Domínguez MT, Vainer E, Massanet MA, Torices I, Jané M, Barrantes-Vidal N

Language: English
References: 32
Page: 517-524
PDF size: 110.50 Kb.

ABSTRACT

International interest has grown over the past 15 years in the prognostic potential of early identification and intervention in the prodromal and first-episode phases of psychosis. This focus is associated with increasing optimism about the benefits of implementing treatment as early as possible in the course of psychosis, at least to help improve the course of illness, reducing its long-term impact.
A clearer framework for guiding, designing, and evaluating preventive interventions in mental disorders has been developed. As a consequence, a series of research projects and real-world services systems are currently emerging. Additionally, several influential international figures and research groups have developed and cooperated in disseminating a more optimistic set of ideas concerning early intervention in psychosis.
The early psychosis programs developed worldwide have a number of common elements and goals: a) early detection of new cases, b) reducing the duration of untreated psychosis (DUP), and c) providing better and continued treatment during the «critical period» of the early years of the disorder.
Moreover, family interventions usually offer psychoeducation and/or individual and group family therapy, in conjunction with communication and problem solving training, which can help to develop coping strategies and reduce distress and burden. Intervention programs in early psychosis are usually composed by interdisciplinary teams, providing a wide range of integrated services that typically include psychoeducation, clinical case management, and group interventions. Specific interventions generally include pharmacotherapy, stress management, relapse prevention, social and employment rehabilitation support, and cognitive and family therapy.
The current challenges in the implementation of psychological interventions in the early stages of psychosis are: 1. to adapt treatment modalities that have been proven effective in stable and residual stages of the disease to its early stages; 2. to develop new forms of therapy tailored to the specific characteristics of these early stages of psychosis; and 3. treatment packages need to be individually tailored to specific needs rather than applied homogenously across early psychosis patients. One example of the integration of all these aspects is the «needadapted integrated treatment» developed by Alanen et al. in Finland, which combines different forms of treatment in a flexible, individually designed intervention in order to take into account the needs of both patients and families.
Following the experience and work of Alanen et al., an Early Psychosis Program (EPP) currently is being developed in the Mental Health Services of Sant Pere Claver in Barcelona, addressed to young people between 14 and 35 years with at risk mental states (ARMS), first episode psychosis (FEP), and post-crisis stages of psychosis.
All cases included in the program are derived from various community resources (primary health care, schools, emergency services, and inpatient units for acute patients) and assessed exhaustively by the team to define the treatment plan for each case. The treatment modalities offered by the EPP are: individual and group therapy, unifamiliar and multifamiliar psychotherapy, psychoeducation and pharmacotherapy in those cases where necessary. Furthermore, there is an intensive community support for those patients who have difficulties engaging with mental health services. During the EPP all patients are monitored through weekly visits with their psychiatrist, psychologist, social worker and/or nursing staff.
The aim of this paper is to present and describe the integrated need-adapted treatment approach of the early psychosis program currently being developed in a specialized center in Barcelona (Spain).

REFERENCES

1. Hegarty JD, Baldessarini RJ, Tohen M, Waternaux C et al. One hundred years of schizophrenia: a meta-analysis of the outcome literature. Am J Psychiatry 1994;151:1409-1416.

2. Corell CU, Hauser M, Auther AM, Cornblatt BA. Research in people with psychosis risk syndrome: a review of the current evidence and future directions. J Child Psychol Psychiatry 2010;51:390-431.

3. Birchwood M, McGorry P, Jackson H. Early intervention in schizophrenia. Br J Psychiatry 1997;170:2-5.

4. McGorry PD. Preventive strategies in early psychosis: verging on reality. Br J Psychiatry 1998;172:1-2.

5. Yung A, McGorry P, McFarlane CA, Jackson HJ et al. Monitoring and care of young people an incipient risk of psychosis. Schizophr Bull 1996;22:283-303.

6. Birchwood M, Fowler D, Jackson C. Early intervention in psychosis. A guide to concepts, evidence and interventions. Chichester, New York, Weinheim, Brisbane, Singapore, Toronto: Wiley; 2002.

7. Gleeson J, McGorry P (eds). Intervenciones psicológicas en la psicosis temprana. Un manual de tratamiento. Bilbao: Biblioteca de Psicología Declée de Brouwer; 2005.

8. Martindale BV, Bateman A, Crowe M, Margison F (eds). Las psicosis. Los tratamientos psicológicos y su eficacia. Barcelona: Editorial Herder; 2009.

9. McGorry PD. The recognition and optimal management of early psychosis: an evidence-based reform. World Psychiatr 2002;1:76-83.

10. Bhangoo RK, Carter CS. Very early intervention in psychotic disorders. Psychiatr Clin N Am 2009;32:81-94.

11. Addington J, Collins A, McCleery A, Addington D. The role of family work in early psychosis. Schizophr Res 2005;79:77-83.

12. O´Brien M, Zinberg JL, Ho L, Rudd A et al. Family problem solving interactions and 6 month symptomatic and functional outcomes in youth at ultra-high risk for psychosis and with recent psychotic symptoms: A longitudinal study. Schizophr Res 2009;107:198-205.

13. Haddock G, Lewis S. Psychological intervention in early psychosis. Br J Psychiatry 2005;31:667-704.

14. Alanen YO, Räkköläinen V, Aaltonen J. Need-adapted treatment of new schizophrenic patients: experiences and results of the Turku Project. Acta Psychiatr Scand 1991;83:363-372.

15. Alanen Y. Schizophrenia. Its origins and need-adapted treatment. London: Karnac books; 1997.

16. Guía de práctica clínica sobre la esquizofrenia y el trastorno psicótico incipiente. Madrid: Plan de ca-lidad para el Sistema Nacional de Salud del Ministerio de Sanidad y Consumo. Agència d’Avaluació de Tecnologia i Recerca Mèdiques;2009.http://www.gencat.cat/salut/depsan/units/aatrm/html/ca/dir303/doc13319.html

17. Fòrum Salut Mental, Proposta de desenvolupament d’un model d’atenció als trastorns psicòtics incipients, «Document de treball», Barcelona: Fòrum de Salut Mental; 2006.

18. Yung A, Pan Yuen H, McGorry PD, Phillips LJ et al. Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Aust N Z J Psychiatry 2005;39:964-971.

19. Schultze-Lutter F, Addington J, Ruhrmann S, Klosterkötter J. Schizophrenia pronness instrument. Adult Version (SPI-A) Roma: Giovanni Fioriti Editore; 2007.

20. Alanen YO, Lehtinen V, Lehtinen K, Aaltonen J et al. El modelo finlandés integrado para el tratamiento precoz de la esquizofrenia y psicosis afines. En: Martindale BV, Bateman A, Crowe M, Margison F (eds). Las psicosis. Los tratamientos psicológicos y su eficacia. Barcelona: Editorial Herder; 2009.

21. Räkköläinen V, Lehtinen K, Alanen YO. Need-adapted treatment of schizophrenic processes: the essential role of family-centered therapy meetings. Contemp Fam Treat 1991;13:573-582.

22. Foulkes SH, Anthony EJ. Psicoterapia psicoanalítica de grupo. Buenos Aires: Paidos; 1964.

23. Bion W. Experiences in groups. New York: Basic Books; 1976.

24. García Badaracco J. Psicoanálisis multifamiliar. Los otros en nosotros y el descubrimiento de sí mismo. Buenos Aires: Paidós; 2000.

25. Lieberman JA. Atypical antipsychotic drugs as a first-line treatment of schizophrenia: a rationale and hypotheses. J Clin Psychiatry 1996;57:68-71.

26. McGlashan TH, Zipursky RB, Perkins MD, Addington J et al. Randomized double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 2006;163:790-799.

27. Woods SW, Breier A, Zipursky RB. Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Biol Psychiatry 2003;54:453-464.

28. Myin-Germeys I, Van Os J. Stress-reactivity in psychosis: Evidence for an affective pathway to psychosis. Clin Psychol Rev 2007;27:409-424.

29. Domínguez T, Vilagrà R, Blanqué JM, Vainer E et al. The association between relatives’ Expressed Emotion with clinical and functional features of early-psychosis patients. Presented at: 7th International Conference on Early Psychosis (Amsterdam, NL), November 2010. Early Interv Psychiatry 2010;a:4:55.

30. Domínguez T, Vilagrà R, Blanqué JM, Vainer E et al. Levels of Emotional Over-involvement (EOI) and Critical Comments (CC) in relatives of first episode psychosis and at risk mental state patients. Presented at: 7th International Conference on Early Psychosis (Amsterdam, NL), November 2010. Early Interv Psychiatry 2010;b:4:128.

31. Vilagrà R, Domínguez T, Blanqué JM, Vainer E et al. Impact of depression on psychotic symptoms in at risk mental state and first episode psychosis patients. Presented at: 7th International Conference on Early Psychosis (Amsterdam, NL), November 2010. Early Interv Psychiatry 2010;4:83.

32. Jorgensen P, Nordentoft M, Abel MB, Gouliaev G et al. Early detection and assertive community treatment of young psychotics: The OPUS Study. Rationale and design of the trial. Soc Psychiatr Psychiatric Epidemiol 2000;35:283-287.