ITAlian Partnership for Psychosis Prevention (ITAPP): improving the mental health of young people

Abstract

Background. The European impact of the clinical high risk for psychosis (CHR-P) paradigm is constrained by the lack of critical mass (detection) to power prognostic and preventive interventions.Methods. An ITAlian partnership for psychosis prevention (ITAPP) was created across CHR-P centers, which were surveyed to describe: (a) service, catchment area, and outreach; (b) service users; and (c) interventions and outcomes. Descriptive statistics and Kaplan-Meier failure function complemented the analyses. Results. The ITAPP included five CHR-P clinical academic centers established from 2007 to 2018, serving about 13 million inhabitants, with a recruitment capacity of 277 CHR-P individuals (mean age: 18.7 years, SD: 4.8, range: 12-39 years; 53.1% females; 85.7% meeting attenuated psychotic symptoms; 85.8% without any substance abuse). All centers were multidisciplinary and included adolescents and young adults (transitional) primarily recruited through healthcare services. The comprehensive assessment of at-risk mental state was the most widely used instrument, while the duration of follow-up, type of outreach, and preventive interventions were heterogeneous. Across 205 CHR-P individuals with follow up (663.7 days AE 551.7), the cumulative risk of psychosis increased from 8.7% (95% CI 5.3-14.1) at 1 year to 15.9% (95% CI 10.6-23.3) at 2 years, 21.8% (95% CI 14.9-31.3) at 3 years, 34.8% (95% CI 24.5-47.9) at 4 years, and 51.9% (95% CI 36.3-69.6) at 5 years. Conclusions. The ITAPP is one of the few CHR-P clinical research partnerships in Europe for fostering detection, prognosis, and preventive care, as well as for translating research innovations into practice.

The ‘Parma At‐Risk mental states’ (PARMS) program: General description and process analysis after 5 years of clinical activity

“…This supports the importance of strictly collaborating with all putative sources of referral to EIP protocols (i.e., primary care, school and social services, general hospitals and emergency rooms), also through regular awareness campaigns and dedicated professional training courses within continuous educational programs (Scazza et al, 2018). About this, in line with other Italian comparable studies (Fusar‐Poli et al, 2021), the most common sources of referral in the PARMS program were general practitioners, school/social agencies and general hospitals/emergency rooms.…”

“…Similarly to other Italian comparable investigations (Fusar‐Poli et al, 2021; Masillo et al, 2018; Pelizza, Poletti, et al, 2020), a relevant proportion of our CHR‐P individuals was single , was still living with parents and was unemployed . These findings indirectly indicate a critical social and occupational functioning already at the enrollment in specialized CHR‐P programs (Raballo & Poletti, 2019).…”

“…As for process indicators of the PARMS protocol, more than 50 CHR-P individuals were consecutively referred to the PARMS program in its first 5 years of clinical activity (i.e., a mean recruitment rate of 10.4 CHR-P subjects per year). This finding is substantially in line with the results of other Italian comparable investigations (i.e., 6.0-12.0 CHR-P individuals enrolled per year in the ITAPP centers, 15.8 CHR-P people per year in the ReARMS protocol) (Fusar-Poli et al, 2021;. This relatively low percentage of referred CHR-P participants could reflect on impact of exclusion criteria (especially drug dependence).…”

Patterns of Care for Adolescent With Schizophrenia: A Delphi-Based Consensus Study

“…On the other hand, the ITAlian Partnership for Psychosis Prevention (ITAPP) project included five Clinical High Risk for Psychosis (CHR-P) academic centers across Italy, representing a promising template for transitional mental health services, aimed at early detection and intervention. In fact, serving both adolescents and young adults with multidisciplinary and integrated interventions, ITAPP project is aimed at developing specialized facilities that bridge the gap in the transitioning phase from youth to adulthood, thus ameliorating presenting symptoms, delaying, and preventing psychosis onset while reducing DUP ( 61 ).…”

Mapping the implementation and challenges of clinical services for psychosis prevention in England

“…The CHR-P paradigm has extended across the world ( 30 ) through the implementation of specialized clinics that provide assessment, clinical monitoring, and interventions to CHR-P individuals ( 31 ), often within a non-stigmatizing community setting ( 32 ). Regional or national networks of CHR-P services have been established in England ( 33 ), Italy ( 34 ), Switzerland ( 35 ), and the United States ( 36 , 37 ). CHR-P services can operate as “standalone” teams working independently from other generic mental health services, as “integrated” teams within broader services, for example within early intervention services for psychosis also offering care to FEP individuals, or under a “hub and spoke” model, which have been described elsewhere ( 38 ).…”