Intervention Effectiveness in Mental Health
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Questions and Answers

What is a significant barrier to improving outcomes for psychosis?

  • Highly successful GP interventions
  • Limited reach of Early Detection Initiatives (correct)
  • The high effectiveness of Early Detection Initiatives
  • Increased funding for psychosis research

Which approach is most likely to succeed in reducing the duration of untreated psychosis (DUP)?

  • Focus on the wider general public and families (correct)
  • Minimal studies with early intervention
  • Targeted interventions for GPs only
  • School-based initiatives with literature support

What advantage is mentioned regarding youth mental health approaches?

  • They tend to overlook severe mental health problems
  • They are more efficient in addressing a wider range of mental health issues (correct)
  • They primarily target psychosis specifically
  • They significantly increase the stigma associated with mental health

What was the outcome of the MINDMap study at Yale?

<p>DUP reduction following a public information campaign (A)</p> Signup and view all the answers

Why is it suggested to focus on a broader population for psychosis detection?

<p>Better identification of those with severe mental health problems can occur (D)</p> Signup and view all the answers

Which intervention has shown a large effect on global functioning according to the findings?

<p>Family Interventions (A)</p> Signup and view all the answers

What is a noted limitation of the current research on Community Mental Health models?

<p>Significant research gaps regarding innovative strategies (B)</p> Signup and view all the answers

Which intervention is NOT mentioned as being superior in reducing hospital admissions?

<p>Family Interventions (D)</p> Signup and view all the answers

What evidence quality supports the small positive effect of Intensive Case Management on global functioning?

<p>Moderate-quality evidence (A)</p> Signup and view all the answers

Which interventions showed a small positive effect on quality of life?

<p>EIS and Self-Management Education (C)</p> Signup and view all the answers

What does the high relapse rate after discharge from early intervention services (EIS) suggest?

<p>Patients often require continued support after EIS. (B)</p> Signup and view all the answers

What is a proposed benefit of extending early intervention services up to five years?

<p>It provides targeted assistance to selected patients. (B)</p> Signup and view all the answers

What critical area regarding early intervention in psychosis remains uncertain?

<p>Which patients benefit most from EIS. (D)</p> Signup and view all the answers

What societal challenge is highlighted in maintaining the quality of EIS?

<p>Social stigmas preventing access to care. (A)</p> Signup and view all the answers

What area of early intervention in psychosis is noted as neglected and needing attention?

<p>Early detection of psychosis and shortening of duration of untreated psychosis (DUP). (D)</p> Signup and view all the answers

What is the median time from CAMHS contact to a diagnosis of psychosis or bipolar disorder?

<p>6 years (B)</p> Signup and view all the answers

Which condition has shown the most considerable decline in hospital admissions over the past 20 years?

<p>Depression (D)</p> Signup and view all the answers

What is the estimated transition rate to psychosis for people assessed with At Risk Mental State within 3 years?

<p>32% (A)</p> Signup and view all the answers

What has been observed about the prognosis of psychosis over the past 30 years in the UK?

<p>There is no evidence of overall improvement in prognosis. (A)</p> Signup and view all the answers

What is one potential limitation of trying to identify individuals with At Risk Mental States through extensive searching?

<p>Increased false positive rates (C)</p> Signup and view all the answers

Which approach has shown promising results in reducing the incidence of psychosis at 12-months according to meta-analyses?

<p>Cognitive Behavioral Therapy (CBT) (D)</p> Signup and view all the answers

What is a common reason for the reported better prognosis in Lower and Middle Income Countries compared to the UK?

<p>Differences in societal attitudes towards psychosis (C)</p> Signup and view all the answers

What methodology is being explored to improve the prediction of At Risk Mental States in research settings?

<p>Risk calculators combining various markers (B)</p> Signup and view all the answers

What factor has likely contributed to the lower recovery rates in more recent studies compared to earlier ones?

<p>Increase in the complexity of cases (C)</p> Signup and view all the answers

What is a suggested change that could potentially improve long-term outcomes for individuals experiencing psychosis?

<p>Implementing shorter waiting times for treatment (D)</p> Signup and view all the answers

What percentage of prediction accuracy for At Risk Mental States has been achieved in research settings using machine learning and AI approaches?

<p>70-80% (C)</p> Signup and view all the answers

What difficulty is associated with detecting 'At Risk Mental States' (ARMS) in individuals?

<p>Occurrence of false positives (D)</p> Signup and view all the answers

Which of the following is NOT mentioned as a marker that could improve the identification of At Risk Mental States?

<p>Blood pressure regulation (A)</p> Signup and view all the answers

What percentage of individuals with psychosis or bipolar disorder have a history of contact with Child and Adolescent Mental Health Services (CAMHS)?

<p>50.2% (C)</p> Signup and view all the answers

What is a proposed benefit of developing transdiagnostic approaches for managing At Risk Mental States?

<p>Applicable to multiple conditions (D)</p> Signup and view all the answers

What has not significantly changed in the past 20/30 years concerning schizophrenia prognosis?

<p>Rates of hospital admissions (C)</p> Signup and view all the answers

What is one major limitation of intervention delivery within Early Intervention Services (EIS)?

<p>Generic model with a '1 size fits all' approach (D)</p> Signup and view all the answers

Which comorbidity is notably lacking effective interventions within Early Intervention Services?

<p>Personality disorders (C)</p> Signup and view all the answers

What is a suggested approach to improve the quality and outcomes of Early Intervention Services?

<p>Systematic understanding of critical ingredients for outcomes (D)</p> Signup and view all the answers

What social issue is highlighted as a barrier to engagement within Early Intervention Services?

<p>Stigma and racism (B)</p> Signup and view all the answers

Which of the following ethnic groups is mentioned as being less likely to receive CBT for Psychosis in EIS?

<p>Bangladeshi and Pakistani (C)</p> Signup and view all the answers

What is a proposed method for individuals to manage their mental health within Early Intervention Services?

<p>Self-management and crisis planning (D)</p> Signup and view all the answers

What can be inferred about the focus of service delivery in Early Intervention Services?

<p>There is a lack of co-production in service design (A)</p> Signup and view all the answers

Why is the evaluation of peer support important in Early Intervention Services?

<p>It helps meet social needs of service users (D)</p> Signup and view all the answers

What is a significant challenge in the early detection of psychosis?

<p>High threshold for referral to mental health services (C)</p> Signup and view all the answers

Which group is identified as a key target for improving early detection of mental health issues?

<p>The general public and families (A)</p> Signup and view all the answers

What phase is referred to as the ‘prodrome’ in the context of mental health?

<p>The early symptom phase preceding an illness (D)</p> Signup and view all the answers

What symptom differentiation challenge is noted in the early detection of psychosis?

<p>Distinguishing early psychotic symptoms from other mental health issues (D)</p> Signup and view all the answers

What is suggested as a largely untested channel for early psychosis detection?

<p>School environments (D)</p> Signup and view all the answers

What is a notable characteristic of the definition of ‘At Risk Mental States’ (ARMS)?

<p>It is often subjective and fuzzy (D)</p> Signup and view all the answers

What main problem arises from the reluctance to refer individuals to mental health services?

<p>Delay in receiving necessary treatment (D)</p> Signup and view all the answers

What is commonly identified as a significant barrier to early detection in mental health?

<p>Stigma surrounding mental health referrals (A)</p> Signup and view all the answers

What risk factor significantly contributes to the likelihood of developing psychosis?

<p>Having a first-degree relative who has had psychosis (C)</p> Signup and view all the answers

Which of the following describes sub-threshold positive symptoms?

<p>Mild perceptual disturbances without significant reality testing issues (D)</p> Signup and view all the answers

What characterizes BLIPS regarding psychotic symptoms?

<p>Symptoms that spontaneously remit within one week (C)</p> Signup and view all the answers

What is a key reason for intervening during the prodromal stage of psychosis?

<p>Distress and impairment of functioning can be quite severe (C)</p> Signup and view all the answers

Which assessment tool is predominantly used in the UK for at risk mental states?

<p>Comprehensive Assessment of At Risk Mental States (CAARMS) (B)</p> Signup and view all the answers

What is the estimated percentage of individuals transitioning to psychosis after a three-year follow-up from clinical high risk?

<p>36% (B)</p> Signup and view all the answers

Which statement accurately reflects the nature of distress in individuals during the prodromal phase?

<p>They might have acute awareness of problems that diminishes over time (B)</p> Signup and view all the answers

What notable finding is associated with the symptoms presented in clinic settings during the prodromal phase?

<p>About 25% may express ideas about harm to self or others (C)</p> Signup and view all the answers

What is a potential benefit of identifying individuals with At Risk Mental States early on?

<p>It can prevent the development of full-blown psychosis. (A)</p> Signup and view all the answers

Which study focuses on the effectiveness of community-based interventions for untreated psychosis?

<p>Reducing the Duration of Untreated Psychosis in a US Community: A Quasi-Experimental Trial (A)</p> Signup and view all the answers

What is one concern regarding preventative interventions for individuals at ultra-high risk for psychosis?

<p>They can result in misdiagnosis and overtreatment. (B)</p> Signup and view all the answers

What is the primary focus of the Reading list PSBS0005 at University College London?

<p>Interventions for psychosis and bipolar disorder. (A)</p> Signup and view all the answers

Which of the following approaches is suggested to improve early intervention outcomes?

<p>Extending early intervention services beyond five years. (B)</p> Signup and view all the answers

What is a noted challenge in the recruitment of intervention studies for psychosis?

<p>Difficulty in finding participants who fit the criteria (D)</p> Signup and view all the answers

What is a limiting factor in the effectiveness of cognitive behavioral therapy (CBT) for at-risk states?

<p>Transition rates to psychosis are generally low in trials (B)</p> Signup and view all the answers

What ethical concern might arise when considering interventions for individuals at risk of developing psychosis?

<p>The risk of misdiagnosing those who will not psychotically transition (B)</p> Signup and view all the answers

What is a proposed benefit of focusing on a broader group of disorders in youth mental health services?

<p>Better service planning for mental health interventions (D)</p> Signup and view all the answers

Why is the long-term effectiveness of prodromal interventions currently unclear?

<p>Research on these interventions is limited in scope (B)</p> Signup and view all the answers

What factor could potentially yield better methods for identifying individuals in the prodromal phase of psychosis?

<p>Advancements in neuroscience and psychological testing (B)</p> Signup and view all the answers

What is a prevalent misconception about screening for at risk mental states in individuals?

<p>All individuals at risk will eventually develop psychosis (B)</p> Signup and view all the answers

What is the implication of requiring ARMS services in every area as per UK policy despite existing challenges?

<p>It signifies a commitment to addressing youth mental health needs (A)</p> Signup and view all the answers

What was the median duration of untreated psychosis (DUP) in areas with early detection?

<p>5 weeks (D)</p> Signup and view all the answers

At the initial contact, how did the severity of symptoms compare between those with early detection and those without?

<p>More severe without early detection (C)</p> Signup and view all the answers

Which percentage of individuals was hospitalized at first contact in areas with early detection?

<p>61% (A)</p> Signup and view all the answers

Which intervention is noted as not effective in reducing DUP?

<p>EPIP (Singapore) (A)</p> Signup and view all the answers

What type of psychopathology was less severe at 3 months with early detection?

<p>Cognitive symptoms (A)</p> Signup and view all the answers

Over the span of 10 years, which aspect showed better outcomes in individuals with early detection?

<p>Better social functioning (A)</p> Signup and view all the answers

Which demographic initiative successfully reduced DUP?

<p>TIPS (Norway) (B)</p> Signup and view all the answers

What common outcome at 2 years was observed for individuals without early detection?

<p>Worsened depressive symptoms (D)</p> Signup and view all the answers

What is a key focus during the acute phase of treatment in Early Intervention Services (EIS)?

<p>Providing a thorough assessment that includes both clinical and social factors (D)</p> Signup and view all the answers

According to the critical period theory, which statement about symptoms and functioning is accurate after five years?

<p>Functioning and residual symptoms tend not to change much after about five years (C)</p> Signup and view all the answers

Which approach is NOT emphasized for improving the prognosis of psychosis in Early Intervention Services?

<p>Integration of long-term psychiatric hospitalization (B)</p> Signup and view all the answers

What aspect is prioritized in promoting recovery through Early Intervention Services?

<p>Structured relapse prevention plans for all clients (B)</p> Signup and view all the answers

What is a significant outcome observed in the LEO study regarding relapse rates?

<p>30% relapse in LEO compared to 48% in CMHT (B)</p> Signup and view all the answers

Which of the following approaches is emphasized for managing co-morbidities in Early Intervention Services?

<p>Preventative early detection and management of co-morbidities (D)</p> Signup and view all the answers

Which outcome is NOT reported as enhanced by the EIS practices as mentioned in the content?

<p>Increased long-term hospitalization rates (B)</p> Signup and view all the answers

What is one of the main components in the therapeutic alliance according to Early Intervention Services?

<p>Engaging the family's significant social network as much as possible (A)</p> Signup and view all the answers

What does the 2/3 suicide statistic highlight regarding the critical period for individuals with psychosis?

<p>Suicides predominantly happen during early recovery stages (D)</p> Signup and view all the answers

What role does psychoeducation for clients and carers play in the Early Intervention Services?

<p>It facilitates understanding and coping strategies throughout the illness (B)</p> Signup and view all the answers

What approach is suggested to facilitate early reintegration into social activities?

<p>Early return to work, education, and recreational activities (C)</p> Signup and view all the answers

What is a highlighted risk factor for relapse during the recovery phase according to Early Intervention Services?

<p>Most likely time to relapse is within the second year (B)</p> Signup and view all the answers

Which aspect is encouraged to avoid dependency on welfare benefits in individuals making good recovery?

<p>Discouraging early reliance on welfare benefits (C)</p> Signup and view all the answers

Which statement best describes the role of evidence-based interventions in Early Intervention Services?

<p>They are essential and should be systematically available from the start (A)</p> Signup and view all the answers

Flashcards

Intervention Effectiveness

Various community mental health interventions, like case management, early intervention services, and caregiver-directed interventions, are more effective than standard care in reducing hospital admissions.

Early Intervention Services (EIS)

Programs providing early support to individuals experiencing mental health challenges.

Case Management

A support system coordinating care for individuals with mental health needs.

Caregiver-Directed Interventions

Programs assisting families supporting individuals with mental health needs.

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Psychosocial Outcomes

Improvements in aspects of functioning, such as daily life, relationships, and overall well-being.

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Global Functioning

A person's overall ability to manage daily tasks and interact with others.

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Family Interventions

Support programs designed to improve the well-being of families with a member facing mental health challenges.

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Quality of Life

Subjective well-being and satisfaction with one's life.

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Self-Management Education

Programs teaching individuals to handle their own mental health needs.

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Community Mental Health (CMH) models

Approaches to mental health care that emphasize community-based support and resources.

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Trends in UK psychiatric admissions

Rates of psychiatric hospital admissions in the UK for various diagnoses, from 1998 to 2020, show inconsistent trends.

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Schizophrenia hospital admissions

Schizophrenia hospital admissions in the UK have shown a slow decline over 20 years, but not as significantly as for other conditions like depression and dementia.

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Recovery from first episode psychosis

Meta-analysis shows a lower rate of recovery from a first episode of psychosis in recent studies, despite a rise in remission.

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Early intervention in psychosis initiatives

These initiatives, while effective in controlled trials, have not demonstrably improved long-term psychosis outcomes across the general population.

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Barriers to improving psychosis outcomes

Difficulties in detecting and identifying individuals with psychosis at an early stage, including false positives and difficulty reaching the individuals in at-risk mental state (ARMS).

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CAMHS contact

Half of people experiencing psychosis or bipolar disorder have a history of contact with Child and Adolescent Mental Health Services (CAMHS).

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Prognosis in Lower and Middle Income Countries

Studies suggest that the prognosis for psychosis may be better in Lower and Middle Income Countries (LMIC) where mental health services might not be as extensively developed.

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Improved Psychosis Outcomes Factors

Factors that may improve psychosis outcomes include longer support durations and shorter wait times for treatment.

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At Risk Mental State (ARMS)

A condition where individuals show symptoms suggestive of psychosis but haven't yet met criteria for a full-blown psychotic disorder.

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6-year median time

The average time it takes, from first contact with CAMHS (Child and Adolescent Mental Health Services), to a diagnosis of psychosis or bipolar disorder.

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Limited predictive validity of ARMS detection

Early detection of ARMS using current methods doesn’t accurately predict who will develop psychosis.

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Transition rates to psychosis (ARMS)

The percentage of people with an At-Risk Mental State who eventually develop psychosis over time.

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False Positive Rate

The proportion of individuals incorrectly identified as having ARMS, but who do not ultimately develop psychosis.

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Risk Calculators (ARMS)

Tools combining clinical assessments and biomarkers (imaging, EEG, genetics, cognitive function) to predict risk of psychosis.

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Cognitive markers (ARMS)

Measurements of cognitive abilities (e.g., working memory, executive function) used in predicting ARMS.

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CBT for ARMS

Cognitive Behavioral Therapy (CBT) as a promising intervention for reducing the risk of psychosis development in ARMS individuals.

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Transdiagnostic approaches

Interventions that target symptoms and social difficulties across various mental health conditions, applicable to ARMS.

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Limited Reach of Early Detection Initiatives

Early detection programs for psychosis often fail to reach enough people, hindering progress in improving outcomes.

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Reducing DUP (Delayed Onset Psychosis)

Strategies to lower instances of psychosis in those who are at risk.

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Public Education for DUP Reduction

Education of the general public, including families, is essential for earlier identification and intervention in psychosis.

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MINDMap Study

A large study illustrating that public information campaigns on social media can reduce the delay of psychosis onset (DUP).

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School-based Initiatives (for DUP)

School-based programs for detecting mental health issues in youth are under-researched and need testing for reducing DUP.

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Focus on Wider Population

Early intervention programs should target people with a wide range of mental health issues, not just those with psychosis.

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ARMS (At Risk Mental States)

Individuals showing signs of mental health challenges, but who haven't yet developed psychosis, yet could still develop other related conditions.

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Early Intervention in Psychosis (EIP) Research

Studies on Early Intervention in Psychosis have been limited and need more research to understand their effectiveness in reducing delayed onset psychosis.

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Barriers to EIS Delivery

Obstacles preventing effective implementation of Early Intervention Services (EIS) for psychosis.

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Culture-Specific Care

Tailoring interventions for psychosis to different cultural backgrounds and personal experiences.

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Comorbidities in Psychosis

Presence of other health conditions (like depression, trauma, or substance use) alongside psychosis.

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Co-Production of Services

Involving service users and their families in the design and delivery of mental health support services.

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Social Difficulties & Psychosis

Significant social challenges often faced by individuals experiencing psychosis, contributing to further difficulties.

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Ethnic Disparities in CBTP

Differences in access to Cognitive Behavioral Therapy for Psychosis (CBTP) across different ethnic groups within Early Intervention Services (EIS).

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Improving EIS Outcomes

Strategies and approaches to enhance the overall effectiveness of Early Intervention Services for improved psychosis outcomes.

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Critical Ingredients for Outcomes

Key elements essential for positive outcomes in psychosis treatment using evidence-based approaches.

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Loss of EIS Effect

The mixed results concerning the sustained benefits of Early Intervention Services for psychosis after individuals leave the service.

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EIS Sustained Benefit After Discharge

Studies show a limited continuation of benefits from Early Intervention Services (EIS) after patients are discharged, with a notable high relapse rate within the first year.

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Extended EIS Benefits

Some evidence suggests potential benefits from extending Early Intervention Services, possibly up to 5 years, for specific patient groups.

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Varied EIS Outcomes

The varied results of EIS programs might be due to discrepancies among control groups in different studies.

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Sustained EIS Benefit Research

Further investigation is needed to determine if benefits from Early Intervention Services are maintained beyond discharge and how long the treatment should be offered.

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Discharge Planning in EIS

Discharge planning for patients from Early Intervention Services needs to be carefully considered, including who should transition to which primary care services, and what factors contribute to a successful transition.

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EIS Accessibility and Quality

Early Intervention Services should be available for everyone, despite challenges in maintaining a consistent high quality throughout the system and various societal barriers.

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Early Intervention in Psychosis Effectiveness

Early Intervention in Psychosis is widely recognized to be effective and cost-effective for achieving moderate prognosis improvements while patients are receiving services.

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Long-Term EIS Approaches

The most effective long-term approaches and determining factors for improving prognosis outcomes after early intervention services are uncertain.

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At-Risk Mental States Research

More research is needed to develop better methods for predicting, managing, and addressing At-Risk Mental States (ARMS), while avoiding negative consequences from interventions.

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Early Psychosis Detection

Preventing delays in detecting psychosis and reducing the duration until a diagnosis is made (Duration Until Psychosis, or DUP), is an area where further research and attention to effective approaches are needed.

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DUP

Duration of Untreated Psychosis. The time it takes for someone experiencing mental health challenges to receive a proper diagnosis and treatment.

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Barriers to Early Detection

Challenges in identifying individuals with psychosis at an early stage, making it harder to provide timely support.

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Early Detection

Identifying mental health issues at an early stage before they become severe.

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Early Detection Strategies

Methods used to identify and prevent mental health issues at an early stage.

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Impact of Early Detection

How early detection influences the severity of symptoms and the duration of untreated psychosis.

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Social Cohesion

The degree to which community members connect and support each other.

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Community-Based Education

Educational initiatives designed to reach the public to raise awareness about mental health issues.

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Evidence-Based Interventions

Interventions that have been shown to be effective through scientific research.

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Early Detection Impediments

Challenges in recognizing and addressing psychosis early on due to vague symptoms, stigma, and reluctance to refer.

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Prodromal Phase

The period leading up to the first psychotic symptom characterized by gradual deterioration and a range of early warning signs.

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Early Detection Strategies: Public Information

Extensive public education efforts, such as campaigns and social media initiatives, are promising avenues for early identification of psychosis.

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Early Detection Strategies: Schools

Schools hold potential as a crucial channel for early detection, but require further research and testing to determine their effectiveness.

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Early Detection Strategies: Social Media

Social media and internet platforms have emerged as a valuable tool for reaching individuals and raising awareness about early detection.

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Challenges in Early Intervention Research

Limited implementation, replication, and methodological complexity of successful approaches present challenges in advancing understanding.

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Broader Intervention Approach

Instead of solely focusing on psychosis, early intervention programs are more effective when targeting a range of mental health issues.

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Sub-threshold Positive Symptoms

Symptoms that resemble psychosis but don't meet the full criteria. Examples include unusual thoughts, perceptual distortions, and disorganized speech.

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BLIPS

Brief Limited Intermittent Psychotic Symptoms. These are psychotic symptoms that last less than a week and disappear on their own.

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Distress and Functioning in the Prodrome

Even without full psychotic symptoms, individuals in the prodromal phase often experience significant distress and impairment in their daily functioning.

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CAARMS (EPPIC)

Comprehensive Assessment of At Risk Mental States. A widely used tool in the UK to assess individuals who may be at risk for psychosis.

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Transition Rate to Psychosis

The percentage of individuals with ARMS who eventually develop full-blown psychosis.

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Predicting Psychosis

While early detection of ARMS can help identify potential psychosis, the ability to predict who will actually develop psychosis is limited due to the complexity of the condition.

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Prodromal Intervention

Treatment aimed at reducing the risk of transitioning to full-blown psychosis in individuals exhibiting early symptoms.

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Ethics of Intervention

The moral challenges and considerations involved in treating individuals with potential psychosis, especially with drugs.

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Recruitment in Studies

The difficulties in finding enough individuals with early psychosis symptoms for research studies.

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Screening for At-Risk States

The lack of reliable methods to identify individuals showing early signs of psychosis.

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Evidence-Based Practice

Using scientific research to guide the delivery of mental health interventions.

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Long-Term Effects

The unknown consequences of prodromal intervention on individuals over longer periods.

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Broader Mental Health Focus

Shifting the focus from psychosis-specific interventions to a wider range of mental health issues in young people.

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Neuroscience and Testing

Using brain science and sophisticated psychological assessments to better identify individuals in the prodrome.

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Critical Period Theory

The theory that the first few years after a first episode of psychosis are crucial for recovery and preventing relapse, with a higher risk of negative outcomes like suicidal behavior, worse functioning, and delayed recovery after each relapse.

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Importance of Early Intervention

Focusing on recovery within the first few years after an initial psychotic episode can improve prognosis by reducing the duration of untreated psychosis, promoting social and clinical recovery, preventing relapse, and reducing early co-morbidities.

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What is the goal of EIS?

Early intervention in psychosis (EIS) aims to improve the prognosis of psychosis by promoting better social and clinical recovery from the first episode, preventing or reducing the severity of early relapse, and minimizing early co-morbidities and social damage.

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Assertive Outreach

A key approach in EIS involving active outreach to individuals, engaging them with a strong therapeutic relationship, and providing flexible and intensive support.

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Maintenance of Functioning

Early intervention emphasizes maintaining and promoting social functioning - work, education, social activities, and relationships - as early as possible to support long-term recovery.

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Relapse Prevention

Structured relapse prevention plans are essential components of EIS, helping individuals understand and manage risk factors, and develop coping mechanisms.

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Family Involvement in EIS

Engaging families and significant social network members is vital in EIS, supporting the individual's recovery by providing emotional support, understanding, and practical assistance.

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Social Recovery Focus

EIS emphasizes social recovery, promoting the individual's return to meaningful roles and connections within their community, including work, education, and social activities.

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LEO Study

A randomized controlled trial in London comparing an assertive outreach EIS (LEO) model to standard care - results showed significantly lower relapse rates (30% vs 48%), improved cost-effectiveness, and better outcomes in quality of life and negative symptoms for the LEO group.

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OPUS Study

A study in Denmark demonstrating the effectiveness of EIS in reducing relapses and improving social functioning in individuals with schizophrenia spectrum disorders.

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Medication in EIS

EIS emphasizes using the minimum effective dose of medication for each individual, while closely monitoring compliance and prioritizing the reduction of side effects.

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Psychoeducational Approach

Providing psychoeducation to individuals and their families about psychosis, treatment options, and coping strategies is essential for empowering individuals and their families to manage the condition more effectively.

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Therapeutic Alliance

Developing a strong and collaborative relationship between the individual, their family, and the healthcare team is crucial for establishing trust, facilitating open communication, and promoting engagement in treatment.

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Challenges in EIS

Significant barriers to widespread EIS implementation and its effectiveness include challenges in early detection, limited resources, and disparities in access to care.

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Study Notes

Intervention Effectiveness

  • Case Management (CM), Early Intervention Services (EIS), and Caregiver-Directed Interventions are superior to standard care in reducing hospital admissions.

Psychosocial Outcomes

  • EIS shows high-quality evidence of a small positive effect on global functioning.
  • Intensive Case Management shows moderate-quality evidence of a similar small effect on global functioning.
  • Family Interventions have a large effect on global functioning supported by moderate-quality evidence.

Quality of Life

  • EIS and Self-Management Education both show a small positive effect on quality of life, supported with moderate-quality evidence.

Research Gaps

  • Significant research exists on effective Community Mental Health (CMH) models.
  • Notable gaps exist in innovative CMH strategies that haven't been covered in meta-analyses.

Summary

  • EIS, Intensive Case Management, and family interventions are effective in reducing hospital admissions and improving psychosocial outcomes.
  • Further exploration of innovative CMH models is needed.
  • Recovery rates are higher in North America and pre-'97 studies.
  • Recovery rates haven't significantly changed in the past 20-30 years.
  • Despite 30 years of Early Intervention Program (EIP) initiatives, overall prognosis hasn't improved; remission from the first episode has increased but rates of full recovery have possibly decreased.
  • Schizophrenia hospital admissions in the UK have decreased.
  • Prognosis may be better in lower and middle-income countries and the USA.
  • Early Intervention in Psychosis (EIP) initiatives show significant impact in trials but have not reduced long-term psychosis outcomes across the population. Possible reasons for this: different attitudes towards psychosis episodes; urbanization versus collectivist societies.

Barriers to Progress in Improving Psychosis Outcomes

  • Difficulties detecting At Risk Mental States (ARMS) and false positives.
  • Few people present to services when psychosis develops (they don't come through the early detection service).
  • 50.2% of people with psychosis/bipolar disorder have a history of Child and Adolescent Mental Health Service (CAMHS) contact; 6 years is the median period from CAMHS contact to psychosis/bipolar diagnosis.

Challenges in Finding People with ARMS

  • Limited predictive validity of detecting ARMS.
  • Transition rates to psychosis are 32% at 3 years for people assessed as having an At-Risk Mental State (ARMS).
  • Transition rates are 15% for under-18s with ARMS after 5 years.

Approaching Improving Management of At Risk Mental States

  • Combining clinical screening tools with biomarkers (e.g., imaging, EEG abnormalities, genetic markers).
  • Incorporating cognitive markers (e.g., working memory, executive functioning.)
  • Using machine learning/AI approaches to combine risk markers for 70-80% prediction.
  • Limited evidence of how to find people with ARMS through assertive screening efforts as these increase false positive rates.

Approaches to Improving Management of At Risk Mental States (cont.)

  • Development of effective interventions for psychosis with less potential for negative side effects or complications.
  • Cognitive Behavioral Therapy (CBT) is considered the most promising approach in meta-analyses, leading to a 52% reduction in incidence at 12 months.
  • Development of transdiagnostic approaches is needed to address conditions like trauma and comorbidities.

Barriers to Progress in Improving Psychosis Outcomes (cont.)

  • Limited evidence for intervention-level models to address service delivery for cultural, illness stage, and comorbidity considerations for individualizing care.
  • Limited focus on interventions for trauma, important comorbidities, and personality disorders.
  • Not sufficient co-production of services (input from patients and caregivers).
  • Severe social difficulties among service users and lack of societal/individual strategies to address these.
  • Lack of funding for services, particularly in underserved areas.

Ethnic Differences in Receipt of CBTP

  • People from certain ethnicities (e.g., Bangladeshi, Pakistani) are less likely to receive CBT for psychosis if they use EIS

Robust Evidence for Psychosis Detection

  • Insufficient evidence to provide robust evidence on the detection of psychosis.
  • Increased focus on detection within early interventions for severe mental health issues (e.g., depression).
  • Further development of interventions that promote engagement with services is needed.

Barriers to Progress in Improving Psychosis Outcomes (cont.)

  • Loss of effect after leaving early intervention services: mixed results regarding the continued effect of interventions for people leaving the service.
  • Better evidence is needed on whether the benefits of early intervention services are sustained beyond discharge and whether extending services has benefits or for whom.

Research and Intervention Development

  • Investigate sustained benefits of early intervention services after discharge to primary care.
  • Explore whether extending early interventions has benefits, and if so, for whom.
  • Further investigation into discharge processes and service pathways; determining appropriate service delivery pathways and whether different discharge criteria exist for individual needs.
  • Early interventions are necessary as a high-quality service for psychosis and must address societal and service challenges.

Summary of Study

  • Large investments in early intervention for psychosis to improve outcomes across various medical conditions (e.g., bipolar disorder).
  • Early intervention is effective and cost-effective to achieve modest improvements in prognosis; however, critical information about ideal intervention approaches is still lacking and needs further research.
  • Early detection of psychosis and shortening duration of untreated psychosis deserve further attention to develop effective approaches, including youth mental health services.

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Description

This quiz explores the effectiveness of various interventions such as Early Intervention Services, Case Management, and Family Interventions in mental health care. It highlights their impact on hospital admissions, global functioning, and quality of life, along with identifying key research gaps in Community Mental Health strategies.

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