The Recognition and Management of Early Psychosis: A Preventive Approach (Cambridge Medicine (Paperback))

Psychotic illness is managed and treated with best results when it is recognized at the earliest stages of a person developing the disorder, or when that person is identified as being at high risk of doing so. Describing a stage-specific model highlighting the risk, the clinical and biological factors present during the development of the illness, and the best treatments available for each of these stages, this new edition will guide practitioners and researchers in the adoption of carefully planned management strategies fully integrating treatment with prevention. Issues such as resistance to drugs and vocational recovery are covered, with related topics such as service organization and community education. This will be essential reading for all those involved in the care of people with early psychotic illness, or those responsible for the organization of services. Cover......Page 1 Half-title......Page 3 Title......Page 5 Copyright......Page 6 Dedication......Page 7 Contents......Page 9 Contributors......Page 13 Foreword......Page 19 Acknowledgements......Page 21 Section 1 Introduction......Page 23 Book overview......Page 25 The early psychosis mission......Page 36 References......Page 37 Introduction......Page 39 Diagnosis of psychosis: issues of validity......Page 40 The staging model and its application to early psychosis......Page 42 Stages 1a–1b: ultra-high risk or prodromal phase......Page 45 Research implications......Page 46 References......Page 47 Section 2 Risk and vulnerability......Page 51 Introduction......Page 53 The phenotype called schizophrenia......Page 54 Linkage studies......Page 55 Dysbindin......Page 56 Regulator of G-protein signalling-4......Page 57 The ‘disrupted in schizophrenia’ genes......Page 58 Brain-derived neurotrophic factor......Page 59 Intermediate phenotypes (endophenotypes)......Page 60 Discussion......Page 61 References......Page 63 Gene–environment relationships......Page 69 First-generation gene–environment interaction studies in psychosis......Page 70 Studies using psychometric psychosis liability approach......Page 71 Studies of environmental impact on DNA sequence and methylation......Page 72 Second-generation gene–environment interaction studies in psychosis......Page 76 Discussion......Page 78 References......Page 79 Background......Page 83 High-risk strategies......Page 84 Neuropsychological studies......Page 85 Psychophysiological studies: event-related potentials......Page 87 Functional neuroimaging studies......Page 89 Structural neuroimaging studies......Page 90 Conclusions......Page 93 References......Page 94 Section 3 At-risk mental state......Page 103 Background: the prodrome of psychotic disorders......Page 105 Rationale: why focus on the prodrome?......Page 106 Ultra-high-risk criteria: the Melbourne PACE approach......Page 107 Basic symptoms criteria......Page 110 Disadvantages of ‘prodromal’ identification......Page 114 Negative symptoms......Page 115 Poor functioning......Page 116 Neurocognitive variables......Page 117 Neurobiological variables......Page 118 Intervention......Page 119 Appendix: Short definition of basic symptoms included in the two basic symptom criteria of the initial prodrome, COPER and COGDIS......Page 120 References......Page 122 Introduction......Page 129 The case supporting antipsychotic medication......Page 130 The case against antipsychotic medication......Page 132 The case supporting psychological interventions......Page 133 The case against psychological interventions......Page 134 No intervention......Page 135 Summary......Page 136 The UK Early Detection and Intervention Team......Page 137 Cologne Early Recognition and Intervention Centre for mental crisis......Page 138 Conclusions and recommendations......Page 139 Section 4 Access and reducing delay to treatment: reducing the duration of untreated psychosis......Page 145 Defining the onset and offset of untreated psychosis......Page 147 Discrepancies between the accounts of patients and carers......Page 149 Failure to use standardized assessment instruments......Page 150 Duration of untreated psychosis and outcome......Page 151 Methods of measuring duration of untreated psychosis......Page 152 Data extraction......Page 154 Cohort characteristics......Page 155 Effect of premorbid adjustment......Page 158 Sensitivity analysis......Page 160 Discussion......Page 161 References......Page 165 Recognition of psychosis......Page 169 First aid skills......Page 170 Beliefs about mental health professionals......Page 171 Beliefs about treatments......Page 172 Contrast between public and professional beliefs......Page 173 Community campaigns......Page 175 School-based programmes......Page 177 Individual training programmes......Page 179 References......Page 180 Introduction......Page 183 Help-seeking is often initiated for reasons other than psychotic symptoms......Page 184 Primary healthcare providers such as family physicians are often the first points of contact in accessing treatment......Page 185 Once help is sought, there is considerable variation in how readily it is provided......Page 186 Accessing the right service does not automatically mean immediate treatment......Page 187 Demographic and personal circumstances......Page 188 Aspects of illness onset......Page 189 Interventions to reduce treatment delay for psychotic disorders......Page 190 Conclusions: what have we learned?......Page 192 References......Page 193 Section 5 The first episode......Page 197 Engagement and development of a therapeutic alliance......Page 199 Treatment of behavioural disturbances......Page 200 Formulation of an integrated treatment plan......Page 201 Clinical and personal history......Page 202 Assessment of comorbid disorders......Page 204 Risk assessment......Page 205 Neuropsychological assessment......Page 206 Reduction of treatment delay improves antipsychotic response......Page 207 Medication side effects should be avoided or treated early to promote response and future adherence......Page 209 Adaptation of pharmacotherapy according to diagnostic shift is needed......Page 210 Pharmacotherapy of acute first-episode non-affective psychosis......Page 211 Pharmacotherapy in psychiatric emergencies......Page 213 Management of adverse events and medical disorders......Page 215 Extrapyramidal motor symptoms and tardive dyskinesia......Page 216 Endocrine and sexual side effects......Page 217 References......Page 218 Introduction......Page 223 Early recovery phase: pharmacological treatments......Page 224 Long-acting novel antipsychotic drugs......Page 225 Psychoeducation......Page 226 Cognitive–behaviour therapy......Page 227 Interventions focusing on vocation......Page 228 Incomplete recovery 3 months after the acute episode......Page 229 Social deficits......Page 230 Stage 1: dealing with outcome confounders......Page 231 Adequacy of psychosocial interventions......Page 233 Adherence......Page 234 Stage 2: dealing with impaired adherence......Page 235 Treatment approaches for incomplete recovery......Page 236 Individual therapy......Page 237 References......Page 238 Rationale for early intervention in bipolar disorders......Page 245 Are targets for early intervention in psychotic disorders relevant to bipolar disorders?......Page 247 Consequences of delayed diagnosis......Page 248 Current guidelines......Page 249 Treatment adherence......Page 250 Defining targets for early intervention in bipolar disorders......Page 251 Initial prodrome to bipolar disorder......Page 252 Improved identification of first-episode mania......Page 253 Identification of the initial prodrome to bipolar disorders......Page 254 Pharmacological treatment......Page 255 Psychological approaches......Page 256 Conclusions......Page 257 References......Page 258 Section 6 The critical period: other psychopathology and comorbidity......Page 263 Rate and patterns......Page 265 Correlates and consequences of substance misuse......Page 266 Substance use causes psychosis......Page 267 Common risk factors for psychosis and substance misuse......Page 268 Studies of psychological interventions for substance misuse in psychosis......Page 269 Initial assessment......Page 271 Motivation to address substance misuse......Page 272 Psychoeducation......Page 273 Cognitive–behavioural therapy......Page 274 References......Page 275 Introduction......Page 279 During the non-psychotic state......Page 280 During the psychotic state......Page 281 First-episode acute phase......Page 282 Recovery phase......Page 284 The initial suicide risk assessment......Page 285 The initial risk formulation and provisional risk management plan......Page 287 Chronic illnesses......Page 288 Wider family, social and cultural risk factors......Page 289 Service and treatment risk factors......Page 290 Routine risk monitoring......Page 291 Examples of systems of risk monitoring......Page 292 Acute suicide risk containment......Page 294 Psychological interventions......Page 295 Self-help......Page 296 Models of mental health service provision......Page 297 The future of suicide prevention in psychosis......Page 298 References......Page 299 Emotion and psychosis......Page 305 Emotional dysfunction in the prodromal phase......Page 306 Depression......Page 307 Content of delusions/hallucinations as a reflection of the content of emotional disorders......Page 308 Similar maintenance processes in delusions, hallucinations and emotion......Page 309 Shared developmental pathways......Page 310 Social anxiety and the shame and stigma of mental illness......Page 311 A cognitive model of social anxiety in psychosis......Page 312 Implications for cognitive–behaviour therapy of early psychosis......Page 313 Cognitive–behaviour therapy for (emotional dysfunction in) psychosis......Page 314 Borderline personality disorder: a neglected issue in first-episode psychosis......Page 315 The prevalence of comorbidity......Page 316 Cognitive analytic therapy......Page 317 Cognitive analytic therapy in psychosis......Page 318 References......Page 319 Section 7 The critical period: specific interventions......Page 325 Families and the course of psychotic disorder......Page 327 The impact of expressed emotion: its predictive validity in formal and informal carers......Page 328 Expressed emotion and first-episode psychosis and ultra-high-risk patients......Page 329 Why is the link between expressed emotion and outcome less consistently detected in first-episode psychosis?......Page 330 The caregiving experience: how distressed are caregivers?......Page 334 Specific issues in the literature on first-episode psychosis and ultra-high-risk groups......Page 335 Family interventions in first-episode psychosis......Page 337 Stage models of family interventions......Page 338 Key components and guidelines for family services in first episode......Page 342 Supportive interventions......Page 343 Coping strategies......Page 344 Future directions......Page 345 References......Page 346 Introduction......Page 353 Unemployment and its consequences in psychotic illness......Page 354 Social firms......Page 356 The Clubhouse model......Page 357 Clubhouse studies......Page 358 Studies on individual placement and support initiatives......Page 360 Vocational interventions in first-episode psychosis......Page 361 Vocational intervention at the Early Psychosis and Prevention Centre, Melbourne, Australia......Page 362 The University of California at Los Angeles Aftercare Research Programme: combining individual placement and support with Workplace Fundamentals Module training......Page 364 The Norfolk Early Intervention Service, UK......Page 365 References......Page 367 Introduction......Page 371 Defining and assessing psychotic relapse......Page 372 Factors associated with the risk for relapse......Page 373 Medication non-adherence......Page 374 Expressed emotion......Page 375 Stress and life events......Page 376 Cognitive deficits......Page 377 Relapse and antipsychotic medication......Page 378 Family interventions for relapse prevention......Page 379 Recommendations regarding relapse prevention in first-episode psychosis......Page 380 Rerferences......Page 382 Schizophrenia and schizoaffective disorder......Page 387 Major depressive disorder......Page 388 Major depressive disorder......Page 389 Service prerequisites......Page 390 Early detection of treatment resistance......Page 392 Schizophrenia and schizoaffective disorder......Page 393 Treatment-resistant bipolar mania or mixed episodes......Page 395 Major depressive disorder......Page 396 Schizophrenia and schizoaffective disorder......Page 397 Major depressive disorder......Page 398 Conclusions......Page 399 References......Page 400 Section 8 Service models......Page 405 Overview......Page 407 Clinical subprogrammes......Page 408 Inpatient care......Page 409 An integrated clinical and research programme......Page 410 Introduction and historical context......Page 411 Inpatient care......Page 412 Research and evaluation......Page 413 Inpatient service......Page 414 The Home Intervention Programme for Psychosis......Page 415 Referral criteria and service pathways......Page 416 The Calgary Early Psychosis Treatment Service......Page 417 Approach to programme evaluation......Page 418 Effectiveness research......Page 419 Overview of the service......Page 420 Assertive community treatment......Page 421 Conclusions......Page 422 References......Page 424 Index......Page 427

guides Practitioners And Researchers In The Adoption Of Carefully Planned Management Strategies Fully Integrating Treatment With Prevention.

doody Review Services

reviewer:eric David Gausche, M.d.(university Of Illinois At Chicago College Of Medicine)
description:this Is Not Just An Updated Version Of The First Edition Of the Recognition And Management Of Early Psychosis Published In 1999, It Is A Near-total Reworking Of The Entire Book.
purpose:it Advocates For Early Intervention In Psychosis By Reviewing The Characteristics, Neurobiology, And Interventions In Early Psychotic Illness. This New Edition Was Inspired By The Explosion Of Literature On Early Psychosis Over The Last Decade. The Happy Result Is A Book That Successfully Incorporates Much Of The More Recent Literature On Early Psychosis.
audience:the Intended Audience Includes Psychiatrists, Psychiatric Residents, Researchers Who Study Psychosis, Or Any Clinicians Who Regularly Encounter Psychotic Patients. The Editors Are Widely Published In The Area Of Early Psychosis.
features:this Book Covers Well Most Of The Essential Areas Of The Study Of Early Psychosis, Including Staging, Genetic Risk Factors, Environmental Risk Factors, Suicide Prevention, Neurobiology, Interventions, And Prevention. One Area That Is Lacking Is The Medical/neurological Assessment Of The Patient With First-episode Psychosis, Making This A Better Book To Consult Once The Determination Of A Psychiatric Psychosis Has Been Made With A Reasonable Degree Of Certainty.
assessment:clinicians Using This Book Should Be More Mindful Of The Medical/neurological Differential Diagnosis Of First-episode Psychosis Than This Book Indicates. Although There Is A Chapter On The Evaluation Of Acute Phase Psychosis, The Treatment Of The Attempt To Determine Nonpsychiatric Etiologies Of Psychosis Is Limited And Consists Mainly Of A Table Listing Tests To Order. A More Expanded Treatment Of This Subject Would Be Quite Welcome. Otherwise, This Is A Superb Book, And Every Clinician Who Encounters Patients At Risk For Psychosis Or Suffering From First Episode Psychosis Should Be Familiar With The Material It Presents.

Rationale for and overview of the 2nd edition of the Recognition and management of early psychosis / Henry J. Jackson, Patrick D. McGorry, and Kelly Allott Diagnosis and the staging model of psychosis / Patrick D. McGorry, Kelly Allott, and Henry J. Jackson Genetic vulnerability / Daniel Weinberger and Gregor Berger Environmental vulnerability and genetic-environmental interactions / Jim Van Os and Richie Poulton Neurobiological endophenotypes of psychosis and schizophrenia : are there biological markers of illness onset? / Christos Pantelis ... [et al.] At risk mental state and prediction / Alison R. Yung ... [et al.] At risk mental state : management / Lisa J. Phillips, Jean Addington, and Anthony P. Morrison Duration of untreated psychosis : definition, measurement, and association with outcome / Max Marshall, Susy Harrigan, and Shon Lewis Improving the community's mental health literacy as a means of facilitating early intervention / Anthony F. Jorm and Annemarie Wright Pathways to care and reducing treatment delay in early psychosis / Ross M.G. Norman and Ashok K. Malla Initial assessment and initial pharmacological treatment in the acute phase / Martin lambert Complete and incomplete recovery from first-episode psychosis / Jean Addington, Tim Lambert, and Peter Burnett Preventive strategies in bipolar disorders : identifying targets for early intervention / Philippe Conus ... [et al.] Substance misuse in first-episode psychosis / Darryl Wade ... [et al.] Suicide prevention in first-episode psychosis / Paddy Power and Jo Robinson Emotional and personality dysfunctions in early psychosis / Max Birchwood ... [et al.] Family intervention in early psychosis / Catharine McNab and Don Linszen Enhancing work functioning in early psychosis / Eoin Killackey ... [et al.] Relapse prevention in early psychosis / John Gleeson, Don Linszen, and Durk Wiersma Treatment resistance in first-episode psychosis / Christian G. Huber and Martin Lambert Using research and evaluation to inform the development of early psychosis service models : international examples / Meredith Harris ... [et al.].