High levels of optimism in persons with first-episode psychosis: Clinical implications |
Emily Schorr |
Introduction: Philosophically, early intervention for psychosis has its roots in rejecting a nihilistic view of the prognosis of psychosis in favour of one that emphasizes therapeutic optimism and hope for functional recovery. In actual clinical practice, however, there is often still an emphasis on symptom resolution and functional impairments. Little is known about how young persons with psychosis themselves view the rest of their lives and its possibilities. Objective: This research seeks to determine the levels of optimism in youth, upon entry into treatment for a first episode of psychosis, regarding reaching goals and living the quality of life they imagine for themselves in the future. Methods: The data was collected as part of a larger project at the Prevention and Early Intervention Program for Psychoses (PEPP) in Montreal. The data is based on questions from two self-report questionnaires administered upon entry into treatment; the Birchwood Social Functioning Scale and adapted items from the hope subsection of Arnett’s Emerging Adulthood Questionnaire. Through these questions, youth with psychosis indicated how hopeful they were regarding both their capacity for work/school and the attainment of their desired quality of life, financial well-being, career/educational goals and personal relationships in the future. Results: Across all questions, young persons with psychosis (N = 60) entering treatment displayed moderate to high levels of optimism/hope. Moreover, none of the patients for any question felt there to be no hope. Of those clients who were not working or in school at baseline, 75% felt they were ‘definitely’ capable of employment or returning to school. When asked about how hopeful they were that they would have the quality of life they desire, the highest proportion of patients felt moderately to very hopeful (85%). Similar results were found when asked about financial wellbeing (84% moderately to very hopeful), career and educational goals (76% moderately to very hopeful) and hopefulness for quality of personal relationships ( 87% moderately to very hopeful) in the future. Clinical implications: Our findings show that young persons recently diagnosed with psychosis report high levels of optimism and hope for their future. Using simple tools to ask patients about hope and optimism early on could provide clinicians with concrete tools to shift the focus of treatment early on towards hope, therapeutic optimism and functional recovery. Assessing hope and optimism and basing treatment on this could likely create improved alliance between patients and clinicians and better engagement in treatment/services.
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Conference Poster |
Does cannabis really influence first episode psychosis outcome negatively? |
Clairélaine Ouellet-Plamondon |
"Objectives: Different studies have concluded that cannabis use disorders (CUD) influenced negatively outcomes in first-episode psychosis (FEP). However, it is rarely mentioned if those cannabis users were also misusing other substances.. Our study examined the specific impact of different SUDs (alcohol, cannabis, psychostimulants) on symptoms, social functioning and service utilization of youth with FEP.
Methods: a prospective longitudinal of 2 years follow-up of 176 FEP between 18 to 30 years old, admitted to early psychosis programs in Montreal.
Results: Half of CUD present polysubstance use disorder. All substances (drugs and alcohol) are associated with lower functioning (GAF) but drugs have a greater negative impact on most measures at 2-year. Psychostimulants and poly-SUD are associated with bad symptomatic and functional outcome early in the course of illness (from the 1st year of treatment), persisting over time and higher service utilization (hospitalization). Persistent CUD is the only group that deteriorates from Year 1 to Year 2 (symptoms and functioning). However, psychostimulants abusers have a bad outcome from the first year.
Conclusions: The negative impact that has been attributed to CUD in previous studies could partly be attributed to methodological flaws (including polysubstance abusers in the cannabis users group). However, our study confirms CUD negative impact on outcome in youth with FEP. Attention should be given to cannabis misusers since their condition seems to worsen over time and to psychostimulant misusers since they have poorer outcome early during follow-up and a high utilization of hospitalization and emergency services."
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Conference Poster |
Promoting functional recovery: Pairing improved neurocognition with engagement in challenging everyday tasks |
Christopher Bowie |
Introduction: Most people with mental disorders experience a reduction of symptoms with treatment, but recovery of everyday functions is often delayed and incomplete. The most robust predictor of difficulty functioning in everyday life is neurocognition, which is not a treatment target of medications or most psychotherapy. Cognitive Remediation is widely recognized as an efficacious treatment that improves attention, memory, and executive functions, but its ability to effectively promote behaviour change is more limited and retention in treatment is low. In response, we developed Action-Based Cognitive Remediation (ABCR) to build on intact procedural learning skills, pair neurocognitive training with skill-based training, and promote engagement in everyday behaviours considered cognitively challenging. Objectives: We sought to determine if ABCR was more efficacious (improved neurocognition) and more effective (improved functional skills and vocational outcomes) than traditional cognitive remediation. Methods: In this study we compared ABCR to a traditional form of cognitive remediation. Treatment was 10 weeks, twice per week, in a group format. Both treatments provided computerized cognitive training, discussions of how to monitor and flexibly adapt strategies when solving problems, and discussions of how cognitive skills and strategies can be used in everyday life. Compared to traditional cognitive remediation, ABCR also included role-plays in simulated work tasks and goal setting with an emphasis on seeking cognitive challenge in everyday life. Results: Cognitive response was favourable for ABCR in verbal memory (p
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Conference Poster |
Minding the Gap: Improving outcomes for young people transitioning to adulthood in the London borough of Camden |
Amit Bhaduri |
Adolescence is a critical developmental stage associated with neurodevelopmental changes, a move towards greater independence and a range of important life choices in education, relationships, career, housing and finances. These potential stressors can contribute to the development of mental health difficulties, and attendant negative social and economic consequences. During the transition into adulthood, young people can find it difficult to navigate the move from CAMH (child and adolescent mental health) services which have previously engaged and supported them, to an unfamiliar territory of adult services. In the course of this, some young people are not able to ‘mind the gap’ and fall out of services. There are good services in Camden for young people aged 16-24, but they are fragmented, not primarily centered on young people and tend not to reach out to difficult to engage young people. Minding the Gap was commissioned in the autumn of 2014 with and aimed to improve the outcomes for this group. Its objectives are: to improve the integration of mental health, physical health, youth support and social care services; to deliver client-friendly services; to improve early intervention and prevention; to decrease the number of clients who disengage, and to create a more straightforward access referral pathway. The two-fold approach involves firstly the age alignment of services within Camden, driven largely by a team of ‘Transition Champions’ and secondly, the development of an integrated community youth base in the heart of Camden to bring together mental health, substance misuse, sexual health, advice on employment, training and housing and other support services under one roof. Young people have been consulted and involved at every stage of design and implementation. In this poster, we describe the implementation and outcomes of the project thus far in more detail.
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Conference Poster |
Immigrants' outcome after a first episode psychosis: Any difference from non-immigrants? |
Amal Abdel-Baki |
Objectives: Immigration is a well-known risk factor for the development of psychosis, but the literature looking at outcomes in youth with first episode psychosis is scarce and heterogeneous. The aim of this study is to compare first and second-generation immigrants and non-immigrants’ treatment engagement as well as symptomatic and functional outcomes 2 years after admission to a First Episode Psychosis Early Intervention Service.Methods: This longitudinal prospective study of 223 subjects entering First Episode Psychosis Services in Montréal, Canada compared retention into treatment and symptomatic and functional outcomes of first and second-generation immigrants and non-immigrants. Data collection at admission, after one year and 2 years included immigration status, other sociodemographic characteristics, adherence to medication, symptoms, social and occupational functioning, and attrition rate. Results: Immigrants and non-immigrants entering the services had similar symptoms and functioning profile. First-generation immigrants present less substance use disorder and are more likely to study at 12 and 24 months. Second-generation immigrants were more likely to be living with their parents throughout the study. Importantly, immigrants were about 3 times more likely to be lost to the 2-year follow up compared to non-immigrants even when controlling for potential confounding factors. Differences were found between first and second-generation immigrants in terms of substance use and occupational outcome. Conclusions: Young immigrants are more likely to quit treatment than non-immigrants 2 years after a first episode psychosis but once engaged in first episode psychosis services, immigrants’ outcome seems to be similar to non-immigrants.
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Conference Poster |
Impact of the course of substance use disorder on symptomatic and functional outcome in first-episode psychosis |
Amal Abdel-Baki |
Objectives: Prevalence of substance use disorders (SUD) in First-Episode Psychosis (FEP) is high and usually associated with poor clinical outcome. Our study examined the impact of the course of SUD on outcome in a sample of youth with FEP. Methods: A prospective longitudinal study of 2 years follow-up of 212 FEP, between 18 to 30 years old, admitted to an early psychosis program in Montreal. Results: Cannabis is the first substance abused (42.9% at baseline), followed by alcohol (19.3%). The SUD rate decreases over time by approximately 30%, especially cannabis. Subjects with persistent SUD at 1 and 2 years follow-up have more symptoms and have a worse functional outcome. The Outcomes of those with remitted SUD is somewhat similar to those who never had a SUD. Patients with an active SUD during follow-up were heavier users of emergency and hospitalization services compared those who had never had a SUD or who stopped. Persistence of SUD was associated with more severe dependence, homelessness and cluster B personality traits or disorders, Those who stopped misuse were rather living with family and supported financially by them. Conclusions: A specific intervention for co-morbidity during the first years, targeting those with predictors of persistence, could increase the proportion of youth with FEP who stop substance abuse/dependency and possibly improve their outcome.
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Conference Poster |
EQUIP SOL: Study measuring the impact of adding an intensive outreach team for homeless youth suffering from psychosis and substance use disorders to an early psychosis specialised clinic |
Amal Abdel-Baki |
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Conference Poster |
Youth engagement in promoting mental health and decreasing stigma |
Michelle Cianfrone |
Youth engagement in the design and delivery of mental health services and resources is a key means of ensuring services and resources are relevant to youth, decreasing stigma, and promoting mental health literacy and well-being. BC Mental Health and Substance Use Services’ (BCMHSUS) Health Literacy team works with and engages youth in meaningful, unique, and empowering ways. Youth are involved in all aspects of our programming, including service delivery, projects, events, and resource development.BCMHSUS’ Kelty Mental Health Resource Centre is a provincial centre providing mental health and substance use resources and information to children, youth, and families from across BC. Within the Centre, and through a partnership with The FORCE Society for Kids’ Mental Health, youth who have lived experience with mental health challenges (“Youth in Residence”) provide peer support, information, and resources related to mental health to other youth throughout BC. Not only does this provide an empowering, meaningful opportunity for the Youth in Residence, but youth-to-youth peer support has been found to help decrease mental health stigma and contribute in an important way to mental health, well-being, and recovery. The Youth in Residence have also taken a leadership role in the Kelty Centre’s Youth Ambassador Program, an innovative program designed to provide youth across BC with opportunities to promote mental health and well-being in their schools and communities. Kelty Youth Ambassadors have been involved in designing BCMHSUS resources for youth, developing anti-stigma videos, writing blog posts shared through the Kelty Centre, speaking to other youth at Kelty Centre events, and also developing their own mental health promotion projects in their own communities with the support of the Kelty Centre and the Youth in Residence. Youth are also engaged in the planning, design, and delivery of BCMHSUS events and resources for youth. This includes the Balancing our Minds Youth Summit, an annual event for high school youth to learn about mental health and engage in fun activities and thoughtful dialogue. Over 1,400 youth were in attendance at the most recent event in February 2015.
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Conference Poster |
Improved mental health services awareness and practices through youth participation and active engagement in community based psychiatric services |
Khalid Pevez |
Improved mental health services awareness and practices through youth participation and active engagement in community based psychiatric services
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Conference Poster |