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Social and cognitive interventions that improve outcomes for patients with psychosis

A 3-month critical time intervention service involving social workers and peer specialists to connect people hospitalized with first episode of psychosis to appropriate community mental health services post-discharge and a systematic review and meta-analysis of the effects of specific positive psychology interventions for people with schizophrenia spectrum disorders were presented at IEPA11. They both improved outcomes for patients with psychosis.

Connecting patients with first-episode psychosis to community mental health services after discharge

New York City (NYC) START is a newly implemented 3-month critical time intervention program involving social workers and peer specialists that connects people aged 18–30 years hospitalized with first episode of psychosis (FEP) to community mental health treatment,1 explained Daniel Anderson from New York City Department of Health and Mental Hygiene, NY.

87% attendance an initial mental health appointment compared with 59% in 2011

The social workers and peer specialists meet patients while hospitalized and enroll them into and provide a voluntary 3-month critical time intervention services to connect them to appropriate community mental health services after discharge.

Of 285 patients (clients) — 65% male and 50% African-American — who accepted NYC START services in 2016, 222 (78%) completed at least 3 months of the program.

Contacts with the social workers and peer specialists were most frequent in the first week after discharge with a mean of 2.5 ± 1.4 contacts, 1.9 of which were with social workers and 0.5 with peer specialists.

Overall:

  • social workers and peer specialists provided a mean of 17.3 ± 4.4 and 8.5 ± 3.5 client-specific activities per week, respectively
  • 249 patients (87%) attended an initial mental health appointment after hospital discharge while receiving services from NYC START compared with 59% in 2011

Promoting strength, resilience and self-compassion in persons with psychosis

Mindfulness appears to be a safe and effective intervention for people with psychosis with beneficial effects on hospitalization, duration of hospitalization, acceptance of depressive symptoms, and well-being, said Jens Einar Jansen of the Mental Health Center, Copenhagen, Denmark. This is in line with findings from two previous meta-analyses.2,3

Beneficial effects on acceptance of depressive symptoms and well-being

Dr Jansen described his recent systemic review and meta-analysis of the effects of specific positive psychology interventions for people with schizophrenia spectrum disorders. The outcome measures for the systematic literature search according to the PRISMA guidelines using relevant databases and manual searches were positive emotions, compassion, mindfulness and subjective well-being. Interventions included individual therapy, group training and group therapy.

The review and meta-analysis showed:

  • moderate evidence for a short- and long-term effect of positive psychology interventions on psychotic symptoms and rehospitalization compared to control conditions (n=868)
  • small-to-moderate effects of mindfulness on depressive symptoms, mindfulness skills and social functioning
  • no significant difference between primarily acceptance-based and primarily mindfulness interventions

Based on two separate studies, there was a significant difference between positive psychotherapy and control conditions on wellbeing, positive relations and resilience, but not on psychotic symptoms.

References
  1. NYC START. https://www1.nyc.gov/site/doh/health/health-topics/crisis-emergency-services-nyc-start.page. Accessed 24 October 2018.
  2. Cramer H, et al. Global Adv Health Med 2016;5(1):30–43.
  3. Khoury B, et al. Clin Psychol Rev 2013;33(6):76371.
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