A new study investigates how a combination of Open Dialogue and Intentional Peer Support was experienced by clients and network members receiving services through the Parachute program in New York City. The Parachute program was designed as an alternative to standard psychiatric care that could respond to psychiatric crises with home visits and network meetings. The results of the new study, published the Community Mental Health Journal, show that participants valued the lack of hierarchy in teams, the accessibility of receiving care in their home environment, and had positive experiences with peer specialists.
“For most,” the authors write, “the network meetings appear to have provided a route by which those experiencing distress and their networks could take time to reflect, be heard, and gain a better understanding of what each other were going through.”
Stressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of associations between adult life events and difficulties and first-episode psychoses, particularly focusing on contextual characteristics, including threat, intrusiveness, and independence.
This study forms part of the Childhood Adversity and Psychosis Study (CAPsy), an epidemiological case-control study in London, United Kingdom. Data on life events and difficulties (problems lasting 4 wk or more) during 1 year prior to onset (cases) or interview (controls) were assessed using the semi-structured Life Events and Difficulties Schedule (LEDS). Data were available on 253 individuals with a first episode of psychosis and 301 population-based controls.
We found strong evidence that odds of exposure to threatening and intrusive events in the 1 year prior to onset were substantially higher among cases compared with controls, independent of age, gender, ethnicity, and social class (ORs > 3). This was consistent across diagnostic categories. We found further evidence that the effect of threatening events and difficulties was cumulative (1 event odds ratio [OR] 2.69 [95% confidence interval (CI) 1.51–4.79]; 2 events OR 4.87 [95% CI 2.34–10.16]; ≥3 events OR 5.27 [95% CI 1.83–15.19]; 1 difficulty OR 3.02 [95% CI 1.79–5.09]; 2 difficulties OR 9.71 [95% CI 4.20–22.40]; ≥3 difficulties OR 12.84 [95% CI 3.18–51.85]).
Threatening and intrusive life events and difficulties are common in the year pre-onset among individuals with a first episode of psychosis. Such experiences may contribute to the development of psychotic disorders.
Ever since humans domesticated the dog, the faithful animal has provided its owner with companionship and emotional well-being. Now, a study from Johns Hopkins Medicine suggests that being around “man’s best friend” from an early age may have a health benefit as well—lessening the chance of developing schizophrenia as an adult.
“Serious psychiatric disorders have been associated with alterations in the immune system linked to environmental exposures in early life, and since household pets are often among the first things with which children have close contact, it was logical for us to explore the possibilities of a connection between the two,” says Robert Yolken, chair of the Stanley Division of Developmental Neurovirology and professor of neurovirology in pediatrics at the Johns Hopkins School of Medicine. He is the lead author of the research paper recently published online in the journal PLOS One.
Read MoreResearch involving socio-cultural factors in psychosis is sparse, despite evidence that points to the importance of social interactions in recovery. A new study investigates these factors by examining the social relationships of young adults with first-episode psychosis. The study finds that participants reported benefits when their uniqueness was acknowledged and their personal preferences respected by the professionals. Alternatively, they reported negative experiences with mental health workers when they felt unheard.
Read MoreORLANDO, Florida — Aerobic exercise reduces brain inflammation in patients with first-episode psychosis (FEP), early research suggests.
In a study involving 25 outpatients newly diagnosed with schizophrenia, aerobic exercise performed once a week led to a significant reduction in interleukin-6 (IL-6), suggesting physical activity may reduce the deleterious effects of brain inflammation.
“IL-6 has been found to be a marker for brain inflammation in schizophrenia, and schizophrenia patients have higher levels than controls,” lead author Joseph Ventura, PhD, University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior, told Medscape Medical News.
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Sleep disturbance is known to be associated with psychosis, but sleep disorders (eg, insomnia, nightmare disorder, sleep apnea) have rarely been investigated. We aimed to provide the first detailed assessment of sleep disorders and their correlates in patients with early psychosis. Sixty outpatients aged between 18 and 30 with nonaffective psychosis were assessed for sleep disorder presence, severity, and treatment using a structured diagnostic interview, sleep diaries, and actigraphy. Psychotic experiences, mood, and psychological wellbeing were also measured. Forty-eight patients (80%) had at least one sleep disorder, with insomnia and nightmare disorder being the most common. Comorbidity of sleep disorders within this group was high, with an average of 3.3 sleep disorders per patient. Over half of the sleep disorders had been discussed with a clinician but almost three-quarters had received no treatment. Treatment according to clinical guidelines was rare, occurring in only 8% of cases (n = 13). Sleep disorders were significantly associated with increased psychotic experiences, depression, anxiety, fatigue, and lower quality of life. Sleep disorders are very common in patients with psychosis, may have wide-ranging negative effects, and merit routine assessment and treatment in psychiatric practice.
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Findings
Between May 1, 2010, and April 1, 2015, we obtained data from 901 patients with first-episode psychosis across 11 sites and 1237 population controls from those same sites. Daily cannabis use was associated with increased odds of psychotic disorder compared with never users (adjusted odds ratio [OR] 3·2, 95% CI 2·2–4·1), increasing to nearly five-times increased odds for daily use of high-potency types of cannabis (4·8, 2·5–6·3). The PAFs calculated indicated that if high-potency cannabis were no longer available, 12·2% (95% CI 3·0–16·1) of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% (15·2–40·0) in London and 50·3% (27·4–66·0) in Amsterdam. The adjusted incident rates for psychotic disorder were positively correlated with the prevalence in controls across the 11 sites of use of high-potency cannabis (r = 0·7; p=0·0286) and daily use (r = 0·8; p=0·0109).
(MadInAmerica.com) – A new study has found that of 10 people who were fully recovered from their first episode of schizophrenia (FES), those not taking antipsychotics did better in terms of cognitive, social, and role functioning—and reached full recovery more quickly. The research was led by Susie Fu at the University of Oslo, Norway. It was published in Psychiatry: Interpersonal and Biological Processes.
According to Fu, “The findings challenge some of the views about medication treatment of FES patients. For a subgroup of FES patients, continuous medication treatment is not necessary for maintaining low levels of symptoms. These patients show sustained good functioning once fully recovered.”
Read More(Medscape) – Young patients with recent-onset schizophrenia do not show signs of cognitive deterioration or disruption of ongoing brain development in the first years following illness onset, new research shows.
Results of a large longitudinal study show that young patients with schizophrenia experience cognitive impairment prior to the onset of psychotic symptoms, but the trajectory of their neurobehavioral development and performance is comparable to that of healthy control persons.
“The study results suggest that whatever effect cognition has in schizophrenia seems to happen before people develop clinical symptoms, the psychotic symptoms,” study investigator Cameron S. Carter, MD, professor of psychiatry and psychology, and director of the Schizophrenia Research and Education Program, Department of Psychiatry and Behavioural Sciences, University of California, Davis, told Medscape Medical News.
“So cognitive dysfunction is already there when people come in for treatment,” he said.
The findings are in line with the neurodevelopmental model of schizophrenia. This model hypothesizes that prenatal central nervous system insultsand/or genetic alterations during early brain developmentinteract with environmental risk factors and lead to the onset of psychosis in late adolescence or early adulthood.
“The study confirms our sense that schizophrenia is not a neurodegenerative disorder; the brain does not necessarily deteriorate after people become ill and develop these symptoms,” said Carter.
“In fact, these young people have the capacity to continue to improve and develop to the same degree as typical individuals,” he said.
The study was published online October 3 in JAMA Psychiatry.
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