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The Many Clinical Phases of Early Psychosis and the Importance of Psychoeducation and Medication Management
Published in Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman, Understanding and Caring for People with Schizophrenia, 2020
Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman
One of those realities is coordinated specialty care. Coordinated specialty care is a treatment for patients with first-episode psychosis (7, 8). It uses a recovery-based model with shared decision-making between specialists, the families, and their patients. Components of coordinated specialty care include medication management, psychotherapy/counseling, vocational training, case management, family education, and general support, all tailored toward a specific patient’s needs and preferences. Coordinated specialty care has been implemented with great success in states such as New York (OnTrackNY) and will hopefully become widely implemented and the standard of care in the near future.
Scoping Review of Cannabis-Reduction Psychosocial Interventions and Reasons for Use among Young Adults with Psychosis
Published in Journal of Dual Diagnosis, 2023
Ryan Petros, Denise D. Walker, Adam Pierce, Maria Monroe-DeVita
Evidence suggests that discontinuing cannabis use after early episodes of psychosis contributes to improved long-term outcomes (González-Pinto et al., 2011). Unfortunately, there is no evidence-based practice that effectively treats CUD for YAP (Bradizza et al., 2014; Cleary et al., 2008; Hunt et al., 2019). For people experiencing first-episode psychosis (FEP), early intervention services that provide pharmacological and psychosocial treatments, including psychoeducation about substance use, are associated with reduced cannabis use in up to half of individuals (Archie et al., 2007; Hinton et al., 2007; Rebgetz et al., 2014; SAMHSA, 2019b; Wisdom et al., 2011). It is not entirely clear why some people reduce or discontinue substance use after initiation of coordinated specialty care (CSC) for FEP (SAMHSA, 2019b), and reduction in use may be unrelated to any substance use intervention per se (Dekker et al., 2008; Rebgetz et al., 2015). Several studies have shown CSC services to be ineffective in treating substance use disorders, in part because service-users get limited exposure to the substance misuse components of these programs (Cather et al., 2018). Moreover, CSC services do not effectively reduce use in the other half of cannabis-using young adults with FEP, who may require a more extensive and/or individualized intervention. YAP who maintain cannabis use tend to have worse functional and clinical outcomes (González-Pinto et al., 2011). An effective intervention is needed to reduce cannabis use for YAP; however, research to inform its development is nascent.
Journeys beyond the Frontier: A Rebellious Guide to Psychosis and Other Extraordinary Experiences
Published in Occupational Therapy in Mental Health, 2023
As an occupational therapist working within a coordinated specialty care model for clinical high risk and first episode psychosis, this book led me to reflect on building greater interpersonal and community relationships in my OT interventions. Dr. Ragins’ psychosis triangle emphasizes equally important dimensions of experiencing reality, relationships, and self-identity. All too often, the mental health system focuses narrowly on how people experience reality. Instead, what if we focused our OT efforts on collaborating with people to empower a greater sense of community and promote occupational engagement to strengthen self-identity and sense of purpose? Enabling people to make friends, to work and play, to find a home, and to build connections within community roles is needed for effective support and inclusion. We can and should support people to find activities and spaces that give them a greater sense of power and well-being as they learn their own unique way of relating to their experience of psychosis.
Improving functional outcomes in college and university students with schizophrenia in the Western world
Published in Journal of American College Health, 2018
Early intervention for schizophrenia, a secondary intervention, has been gaining traction internationally, in Australia, the United Kingdom, Denmark, and the United States. By beginning efficacious treatments soon after an FEP, the goal of these interventions is to decrease the length of untreated psychosis—and, in so doing, improve disease course for those who may later convert to schizophrenia. These programs, and research on their efficacy, began in Australia with the Early Psychosis Prevention and Intervention Centre (EPPIC), whose preliminary results were published in 1996. In 2004, researchers in the United Kingdom published results from an RCT involving a similar intervention, entitled the Lambeth Early Onset (LEO) Team. One year after LEO results were published, a study based in Denmark reported their results on integrated versus standard treatment for FEP. And since 2008, the National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) in the United States has also been researching coordinated specialty care for FEP.