Week 4 Flashcards
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are the primary symptoms of psychosis?
The primary symptoms of psychosis include delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms such as avolition and social withdrawal.
School-based Approaches to Reducing the Duration of Untreated Psychosis
Why is early intervention important for psychosis?
Early intervention is crucial as shorter durations of untreated psychosis (DUP) are associated with better outcomes, such as improved treatment response, fewer negative symptoms, and reduced mortality.
School-based Approaches to Reducing the Duration of Untreated Psychosis
Why are schools important for addressing adolescent psychosis?
Since psychosis often emerges during adolescence when youth are in school, schools can play a pivotal role in early identification, psychoeducation, and reducing the DUP through appropriate interventions.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are some key factors contributing to a longer DUP?
Factors include poor insight, avolition, lack of access to mental health services, stigma, caregiver strain, and inadequate screening and referral systems.
School-based Approaches to Reducing the Duration of Untreated Psychosis
How does stigma impact the treatment of psychosis?
Stigma, both public and self-imposed, can delay help-seeking behavior and hinder early identification and treatment, leading to longer DUP and poorer outcomes.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What role have school-based interventions played in reducing DUP globally?
Programs like TIPS in Norway and EPIP in Singapore show that school outreach, education campaigns, and accessible mental health services can significantly reduce DUP and improve outcomes.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are the potential benefits of reducing stigma through schools?
Reducing stigma in schools can create a more inclusive environment, encourage early help-seeking, and educate the community about mental health, thereby facilitating timely intervention.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What strategies can schools use to improve psychosis identification?
Schools can employ standardized mental health screening tools, provide psychoeducation, and train staff to recognize early signs of psychosis and make appropriate referrals.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What treatments are recommended for students with psychosis?
Recommended treatments include psychopharmacological interventions, psychosocial support, individualized education plans, and addressing comorbid conditions through a multidisciplinary approach.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are some future directions for school-based efforts to reduce DUP?
Future research should focus on improving psychoeducational programs, standardizing definitions and measurements of DUP, enhancing screening tools, and increasing access to specialized mental health care.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What developmental milestones are at risk for disruption during adolescent psychosis?
Completing high school, advancing to college, acquiring life skills, maintaining social relationships, and achieving professional or intimate connections.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What is the definition of Duration of Untreated Psychosis (DUP)?
DUP is the time between the onset of psychotic symptoms and the initiation of appropriate treatment.
School-based Approaches to Reducing the Duration of Untreated Psychosis
Why is reducing DUP crucial for adolescents?
Shorter DUP is linked to better responses to treatment, higher quality of life, fewer negative symptoms, and reduced mortality.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are some disorders that may present with psychotic features?
Schizophrenia, schizoaffective disorder, delusional disorder, mood disorders, substance use, trauma, dementia, and certain medical or sleep conditions.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What factors may lead to a longer DUP in adolescents?
Poor insight, stigma, logistical barriers to accessing mental health care, and lack of knowledge about psychotic symptoms among school personnel and families.
School-based Approaches to Reducing the Duration of Untreated Psychosis
How can schools reduce stigma associated with psychosis?
By implementing psychoeducation programs, creating a supportive school climate, and engaging students in discussions about mental health.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are examples of international programs aimed at reducing DUP?
TIPS (Norway), EPPIC (Australia), PEPP (Canada), and EPIP (Singapore) have employed strategies such as public education, school visits, and improved access to mental health services.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What is one key finding from the TIPS program in Norway?
It significantly reduced DUP from 16 weeks to 5 weeks through early detection and education initiatives.
School-based Approaches to Reducing the Duration of Untreated Psychosis
How did the EPIP program in Singapore reduce DUP?
By using mass media, public forums, and school workshops to raise awareness and provide resources, reducing the median DUP from 12 months to 4 months.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are some recommended elements of psychoeducation to reduce psychosis stigma?
Youth-focused, discussion-oriented programs involving personal stories, tangible referral resources, and regular meetings.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What role can behavioral assessment tools play in identifying psychosis?
Tools like the Behavioral Assessment Scale for Children (BASC-2) can screen for symptoms of psychosis and link students to specialized care.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What are key treatment strategies for psychosis in students?
Psychopharmacological treatment, psychosocial interventions, and individualized educational accommodations.
School-based Approaches to Reducing the Duration of Untreated Psychosis
How can schools support families of students with psychosis?
By providing psychoeducation, reducing stigma, and assisting families in accessing mental health resources.
School-based Approaches to Reducing the Duration of Untreated Psychosis
What is a clinical vignette’s role in highlighting psychosis identification?
It demonstrates real-world scenarios of how delayed recognition of psychosis impacts students and emphasizes the importance of school-based intervention programs.
Predicting Psychosis
What is the main context of the study on predicting psychosis?
A substantial proportion of people at clinical high risk of psychosis will develop a psychotic disorder over time, but the risk of transition varies between centers and may be declining.
Predicting Psychosis
What was the objective of the study?
To quantitatively examine the literature on transition risk to psychosis in individuals at clinical high risk.
Predicting Psychosis
What data sources were used in the study?
Electronic databases were searched until January 2011, and all studies reporting transition risks in patients at clinical high risk were retrieved.
Predicting Psychosis
How many studies were selected for analysis?
Twenty-seven studies met the inclusion criteria, comprising a total of 2502 patients.
Predicting Psychosis
What was the risk of transition to psychosis over different time periods?
The transition risk was 18% after 6 months, 22% after 1 year, 29% after 2 years, and 36% after 3 years.
Predicting Psychosis
What factors influenced the transition risk to psychosis?
Age of participants, publication year, treatments received, and diagnostic criteria used.
Predicting Psychosis
What conclusion did the study reach about clinical high-risk individuals?
Clinical high-risk individuals have a high risk of developing psychosis within three years, with the risk increasing over time.
Predicting Psychosis
What was the historical approach to managing psychosis?
Psychotic disorders were typically managed only after the first episode of frank psychosis, with little attention given to the period preceding it.
Predicting Psychosis
What are the criteria for identifying individuals at high risk of psychosis?
The criteria include attenuated psychotic symptoms, brief full-blown psychotic episodes, or significant functional decline with genetic risk for schizophrenia.
Predicting Psychosis
What structural and functional brain impairments are associated with high-risk individuals?
Impairments in neuropsychological performance, brain structure, function, connectivity, and neurochemistry.
Predicting Psychosis
Why is the predictive validity of the high-risk state debated?
Because transition risks vary across studies and some recent findings suggest a decline in transition rates.
Predicting Psychosis
What effect did treatment have on transition risk?
Patients receiving psychological treatment had lower transition risks (24.9%) compared to those receiving standard psychiatric care (32.8%).
Predicting Psychosis
How did the transition risk vary by age?
Older individuals had a slightly higher transition risk compared to younger ones.
Predicting Psychosis
What impact did the year of publication have on transition risk?
More recent studies showed a decrease in transition risks, possibly due to earlier detection and intervention.
Predicting Psychosis
What was a major limitation identified in the study?
There is no standardized method for assessing and defining high-risk states or transition to psychosis across studies.
Predicting Psychosis
What was one of the key recommendations for future research?
Future studies should standardize criteria for high-risk states and transition definitions to improve comparability.
Preventive interventions for individuals at ultra high risk for psychosis
What is the purpose of the ultra-high risk (UHR) criteria developed in the early 1990s?
The UHR criteria were developed as part of an early intervention approach to detect individuals at high and imminent risk of developing first-episode psychosis (FEP).
Preventive interventions for individuals at ultra high risk for psychosis
How has the rate of transition to psychosis in UHR samples changed over time?
It has declined from an initial level of 40% to an estimated 22% over the medium term.
Preventive interventions for individuals at ultra high risk for psychosis
What are some of the risks for individuals who do not develop sustained psychosis?
They remain at risk for persistent attenuated positive and negative psychotic symptoms, non-psychotic disorders (notably anxiety and depression), and impaired psychosocial functioning.
Preventive interventions for individuals at ultra high risk for psychosis
What is the primary outcome measured in studies of interventions for UHR individuals?
The primary outcome is the transition to psychosis at 12 months.
Preventive interventions for individuals at ultra high risk for psychosis
What secondary outcomes are assessed in these studies?
Secondary outcomes include attenuated psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, global and social functioning, quality of life, and treatment acceptability.
Preventive interventions for individuals at ultra high risk for psychosis
What methodological quality concerns were identified in the studies analyzed?
Twelve studies (46%) were at risk of bias due to methodological limitations, including small sample sizes, lack of randomization details, and absence of blinding.
Preventive interventions for individuals at ultra high risk for psychosis
What was the overall effect of pharmacological and psychological interventions on transition to psychosis at 12 months?
The risk of transitioning to psychosis was significantly reduced by 43%, favoring the experimental condition.
Preventive interventions for individuals at ultra high risk for psychosis
Which intervention was found to be the most effective at reducing transition rates?
Cognitive Behavioral Therapy (CBT) was the only intervention that significantly reduced transition rates compared to control interventions.
Preventive interventions for individuals at ultra high risk for psychosis
How did risperidone plus CBT perform in preventing transition to psychosis?
It was not significantly effective at 12 months or medium-term follow-up, but showed a significant effect at 6 months.
Preventive interventions for individuals at ultra high risk for psychosis
What was the impact of omega-3 fatty acids on psychosis prevention?
Omega-3 fatty acids did not have a significant effect on transition at any time point.
Preventive interventions for individuals at ultra high risk for psychosis
Were there significant differences in global functioning and quality of life between intervention and control groups?
No significant differences were found at 12 months or at other time points.
Preventive interventions for individuals at ultra high risk for psychosis
Did treatment discontinuation rates differ between experimental and control groups?
No significant differences were found in all-cause treatment discontinuation across interventions.
Preventive interventions for individuals at ultra high risk for psychosis
How much did psychosis incidence decrease at 12 months and 18–48 months?
Psychosis incidence was reduced by 45% at 12 months and by 40% at 18–48 months.
Preventive interventions for individuals at ultra high risk for psychosis
What factors contributed to study heterogeneity in intervention effectiveness?
Factors included sample age, inclusion criteria, and the use of enriched CBT protocols.
Preventive interventions for individuals at ultra high risk for psychosis
How did the enriched CBT protocol differ from standard CBT?
It included education and homework assignments to address cognitive biases, leading to greater effectiveness.
Preventive interventions for individuals at ultra high risk for psychosis
What was the main limitation of the studies included in the meta-analysis?
The studies had wide confidence intervals and some methodological weaknesses, requiring further well-designed trials.
Evidence for Differential Predictive Performance
What is the purpose of self-report screening instruments for emerging psychosis?
To improve early detection efforts by increasing the number of true positives among persons deemed to be at ‘clinical high risk’ of the disorder.
Evidence for Differential Predictive Performance
What was the objective of the study?
To examine whether a commonly used self-report screening tool for psychosis risk performed equally among black and white youths in its ability to predict clinical high-risk status.
Evidence for Differential Predictive Performance
What methods were used in the study?
Black (N=58) and white (N=50) help-seeking individuals ages 12–25 were assessed with the Prime Screen and the Structured Interview for Psychosis-Risk Syndromes (SIPS). A logistic regression model estimated race differences in the strength of the relation between Prime Screen scores and SIPS-defined risk status.
Evidence for Differential Predictive Performance
What were the results of the study?
Higher Prime Screen scores significantly predicted clinical high-risk status among white (p<.01) but not black participants.
Evidence for Differential Predictive Performance
What did the study conclude?
Consideration of race or ethnicity and associated cultural factors is important when screening for clinical high-risk status. The findings support the need to develop culturally valid early psychosis screening tools.
Evidence for Differential Predictive Performance
Who are individuals at ‘clinical high risk’ for psychosis?
Those experiencing recent attenuated psychotic syndromes or other indicators of susceptibility during adolescence or young adulthood.
Evidence for Differential Predictive Performance
What is one limitation of psychosis prevention efforts?
False-positive identification of psychosis risk syndromes limits the capacity of psychosis prevention efforts.
Evidence for Differential Predictive Performance
Why might self-report screening tools be useful in identifying psychosis risk?
They can indicate one’s probability of meeting high-risk criteria once fully assessed and have strong validity in the prediction of subsequent psychosis.
Evidence for Differential Predictive Performance
What is a major problem with many psychometric instruments?
They lack sensitivity to important cultural factors, which may contribute to sociodemographic health disparities.
Evidence for Differential Predictive Performance
Why is it important to develop culturally valid screening tools for psychosis?
To promote appropriately tailored early intervention efforts and reduce disparities in misdiagnosis and treatment.
False-positives and Clinical Heterogeneity among Youth
What is the primary goal of early detection and prevention of psychosis?
To identify individuals showing early, attenuated manifestations and provide appropriate interventions.
False-positives and Clinical Heterogeneity among Youth
What are some factors that influence whether attenuated psychotic signs are considered risk factors for psychosis?
Clients’ life experiences, cultural background, and co-occurring psychopathology.
False-positives and Clinical Heterogeneity among Youth
What has research shown about individuals identified as being at clinical high-risk (CHR)?
Only about 32% develop a psychotic disorder, but many experience persistent functional impairment and comorbid conditions.
False-positives and Clinical Heterogeneity among Youth
What are some ethical concerns in providing intervention for CHR individuals?
Contextual influences on diagnosis, clinical heterogeneity, consequences of disclosing psychosis-risk, and lack of evidence-based guidelines.
False-positives and Clinical Heterogeneity among Youth
What is a ‘false positive’ in the context of CHR identification?
An individual classified as at-risk for psychosis who was never actually going to develop the illness.
False-positives and Clinical Heterogeneity among Youth
How can life experiences contribute to false-positive identification?
Childhood adversity and substance abuse can lead to transient psychosis-like experiences that may not indicate true psychosis-risk.
False-positives and Clinical Heterogeneity among Youth
How does referral source impact CHR diagnosis?
Clients referred from early psychosis clinics are more likely to require urgent intervention compared to those referred from general sources.
False-positives and Clinical Heterogeneity among Youth
What cultural factors should be considered in CHR diagnosis?
Ethnic minorities and immigrants may show different symptom presentations, and clinician biases may affect diagnoses.
False-positives and Clinical Heterogeneity among Youth
Why is comorbidity important in CHR diagnosis and treatment?
Most CHR individuals have comorbid disorders, which may require prioritized treatment over psychosis prevention.
False-positives and Clinical Heterogeneity among Youth
What is one of the major challenges in implementing CHR treatment?
Lack of strong evidence supporting psychosocial interventions like CBT for CHR symptoms.
False-positives and Clinical Heterogeneity among Youth
How can disclosure of CHR diagnosis affect clients and families?
It may cause fear, confusion, stigma, and misaligned treatment priorities.
False-positives and Clinical Heterogeneity among Youth
What are some strategies to improve CHR identification and treatment?
Use of brief screeners to reduce false-positives and modular, needs-based treatment approaches.
