Early Intervention for Psychosis - Annotated Bibliography Example

Early Intervention for Psychosis Introduction Psychosis is a mental disorder, which can narrowly be defined in the opinion of Munson 2001, p.151 as “a loss of reality-testing capability that is manifested by delusions and hallucinations about which the individual has no insight”. The broader perspective of psychosis involves the presence of hallucinations even in the case of the individual being aware of the origin of these hallucinations (Manson, 2001). According to McGorry 2000, p.270, “people suffering from schizophrenia and other psychoses fall within the serious mental illness rubric, and not only have a profile of severe morbidity and mortality, but have been traditionally neglected when it came to the quality of their psychiatric care”. Psychosis as a serious mental illness typically begins at a young age of adolescence or in the very early stages of adult life. The pervasive nature of the mental disturbance in psychosis, places a high risk potential to the normal life span of the individual, as also the quality of life of the individual during the course of the illness (McGorry, 2000). The early course of the disease sees relapsing illness occurring for several years, with crisis events carrying a significant risk for suicide. In most of the individuals the relapses and the intensity of the crisis events reduce over time, with maturing of the individual and reduction in vulnerability of the individual. This amelioration in the vulnerability of the individual however, is influenced by the level of irreversible damage occurring during the height of the illness in the individual. These factors make early and efficient intervention in psychosis integral to better outcomes for these patients. In the developed world including Australia the enhanced competition for scarce mental health resources leaves gaps in the intervention strategies and the quality of care for patients experiencing psychosis (McGorry, 2000). Annotated Bibliography Marshall, M. & Rathbone, J. 2006, ‘Early Intervention for psychosis, Cochrane Database of Systematic Reviews, No.4, CD004718.pub2. Early intervention for schizophrenia has become the treatment approach h in the management of schizophrenia in the developed world of Europe, America and Australia. There are two essential components to early intervention in schizophrenia, which are detection at an early stage and treatment that is phase-specific. The components are used to augment standard care or as applied to the patient using a specialist early intervention team. The authors conducted a review into seven studies conducted in different parts of the world to evaluate the efficiency of early detection, phase-specific treatments and the use of specialist early intervention teams in the treatment of patients with first episode psychosis. The study found no significant advantages in efficiency of these treatment strategies, which led them to conclude that their small sample size was insufficient to find any conclusive evidence of the efficiency of these treatment approaches in psychosis, but the interest in the use of these treatment strategies provides an opportunity to answer the critical questions that this study was unable to provide. McGorry, Kilackey & Yung, 2008, support the assertions and finding of this study in that though evidence is required to support the early intervention strategy in psychosis, such evidence is not sufficient . It is a by-product as well as the catalyst for change in the treatment strategy for psychosis and remains a challenging project (McGorry, Kilackey & Yung, 2008). The relevance of this study is that it brings out the lack of evidence in the use of early intervention strategy in the treatment of psychosis and the need for this evidence. Whitewell, D. 2001, ‘Service innovations: Early intervention in psychosis as a core task for general psychiatry’, Psychiatric Bulletin, vol.25, pp.146-148. The strategy of early intervention in psychosis has gained ground. Specialized intervention teams are suggested for the implementation of this innovative scarcity of funds and the increased complexity that such a team introduces to the care needs in psychosis have hindered the use of specialized intervention teams. This article suggests a more feasible alternate model strategy from the experiences of a generic community mental health team CMHT) in U.K. for early intervention in psychosis. The team was made up of one part-time consultant, one part-time clinical assistant, one psychologist, one full-time and one part-time occupational therapists, two G grade and two E grade nurses, one part-time art therapist, two social workers, two support workers and one secretary. With shared decision-making a key component of this partnership model, the style of intervention flexible, though assertive. On receipt of a referral a key worker initiates action of contact and engagement and is supported by the other team members. The psychological approach which is the starting point of the treatment consists of simple counseling. A problem-solving framework is employed to arrive at the care needs to handle daily issues and the management of anxiety. Cognitive-behavioural therapy to handle psychotic symptoms is provided where necessary. In the event that in-patient treatment is required the team makes arrangements for it through the close links established wards in hospitals. Evaluation of the early results from such a team approach has been found to be encouraging, because of the changed attitude and focus of the team in the management of psychosis (Whitwell, 2001). Though this study recommends the use of intervention teams in the early intervention strategy, the utility of such teams has not been fully established. Kuipers et al, 2004 comparing the effectiveness of Croydon Outreach and Assertive Supportive Team (COAST) with treatment as usual (TAU) found that there were minor gains through the use of COAST, but these did not give any significantly valid advantages for COAST over TAU. The lesson for nurses is that they form an integral part of any early intervention team in the management of psychosis and being such a member calls for additional knowledge and skills and a changed attitude for improved care needs in the management of psychosis (Whitwell, 2001). Barnes, T. R. E., Leeson, V. C., Mutsatsa, S. H., Watt, H. C., Hutton, S. B. & Joyce, E. M. 2008, ‘ Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia’, The British Journal of Psychiatry, vol.193, pp.203-209. The rationale for early intervention in psychosis stems from evidence that has shown that the greater the time duration of unchecked and untreated psychosis the worse the prognosis. The main theme in this study was the evaluation of whether the relationship between longer duration of untreated psychosis (DUP) and outcome resulted from direct causal reasons or the association between symptoms and/or cognitive functioning and social functioning at the same time, through the assessment of symptoms, social and cognitive functioning in 98 subjects with first-episode schizophrenia at the time of presentation and after a period of one year. The study found that though there were no significant clinical variations in the subjects with long and short DUP at the time of presentation, the use of linear regression analysis demonstrated that enhanced periods of DUP were predictive of more severe positive and negative symptoms and poorer social functioning after a period of one year, with the scores attained at presentation having no bearing on these symptoms and functioning. The use of path analysis uncovered that there was no significant relationship between DUP and cognition (Barnes et al, 2008). This finding of significant association of DUP with positive symptoms after one year of presentation is tallies with the similar finding of Addington, Van Mastrigt & Addington, 2004, who go on to add that the period of time of untreated psychosis must be reduced through lowering of the timing in treatment and improving the quality of treatment. Killackey and Young, 2007 support this assertion and state that there is sufficient evidence to show that reduced DUP provides patients with psychosis better outcomes in symptoms and functional ability and proves to be less expensive than the conventional standard models of care. Reed 2008 gives the role of a nursing professional in first-episode psychosis as not only facilitating early intervention by recognizing symptoms to reduce DUP, but also as including working towards the reduction of risks for patients and also the risk for relapse. Lauber, C. & Rossler, W. 2003, ‘Relatives and their attitude to early detection of schizophrenic psychosis’, Psychiatric Bulletin, vol.17, pp.134-136. It is not only the person suffering from psychosis that is affected by it, but also the family members and are also involved in the support system for the patient, which involves the intervention strategy. This means that the attitude of the family members is also important to the success of the early intervention in psychosis. This study used a questionnaire sent by post to evaluate the attitude of family members of patients to evaluate their attitude to early detection of psychosis. The study found that a majority of the family members are supportive of early detection that leads to early intervention in psychosis. With relatives being supportive of early diagnosis and early intervention in psychosis, the relatives make up a useful support source for the professionals involved to convince patients in the diagnostic procedures and intervention required in the management of psychosis (Lauger & Rossler, 2003). A family-inclusive approach to cater to the care needs is a part of the early intervention in psychosis for young adults with first-episode psychosis. The flexible approach in this intervention includes much-researched psych-educational family interventions. Nursing professionals have a significant role to play in the addressing the needs of the family carers that include knowledge, skill and support to be able to cope with the demands of the role of a carer for a patient with psychosis that is likely to be demanding and extended. This is a major implication for nursing in the early intervention strategy in the management of psychosis (Sin, Moon & Newell, 2007). Literary References Addington, J., Van Mastrigt, S. & Addington, D. 2004, ‘Duration of untreated psychosis: impact on 2-year outcome, Psychological Medicine, vol.34, pp.277-284. Barnes, T. R. E., Leeson, V. C., Mutsatsa, S. H., Watt, H. C., Hutton, S. B. & Joyce, E. M. 2008, ‘ Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia’, The British Journal of Psychiatry, vol.193, pp.203-209. Killackey, E. & Young, A. R. 2007, ‘Effectiveness of early intervention in psychosis’, Current Opinion in Psychiatry, vol.20, n0.2, pp.121-125. Kuiper, E., Holloway, F., Rabe-Hesket, S. & Tennakoon, L. 2004, ‘An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST)’, Social psychiatry and psychiatric epidemiology, vol.39, no.5, pp.358-363. Lauber, C. & Rossler, W. 2003, ‘Relatives and their attitude to early detection of schizophrenic psychosis’, Psychiatric Bulletin, vol.17, pp.134-136. Marshall, M. & Rathbone, J. 2006, ‘Early Intervention for psychosis, Cochrane Database of Systematic Reviews, No.4, CD004718.pub2. McGorry, P. D. 2000, ‘Psychotherapy and recovery in early psychosis: a core clinical and research challenge’, in Psychological Approaches and their Effectiveness, eds., Brian Martindale, Anthony Bateman, Michael Crowe & Frank Margison, Gaskell: London, pp.266-292. McGorry, P. D., Kilackey, E. & Yung, A. 2008, ‘Early intervention in psychosis: concepts, evidence and future directions’, World Psychiatry, vol.7, no.3, pp.148-156. Munson, E.C. 2001, ‘Chapter 9, Schizophrenia and Other Psychotic Disorders’, in The Mental Health Diagnostic Desk Reference: Visual Guides and More for Learning to Use the Diagnostic and Statistical Manual(DSM-IV-TR), Second Edition, The Haworth Press Inc., New York, pp. 151-158. Reed, S. I. 2008, ‘First-episode psychosis: a literature review’, International journal of mental health nursing, vol.17, no.2, pp.85-91. Sin, J., Moon, N. & Newell, J. 2007, ‘Developing services for the carers of young adults with early-onset psychosis - implementing evidence-based practice on psycho-educational family intervention’, Journal of psychiatric and mental health nursing, vol.14, no.3, pp.282-290. Whitewell, D. 2001, ‘Service innovations: Early intervention in psychosis as a core task for general psychiatry’, Psychiatric Bulletin, vol.25, pp.146-148. Read More