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Objective About one-third of patients referred to services for people at high risk for psychosis may have already developed a first episode of psychosis ( FEP). We compared clinical outcomes in FEP patients who presented to either high risk or conventional mental health services. Method Retrospective study comparing duration of hospital admission, referral-to-diagnosis time, need for compulsory hospital admission and frequency of admission in patients with FEP who initially presented to a high-risk service ( n = 164) to patients with FEP who initially presented to conventional mental health services ( n = 2779). Regression models were performed, controlling for several confounders. Results FEP patients who had presented to a high-risk service spent 17 fewer days in hospital [95% CI: −33.7 to (−0.3)], had a shorter referral-to-diagnosis time [B coefficient −74.5 days, 95% CI: −101.9 to −(47.1)], a lower frequency of admission [ IRR: 0.49 (95% CI: 0.39-0.61)] and a lower likelihood of compulsory admission [ OR: 0.52 (95% CI: 0.34-0.81)] in the 24 months following referral, as compared to FEP patients who were first diagnosed at conventional services. Conclusion Services for people at high risk for psychosis are associated with better clinical outcomes in patients who are already psychotic. [ABSTRACT FROM AUTHOR]

Broome MR, Matthiasson P, Fusar-Poli P, Woolley JB, Johns LC, Tabraham P, Bramon E, Valmaggia L, Williams SCR, Brammer MJ, Chitnis X, McGuire PK. Neural correlates of movement generation in the ‘at-risk mental state’. Objective: People with ‘prodromal’ symptoms have a very high risk of developing psychosis. We examined the neurocognitive basis of this vulnerability by using functional MRI to study subjects with an at-risk mental state (ARMS) while they performed a random movement generation task. Method: Cross-sectional comparison of individuals with an ARMS ( n = 17), patients with first episode schizophreniform psychosis ( n = 10) and healthy volunteers ( n = 15). Subjects were studied using functional MRI while they performed a random movement generation paradigm. Results: During random movement generation, the ARMS group showed less activation in the left inferior parietal cortex than controls, but greater activation than in the first episode group. Conclusion: The ARMS is associated with abnormalities of regional brain function that are qualitatively similar to those in patients who have recently presented with psychosis but less severe. [ABSTRACT FROM AUTHOR]

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., (© 2020 John Wiley & Sons Australia, Ltd.)

Aim: Prisoners exhibit high rates of substance use and mental health problems. In the present study, we sought to gain a detailed understanding of substance use amongst young prisoners to inform early detection and early intervention strategies in a prison setting., Methods: This is a cross-sectional study of 2102 prisoners who were screened by the London Early Detection and Prevention in Prison Team (LEAP). Data on the use of substances were collected including age of first use, recent use, duration of use and poly-drug use. The Prodromal Questionnaire - Brief Version was used to screen for the at-risk mental state., Results: We found high rates of lifetime and recent use and low age of first use of a number of substances. We also found strong associations between substance use and screening positive for an at-risk mental state. Logistic regression analysis confirmed that use of any drug in the last year, poly-drug and early use, as well as heavy alcohol use, were related to an increased risk of screening positive., Conclusions: Substance use in the prison population is not only widespread and heavy but is also strongly linked with a higher risk of developing mental health problems. The need for early detection and early intervention in prison is discussed., (© 2016 John Wiley & Sons Australia, Ltd.)

Aim: To investigate the clinical and social correlates of a lifetime history of crime victimization among first-episode psychosis patients at entry to an Early Intervention Service and following 18 months of specialist care., Methods: Face-to-face interviews were conducted with 149 individuals who presented to an Early Intervention Service for the first time with psychosis in the London borough of Lambeth, UK. A range of demographic and clinical measures were completed including self-reported history of victimization along with the type of crime and its subjective effect on the patient. Clinical and functional outcomes at 18-month follow up were ascertained from clinical case notes by a psychiatrist., Results: A large proportion of patients (n = 64, 43%) reported a history of crime victimization. This was associated with significantly higher levels of depression and substance misuse at initial presentation. Being a victim of a crime was not significantly associated with poorer clinical or functional outcomes after 18 months of specialist care. However, non-significant differences were found for those who reported crime victimization in terms of their increased use of illegal substances or having assaulted someone else during the follow-up period., Conclusion: Past experience of being a victim of crime appears to be common in patients presenting for the first time with psychosis and is associated with increased likelihood of comorbidity. Thus, Early Intervention Services should consider screening for past victimization and be prepared to deal with comorbid problems. The impact of crime victimization on clinical and functional outcomes requires investigation over a longer period of time., (© 2015 Wiley Publishing Asia Pty Ltd.)

Aim: This project explored the impact of a general practitioner (GP) training programme on referrals and pathways to care for people at high clinical risk of psychosis or with a first-episode psychosis. The resources needed to deliver the training were measured to help inform other teams considering this approach. Satisfaction with the training was also explored., Methods: All of the GP (48) practices in the London Borough of Southwark were approached. Presentations were given on the symptoms of a clinical high-risk state and the first signs of psychosis alongside information on how to access the teams. Referrals to the prodromal and first-episode teams 6 months before and after the training were recorded. Resources needed to deliver the training in terms of staff time were recorded. A questionnaire on attendees' satisfaction with the training was given., Results: Sixty percent of eligible practices received education. On average, it took 2 h for every two staff members each to deliver the training. Over the 12-month period, the teams received 148 referrals. The training led to a significant increase in referrals to the two specialized teams and a significant increase in direct referrals to the teams from GPs. Attendees were satisfied with the training., Conclusions: This study indicates that GP education programmes are a viable and acceptable way of increasing the identification of young people at high clinical risk for psychosis or with a first-episode psychosis and increasing direct referrals to specialist teams., (© 2014 Wiley Publishing Asia Pty Ltd.)

Aim: To establish a comprehensive phase-oriented early intervention service for young people with early psychosis in south London and to evaluate its effectiveness in delivering user friendly interventions and better outcomes., Methods: The Lambeth Early Onset (LEO) and Outreach & Support in South London (OASIS) service has been developed incrementally over the last 6 years into 4 teams each addressing one of the phases of early psychosis: (i) prodrome/ultra-high risk (ii) untreated psychosis (c) acute inpatient treatment and (d) recovery/ relapse prevention phases. Research and evaluation have been integral to each team's development with three of the teams configured as Randomised Controlled Trials., Results: During the first 6 years, 1255 young people in Lambeth were referred for assessment (963 to LEO and 292 to OASIS). Of them 578 were diagnosed as suffering from first episode psychosis (some before or after they presented to OASIS), 450 have been followed up in Lambeth by the LEO Community Team and 40% discharged back to GPs in remission at the end of their two years of follow-up. Compared to standard service, patients' delays in accessing treatment are less, and outcomes at 18 months are better., Conclusions: The LEO and OASIS service now provide most of the mental health service requirements for young people with early psychosis in Lambeth. It represents good value for money and improved outcomes for clients. Further interventions are planned and ultimately it will be possible to evaluate the impact of each incremental step in the service's development.