Prediction of response to prophylactic treatment of bipolar disorder (BPD) and other forms of man... more Prediction of response to prophylactic treatment of bipolar disorder (BPD) and other forms of manicdepressive illness (MDI) remains challenging. A clinically plausible hypothesis is that a greater number of prior episodes of illness, or longer temporal delay (latency) of long-term, prophylactic treatment may lead to inferior treatment responses. At the extreme, illness history can affect treatment
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003
To analyze new and reviewed findings to evaluate relations between treatment response and latency... more To analyze new and reviewed findings to evaluate relations between treatment response and latency from onset of bipolar disorder (BD) to the start of mood-stabilizer prophylaxis. We analyzed our own new data and added findings from research reports identified by computerized searching. We found 11 relevant studies, involving 1485 adult patients diagnosed primarily with BD. Reported latency to prophylaxis averaged 9.6 years (SD 1.3), and follow-up in treatment averaged 5.4 years (SD 3.1). Greater illness intensity and shorter treatment latency were closely associated, resulting in a greater apparent reduction in morbidity with earlier treatment. However, this finding was not sustained after correction for pretreatment morbidity, and treatment latency did not predict morbidity during treatment. Therefore, assessments based on improvement with treatment, or without correction for pretreatment morbidity, can be misleading. Available evidence does not support the proposal that delayed pr...
Objectives: To further test the hypothesis that past illness episodes and delay of long‐term trea... more Objectives: To further test the hypothesis that past illness episodes and delay of long‐term treatment do not limit maintenance treatment response among patients with manic‐depressive illnesses (MDI).Methods: In a sample of 764 MDI patients in Cagliari and Berlin, 77% of whom had bipolar disorder (BPD), we: (i) correlated treatment latency or pretreatment episode counts versus hospitalized morbidity during treatment; (ii) correlated treatment duration versus pretreatment morbidity; (iii) correlated treatment latency versus pretreatment or treated morbidity; (iv) modeled factors associated with longer treatment latency; (v) compared treatment latencies at extremes of treatment outcomes, and (vi) compared pretreatment morbidity within 2 years of the longest versus shortest treatment latency quartiles.Results: Pretreatment morbidity was strongly correlated with shorter treatment latency, but morbidity during treatment was unrelated to treatment latency, pretreatment episode counts, s...
is a 34-year-old man with a 13-year history of schizophrenia. His early treatment consisted of br... more is a 34-year-old man with a 13-year history of schizophrenia. His early treatment consisted of brief trials of first-generation antipsychotics, which he refused to take for any significant period of time. He was then started on risperidone at an average of 5 mg/day. Within a few months, he and his mother noticed that he had upper and lower extremity tremor and profound motor restlessness, especially of the legs. These symptoms worsened until Mr. B was taken off risperidone and started on olanzapine, after which the tremor resolved, but the restlessness persisted. Mr. B's discomfort was so severe that he was unable to sit through a 15-minute medication management appointment without getting up and pacing the room. His mother noted that the restlessness lasted throughout the day, relenting only when he slept. Mr. B stated that he could not stay still for more than a few minutes at a time and that he had an irresistible urge to move, which led him to pace the house and neighborhood until the soles of his feet were bleeding. Mr. B's mother also reported that when the restlessness was at its worst, he was extremely irritable, easily agitated, and sometimes violent.
OBJECTIVEIndividuals at high risk for schizophrenia may benefit from early intervention but few v... more OBJECTIVEIndividuals at high risk for schizophrenia may benefit from early intervention but few validated risk predictors are available. Genetic profiling is one approach to risk stratification that has been extensively validated in research cohorts, but its utility in clinical settings remains largely unexplored. Moreover, the broad health consequences of a high genetic risk of schizophrenia are poorly understood, despite being relevant to treatment decisions.METHODWe used electronic health records for 106,160 patients from four healthcare systems to evaluate the penetrance and pleiotropy of genetic risk for schizophrenia. Polygenic risk scores (PRSs) for schizophrenia were calculated from summary statistics and tested for association with 1359 disease categories, including schizophrenia and psychosis, in phenome-wide association studies. Effects were combined through meta-analysis across sites.RESULTSPRSs were robustly associated with schizophrenia (odds ratio per standard deviati...
... Schizophr Res 2007;94:231239. Bowie CR, Leung WW, Reichenberg A, et al. ... Clin Neuropsycho... more ... Schizophr Res 2007;94:231239. Bowie CR, Leung WW, Reichenberg A, et al. ... Clin Neuropsychol 2001;15:109113. Joy S, Kaplan E, Fein D. Speed and memory in the WAIS-III Digit SymbolCoding subtest across the adult lifespan. Arch Clin Neuropsychol 2004;19:759767. ...
Introduction: Schizophrenia is marked by a global cognitive impairment that contributes significa... more Introduction: Schizophrenia is marked by a global cognitive impairment that contributes significantly to chronic disability and unemployment. As new treatments are developed for cognition in schizophrenia, clinicians require easily administered instruments to assess cognition. We previously developed a very brief cognitive battery (Bell et al., 2005). The Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) was developed specifically to provide clinicians with a way to assess cognition in their patients with schizophrenia. Here, we report the results of a validity study comparing B-CATS to a larger neurocognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery. Methods: Outpatients with schizophrenia (N = 91) were administered the B-CATS and the non-overlapping tests of the MATRICS battery at two time points separated by 1 month. They were also administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B), a measure of functional capacity. Result: The B-CATS has an administration time of approximately 10 min. It demonstrates good test-retest reliability and internal consistency. It correlates 0.76 (p b 0.01) with the MATRICS battery. The shorter B-CATS and the MATRICS battery correlate with the UPSA-B at 0.50 and 0.58 respectively. Conclusion: A 10-minute version of the B-CATS correlates highly with the "gold standard" neurocognitive battery that has an administration time of over 60 min. Both measures correlate moderately with a measure of functional capacity. This brief battery was designed to allow clinicians to monitor cognitive change and better inform treatment decisions.
Background: Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk ... more Background: Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patientlevel factors on SDM. Methods: A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the appointment (T1), and at 3-and 6-month follow-ups (T2 and T3). The study staff and participating psychiatrists are not blinded to the intervention. The data are de-identified to maintain blinding during the analysis process. The primary aims are feasibility of intervention delivery and research procedures and preliminary impact of the intervention on SDM-related outcomes, medication adherence, and service engagement. As a secondary aim, we will explore the contribution of personality and motivation variables, clinical relationships, cognitive functioning, and mental-health-related stigma to SDM. If the sample size permits, we plan to conduct parametric tests such as independent-samples t tests at T1 to compare differences in SDM, adherence, and engagement scales. In the case of a small sample size, we will use non-parametric tests and descriptive statistics.
Aim:Many emerging adults disengage from early intervention in psychosis (EIP) services prematurel... more Aim:Many emerging adults disengage from early intervention in psychosis (EIP) services prematurely. Service disengagement may be in part due to having unresolved treatment decision-making needs about use of mental health services. A basic understanding of the decision-making needs of this population is lacking. The purpose of this qualitative study was to identify the range of treatment decisions that emerging adults face during their initial engagement in an EIP program and elucidate barriers and facilitators to decision-making.Methods:Twenty emerging adults with early psychosis were administered semi-structured interviews to capture treatment decision-making experiences during the first six months after enrollment in an EIP program. Interviews were audio-recorded and transcribed verbatim. Responses were independently coded by two authors using an integrated thematic analysis approach; differences in coding were discussed to consensus. Data analysis was facilitated using NVivo 12 Plus.Results:Emerging adults identified numerous decisions faced after EIP enrollment. Decisions pertaining to life and treatment goals and to starting and continuing psychiatric medication were commonly selected as the most difficult/complicated. Decision-making barriers included not having the right amount or type of information/knowledge; social factors (e.g., lacking social support, opposition/pressure); lacking internal resources (e.g., cognitive and communication skills, self-efficacy, motivation); and unappealing options. Obtaining information/knowledge, social supports (e.g., connection/trust, learning from others’ experiences, encouragement), considering personal values, and time were decision-making facilitators.Conclusions:This study informs development and optimization of interventions to support decision-making among emerging adults with early psychosis, which may promote service engagement.
Cognitive impairment in schizophrenia is often severe, enduring, and contributes significantly to... more Cognitive impairment in schizophrenia is often severe, enduring, and contributes significantly to chronic disability. But clinicians have difficulty in assessing cognition due to a lack of brief instruments. We evaluated whether a brief battery of cognitive tests derived from larger batteries could generate a summary score representing global cognitive function. Using data from 3 previously published trials, we calculated the corrected item-total correlations (CITCs) or the correlation of each test with the battery total score. We computed the proportion of variance that each test shares with the global score excluding that test (R 2 t 5CITC 2) and the variance explained per minute of administration time for each test (R 2 t /min). The 3 tests with the highest R 2 t /min were selected for the brief battery. The composite score from the trail making test B, category fluency, and digit symbol correlated .86 with the global score of the larger battery in 2 of the studies and correlated between .73 and .82 with the total battery scores excluding these 3 tests. A Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) using the above 3 tests can be administered in 10-11 min. The full batteries of the larger studies have administration times ranging from 90 to 210 min. Given prior research suggesting that a single factor of global cognition best explains the pattern of cognitive deficit in schizophrenia, an instrument like B-CATS can provide clinicians with meaningful data regarding their patients' cognitive function. It can also serve researchers who want an estimate of global cognitive function without requiring a full neuropsychological battery.
AimMany emerging adults disengage from early intervention in psychosis (EIP) services prematurely... more AimMany emerging adults disengage from early intervention in psychosis (EIP) services prematurely. Service disengagement may be in part due to having unresolved treatment decision‐making needs about use of mental health services. A basic understanding of the decision‐making needs of this population is lacking. The purpose of this qualitative study was to identify the range of treatment decisions that emerging adults face during their initial engagement in an EIP program and elucidate barriers and facilitators to decision‐making.MethodsTwenty emerging adults with early psychosis were administered semistructured interviews to capture treatment decision‐making experiences during the first six months after enrolment in an EIP program. Interviews were audio‐recorded and transcribed verbatim. Responses were independently coded by two authors using an integrated thematic analysis approach; differences in coding were discussed to consensus. Data analysis was facilitated using NVivo 12 Plus....
A review of some of the latest study findings on the pharmacological treatment of prodromal psych... more A review of some of the latest study findings on the pharmacological treatment of prodromal psychosis.
Background Emerging adults with early psychosis demonstrate high rates of service disengagement f... more Background Emerging adults with early psychosis demonstrate high rates of service disengagement from critical early intervention services. Decision support interventions and peer support have both been shown to enhance service engagement but are understudied in this population. The purposes of this article are to describe the development of a novel peer-delivered decision coaching intervention for this population and to report plans for a pilot study designed to gather preliminary data about its feasibility, acceptability, and potential impact. Methods The intervention was developed based on formative qualitative data and in collaboration with a diverse team of researchers, key stakeholders, and expert consultants. The pilot trial will utilize a single-group (N = 20), pre-post, convergent mixed-methods design to explore whether and how the intervention addresses decision-making needs (the primary intervention target). The impact of the intervention on secondary outcomes (e.g., engag...
Background Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk o... more Background Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patient-level factors on SDM. Methods A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the...
Prediction of response to prophylactic treatment of bipolar disorder (BPD) and other forms of man... more Prediction of response to prophylactic treatment of bipolar disorder (BPD) and other forms of manicdepressive illness (MDI) remains challenging. A clinically plausible hypothesis is that a greater number of prior episodes of illness, or longer temporal delay (latency) of long-term, prophylactic treatment may lead to inferior treatment responses. At the extreme, illness history can affect treatment
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003
To analyze new and reviewed findings to evaluate relations between treatment response and latency... more To analyze new and reviewed findings to evaluate relations between treatment response and latency from onset of bipolar disorder (BD) to the start of mood-stabilizer prophylaxis. We analyzed our own new data and added findings from research reports identified by computerized searching. We found 11 relevant studies, involving 1485 adult patients diagnosed primarily with BD. Reported latency to prophylaxis averaged 9.6 years (SD 1.3), and follow-up in treatment averaged 5.4 years (SD 3.1). Greater illness intensity and shorter treatment latency were closely associated, resulting in a greater apparent reduction in morbidity with earlier treatment. However, this finding was not sustained after correction for pretreatment morbidity, and treatment latency did not predict morbidity during treatment. Therefore, assessments based on improvement with treatment, or without correction for pretreatment morbidity, can be misleading. Available evidence does not support the proposal that delayed pr...
Objectives: To further test the hypothesis that past illness episodes and delay of long‐term trea... more Objectives: To further test the hypothesis that past illness episodes and delay of long‐term treatment do not limit maintenance treatment response among patients with manic‐depressive illnesses (MDI).Methods: In a sample of 764 MDI patients in Cagliari and Berlin, 77% of whom had bipolar disorder (BPD), we: (i) correlated treatment latency or pretreatment episode counts versus hospitalized morbidity during treatment; (ii) correlated treatment duration versus pretreatment morbidity; (iii) correlated treatment latency versus pretreatment or treated morbidity; (iv) modeled factors associated with longer treatment latency; (v) compared treatment latencies at extremes of treatment outcomes, and (vi) compared pretreatment morbidity within 2 years of the longest versus shortest treatment latency quartiles.Results: Pretreatment morbidity was strongly correlated with shorter treatment latency, but morbidity during treatment was unrelated to treatment latency, pretreatment episode counts, s...
is a 34-year-old man with a 13-year history of schizophrenia. His early treatment consisted of br... more is a 34-year-old man with a 13-year history of schizophrenia. His early treatment consisted of brief trials of first-generation antipsychotics, which he refused to take for any significant period of time. He was then started on risperidone at an average of 5 mg/day. Within a few months, he and his mother noticed that he had upper and lower extremity tremor and profound motor restlessness, especially of the legs. These symptoms worsened until Mr. B was taken off risperidone and started on olanzapine, after which the tremor resolved, but the restlessness persisted. Mr. B's discomfort was so severe that he was unable to sit through a 15-minute medication management appointment without getting up and pacing the room. His mother noted that the restlessness lasted throughout the day, relenting only when he slept. Mr. B stated that he could not stay still for more than a few minutes at a time and that he had an irresistible urge to move, which led him to pace the house and neighborhood until the soles of his feet were bleeding. Mr. B's mother also reported that when the restlessness was at its worst, he was extremely irritable, easily agitated, and sometimes violent.
OBJECTIVEIndividuals at high risk for schizophrenia may benefit from early intervention but few v... more OBJECTIVEIndividuals at high risk for schizophrenia may benefit from early intervention but few validated risk predictors are available. Genetic profiling is one approach to risk stratification that has been extensively validated in research cohorts, but its utility in clinical settings remains largely unexplored. Moreover, the broad health consequences of a high genetic risk of schizophrenia are poorly understood, despite being relevant to treatment decisions.METHODWe used electronic health records for 106,160 patients from four healthcare systems to evaluate the penetrance and pleiotropy of genetic risk for schizophrenia. Polygenic risk scores (PRSs) for schizophrenia were calculated from summary statistics and tested for association with 1359 disease categories, including schizophrenia and psychosis, in phenome-wide association studies. Effects were combined through meta-analysis across sites.RESULTSPRSs were robustly associated with schizophrenia (odds ratio per standard deviati...
... Schizophr Res 2007;94:231239. Bowie CR, Leung WW, Reichenberg A, et al. ... Clin Neuropsycho... more ... Schizophr Res 2007;94:231239. Bowie CR, Leung WW, Reichenberg A, et al. ... Clin Neuropsychol 2001;15:109113. Joy S, Kaplan E, Fein D. Speed and memory in the WAIS-III Digit SymbolCoding subtest across the adult lifespan. Arch Clin Neuropsychol 2004;19:759767. ...
Introduction: Schizophrenia is marked by a global cognitive impairment that contributes significa... more Introduction: Schizophrenia is marked by a global cognitive impairment that contributes significantly to chronic disability and unemployment. As new treatments are developed for cognition in schizophrenia, clinicians require easily administered instruments to assess cognition. We previously developed a very brief cognitive battery (Bell et al., 2005). The Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) was developed specifically to provide clinicians with a way to assess cognition in their patients with schizophrenia. Here, we report the results of a validity study comparing B-CATS to a larger neurocognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery. Methods: Outpatients with schizophrenia (N = 91) were administered the B-CATS and the non-overlapping tests of the MATRICS battery at two time points separated by 1 month. They were also administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B), a measure of functional capacity. Result: The B-CATS has an administration time of approximately 10 min. It demonstrates good test-retest reliability and internal consistency. It correlates 0.76 (p b 0.01) with the MATRICS battery. The shorter B-CATS and the MATRICS battery correlate with the UPSA-B at 0.50 and 0.58 respectively. Conclusion: A 10-minute version of the B-CATS correlates highly with the "gold standard" neurocognitive battery that has an administration time of over 60 min. Both measures correlate moderately with a measure of functional capacity. This brief battery was designed to allow clinicians to monitor cognitive change and better inform treatment decisions.
Background: Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk ... more Background: Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patientlevel factors on SDM. Methods: A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the appointment (T1), and at 3-and 6-month follow-ups (T2 and T3). The study staff and participating psychiatrists are not blinded to the intervention. The data are de-identified to maintain blinding during the analysis process. The primary aims are feasibility of intervention delivery and research procedures and preliminary impact of the intervention on SDM-related outcomes, medication adherence, and service engagement. As a secondary aim, we will explore the contribution of personality and motivation variables, clinical relationships, cognitive functioning, and mental-health-related stigma to SDM. If the sample size permits, we plan to conduct parametric tests such as independent-samples t tests at T1 to compare differences in SDM, adherence, and engagement scales. In the case of a small sample size, we will use non-parametric tests and descriptive statistics.
Aim:Many emerging adults disengage from early intervention in psychosis (EIP) services prematurel... more Aim:Many emerging adults disengage from early intervention in psychosis (EIP) services prematurely. Service disengagement may be in part due to having unresolved treatment decision-making needs about use of mental health services. A basic understanding of the decision-making needs of this population is lacking. The purpose of this qualitative study was to identify the range of treatment decisions that emerging adults face during their initial engagement in an EIP program and elucidate barriers and facilitators to decision-making.Methods:Twenty emerging adults with early psychosis were administered semi-structured interviews to capture treatment decision-making experiences during the first six months after enrollment in an EIP program. Interviews were audio-recorded and transcribed verbatim. Responses were independently coded by two authors using an integrated thematic analysis approach; differences in coding were discussed to consensus. Data analysis was facilitated using NVivo 12 Plus.Results:Emerging adults identified numerous decisions faced after EIP enrollment. Decisions pertaining to life and treatment goals and to starting and continuing psychiatric medication were commonly selected as the most difficult/complicated. Decision-making barriers included not having the right amount or type of information/knowledge; social factors (e.g., lacking social support, opposition/pressure); lacking internal resources (e.g., cognitive and communication skills, self-efficacy, motivation); and unappealing options. Obtaining information/knowledge, social supports (e.g., connection/trust, learning from others’ experiences, encouragement), considering personal values, and time were decision-making facilitators.Conclusions:This study informs development and optimization of interventions to support decision-making among emerging adults with early psychosis, which may promote service engagement.
Cognitive impairment in schizophrenia is often severe, enduring, and contributes significantly to... more Cognitive impairment in schizophrenia is often severe, enduring, and contributes significantly to chronic disability. But clinicians have difficulty in assessing cognition due to a lack of brief instruments. We evaluated whether a brief battery of cognitive tests derived from larger batteries could generate a summary score representing global cognitive function. Using data from 3 previously published trials, we calculated the corrected item-total correlations (CITCs) or the correlation of each test with the battery total score. We computed the proportion of variance that each test shares with the global score excluding that test (R 2 t 5CITC 2) and the variance explained per minute of administration time for each test (R 2 t /min). The 3 tests with the highest R 2 t /min were selected for the brief battery. The composite score from the trail making test B, category fluency, and digit symbol correlated .86 with the global score of the larger battery in 2 of the studies and correlated between .73 and .82 with the total battery scores excluding these 3 tests. A Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) using the above 3 tests can be administered in 10-11 min. The full batteries of the larger studies have administration times ranging from 90 to 210 min. Given prior research suggesting that a single factor of global cognition best explains the pattern of cognitive deficit in schizophrenia, an instrument like B-CATS can provide clinicians with meaningful data regarding their patients' cognitive function. It can also serve researchers who want an estimate of global cognitive function without requiring a full neuropsychological battery.
AimMany emerging adults disengage from early intervention in psychosis (EIP) services prematurely... more AimMany emerging adults disengage from early intervention in psychosis (EIP) services prematurely. Service disengagement may be in part due to having unresolved treatment decision‐making needs about use of mental health services. A basic understanding of the decision‐making needs of this population is lacking. The purpose of this qualitative study was to identify the range of treatment decisions that emerging adults face during their initial engagement in an EIP program and elucidate barriers and facilitators to decision‐making.MethodsTwenty emerging adults with early psychosis were administered semistructured interviews to capture treatment decision‐making experiences during the first six months after enrolment in an EIP program. Interviews were audio‐recorded and transcribed verbatim. Responses were independently coded by two authors using an integrated thematic analysis approach; differences in coding were discussed to consensus. Data analysis was facilitated using NVivo 12 Plus....
A review of some of the latest study findings on the pharmacological treatment of prodromal psych... more A review of some of the latest study findings on the pharmacological treatment of prodromal psychosis.
Background Emerging adults with early psychosis demonstrate high rates of service disengagement f... more Background Emerging adults with early psychosis demonstrate high rates of service disengagement from critical early intervention services. Decision support interventions and peer support have both been shown to enhance service engagement but are understudied in this population. The purposes of this article are to describe the development of a novel peer-delivered decision coaching intervention for this population and to report plans for a pilot study designed to gather preliminary data about its feasibility, acceptability, and potential impact. Methods The intervention was developed based on formative qualitative data and in collaboration with a diverse team of researchers, key stakeholders, and expert consultants. The pilot trial will utilize a single-group (N = 20), pre-post, convergent mixed-methods design to explore whether and how the intervention addresses decision-making needs (the primary intervention target). The impact of the intervention on secondary outcomes (e.g., engag...
Background Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk o... more Background Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patient-level factors on SDM. Methods A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the...
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Papers by Irene Hurford