Disorders - Psychosis Disorders
Mesholam-Gately, R., Shashidhar, G., Ramadurai, R., Padani, S., Lausberg, A., Wojcik, J., Sandoval, L., Johnson,
R., Endsley, J., Eack, S., Keshavan, M.
Cognitive Enhancement Therapy (CET) has shown substantial and lasting effects on neurocognition in schizophrenia. This ongoing study
compares the effects and durability of CET to an Enriched Supportive Therapy (EST) control condition in early-course schizophrenia (ES). Prior pilot
findings from this study suggested differential neurocognitive improvements favoring CET but have not yet examined the role of hedonic capacity (HC)
on these effects. ES outpatients were randomized to CET or EST as part of a 2.5-year randomized-controlled trial. Neurocognition was assessed with
the MATRICS Consensus Cognitive Battery (MCCB) and HC was evaluated with pleasantness ratings on the Modified Brief Smell Identification Test. Linear
mixedeffects analyses were performed on data from 67 participants at baseline (41 CET, 26 EST) and 37 at 9 months (21 CET, 16 EST). Preliminary
results confirmed previous findings of a significant time x group interaction favoring CET on the MCCB Composite score. Of note, there was a main
effect for HC in both groups, indicating that those with the largest ranges of ratings between the most pleasant and unpleasant odors showed better
neurocognitive performance in their respective conditions. These initial findings continue to suggest that CET is effective in ES, but that the
extent of neurocognitive improvement may be partially moderated by HC. Considering the critical role of hedonic and other reward processes in
learning, these findings have important implications for incorporating targeted reward-enhancing interventions in cognitive rehabilitation for people
with ES. As data for this study accrues, the durability of these effects can be examined further.
Early Intervention in Psychiatry, 12
(Supplement 1) : 156
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Supportive
therapy
Guimond, S., Ling, G., Lopez, B., Templeton, R., Brady, R., Thermenos, H., Eack, S., Keshavan, M.
S.
Social cognition is a key determinant of functional outcomes in early course
schizophrenia. The goal of our study was to examine the impact of cognitive enhancement therapy (CET) on social cognition and on functional
connectivity in early course schizophrenia. Eightyfour participants were randomly assigned to either treatment groups (CET, n = 49; Enriched
Supportive Therapy (EST), n = 35). Resting state scans and social cognition performance, as measured by the MATRICS battery, were collected at
baseline, 9, 18 and 30 months. We conducted mixed linear model analyses to investigate the impact of treatment (CET vs. EST) on social cognition and
on the dorsolateral prefrontal cortex (DLPFC) functional connectivity to the right and left amygdala. CET group showed significant improvement over
time in social cognition in comparison to the EST group (p<.05). Change in functional connectivity over time did not significantly differ between
treatments. However, we observed a significant positive correlation between increased right DLPFC functional connectivity to the right amygdala and
social cognition performance in the CET group (p<.05). Our results replicate previous work demonstrating that CET is effective at improving social
cognition in schizophrenia. In addition, we found evidence that this improvement could be reflected in the DLPFC-amygdala circuit connectivity. This
neural circuit potentially provides a mechanistic link between the biology of emotion regulation and more complex social cognition processes that can
be improved in early stage of the illness.
Early Intervention in Psychiatry, 12 (Supplement
1) : 75
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Supportive
therapy
Anonymous,
Background Cognitive behavioural therapy (CBT) for psychosis is a distinct type of psychotherapy that
has been recommended together with antipsychotic drugs and comprehensive usual care in the management of schizophrenia, a complex mental health
disorder associated with a high economic and societal burden. The objectives of this report were to assess the effectiveness, harms, cost-
effectiveness, and lived experience of CBT for psychosis in improving outcomes for adults with a primary diagnosis of schizophrenia. Methods We
performed literature searches on March 28 and April 5, 2017, and undertook a qualitative synthesis of systematic reviews of the clinical and economic
literature comparing CBT for psychosis with any comparator interventions (e.g., usual care, waitlist control, or pharmacotherapy) in adults with a
diagnosis of schizophrenia as defined by any criteria (including related disorders such as schizoaffective disorder). We developed an individual-
level state-transition probabilistic model for a hypothetical cohort of adults aged 18 years and older starting with first-episode psychosis. We
compared three strategies: usual care, CBT for psychosis by physicians, and CBT for psychosis by regulated nonphysician therapists. The CBT was
provided in person together with usual care including pharmacotherapy: 16 structured sessions (individual or group) for first-episode psychosis and
24 individual sessions for relapse or treatment-resistant disease. We calculated incremental cost-effectiveness ratios (ICERs) over 5 years using the
Ontario Ministry of Health and Long-Term Care perspective and a discount rate of 1.5%. We also estimated the 5-year budget impact of publicly funding
CBT for psychosis in Ontario. In addition, we interviewed 13 people with lived experience of schizophrenia and psychosis about their values and
preferences surrounding CBT and other treatments. Results CBT for psychosis compared with usual care significantly improved overall psychotic
symptoms (standard mean difference [SMD] -0.33, 95% confidence interval [CI] -0.45 to -0.21), positive symptoms (e.g., hallucinations) (SMD -0.34,
95% CI -0.58 to -0.10), auditory symptoms (SMD 0.39, 95% CI not reported, P <.005), delusions (SMD 0.33, 95% CI not reported, P <.05) and negative
symptoms (e.g., blunt affect) (SMD -0.32, 95% CI -0.59 to -0.04) at end of treatment. No significant differences were observed for social function,
distress associated with psychosis, relapse, or quality of life. Compared with any control, CBT for psychosis significantly improved overall
psychotic symptoms, positive symptoms, auditory hallucinations, delusions, and negative symptoms. Compared with other forms of therapy, CBT for
psychosis showed inconsistent results at end of treatment for overall psychotic symptoms, positive symptoms, auditory hallucinations, and delusions.
In people with first-episode psychosis, CBT for psychosis was not significantly more effective for the prevention of relapse when compared with other
forms of therapy or usual care (odds ratio [OR] 1.11, 95% CI 0.63-1.95 and OR 1.15, 95% CI 0.65-2.04, respectively). Low-intensity CBT for psychosis
(fewer than 16 face-to-face sessions) compared with any type of treatment significantly improved overall psychotic symptoms and social function at
follow-up (SMD -0.40, 95% CI -0.74 to -0.06 and SMD -0.57, 95% CI -0.81 to -0.33, respectively). In the cost-utility analysis, CBT for psychosis
provided by nonphysician therapists compared with usual care was associated with increases in both quality-adjusted life-years (mean 0.1159 QALYs,
95% credible interval [CrI] 0.09-0.14) and costs (mean $2,494, 95% Crl $1,472- $3,544), yielding an ICER of $21,520 per QALY gained. CBT for
psychosis provided by physicians was dominated because it was equally effective but more expensive (mean $2,976, 95% CrI $2,822-$3,129; ICER of CBT
for psychosis vs. usual care: $47,196/QALY gained). Assuming a 20% increase in access per year (from 0% at baseline to 100% in year 5), we estimated
the total 5-year net budget impact of publicl funding CBT for psychosis would be about $15.2 million for nonphysician providers and about $35.4
million if provided by psychiatrists. It is estimated that by the year 2021, approximately 110 nonphysician therapists or 150 physicians would be
needed to provide CBT for psychosis to more than 12,000 adults with schizophrenia (including about 8,500 incident cases) in Ontario. People with
schizophrenia and their family members reported positive experiences with CBT for psychosis. They felt it provided effective tools to help manage
their schizophrenia but stressed that it was only effective in conjunction with medication to control psychotic episodes and overcome a patient's
denial of illness. Geographic and financial barriers have restricted access to this psychotherapy. Conclusions Compared with usual care or any
control, CBT for psychosis significantly improved psychotic symptoms, based on evidence of moderate to adequate quality; no significant improvements
were observed for social function, relapse, or quality of life outcomes. People affected by schizophrenia reported that CBT for psychosis was
valuable in conjunction with antipsychotic medication but that access to this type of psychotherapy is limited. Adding CBT for psychosis to usual
care in the management of adult schizophrenia probably represents good value for money in Ontario. Depending on the type of provider, therapy format,
and rate of access, the net budget impact to Ontario's publicly funded health system would likely be between $15 million to $35 million over the
next 5 years. Copyright © Queen's Printer for Ontario, 2018.
Ontario Health Technology Assessment
Series, 18(5) : 1-141
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Wijnen, B. F. M., Pos, K., Velthorst,
E., Schirmbeck, F., Chan, H. Y., de-Haan,
L., van-der-Gaag, M., Evers, S. M. A. A., Smit, F.
Background In schizophrenia spectrum disorders, negative symptoms
(e.g. social withdrawal) may persist after initial treatment with antipsychotics, much affecting the quality of life (QOL) of patients. This health-
economic study evaluated if a dedicated form of cognitive behaviour therapy for social activation (CBTsa) would reduce negative symptoms and improve
QOL in an economically sustainable way. Methods A health-economic evaluation was conducted alongside a single-blind randomised controlled trial in
two parallel groups: guideline congruent treatment as usual (TAU; n = 50) versus TAU augmented with adjunct CBTsa (n = 49). Outcomes were PANSS
negative symptom severity and EQ-5D quality adjusted life years (QALYs) gained. The health-economic evaluation was conducted both from the societal
and the health sector perspective. Results Both conditions showed improvement in the respective outcomes over the follow-up period of six months, but
QALY gains were significantly higher in the CBTsa condition compared to the TAU condition. Treatment response rate (i.e. >= 5-point decrease on the
PANSS) was not significantly different. However, the add-on CBT intervention was associated with higher costs. This did not support the idea that
CBTsa is a cost-effective adjunct. Various sensitivity analyses attested to the robustness of these findings. Conclusions In the Dutch context where
TAU for psychosis is guideline congruent and well implemented there appears no added value for adjunct CBTsa. In other settings where the treatment
for the schizophrenia spectrum disorders solely relies on antipsychotics, add-on CBTsa may lead to clinically superior outcomes, but it should still
be evaluated if adjunct CBTsa therapy is a cost-effective alternative. Copyright © 2018 Wijnen et al. This is an open access article distributed
under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.
PLoS ONE, 13 (11) (no pagination)(e0206236) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Heinssen, R.
The
Recovery After an Initial Schizophrenia Episode initiative evaluated the feasibility, effectiveness, and scalability of a multi-element, team-based
approach to first episode psychosis care in the United States. The Early Treatment Program comparative effectiveness trial (RAISE-ETP) enrolled 404
participants from 34 community centers in 21 states; clinics were randomly assigned to provide specialized early intervention services (NAVIGATE; N =
17) or usual community care (N = 17). The median duration of untreated psychosis (DUP) among participants was 74 weeks. After 24 months, NAVIGATE
recipients experienced greater improvements in quality of life, psychopathology, and involvement in work or school compared with patients in
community care. In addition, NAVIGATE was more cost-effective than typical treatment. Median DUP was a significant moderator of treatment effects on
quality of life and overall symptoms, but not on employment or school attendance. Patients with shorter DUP derived substantially more benefit from
NAVIGATE compared to those with longer DUP, and participants in community care. For NAVIGATE patients with DUP <74 weeks, average annual treatment
costs were 15 percent lower compared to the annual cost of typical care. Together these findings underscore the importance of complementary
approaches for improving FEP outcomes. In 2013, the National Institute of Mental Health launched research initiatives to test feasible strategies for
reducing DUP and achieving rapid referral of persons with FEP to specialized treatment programs. The focus, methods, and preliminary findings from 10
funded projects will be presented, along with implications for reducing DUP in ~200 specialized early intervention clinics now established in the
United States.
Early Intervention in
Psychiatry, 12 (Supplement 1) : 22
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Murru, A., Carpiniello, B.
The first psychotic episode is classically viewed as a critical period which management is important in determining the long-term outcome
of the schizophrenia (SCZ). For this reason, the duration of untreated illness (DUI), defined as the interval between the onset of the psychiatric
disorder and the administration of the first pharmacological treatment, is a clinical variable that has been increasingly investigated due to its
potentially modifiable nature and its value as a predictor of outcome. DUI is poorly applicable and highly unreliable in psychosis. The present
critical review examines the impact of DUI and its more operative definition of \"duration of untreated psychosis\" (DUP) in the course and outcome
of SCZ, focusing on its epidemiologic, clinical, prognostic factors. Length of DUP has been identified as positively related to a worst treatment
response, symptom control and overall functional outcome in SCZ. Negative symptoms appear to be prominently related to longer DUP. Neuroimaging
correlates of DUP have not been clearly outlined: few of the studies considering first-episode patients and DUP showed structural abnormalities. A
low proportion of significant associations were found mostly in cerebellum and occipital lobe of patients with longer DUP. Also, evidence of an
inverse correlation between cognitive alterations and DUP is not conclusive. DUI and DUP are multidimensional constructs that imply both intrinsic,
illness related (e.g. subtle symptoms at onset) and extrinsic factors (e.g. access to mental health services), so that from its study sprouted in the
last decades First-Episode Units, aimed at providing secondary prevention in SCZ such as providing a timely diagnosis and treatment to patients
experiencing their first psychotic episode. Early intervention seems to ensure a shortened DUP, especially for people presenting with brief limited
intermittent psychotic symptoms, and, ultimately, ensure a more favorable prognosis for patients affected by SCZ. Copyright © 2016 Elsevier Ireland
Ltd
Neuroscience
Letters, 669 : 59-67
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Schlosser, D. A., Campellone, T. R., Truong, B., Etter,
K., Vergani, S., Komaiko, K., Vinogradov, S.
The onset of schizophrenia occurs during a period critical for development of social
relationships and functional independence. As such, interventions that target the early course of illness have the potential to stave off functional
decline and restore functioning to pre-illness levels. In this entirely remote study, people with recent-onset schizophrenia spectrum disorders
(SSDs) participated in a 12-week randomized controlled trial to determine the efficacy of PRIME (personalized real-time intervention for motivational
enhancement), a mobile-based digital health intervention designed to improve motivation and quality of life.
Schizophrenia Bulletin, 44(5) : 1010-
1020
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Wu, R. Q., Lin, C. G., Zhang, W., Lin, X. D., Chen, X. S., Chen, C., Zhang, L. J., Huang, Z. Y., Chen, G.
D., Xu, D. L., Lin, Z. G., Zhang, M. D.
Background: Risperidone and paliperidone have been the mainstay
treatment for schizophrenia and their potential role in neuroprotection could be associated with brain-derived neurotrophic factor (BDNF) and N400
(an event-related brain potential component). So far, different effects on both BDNF and N400 were reported in relation to various antipsychotic
treatments. However, few studies have been conducted on the mechanism of risperidone and paliperidone on BDNF and N400. This study aimed to compare
the effects of risperidone and paliperidone on BDNF and the N400 component of the event-related brain potential in patients with first-episode
schizophrenia.\rMethods: Ninety-eight patients with first-episode schizophrenia were randomly divided into the risperidone and paliperidone groups
and treated with risperidone and paliperidone, respectively, for 12 weeks. Serum BDNF level, the latency, and amplitude of the N400 event-related
potential before and after the treatment and Positive and Negative Syndrome Scale (PANSS) scores were compared between the two groups.\rResults: A
total of 94 patients were included in the final analysis (47 patients in each group). After the treatment, the serum BDNF levels in both groups
increased (all P < 0.01), while no significant difference in serum BDNF level was found between the groups before and after the treatment (all P >
0.05). After the treatment, N400 amplitudes were increased (from 4.73 +/- 2.86 muv and 4.51 +/- 4.63 muv to 5.35 +/- 4.18 muv and 5.52 +/- 3.08 muv,
respectively) under congruent condition in both risperidone and paliperidone groups (all P < 0.01). Under incongruent conditions, the N400 latencies
were shortened in the paliperidone group (from 424.13 +/- 110.42 ms to 4.7.41 +/- 154.59 ms, P < 0.05), and the N400 amplitudes were increased in the
risperidone group (from 5.80 +/- 3.50 muv to 7.17 +/- 5.51 muv, P < 0.01). After treatment, the total PANSS score in both groups decreased
significantly (all P < 0.01), but the difference between the groups was not significant (P > 0.05). A negative correlation between the reduction rate
of the PANSS score and the increase in serum BDNF level after the treatment was found in the paliperidone group but not in the risperidone group.
\rConclusions: Both risperidone and paliperidone could increase the serum BDNF levels in patients with first-episode schizophrenia and improve their
cognitive function (N400 latency and amplitude), but their antipsychotic mechanisms might differ.
Chinese Medical Journal, 131(19) : 2297-
2301
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Kuzman, M. R., Kuharic, D. B., Kekin, I., Makaric, P., Madzarac, Z., Makar, A. K., et al.
Background: Antipsychotic-induced weight gain and metabolic abnormalities are one of the major challenges in the
treatment of psychosis, contributing to the morbidity, mortality and treatment non-adherence. Different approaches were used to counteract these side
effects but showed only limited or short-term effects. This study aims to analyse the effects of a long-term multimodal treatment program for first
episode psychosis on antipsychotic-induced metabolic changes. Method(s): We enrolled 71 patients with first episode psychosis treated at the Zagreb
University Hospital Centre from 2016 until 2018. Participants were assigned to one of the two groups: day hospital program vs. treatment as usual
(TAU). Outcomes were: body weight, blood glucose, lipids and cholesterol, psychopathology and global level of functioning during the 18-months
follow-up. Result(s): Although the TAU group gained more weight and had higher increase of blood glucose, while the day hospital group had a higher
increase in total cholesterol at 18th month follow-up, after the adjustment for age, gender and baseline measures, the type of treatment was not
significantly associated with any of the primary outcome measures. Patients' psychopathology measures significantly decreased and their functional
level significantly increased at month 18th in both groups. Conclusion(s): While both types of treatment were effective in reducing psychopathology
and restoring the patients' level of functioning, both were relatively ineffective in counteracting antipsychotic-induced metabolic abnormalities
and antipsychotic-induced weight gain. Copyright © 2018 Rojnic Kuzman, Bosnjak Kuharic, Kekin, Makaric, Madzarac, Koricancic Makar, Kudlek Mikulic,
Bajic, Bistrovic, Bonacin and Vogrinc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC
BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and
that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is
permitted which does not comply with these terms.
Frontiers in Psychiatry, 9 (OCT) (no
pagination)(00488) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Ahuir, M., Cabezas, A., Minano, M. J., Algora, M. J., Estrada, F., Sole, M. et al.
Metacognitive training (MCT) improves cognitive biases in psychosis. We aimed to
explore whether the effectiveness of the combination of psychoeducation and MCT group treatments on cognitive biases differed if the combination was
started by psychoeducation or by MCT. Fourty-nine stable patients with a recent-onset psychosis were randomized to two different sequences: MCT
+psychoeducation vs psychoeducation+MCT. Cognitive biases, psychopathology symptoms, insight and functioning were assessed. Cognitive biases and
depressive symptoms improved with both group interventions, without differential effects between both sequences. Our study suggests that MCT and
psychoeducation are useful in improving cognitive biases and depressive symptoms in recent-onset psychosis.
Psychiatry Research, 270 : 720-
723
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Psychoeducation
Landa, Y., Mueser, K., Jacobs, M., Jespersen, R., Wyka, K., Swiderski, C., Cahalan, C., Gossrau, J. J., Doss, A., Reyna, V., Silbersweig, D.
To decrease the severity of symptoms and functional impairment in
youth at high risk of developing psychosis we have established a comprehensive Group and Family-based Cognitive Behavioral Therapy Program (GF-CBT).
GF-CBT, which is grounded in theory and research on information processing in delusions, decision making, memory and behavioral change, teaches youth
at-risk strategies for reducing biased information processing in order to prevent the formation of delusional beliefs. Families learn CBT techniques
to support, encourage and maintain use of these skills at home. Two mixed methods studies were completed: a pilot open trial to evaluate the
program's feasibility and a pilot randomized controlled trial to evaluate its efficacy, as compared to symptom monitoring, over a 2-year follow-up.
Nineteen youth ages 12-25 and 20 family members participated. Results support the feasibility and preliminary efficacy of GF-CBT, as evidenced by
high levels of program satisfaction and significant remission rates among GF-CBT participants, with the majority no longer meeting ARMS criteria
post-CBT, and maintaining recovery at the follow-up. At post-treatment GF-CBT group showed greater decreases in positive and negative symptoms
(CAARMS) as well as improvements in functioning (SOFAS). The difference between groups increased over time. As part of the SAMHSA funded project to
improve outcomes for as many as 2,000 youth and their families affected by, or at risk of, early onset psychosis in the State of Missouri, GF-CBT has
been implemented in 3 DMH clinics. GF-CBT state-wide implantation, including clinician training and \"Train-the-Trainer\" procedures to allow
sustainability of the intervention will be discussed.
Early Intervention in Psychiatry, 12 (Supplement 1) : 183
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Erickson, D., Whitehurst, D., Roes, M., Digiacomo, A.
Purpose: Although the Individual Placement and Support (IPS) strategy has
achieved 'gold standard' status for enhancing employment among older clients in the later stages of mental illness, the nature and timing of its
contributions to younger clients in the early stages of illness is less understood. This randomized controlled trial assesses the effectiveness of
the IPS model of employment support in a population-based sample of early-psychosis clients. Method(s): We have recruited 109 clients from the Fraser
Health Early Psychosis program; 55 clients received one year of IPS support and 54 received 'treatment as usual' (TAU). A variety of employment,
clinical, and service-use outcomes were assessed at 6- and 12-months; this presentation describes employment outcomes. Result(s): Over 12 months,
clients who received IPS in addition to TAU more often worked (80%) than did those receiving TAU alone (60%; chi-square = 4.50, p = .03). However,
there was no significant difference in the number of days worked (58.7 days in IPS, versus 46.4 in TAU; p = .33). Conclusion(s): When EPI clients are
ready to look for work many are successful, compared to clients in later stages of illness. In our early psychosis clients, IPS increased the
likelihood of getting work, but did not significantly affect job tenure. Further analyses will assess the nature and timing of differential
employment outcomes attributable to IPS.
Early
Intervention in Psychiatry, 12 (Supplement 1) : 209
- Year: 2018
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational
interventions