A Method to Compare the Delivery of Psychiatric Care for People with Treatment-Resistant Schizophrenia

Esquizofrènia resistent al tractament; Tecnologies de la informació i la comunicació (TIC); Serveis de salut mentalEsquizofrenia resistente al tratamiento; Tecnologías de la información y la comunicación (TIC); Servicios de salud mentalTreatment-resistant schizophrenia; Information and communication technologies (ICT); Mental health servicesIntroduction: Community services are gaining ground when it comes to attention to patients with psychiatric diseases. Regarding patients with treatment-resistant schizophrenia (TRS), the use of information and communication technology (ICT) could help to shift the focus from hospital-centered attention to community services. This study compares the differences in mental health services provided for patients with TRS in Budapest (Hungary), Tel-Aviv (Israel) and Catalonia (Spain) by means of a method for the quick appraisal of gaps among the three places, for a potential implementation of the same ICT tool in these regions. Methods: An adapted version of the Description and Standardised Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) instrument was made by researchers in Semmelweis University (Budapest, Hungary), Gertner Institute (Tel-Aviv, Israel) and Hospital de la Santa Creu I Sant Pau and Parc Sanitari Sant Joan de Déu (Catalonia, Spain). Results: Two types of outpatient care services were available in the three regions. Only one type of day-care facility was common in the whole study area. Two residential care services, one for acute and the other for non-acute patients were available in every region. Finally, two self-care and volunteer-care facilities were available in the three places. Conclusion: Although the availability of services was different in each region, most of the services provided were sufficiently similar to allow the implementation of the same ICT solution in the three places.This work has been supported by the Horizon 2020 Framework Programme of the European Union (grant number 643552). This research was also funded by ONA CORPORATION

Cognitive insight in first-episode psychosis : changes during Metacognitive Training

Altres ajuts: The project has been funded by the Instituto de Salud Carlos III (Spanish Government); by the Fondo Europeo de Desarrollo Regional (FEDER), Progress and Health Foundation of the Andalusian Regional Ministry of Health, grant PI-0634/2011; Obra Social La Caixa (RecerCaixa call 2013); and Obra Social Sant Joan de Déu (BML).Background: Metacognitive training (MCT) has demonstrated its efficacy in psychosis. However, the effect of each MCT session has not been studied. The aim of the study was to assess changes in cognitive insight after MCT: (a) between baseline, post-treatment, and follow-up; (b) after each session of the MCT controlled for intellectual quotient (IQ) and educational level. Method: A total of 65 patients with first-episode psychosis were included in the MCT group from nine centers of Spain. Patients were assessed at baseline, post-treatment, and 6 months follow-up, as well as after each session of MCT with the Beck Cognitive Insight Scale (BCIS). The BCIS contains two subscales: self-reflectiveness and self-certainty, and the Composite Index. Statistical analysis was performed using linear mixed models with repeated measures at different time points. Results: Self-certainty decreased significantly (p = 0.03) over time and the effect of IQ was negative and significant (p = 0.02). From session 4 to session 8, all sessions improved cognitive insight by significantly reducing self-certainty and the Composite Index. Conclusions: MCT intervention appears to have beneficial effects on cognitive insight by reducing self-certainty, especially after four sessions. Moreover, a minimum IQ is required to ensure benefits from MCT group intervention

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

Altres ajuts: PERIS call (grant no. SLT006/17/00231); the Progress and Health Foundation of the Andalusian Regional Ministry of Health (grant no. PI-0634/2011 and PI-0193/2014); Obra Social La Caixa (RecerCaixa call 2013); CERCA Programme/Generalitat de Catalunya; Obra Social Sant Joan de Déu (BML); and FI19/00062 (Ayudas para la Contratación de Personal Predoctoral).A protective effect has traditionally been attributed to estrogen in psychotic disorders. The aim of this study was to investigate cumulative lifetime estrogen by assessing the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and the age of menarche, measuring their effects on symptoms, cognition, social cognition, and metacognition. As it was not possible to directly measure cumulative estrogen levels over the lifetime of a patient, the study sample was composed of 42 women with first-episode psychosis; estrogen levels were inferred by the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and menarche. All patients were assessed with a battery of questionnaires using the BDI, PSYRATS, PANSS, STROOP, TAVEC, WSCT, IPSAQ, and BCIS questionnaires. The results related to menstrual cycle length showed a relationship with memory; specifically, shorter cycles with semantic strategies (p = 0.046) and longer cycles with serial strategies in the short term (p = 0.005) as well as in the long term (p = 0.031). The results also showed a relationship with perseverative errors (p = 0.035) and self-certainty (p = 0.049). Only personalized bias (p = 0.030) was found to be significant in relation to the age at menarche. When analyzing the differences in years of difference between the age at menarche and the onset of psychotic symptoms, the results indicated lower scores in women with a smaller difference between both events in memory (short-term (p = 0.050), long-term (p = 0.024), intrusions (p = 0.013), and recognition (p = 0.043)) and non-perseverative errors (p = 0.024). No relationship was found between symptoms and menstrual characteristics. The investigatory outcomes seem to indicate a relationship between estrogen cumulative effects and the memory domain. More in-depth investigations in the field are necessary in order to improve personalized treatment in women with psychosis

Persons with first episode psychosis have distinct profiles of social cognition and metacognition

Altres ajuts: Obra Social La Caixa (RecerCaixa call 2013), by the Agencia Estatal de Investigación (AEI, Spain). Junta de Andalucía: PI-0634/2011; PI-0193/2014.Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck's Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventions

Heterogeneity in Response to MCT and Psychoeducation : A Feasibility Study Using Latent Class Mixed Models in First-Episode Psychosis

Metacognitive training (MCT) is an effective treatment for psychosis. Longitudinal trajectories of treatment response are unknown but could point to strategies to maximize treatment efficacy during the first episodes. This work aims to explore the possible benefit of using latent class mixed models (LCMMs) to understand how treatment response differs between metacognitive training and psychoeducation. We conducted LCMMs in 28 patients that received MCT and 34 patients that received psychoeducation. We found that MCT is effective in improving cognitive insight in all patients but that these effects wane at follow-up. In contrast, psychoeducation does not improve cognitive insight, and may increase self-certainty in a group of patients. These results suggest that LCMMs are valuable tools that can aid in treatment prescription and in predicting response to specific treatments

m-RESIST: Atención Terapéutica Móvil para la Esquizofrenia Resistente al Tratamiento Estudio prospectivo multicéntrico de viabilidad y aceptabilidad

A la Unió Europea, entre el 0,2 i el 2,6% de la població té un diagnòstic de trastorn psicòtic. Malgrat els avenços en el tractament farmacològic, al voltant del 40% de les persones amb diagnòstic d’esquizofrènia és resistent al trastorn. Aquesta condició clínica severa és coneguda com Esquizofrènia Resistent al Tractament (ERT). A dia d’avui, segueix sent tot un desafiament la recuperació clínica i funcional de les persones amb diagnòstic d’ERT. En conseqüència, aquest trastorn comporta elevats costos sanitaris i un augment creixent de la càrrega a l’entorn del pacient. Donada la situació actual, cal dissenyar noves fórmules de tractament. La incorporació de la tecnologia digital a l’àrea de la salut mental ofereix possibilitats reals de canvi. La seva metodologia, basada en situar l’usuari en el centre, permet una participació més activa des de les primeres etapes del disseny d’una solució digital. D’aquesta manera, es fomenta la implicació i l’acceptabilitat de l’usuari des del primer moment i es facilita que el resultat final respongui a les necessitats de la població objectiu. En el cas concret de l’esquizofrènia, les intervencions basades en tecnologia digital han demostrat potencial per augmentar l’adherència al tractament i reduir la intensitat dels símptomes. Però, malgrat les prometedores troballes, encara no s’han realitzat estudis en persones amb ERT. En aquesta tesi es presenten els resultats de l’estudi de viabilitat del projecte europeu m-RESIST, l’objectiu del qual era avaluar la viabilitat, acceptabilitat, usabilitat i satisfacció dels pacients, cuidadors informals i professionals de salut mental després de tres mesos d’utilització de la solució de salut mòbil m-RESIST.En la Unión Europea, entre el 0,2 y el 2,6% de la población tiene un diagnóstico de trastorno psicótico. A pesar de los avances en el tratamiento farmacológico, alrededor del 40% de las personas con diagnóstico de esquizofrenia es resistente a este trastorno. Esta severa condición clínica es conocida como Esquizofrenia Resistente al Tratamiento (ERT). A día de hoy, sigue siendo todo un desafío la recuperación clínica y funcional de las personas con diagnóstico de ERT. En consecuencia, este trastorno comporta elevados costes sanitarios y un aumento creciente de la carga en el entorno del paciente. Dada la situación actual, es necesario diseñar nuevas fórmulas de tratamiento. La incorporación de la tecnología digital al área de la salud mental ofrece posibilidades reales de cambio. Su metodología, basada en situar al usuario en el centro, permite una participación más activa desde las primeras etapas del diseño de una solución digital. De esta manera, se fomenta la implicación y la aceptabilidad del usuario desde el primer momento y se facilita que el resultado final responda a las necesidades de la población objetivo. En el caso concreto de la esquizofrenia, las intervenciones basadas en tecnología digital han demostrado potencial para aumentar la adherencia al tratamiento y reducir la intensidad de los síntomas. Pero, a pesar de estos prometedores hallazgos, todavía no se han realizado estudios en personas con ERT. En esta tesis, se presentan los resultados del estudio de viabilidad del proyecto europeo m-RESIST, cuyo objetivo era evaluar la viabilidad, aceptabilidad, usabilidad y satisfacción de los pacientes, cuidadores informales y profesionales de salud mental tras tres meses de utilización de la solución de salud móvil m-RESIST.In the European Union, between 0.2 and 2.6% of the population have a diagnosis of psychotic disorder. Despite advances in pharmacological treatment, about 40% of people with a diagnosis of schizophrenia are resistant to it. This severe clinical condition is known as treatment-resistant schizophrenia (TRS). To date, the clinical and functional recovery of this population still remains a challenge. Consequently, the disorder entails high healthcare costs and an increasing burden on the patient's environment. The reality of the current situation makes it necessary to generate new treatment procedures. The implementation of digital technology in mental health care fosters real possibilities of change. Its methodology, based on a user-centred approach, allows more active participation of person from the early stages of the digital solution design. In this way, the user's involvement and acceptability are encouraged since the beginning, and it is ensured that the final product meets user needs. In the specific case of schizophrenia, digital technology-based interventions have the potential to increase adherence to treatment and reduce the intensity of symptoms. Therefore, they can help prevent relapse. But, despite the promising characteristics of the new technologies, the studies carried out to date have not been performed on samples of people with TRS. In this thesis, the results of the feasibility study of the European m-RESIST project are presented, whose objective was to evaluate the feasibility, acceptability, usability and satisfaction of patients, informal caregivers and mental health professionals after three months of using the mHealth solution m-RESIST.Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatri

m-RESIST : Atención Terapéutica Móvil para la Esquizofrenia Resistente al Tratamiento Estudio prospectivo multicéntrico de viabilidad y aceptabilidad

A la Unió Europea, entre el 0,2 i el 2,6% de la població té un diagnòstic de trastorn psicòtic. Malgrat els avenços en el tractament farmacològic, al voltant del 40% de les persones amb diagnòstic d'esquizofrènia és resistent al trastorn. Aquesta condició clínica severa és coneguda com Esquizofrènia Resistent al Tractament (ERT). A dia d'avui, segueix sent tot un desafiament la recuperació clínica i funcional de les persones amb diagnòstic d'ERT. En conseqüència, aquest trastorn comporta elevats costos sanitaris i un augment creixent de la càrrega a l'entorn del pacient. Donada la situació actual, cal dissenyar noves fórmules de tractament. La incorporació de la tecnologia digital a l'àrea de la salut mental ofereix possibilitats reals de canvi. La seva metodologia, basada en situar l'usuari en el centre, permet una participació més activa des de les primeres etapes del disseny d'una solució digital. D'aquesta manera, es fomenta la implicació i l'acceptabilitat de l'usuari des del primer moment i es facilita que el resultat final respongui a les necessitats de la població objectiu. En el cas concret de l'esquizofrènia, les intervencions basades en tecnologia digital han demostrat potencial per augmentar l'adherència al tractament i reduir la intensitat dels símptomes. Però, malgrat les prometedores troballes, encara no s'han realitzat estudis en persones amb ERT. En aquesta tesi es presenten els resultats de l'estudi de viabilitat del projecte europeu m-RESIST, l'objectiu del qual era avaluar la viabilitat, acceptabilitat, usabilitat i satisfacció dels pacients, cuidadors informals i professionals de salut mental després de tres mesos d'utilització de la solució de salut mòbil m-RESIST.En la Unión Europea, entre el 0,2 y el 2,6% de la población tiene un diagnóstico de trastorno psicótico. A pesar de los avances en el tratamiento farmacológico, alrededor del 40% de las personas con diagnóstico de esquizofrenia es resistente a este trastorno. Esta severa condición clínica es conocida como Esquizofrenia Resistente al Tratamiento (ERT). A día de hoy, sigue siendo todo un desafío la recuperación clínica y funcional de las personas con diagnóstico de ERT. En consecuencia, este trastorno comporta elevados costes sanitarios y un aumento creciente de la carga en el entorno del paciente. Dada la situación actual, es necesario diseñar nuevas fórmulas de tratamiento. La incorporación de la tecnología digital al área de la salud mental ofrece posibilidades reales de cambio. Su metodología, basada en situar al usuario en el centro, permite una participación más activa desde las primeras etapas del diseño de una solución digital. De esta manera, se fomenta la implicación y la aceptabilidad del usuario desde el primer momento y se facilita que el resultado final responda a las necesidades de la población objetivo. En el caso concreto de la esquizofrenia, las intervenciones basadas en tecnología digital han demostrado potencial para aumentar la adherencia al tratamiento y reducir la intensidad de los síntomas. Pero, a pesar de estos prometedores hallazgos, todavía no se han realizado estudios en personas con ERT. En esta tesis, se presentan los resultados del estudio de viabilidad del proyecto europeo m-RESIST, cuyo objetivo era evaluar la viabilidad, aceptabilidad, usabilidad y satisfacción de los pacientes, cuidadores informales y profesionales de salud mental tras tres meses de utilización de la solución de salud móvil m-RESIST.In the European Union, between 0.2 and 2.6% of the population have a diagnosis of psychotic disorder. Despite advances in pharmacological treatment, about 40% of people with a diagnosis of schizophrenia are resistant to it. This severe clinical condition is known as treatment-resistant schizophrenia (TRS). To date, the clinical and functional recovery of this population still remains a challenge. Consequently, the disorder entails high healthcare costs and an increasing burden on the patient's environment. The reality of the current situation makes it necessary to generate new treatment procedures. The implementation of digital technology in mental health care fosters real possibilities of change. Its methodology, based on a user-centred approach, allows more active participation of person from the early stages of the digital solution design. In this way, the user's involvement and acceptability are encouraged since the beginning, and it is ensured that the final product meets user needs. In the specific case of schizophrenia, digital technology-based interventions have the potential to increase adherence to treatment and reduce the intensity of symptoms. Therefore, they can help prevent relapse. But, despite the promising characteristics of the new technologies, the studies carried out to date have not been performed on samples of people with TRS. In this thesis, the results of the feasibility study of the European m-RESIST project are presented, whose objective was to evaluate the feasibility, acceptability, usability and satisfaction of patients, informal caregivers and mental health professionals after three months of using the mHealth solution m-RESIST