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3. Randomized Controlled Trial of the Effects of Early Intervention Services On Insight in First Episode Psychosis.

Author

DeTore, N R, Bain, K, Wright, A, Meyer-Kalos, P, Gingerich, S, and Mueser, K T

Subjects
PSYCHOSES, TIME, SCHIZOPHRENIA, REGRESSION analysis, COMMUNITY health services, TREATMENT effectiveness, RANDOMIZED controlled trials, MENTAL depression, STATISTICAL sampling, EARLY medical intervention, PSYCHIATRIC treatment
Abstract

Background and Hypothesis Impaired insight into one's illness is common in first episode psychosis (FEP), is associated with worse symptoms and functioning, and predicts a worse course of illness. Despite its importance, little research has examined the effects of early intervention services (EIS) on insight. Designs This paper evaluated the impact of EIS (NAVIGATE) on insight compared to usual community care (CC) in a large cluster randomized controlled trial. Assessments were conducted at baseline and every 6 months for 2 years. Results A multilevel regression model including all time points showed a significant time by treatment group interaction (P <.001), reflecting greater improvement in insight for NAVIGATE than CC participants. Impaired insight was related to less severe depression but worse other symptoms and functioning at baseline for the total sample. At 6 months, the same pattern was found within each group except insight was no longer associated with depression among NAVIGATE participants. Impaired insight was more strongly associated with worse interpersonal relationships at 6 months in NAVIGATE than in CC, and changes in insight from baseline to 6 months were more strongly correlated with changes in relationships in NAVIGATE than CC. Conclusions The NAVIGATE program improved insight significantly more than CC. Although greater awareness of illness has frequently been found to be associated with higher depression in schizophrenia, these findings suggest EIS programs can improve insight without worsening depression in FEP. The increased association between insight and social relationships in NAVIGATE suggests these 2 outcomes may synergistically interact to improve each other in treatment. [ABSTRACT FROM AUTHOR]

Published
2022
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10. Fidelity scales and performance measures to support implementation and quality assurance for first episode psychosis services

Author

Addington, D, Birchwood, M, Jones, P, Killackey, E, McDaid, D, Melau, M, Mizuno, M, Mueser, K, Nordentoft, M, Addington, D, Birchwood, M, Jones, P, Killackey, E, McDaid, D, Melau, M, Mizuno, M, Mueser, K, and Nordentoft, M

Abstract

AIM: The purpose of this paper is to review fidelity and outcome measures which can be used to support broad implementation of first episode psychosis services and ensure quality of existing services. First episode psychosis services use a combination of evidence-based practices to improve the outcome of a first episode of psychosis and the early stages of schizophrenia. Now that there is an established international evidence base to show that they are effective, efforts are being made to make such services widely available as a routine part of health care. METHODS: We provide an overview of the literature from the perspective of an expert task force that was commissioned to report to the board of the International Early Psychosis Association IEPA. First, we examined the evidence-based components that underpin first episode psychosis services and identified common elements. Next, we reviewed the availability of fidelity measures and outcome indicators, finally we reviewed how broadly these services are delivered internationally, and the barriers to ensuring broad access to quality services. RESULTS: There is a growing consensus about the elements required to deliver effective services. Fidelity scales and performance measures are available to assess quality, access, and outcome. First episode psychosis services are variably offered in high-income countries and rarely with attention to access and quality of services. Several strategies to promote implementation are identified. CONCLUSIONS: Fidelity scales and outcome measure are valuable resources to support widespread implementation and quality assurance for first episode psychosis services.

Published
2018

11. Clinical and demographic correlates of stigma in first‐episode psychosis: the impact of duration of untreated psychosis.

Author

Mueser, K. T., DeTore, N. R., Kredlow, M. A., Bourgeois, M. L., Penn, D. L., and Hintz, K.

Subjects
*SOCIAL stigma, *SCHIZOAFFECTIVE disorders, *PSYCHOSES, *DEMOGRAPHIC characteristics
Abstract

Objective: To evaluate the relationships between perceived stigma and duration of untreated psychosis (DUP), demographic characteristics, and clinical and psychosocial functioning in persons with a first episode of psychosis (FEP). Method: A total of 399 participants with FEP presenting for treatment at 34 sites in 21 states throughout the United States were evaluated using standardized instruments to assess diagnosis, symptoms, psychosocial functioning, perceived stigma, wellbeing, and subjective recovery. Results: Perceived stigma was correlated with a range of demographic and clinical variables, including DUP, symptoms, psychosocial functioning, and subjective experience. After controlling for symptom severity, perceived stigma was related to longer DUP, schizoaffective disorder diagnosis, more severe depression, and lower wellbeing and recovery. The associations between stigma and depression, wellbeing, and recovery were stronger in individuals with long than short DUP, suggesting the effects of stigma on psychological functioning may be cumulative over the period of untreated psychosis. Conclusion: The findings suggest that independent of symptom severity, perceived stigma may contribute to delay in seeking treatment for FEP, and this delay may amplify the deleterious effects of stigma on psychological functioning. The results point to the importance of reducing DUP and validating interventions targeting the psychological effects of stigma in people with FEP. [ABSTRACT FROM AUTHOR]

Published
2020
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15. The Illness Management and Recovery Program: Rationale, Development, and Preliminary Findings

Author

Mueser, K. T.

Abstract

The Illness Management and Recovery (IMR) program was developed based on a comprehensive review of research on teaching illness self-management strategies to clients with schizophrenia and other severe mental illnesses and “packaged” in a resource kit to facilitate dissemination. Despite growing dissemination of this program, it has not yet been empirically validated. This article describes the development and theoretical underpinnings of the IMR program and presents pilot data from the United States and Australia (N = 24, 88% schizophrenia or schizoaffective) on the effects of individual-based and group-based treatment over the 9-month program and over a 3-month follow-up. High satisfaction was reported by participants. Strong improvements over treatment and at follow-up were found in clients' self-reported effectiveness in coping with symptoms and clinicians' reports of global functioning and moderate improvements in knowledge about mental illness, distress related to symptoms, hope, and goal orientation. These findings support the feasibility and promise of the IMR program and point to the need for controlled research to rigorously evaluate its effects.

Published
2006
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17. Management of co-occurring substance use disorders

Author

Jeste, D, Mueser, K, Kavanagh, David, Jeste, D, Mueser, K, and Kavanagh, David

Abstract

Reviewing the breadth of current knowledge on schizophrenia, this handbook provides clear, practical guidelines for effective assessment and treatment in diverse contexts. Leading authorities have contributed 61 concise chapters on all aspects of the disorder and its clinical management. In lieu of exhaustive literature reviews, each chapter summarizes the current state of the science; highlights key points the busy practitioner needs to know; and lists recommended resources, including seminal research studies, invaluable clinical tools, and more. Comprehensive, authoritative, and timely, the volume will enable professionals in any setting to better understand and help their patients or clients with severe mental illness.

Published
2008

19. Family Interventions

Author

Mueser, K., Jeste, DV, Barrowclough, Christine, Lobban, Fiona, Mueser, K., Jeste, DV, Barrowclough, Christine, and Lobban, Fiona

Published
2007

22. Start over and survive: A brief intervention for substance misuse in early psychosis

Author

Graham, H L, Mueser, K T, Copello, A, Birchwood, M J, Kavanagh, David, Young, Ross, White, Angela, Saunders, John, Shockley, Natalie, Wallis, Jeff, Clair, Anne, Graham, H L, Mueser, K T, Copello, A, Birchwood, M J, Kavanagh, David, Young, Ross, White, Angela, Saunders, John, Shockley, Natalie, Wallis, Jeff, and Clair, Anne

Abstract

Over the last decade, brief intervention for alcohol problems has become a well-validated and accepted treatment, with bried interventions frequently showing equivalence in terms of outcome to more extended treatments (Bien et al, 1993). A recent review of this studies found that heavy drinkers who received interventions of less than 1 h were almost twice as likely to moderate their drinking over the following 6-12 months as did those not receiving intervention (Wilk etal, 1997).Some studies have used motivational interviewing (MI) strategies (Monti et al, 1999); others have simply given information ajnd advice to reduce drinking (Fleming et al, 1997). Leaflets or information on strategies to assist in the attempt or follow-up sessions are sometimes provided (Fleming et al, 1997). In general practice research, provision of one or more follow-up sessions increases the reliability of intake reductions across studies (Poikolainen, 1999).

Published
2003

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