Early Intervention In Psychosis Flashcards
What is the relationship between Duration of Untreated Psychosis (DUP) and negative symptom severity?
Longer DUP is associated with greater severity of negative symptoms.
What is the current evidence regarding psychological interventions for At Risk Mental States (ARMS)?
Psychological interventions are promising but challenging to implement widely.
What is the ethical concern regarding antipsychotic use in ARMS?
Antipsychotics can reduce transition rates but are ethically problematic since only 30% of individuals in ARMS transition to psychosis.
How does a first-degree relative with psychosis affect the ARMS threshold?
It lowers the threshold for ARMS and is associated with a severe decline in functioning.
Why is the period 3-5 years after the onset of psychosis critical?
Approximately two-thirds of individuals with psychosis may attempt suicide during this period.
What is the effectiveness of Early Intervention Services (EIS) in improving psychosis outcomes?
EIS shows modest effects on outcomes including relapse rates and functioning.
What are the key findings regarding community-based mental health interventions?
Case Management, EIS, and caregiver-directed interventions are superior to standard care in reducing hospital admissions.
What evidence supports EIS’s impact on global functioning?
EIS has high-quality evidence showing a small positive effect on global functioning.
How do EIS and self-management education affect quality of life?
Both show a small positive effect on quality of life with moderate-quality evidence.
What notable gaps exist in community mental health research?
There are significant gaps in innovative community mental health strategies that have not been covered in meta-analyses.
What has been observed about long-term outcomes despite early intervention initiatives?
Although remission from the first episode has increased, rates of full recovery may have declined over time.
What challenges exist in detecting individuals with ARMS?
False positives and difficulties finding individuals who present only when developing psychosis hinder detection efforts.
What percentage of individuals with psychosis/bipolar had prior CAMHS contact?
50.2% had a history of CAMHS contact before their diagnosis.
What did Fusar-Poli et al.’s meta-analysis reveal about transition rates to psychosis for those assessed as having an ARMS?
The transition rate was found to be 32% at three years.
What strategies are being researched to improve detection of ARMS?
Combining clinical screening tools with biomarkers, cognitive markers, and machine learning approaches.
What does recent meta-analysis suggest about CBT for reducing incidence in ARMS?
CBT remains the most promising approach, showing a reduction in incidence at 12 months (RR = 0.52).
What are some barriers to improving EIS effectiveness?
Limited focus on individualizing care, lack of trauma-informed approaches, and insufficient service user involvement.
Which ethnic groups are less likely to receive CBT for psychosis within Early Intervention Services?
Bangladeshi and Pakistani individuals are less likely to receive CBT for psychosis.
What challenges exist regarding maintaining benefits after discharge from EIS?
High relapse rates and mixed results regarding sustained benefits beyond discharge indicate challenges in continuity of care.
What areas require further investigation to improve early intervention outcomes?
Research should focus on sustaining benefits post-discharge, individualizing interventions, and addressing societal barriers to engagement.
What does DUP stand for in the context of psychosis?
Duration of Untreated Psychosis.
How do early detection initiatives impact the duration of untreated psychosis (DUP)?
They aim to reduce DUP, which is typically 1-2 years without EIS.
What are the main goals of early detection initiatives?
To improve prognosis, alleviate distress, reduce adverse incidents, and decrease crisis service entry.
What was the TIPS study’s primary focus?
To assess the impact of an extensive early detection program on reducing DUP in Norway.
What were the median DUP findings in the TIPS study?
Median DUP was 5 weeks with early detection vs. 16 weeks without it.
How did symptoms at first contact differ with and without early detection?
Symptoms were more severe without early detection.
What long-term benefits were observed from early detection initiatives?
Better social functioning and reduced negative symptoms over time.
What are some impediments to effective early detection of psychosis?
Vagueness of symptoms, stigma, reluctance to refer, and withdrawal of individuals with psychosis.
What is the prodrome phase in relation to psychosis?
The phase characterized by gradual deterioration leading up to the first psychotic symptom.
What are the three groups defined under At Risk Mental States (ARMS)?
Family history with decline in functioning, sub-threshold positive symptoms, and BLIPS (brief limited intermittent psychotic symptoms).
What kind of distress is often experienced during the prodrome phase?
Severe distress and impairment of functioning despite the absence of frank psychotic symptoms.
What tools are commonly used to assess At Risk Mental States?
CAARMS (Comprehensive Assessment of At Risk Mental States) and SIPS (Structured Interview for Prodromal Syndromes).
What are the estimated transition rates from ARMS to psychosis after 3 years?
Approximately 36%.
What does research suggest about CBT for individuals at risk for psychosis?
Meta-analyses indicate a positive effect on reducing transition rates when trials are pooled.
What are the primary goals of Early Intervention Services (EIS) in promoting recovery?
To reduce DUP, improve social recovery, prevent relapse, and engage family support.
What does critical period theory suggest about outcomes after a first episode of psychosis?
Functioning and residual symptoms tend not to change much after about 5 years post-episode.
Why is family involvement crucial in EIS?
It helps develop a strong therapeutic alliance and supports recovery efforts.
Which studies provide evidence for the effectiveness of EIS?
LEO study, OPUS study, and RAISE trial show reduced relapse rates and improved quality of life.
What are some reservations regarding Early Intervention Services (EIS)?
Lack of clear long-term effects on prognosis and uncertainty about critical intervention components.
What areas require further research regarding ARMS interventions?
Better screening methods, broader service models, and understanding long-term effects of interventions.
