The Ohio State University Early Psychosis Intervention Center (EPICENTER) step-based care programme for individuals at clinical high risk for psychosis: study protocol for an observational study

Breitborde, Nicholas J. K.; Guirgis, Hossam; Stearns, Walter H.; Carpenter, Kristen M.; Lteif, Ghada N; Pine, Jacob G.; Storey, Nichole; Wastler, Heather M.; Moe, Aubrey M.

doi:10.1136/bmjopen-2019-034031

Cited by 6 publications

(4 citation statements)

References 94 publications

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“…For instance, avoidance behaviors may be addressed using behavioral techniques (e.g., exposures and reality testing) regardless of whether the patient is experiencing symptoms of OCD, overt psychosis, or attenuated psychosis. Additionally, transdiagnostic treatment approaches (e.g., The Unified Protocol) 133 are utilized for treating patients with various types of emotional disturbances, including those at CHR-P. 22 Finally, many evidence-based interventions designed for other diagnoses (e.g., Cognitive Processing Therapy for PTSD) 134 can be useful for addressing comorbidities among individuals with psychotic-spectrum disorders.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Despite a rapid increase in specialized clinical services for individuals at CHR-P 22 and individuals with FEP, 135 the majority of individuals early in the course of a psychotic or putative psychotic disorder do not access such specialized treatment programs. Consequently, outreach and recruitment activities are critical components for identifying individuals early in the course of a psychotic disorder to ensure access to specialized care during the time their illnesses are most malleable.…”

Section: Screening and Outreachmentioning

confidence: 99%

“…Accurate assessment of where a person's symptoms fall on the psychosis continuum is important for both: 1) clarifying whether intervention is warranted; and 2) selecting the appropriate evidence-based interventions among available options. With regard to the former, for example, youth experiencing mild psychotic-like symptoms in some cases might not warrant clinical attention, whereas youth exhibiting distressing, attenuated psychotic symptoms may benefit from intervention (e.g., step-based care 22,23 ), which could lower their risk of developing a psychotic disorder. 24 With regard to the latter, antipsychotic medications have demonstrated efficacy for many individuals with first-episode psychosis (FEP) [25][26][27] but are currently discouraged as front-line treatments for individuals with attenuated psychotic symptoms given limited evidence of efficacy for preventing conversion to psychosis and high side effect burden.…”

Section: Introductionmentioning

confidence: 99%

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Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians

Lundin,

Blouin,

Cowan

et al. 2024

PRBM

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Early detection of psychotic-spectrum disorders among adolescents and young adults is crucial, as the initial years after psychotic symptom onset encompass a critical period in which psychosocial and pharmacological interventions are most effective. Moreover, clinicians and researchers in recent decades have thoroughly characterized psychosis-risk syndromes, in which youth are experiencing early warning signs indicative of heightened risk for developing a psychotic disorder. These insights have created opportunities for intervention even earlier in the illness course, ideally culminating in the prevention or mitigation of psychosis onset. However, identification and diagnosis of early signs of psychosis can be complex, as clinical presentations are heterogeneous, and psychotic symptoms exist on a continuum. When a young person presents to a clinic, it may be unclear whether they are experiencing common, mild psychotic-like symptoms, early warning signs of psychosis, overt psychotic symptoms, or symptoms better accounted for by a non-psychotic disorder. Therefore, the purpose of this review is to provide a framework for clinicians, including those who treat non-psychotic disorders and those in primary care settings, for guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic. We first provide descriptions and examples of first-episode psychosis (FEP) and psychosis-risk syndromes, as well as assessment tools used to diagnose these conditions. Next, we provide guidance as to the differential diagnosis of conditions which have phenotypic overlap with psychotic disorders, while considering the possibility of co-occurring symptoms in which case transdiagnostic treatments are encouraged. Finally, we conclude with an overview of early detection screening and outreach campaigns, which should be further optimized to reduce the duration of untreated psychosis among youth.

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Section: Differential Diagnosismentioning

confidence: 99%

Section: Screening and Outreachmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians

Lundin,

Blouin,

Cowan

et al. 2024

PRBM

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“…Participants and proceduresTwenty-five individuals at CHR-P were recruited from The Ohio State University Early Psychosis Intervention Center (EPICENTER;Breitborde et al, 2020). Eligibility criteria included (1) meeting criteria for clinical high-risk syndrome on the structured interview forpsychosis-risk syndromes (SIPS; McGlashan et al, 2010) administered by a SIPS certified clinician; (2) ages 12-25; and (3) no evidence of an intellectual disability.…”

mentioning

confidence: 99%

Variability in suicidal ideation during treatment for individuals at clinical high risk for psychosis: The importance of repeated assessment

Wastler

Cowan

Hamilton

et al. 2023

Early Intervention Psych

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AimSuicide risk is elevated among individuals at clinical high risk for psychosis (CHR‐P). The current study examined variability in suicidal ideation during treatment for individuals at CHR‐P.MethodsA retrospective chart review was used to examine the course of suicidal ideation during 16 sessions of individual psychotherapy for 25 individuals at CHR‐P.ResultsSuicidal ideation was reported by 24% of participants at session 1 and 16% at session 16, with minimal within‐subject change in the presence of suicidal ideation across the two time points. However, a more fine‐grained investigation at each session indicated that 60% of individuals at CHR‐P experienced suicidal ideation at least once during treatment. Additionally, there was great variability in suicidal ideation both within and between participants over the course of the 16 sessions.ConclusionsThese findings highlight the importance of repeated assessment when examining suicidal ideation as a treatment outcome for individuals at CHR‐P.

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Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis

2022

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Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.

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The Ohio State University Early Psychosis Intervention Center (EPICENTER) step-based care programme for individuals at clinical high risk for psychosis: study protocol for an observational study

Cited by 6 publications

References 94 publications

Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians

Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians

Variability in suicidal ideation during treatment for individuals at clinical high risk for psychosis: The importance of repeated assessment

Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis

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