Receipt and targeting of evidence-based psychosocial interventions for people living with psychoses: findings from the second Australian national survey of psychosis

Harvey, Carol; Lewis, Jerry L.; Farhall, John

doi:10.1017/s2045796018000288

Cited by 15 publications

(15 citation statements)

References 60 publications

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“…Marwaha et al ., 2016 ), the results offer some helpful guidance on resource allocation and prioritisation. Though the evidence base for targeting recommended evidence-based interventions in psychosis to those identified to derive greatest benefit remains limited (Harvey et al , 2018 ), our preliminary findings support the approach. The important role played by carers in helping to improve the scale and quality of patient outcomes in psychosis is well established, as is the need to provide comprehensive care packages to support them in their role (Mueser et al ., 2015 ).…”

Section: Discussionsupporting

confidence: 56%

Predictors and moderators of burden of care and emotional distress in first-episode psychosis caregivers: results from the GET UP pragmatic cluster randomised controlled trial

Onwumere

Bonetto

Lasalvia

et al. 2019

Epidemiol Psychiatr Sci

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Aims First-episode psychosis (FEP) is a major life event and can have an adverse impact on the diagnosed individual and their families. The importance of intervening early and providing optimal treatments is widely acknowledged. In comparison to patient groups, literature is scarce on identifying treatment predictors and moderators of caregiver outcomes. This study aimed to identify pre-treatment characteristics predicting and/or moderating carer outcomes, based on data from a multi-element psychosocial intervention to FEP patients and carers (GET-UP PIANO trial). Methods Carer demography, type of family relationship, patient contact hours, pre-treatment carer burden, patient perceptions of parental caregiving and expressed emotion (EE) were selected, a priori, as potential predictors/moderators of carer burden and emotional distress at 9 months post treatment. Outcomes were analysed separately in mixed-effects random regression models. Results Analyses were performed on 260 carers. Only patient perceptions of early maternal criticism predicted reports of lower carer burden at follow-up. However, multiple imputation analysis failed to confirm this result. For treatment moderators: higher levels of carer burden at baseline yielded greater reductions in carer emotional distress at follow-up in the experimental group compared with treatment as usual (TAU). Higher levels of perceived EE moderated greater reductions in carer reports of tension in experimental group, compared with TAU, at follow-up. In younger caregivers (<51 years old), there were greater reductions in levels of worry during the baseline to follow-up period, within the experimental group compared with TAU. Conclusion The study failed to identify significant treatment predictors of FEP carer outcomes. However, our preliminary findings suggest that optimal treatment outcomes for carers at first episode might be moderated by younger carer age, and carers reporting higher baseline levels of burden, and where patients perceive higher levels of negative effect from caregivers.

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Section: Discussionsupporting

confidence: 56%

Predictors and moderators of burden of care and emotional distress in first-episode psychosis caregivers: results from the GET UP pragmatic cluster randomised controlled trial

Onwumere

Bonetto

Lasalvia

et al. 2019

Epidemiol Psychiatr Sci

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“…26 Family therapy has a strong evidence base in reducing relapse and carer burden but similarly is rarely accessible for people living with severe mental illness, and this is due not to individual characteristics but rather to the ability of services to offer and deliver this care. 27 There is growing recognition of the need to increase access to trained therapists in these evidence-based modalities. 11 Psychosocial support was recommended for every five in six people, demonstrating that current support was nonoptimal.…”

Section: Discussionmentioning

confidence: 99%

The tertiary service for psychosis: Holistic recommendations for people with complex psychosis

Davies

Grattan

Gott³

et al. 2023

Australas Psychiatry

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Objective To describe (i) the clinical characteristics of individuals referred to the Tertiary Referral Service for Psychosis (TRSP) and (ii) the recommendations TRSP made for future treatment across psychopharmacological and other intervention domains. Method Retrospective audit of clinical data collected during the assessment process of individuals who accessed TRSP between 02/06/2020 and 31/12/2022. Categories of recommendations made following collaborative care planning comprised psychopharmacological, neuropsychological, psychological, psychosocial, physical health, substance misuse and other domains. Results Eighty-two individuals were included, with diagnoses most commonly of schizophrenia (54.9%) and schizoaffective disorder (30.5%). The median PANSS score was 88.0 (73–100). Social occupational functioning was very poor (SOFAS M = 37.0, SD = 15.1). Cognitive functioning was poor (RBANS: M = 74.6; SD: 15.0). 67.1% had physical health comorbidities, with high prevalence of smoking (52.4%) and substance misuse (25.6%). Psychopharmacological recommendations (made for 81.7%) included clozapine trial (25.6%), clozapine dose change/augmentation (22.0%) and rationalisation of polypharmacy (12.2%). Neuropsychological (73.2%), psychological (39.0%) and psychosocial (85.4%) recommendations included access to cognitive remediation, psychological therapy and disability support. Physical health and substance misuse interventions were recommended for 91.5% and 20.7%, respectively. Conclusions Individuals referred to the TRSP had marked clinical and functional impairments. Holistic collaborative care planning complemented psychopharmacological interventions with psychological, psychosocial and physical healthcare recommendations.

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“…In addition, significantly fewer had participated in community rehabilitation programmes, had received psychosocial interventions or had carer support over the past year. These changes are likely to impact adversely on functional and personal recovery in particular, and further investigation is warranted to understand why access to and/or uptake of these resources has fallen rather than increased in face of guidelines advocating their effectiveness in the coordination of care for and treatment of people with psychotic disorders (Galletly et al, 2016; Harvey et al, 2019; National Institute for Health and Care Excellence (NICE), 2014).…”

Section: Discussionmentioning

confidence: 99%

Mental health recovery and physical health outcomes in psychotic illness: Longitudinal data from the Western Australian survey of high impact psychosis catchments

Morgan

Waterreus

Ambrosi

et al. 2020

Aust N Z J Psychiatry

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Objective: There is a dearth of longitudinal data on outcomes in prevalent cases of psychotic illness across a range of ages and levels of chronicity. Our aim was to describe changes over time in mental and physical health outcomes, as well as patterns of service utilisation that may have influenced outcomes, in a representative prevalence sample of 641 Western Australians with a psychotic illness who, at Wave 1, were part of the National Survey of High Impact Psychosis. Methods: In Wave 1 (2010, 2012), a two-phase design was employed to ensure representativeness: Phase 1 psychosis screening took place in public mental health and non-government organisation services, while, in Phase 2, a randomised sample was interviewed. In Wave 2, 380/641 (59%) of participants were re-interviewed, with interviews staggered between 2013 and 2016 (follow-up time: 2.3–5.6 years). Data collection covered mental and physical health, functioning, cognition, social circumstances and service utilisation. Mental health outcomes were categorised as symptomatic, functional and personal recovery. Physical health outcomes covered metabolic syndrome and its component criteria. Results: In mental health, there were encouraging improvements in symptom profiles, variable change in functional recovery and some positive findings for personal recovery, but not quality of life. Participants ranked physical health second among challenges. Metabolic syndrome had increased significantly. While treatment for underlying cardiovascular risk conditions had improved, rates of intervention were still very low. More people were accessing general practices and more frequently, but there were sharp and significant declines in access to community rehabilitation, psychosocial interventions and case management. Conclusion: Although we observed some positive outcomes over time, the sharp decline in access to evidence-based interventions such as community rehabilitation, psychosocial interventions and case management is of great concern and augurs poorly for recovery-oriented practice. Changes in service utilisation appear to have influenced the patterns found.

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Receipt and targeting of evidence-based psychosocial interventions for people living with psychoses: findings from the second Australian national survey of psychosis

Cited by 15 publications

References 60 publications

Predictors and moderators of burden of care and emotional distress in first-episode psychosis caregivers: results from the GET UP pragmatic cluster randomised controlled trial

Predictors and moderators of burden of care and emotional distress in first-episode psychosis caregivers: results from the GET UP pragmatic cluster randomised controlled trial

The tertiary service for psychosis: Holistic recommendations for people with complex psychosis

Mental health recovery and physical health outcomes in psychotic illness: Longitudinal data from the Western Australian survey of high impact psychosis catchments

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