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

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VA Secretary Says Veterans Are the ‘Canary in the Coal Mine’ of Mental Illness

“We are the canary in the coal mine” when it comes to mental health, said Veterans Administration Secretary Bob McDonald in an interview with Psychiatric News. “Mental health care is a problem in this country–it’s not just a problem for those who have suffered PTSD or traumatic brain injury in combat; it is a problem for football players, hockey players, police officers, and many others. We have got to get ahead as a society on mental health.”

McDonald spoke to reporters after a speech to the AMA’s House of Delegates, which held the opening session of its 2014 Interim Meeting yesterday in Dallas. During his speech to delegates outlining efforts to reform the VA in the wake of publicity about substandard care and unusually long waits for appointments in some VA facilities, McDonald specifically addressed the need for better psychiatric care, including increased reimbursement for psychiatrists. Regarding reimbursement, psychiatry won a recent victory that will bring their pay to more competitive levels effective November 30.

“As I’ve gone around the country, I’ve discovered we don’t have enough students in medical school studying mental health,” he said. “Why? Insurance reimbursement rates are low, and there’s a stigma in society about mental health.

“The good news is that at the VA we know about mental health,” McDonald said. “We are on the cutting edge of mental health….It’s a big issue, and as a society we have to get on top of it.”

For related information, see the Psychiatric News article “Psychiatrists’ Pay to Rise at Veterans Health Administration.”

Psychiatric Diagnoses Appear to be Underreported

On the Threshold of Eternity

On the Threshold of Eternity (Photo credit: Wikipedia)

A new study in JAMA Psychiatry concludes that mental disorders are still being underreported by patients, including those who are in midlife to late life.

Researchers in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health examined the answers of 1,071 adults asked to report previous psychiatric diagnoses (major depression, substance use disorder, serious mental illnesses), as well as other general medical disorders (e.g., diabetes and cancer). Self-reports were compared to actual records, showing that 81% of those with a psychiatric diagnosis underreported their condition, compared with 13% underreporting general medical conditions.

The researchers posit that stigma may be a cause. “Stigma associated with mental disorders, as well as the fluctuating course of mental illnesses, might partly explain the discrepancies as well as differences in ages of onset of mental and physical disorders,” said Ramin Mojtabai, M.D., Ph.D., M.P.H., an associate professor and senior author of the study. Moreover, Mojtabai concluded that because symptoms associated with general medical illnesses may be more prevalent in late life, patients may feel the need to report current ones over past mental illnesses.

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