Study Finds Coordinated Specialty Care for First-Episode Psychosis Improves Functioning and Recovery

From Psychiatric News Alert: Measures of occupational and social functioning improved significantly over time, symptoms declined, and rates of remission improved in patients who received services in a specially designed, team-based intervention for first-episode psychosis.

?????????????Those results were reported in “Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program,” published online in Psychiatric Services in Advance.

The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program Implementationand Evaluation Study developed tools to implement and disseminate an innovative, team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. RAISE is a project of the National Institute of Mental Health; the study was conducted by researchers at multiple institutions involved in RAISE.

A total of 65 individuals in RAISE Connection Program treatment across two sites (Baltimore and New York City) were enrolled and received services for up to two years. Primary outcomes such as social and occupational functioning and illness symptoms were evaluated. Trajectories for individuals’ outcomes over time were analyzed.

In the follow-up period, the occupational functioning score on the Mental Illness Research, Education, and Clinical Center (MIRECC) version of the Global Assessment of Functioning increased on average by .96 points per month, and the MIRECC GAF social functioning scale increased by .38 points per month. In the follow-up period, the Positive and Negative Syndrome Scale (PANSS) total score decreased on average by .54 points per month. For every month of follow-up, the PANSS positive score decreased on average by .20 points.

“The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced,” the researchers said. “The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model… Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.”

For related information on this topic, see the Psychiatric News article, “Benefits Persist Decade After Early Psychosis Intervention.”

Photo Credit: DPC | Andres Rodriguez

Adolescence Serves a Valuable Function

From: Psychiatric News Alert: As frustrating as it can be to deal with teenagers’ often challenging behaviors such as risk taking, sensation seeking, or choice of friends, adolescence bestows some strong benefits on humanity, psychiatrist Jay Giedd, M.D., declared at a symposium of the Brain and Behavior Research Foundation(BBRF) in New York City.

Giedd, chief of the Brain Imaging Section of the Child Psychiatry Branch at the National Institute of Mental Health, is also the recipient of the BBRF’s 2013 Ruane Prize for Outstanding Achievement in Child and Adolescent Psychiatric Research.

The major benefit of adolescence, Giedd explained, is a slowly maturing brain that makes humans more adaptable and more open to change than if their brains had matured more rapidly. The Neanderthals, in contrast, had a less-protected period of adolescence. Their brains matured rapidly, and they quickly grew into adults, yet the downside was that they did not adapt well and eventually became extinct, he said. Moreover, because the adolescent brain is in the process of maturing, teens tend to be much more adaptable and more at home with the dizzying advances of the digital revolution than adults are, Giedd noted.

More information about human adolescence and Giedd’s view of this developmental stage is in the Psychiatric News article “Prolonged Adolescence Helps Build a Better Brain.”  Information about adolescent development from a psychodynamic perspective can be found in the new American Psychiatric Publishing book Normal Child and Adolescent Development: A Psychodynamic Primer.

Common Genetic Variation May Underlie Different Mental Health Conditions

An international research group has identified a 15% overlap between inherited schizophrenia and bipolar-disorder attributable to common genetic variation. The Cross Disorders Group of the Psychiatric Genomics Consortium published the study online in Nature Genetics August 11.

The group used genomewide-genotype data from thousands of people and compared them with control subjects. Besides the relationship between schizophrenia and bipolar disorder, there was a 10% inheritability overlap between bipolar disorder and depression, a 9% overlap between schizophrenia and depression, and a 3% overlap between schizophrenia and autism. The common genetic variants with small effects revealed in this and related studies will eventually be supplemented by other research on other variations. Study co-leader Naomi Wray, Ph.D., of the University of Queensland in Australia, said in a statement accompanying the study:

“Shared variants with smaller effects, rare variants, mutations, duplications, deletions, and gene-environment interactions also contribute to these illnesses. Since our study only looked at common gene variants, the total genetic overlap between the disorders is likely higher.” 

The study was funded in part by the National Institute of Mental Health. Read more about the work of the Psychiatric Genomics Consortium in Psychiatric News.