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June 30, 2020 by Dr. Oladunni Oluwoye & Dr. Deidre M. Anglin | International Early Psychosis Association

Racial inequities in early intervention: Time to acknowledge the elephant in the room

Following the tragic killing of George Floyd in May, protests were held globally against the excessive use of force by police and entrenched systemic racism against Black people and people of colour. We asked Dr. Oluwoye of Washington State Center of Excellence in Early Psychosis and Dr Anglin  of The City College and Graduate Center of the City University of New York, both early intervention researchers with expertise in racial health equity, to share with us the relationship between race and mental health in the USA and recommendations on how the global early intervention community can make progress towards addressing inequity in mental health research and practice.

There are now a multitude of calls and statements to end systemic racism in the U.S. and around the world. From the Ivory Towers of academia to CEOs to NASCAR (of all sports), it seems like almost every entity has woken up to an entrenched reality existential to the very fabric of the U.S. social hierarchical system. The public display of brutal police victimization, murder, and hate in the public execution of George Floyd finally has everyone aghast! The racism, discrimination, and violence that Black people have voiced for centuries are on display right before our very eyes and all this is on the backdrop of the COVID-19 pandemic which has highlighted the racial inequities that plague our health care systems.

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June 22, 2020 by Peter Simons | MadInAmerica.com

CBT for First-Episode Psychosis Effective Without Antipsychotics

A study providing cognitive-behavioral treatment to people experiencing first-episode psychosis found antipsychotics did not improve outcomes.

A new study compared intensive cognitive behavioral case management (CBCM) with and without antipsychotic use in young people diagnosed with first-episode psychosis. The researchers found that there was no difference in outcomes at the six-month endpoint. Both groups improved, and there was no added benefit to having taken antipsychotic medications. The study authors, writing in Schizophrenia Bulletin, explain:

“There was no discernible advantage to receiving antipsychotic medication from the start of the trial,” the researchers write.

The study was led by Shona M. Francey at Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.

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April 14, 2020 by Ana Florence, PhD | MadInAmerica.com

Open Dialogue and Intentional Peer Support: Experiences of Parachute NYC Enrollees

Study finds positive experiences with the Parachute program in New York City, which combined Open Dialogue and Intentional Peer Support.

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.”

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February 22, 2020 by Stephanie Beards et al | Schizophrenia Bulletin

Threatening Life Events and Difficulties and Psychotic Disorder

Abstract

Objective

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.

Method

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.

Results

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]).

Conclusions

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.

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January 9, 2020 by Michael E. Newman | Johns Hopkins University

Study suggests childhood exposure to dogs may lessen risk of developing schizophrenia

Study adds to evidence that exposure to pets in early childhood may be environmental factors that alter the immune system, affecting the development of certain psychiatric 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.

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October 27, 2019 by Ayurdhi Dhar, PhD | MadInAmerica.com

Social Relationships Integral to Recovery in First Episode Psychosis

Research finds patients of first-episode psychosis report benefits from social relationships where their personhood is respected.

Research 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.

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June 23, 2019 by Sandra Steingard, MD

“Critical Psychiatry: A way forward for my profession?”

An engaging talk by Board Chair Sandra Steingard, community psychiatrist and international thought leader.

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April 16, 2019 by Fran Lowry | Medscape

Exercise Cuts Brain Inflammation in First-Episode Psychosis

ORLANDO, 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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March 27, 2019 by Sarah Reeve; Bryony Sheaves; Daniel Freeman | Schizophrenia Bulletin

Sleep Disorders in Early Psychosis: Incidence, Severity, and Association With Clinical Symptoms

Sarah Reeve; Bryony Sheaves; Daniel Freeman. Schizophr Bull. 2019;45(2):287-295

 

Abstract

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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March 21, 2019 by Marta Di Forti, PhD et al | The Lancet

The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study

Summary

Background
Cannabis use is associated with increased risk of later psychotic disorder but whether it affects incidence of the disorder remains unclear. We aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder.
 
Methods
We included patients aged 18–64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We applied adjusted logistic regression models to the data to estimate which patterns of cannabis use carried the highest odds for psychotic disorder. Using Europe-wide and national data on the expected concentration of Δ9-tetrahydrocannabinol (THC) in the different types of cannabis available across the sites, we divided the types of cannabis used by participants into two categories: low potency (THC <10%) and high potency (THC ≥10%). Assuming causality, we calculated the population attributable fractions (PAFs) for the patterns of cannabis use associated with the highest odds of psychosis and the correlation between such patterns and the incidence rates for psychotic disorder across the study sites.

 
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).

Interpretation
Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, this has important implications for public health.
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