Intro

Question 1

What is psychosis?

Answer 1

An umbrella turm which inludes schizophrenia and BP- can casue problems in research due to implied heterogenity Maj et al., 2021

2-3% of worldwide populations are affected

Onset in adolescents/eary adulthood

Includes mixture of positive, negative and cognitive symptom

Question 2

Why is EIP important? (5)

Answer 2

1. Longer duration of untreated psychosis is linke with poorer clinical outcome/ harder to get better + Evidence across culturs
2. Initial response to first treatment is a predictor of how well they will react in long-term
3. First few years of the illness carry the highest risk of physical (self) harm
4. Early phase of psychosis is a crutial period for return to education and stable employment
5. Minimise the risk of socila exclusion, possible to work with immediate community of the people

Question 3

What casues psychosis?

Answer 3

No one size fits all resposne

Generally: Gene x Environemtn interaction

Study: e.g. Caspi et al. (2005)

Question 4

Does psychosis affect the brain?

Answer 4

Yes, it affects brain studcutre (Gong et al. 2015)
and function (Fornito & Bullmore 2016)

Question 5

The Dysconnectivity Hypothesis
rationale + hypothesis+ support +critique

Answer 5

Rationale: It has not been possible to explain the complex symptoms of psychosis simply in terms of localised changes in the brain.

The hypothesis: This has led to the hypothesis that the core neural deficit of psychosis lies in abnormal interactions between regions.

Support:
Structural and functional neuroimaging is providing strong evidence for this hypothesis.(Del Fabro et al., 2021; Li et al., 2019)

Critique:
But is dysconnectivity a cause, a correlate or a consequence of the illness? And is it unique to psychosis or a trans-diagnostic feature of all mental illness (especially in the face of mutiple comorbidies present?

Question 6

Principles of EI (7)

Answer 6

1. Treatment is appropriate and tailored to a phase of illness (staging model)
2. Individualised interventions
3. Holistic approach (mental + physical health)
4. Focus on recovery over remission (functioning not removing symptoms)
5. Therapeutic optimism (hope and possible recovery)
6. Minimise stigma
7. Engagement

Question 7

What is engagement in EI? (5)

Answer 7

• Supportive / emphatic relationship in which the patient’s needs, aspirations, strengths are central
• Non-coercive but assertive maintenance of contact (e.g. keeping in touch with family when difficult to access client)
• Flexibility about frequency and location of meetings
• Peer support as a vital ingredient in engagement
• Failure to engage does not lead to case closure (persistance to engage people, not punish them for not coming)

Question 8

Evidence for EI (CBT for URH - this early)

Answer 8

CBT can reduce transition rates into psychosis of UHR groups (+ reducing positive symptoms)

Longer DUP = worse outcomes of psychosis

BUT: CBT is not the most cost effective + for UHR - not everyone will respond and many (2/3) will not develop psychosis anyway = waste of resorces

Question 9

OPUS trial (2 studies)

Answer 9

Bertelsen et al. 2008:
At 5 year follow-up, no difference in positive or negative symptoms between the EI and standard care groups.
The EI group less likely to be in supported housing than the standard care group (4% vs 10%; p=0.02).
The EI group had fewer days of hospital use than the standard care group (149 vs 193 days; p=0.05)

Petersen et al. 2005:
RCT comparing EI for FEP vs standard treatment (ST) in Denmark between 1998 and 2000 (n=547)

Follow-up at 1, 2 and 5 years
People receiving EI showed improved outcome in:
* Positive symptoms at 1 & 2 years
* Negative symptoms at 1 & 2 years
* Global functioning
* User satisfaction
* Secondary substance abuse
* Treatment adherence

Question 10

EI overall evidence

Answer 10

EI results in:
* Reduced relapse rates
* Improved global functioning
* Greater treatment adherence
+ really good for economy (McCrone et al., 2007)

But:
* A significant proportion of patients does not show benefit
* While positive impact on functioning seems durable, clinical improvement is not sustained once EI ends.

Question 11

Challanges with EI (3?)

Answer 11

1) How to effectively help people transition form stanard to EI care?
2) Should EI be limited to 3 years or extended? If so, for how long?
3) Should EI be extened to cover any other MH issues in young people or just psychosis?