

Answer 22

They aim to reduce DUP, which is typically 1-2 years without EIS.

Question 23

What are the main goals of early detection initiatives?

Answer 23

To improve prognosis, alleviate distress, reduce adverse incidents, and decrease crisis service entry.

Question 24

What was the TIPS study’s primary focus?

Answer 24

To assess the impact of an extensive early detection program on reducing DUP in Norway.

Question 25

What were the median DUP findings in the TIPS study?

Answer 25

Median DUP was 5 weeks with early detection vs. 16 weeks without it.

Question 26

How did symptoms at first contact differ with and without early detection?

Answer 26

Symptoms were more severe without early detection.

Question 27

What long-term benefits were observed from early detection initiatives?

Answer 27

Better social functioning and reduced negative symptoms over time.

Question 28

What are some impediments to effective early detection of psychosis?

Answer 28

Vagueness of symptoms, stigma, reluctance to refer, and withdrawal of individuals with psychosis.

Question 29

What is the prodrome phase in relation to psychosis?

Answer 29

The phase characterized by gradual deterioration leading up to the first psychotic symptom.

Question 30

What are the three groups defined under At Risk Mental States (ARMS)?

Answer 30

Family history with decline in functioning, sub-threshold positive symptoms, and BLIPS (brief limited intermittent psychotic symptoms).

Question 31

What kind of distress is often experienced during the prodrome phase?

Answer 31

Severe distress and impairment of functioning despite the absence of frank psychotic symptoms.

Question 32

What tools are commonly used to assess At Risk Mental States?

Answer 32

CAARMS (Comprehensive Assessment of At Risk Mental States) and SIPS (Structured Interview for Prodromal Syndromes).

Question 33

What are the estimated transition rates from ARMS to psychosis after 3 years?

Answer 33

Approximately 36%.

Question 34

What does research suggest about CBT for individuals at risk for psychosis?

Answer 34

Meta-analyses indicate a positive effect on reducing transition rates when trials are pooled.

Question 35

What are the primary goals of Early Intervention Services (EIS) in promoting recovery?

Answer 35

To reduce DUP, improve social recovery, prevent relapse, and engage family support.

Question 36

What does critical period theory suggest about outcomes after a first episode of psychosis?

Answer 36

Functioning and residual symptoms tend not to change much after about 5 years post-episode.

Question 37

Why is family involvement crucial in EIS?

Answer 37

It helps develop a strong therapeutic alliance and supports recovery efforts.

Question 38

Which studies provide evidence for the effectiveness of EIS?

Answer 38

LEO study, OPUS study, and RAISE trial show reduced relapse rates and improved quality of life.

Question 39

What are some reservations regarding Early Intervention Services (EIS)?

Answer 39

Lack of clear long-term effects on prognosis and uncertainty about critical intervention components.

Question 40

What areas require further research regarding ARMS interventions?

Answer 40

Better screening methods, broader service models, and understanding long-term effects of interventions.