Worldwide implementation of clinical services for the prevention of psychosis: The IEPA early intervention in mental health survey

Abstract

Background: Clinical research into the Clinical High Risk state for Psychosis (CHR-P) has allowed primary indicated prevention in psychiatry to improve outcomes of psychotic disorders. The strategic component of this approach is the implementation of clinical services to detect and take care of CHR-P individuals, which are recommended by several guidelines. The actual level of implementation of CHR-P services worldwide is not completely clear. Aim: To assess the global geographical distribution, core characteristics relating to the level of implementation of CHR-P services; to overview of the main barriers that limit their implementation at scale. Methods: CHR-P services worldwide were invited to complete an online survey. The survey addressed the geographical distribution, general implementation characteristics and implementation barriers. Results: The survey was completed by 47 CHR-P services offering care to 22 248 CHR-P individuals: Western Europe (51.1%), North America (17.0%), East Asia (17.0%), Australia (6.4%), South America (6.4%) and Africa (2.1%). Their implementation characteristics included heterogeneous clinical settings, assessment instruments and length of care offered. Most CHR-P patients were recruited through mental or physical health services. Preventive interventions included clinical monitoring and crisis management (80.1%), supportive therapy (70.2%) or structured psychotherapy (61.7%), in combination with pharmacological treatment (in 74.5%). Core implementation barriers were staffing and financial constraints, and the recruitment of CHR-P individuals. The dynamic map of CHR-P services has been implemented on the IEPA website: https://iepa.org.au/list-a-service/. Conclusions: Worldwide primary indicated prevention of psychosis in CHR-P individuals is possible, but the implementation of CHR-P services is heterogeneous and constrained by pragmatic challenges.

Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis

“…Third, the current findings can be used to design or refine preventive approaches. Services for individuals at Clinical High Risk for Psychosis (Fusar-Poli et al, 2020;Kotlicka-Antczak et al, 2020;Salazar de Pablo et al, 2019) may leverage our findings to refine preventive approaches. For example, there is emerging evidence that Covid-19 may increase the incidence of short-lived psychotic episodes (Anmella et al, 2020;Valdés-Florido et al, 2020;Zulkifli et al, 2020) also termed as brief and limited intermittent psychotic symptoms (Castagnini and Fusar-Poli, 2017;Fusar-Poli et al, 2016;Fusar-Poli et al, 2017;Fusar-Poli et al, 2019;Minichino et al, 2019;Rutigliano et al, 2018).…”

Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care

“…Young individuals at Clinical High-Risk for Psychosis (CHR-P) [ 1 , 2 ] accumulate risk factors for the disorder [3] , [4] , [5] , attenuated psychotic symptoms [6] and functional impairments [7] , and seek help [8] at specialised CHR-P clinical services [9] , [10] , [11] . The preventive care (termed primary indicated prevention) implemented in these CHR-P services has the potential to maximise the benefits of early interventions for psychosis [12] .…”

“…Because of the limited knowledge of long-term outcomes, preventive interventions have similarly targeted the short-term period [28] . Accordingly, most CHR-P services worldwide limit the duration of care to the short-term (median 2 years [11] ) period since the initial presentation. Another limitation of knowledge is that factors predicting long term outcomes are not completely clear.…”

Risk factors for eating disorders: an umbrella review of published meta-analyses

“…21 Poor knowledge of the mechanistic processes that lead to ED and risk factors for ED might be one of the reasons why early ED intervention and prevention has been studied less than psychotic and other non-psychotic disorders. 22,23 Despite preliminary evidence suggesting the potential efficacy of ED prevention, more evidence synthesis is needed, 24,25 since the state of the art for evidence on interventions to prevent or delay ED onset seems to be relatively less explored than in other fields of psychiatry. 26,27 Although the prevention of mental disorders, particularly psychosis, is being explored, it has only been partially implemented worldwide.…”