Early Intervention in Psychiatry E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 965

Veröffentlichungsjahr: 2014

Beschreibung

Early intervention (EI) is the single most important advance in mental health care in recent decades, representing a key shift in both theoretical standpoint and service delivery.

Early Intervention in Psychiatry clearly describes best practice for extending this approach to all psychiatric disorders. Beginning with the rationale for EI, it informs interventions in people from all age groups across the lifespan, from perinatal to old age. It addresses EI in specific settings, such as primary health care, community health, the general hospital, non-government agencies, and in social movements, and for specific disorders including depression and anxiety, alcohol and substance use, childhood disorders, psychoses, bipolar disorders, eating disorders and borderline personality disorders.

Early Intervention in Psychiatry is an essential guide for all psychiatrists, general practitioners, family physicians and public health doctors. It is also a valuable resource for mental health professionals and primary care colleagues, including nurses, social workers, psychologists, occupational therapists, vocational rehabilitation specialists, peer and support workers and for mental health commissioners and policy-makers.

Leseprobe

Early Intervention in Psychiatry

EI of nearly everything for better mental health

Edited by

Peter Byrne

Homerton University Hospital, London; Royal College of Psychiatrists, UK

Alan Rosen

School of Public Health, University of Wollongong Brain and Mind Research Institute, University of Sydney

This edition first published 2014 © 2014 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Early intervention in psychiatry (Byrne) Early intervention in psychiatry : EI of nearly everything for better mental health / edited by Peter Byrne, Alan Rosen. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-68342-2 (cloth : alk. paper) I. Byrne, Peter, 1964- editor. II. Rosen, Alan, 1946 January 3- editor. III. Title. [DNLM: 1. Mental Disorders–prevention & control. 2. Early Medical Intervention–methods. 3. Mental Health Services–organization & administration. WM 400] RC454.4 616.89–dc23

2014014775

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Dedication

This book is dedicated to one of our Early Intervention of Nearly Everything book co-authors, Professor Helen Lester, who died on this journey at the height of her academic and practical achievements, many of them concerning early intervention in primary care settings. She left a young family behind her. We also pay tribute to all the contributing authors in this book, from whom we have learned so much of value relevant to early prevention and intervention in a wider world. We acknowledge too all the people with lived experience of mental illnesses and their families, and the many dedicated service providers and researchers from whom we have learned about the immense value of earlier intervention approaches to many mental health conditions. Finally, we sincerely thank our families for their unflinching support for this, at least initially, quixotic dash into uncharted territory, and forbearance in living with our cognitive absences from them at times, due to our intermittent preoccupation with this most absorbing project.

CONTENTS

List of Contributors

Foreword

Part I: The Rationale for Early Intervention in Nearly Everything

Chapter 1: Introduction

Prevention

Overview: structure of this book

What do we mean by prevention?

The how of prevention

Evidence

Parallels with medicine

And finally

References

Chapter 2: How Early Intervention Can Turn Things Upside Down and Turn a Patient Into a Psychiatrist

Introduction

The lead up to psychosis

Psychosis and mania

Involuntary treatment

Arriving at EPPIC

Meeting my housemates

Living at EPPIC

Maintaining control

Time to go

Life as an outpatient

The following 5 years

And then the next 5 years

Now

The future

Creating the community healthfulness cooperative

Conclusion

References

Chapter 3: Involving the Family in Early Interventions

Introduction

Family interventions across the lifespan

Family intervention in early psychosis

Conclusion

References

Chapter 4: Do Early Intervention Services for Psychosis Represent Value for Money?

Introduction

Approaches to economic evaluation

Cost-effectiveness analysis

What do we know?

Employing economic evidence

References

Part II: Early Intervention Across the Lifespan

Chapter 5: Perinatal Preventive Interventions in Psychiatry: A Clinical Perspective

Introduction

The perinatal period: a critical transition

Developmental trajectories get established early for children

The antenatal environment: stress during pregnancy and the impact of untreated psychopathologies

Psychopathology during the perinatal period

Perinatal programs

Conclusion

References

Chapter 6: Psychiatry and Intervention in Infancy and Early Childhood

Introduction

The aetiology of child psychiatric disorder

Methods of working with childhood psychiatric disorder

Conclusions

References

Chapter 7: Early Intervention for Young People with Mental Illness

Introduction

The need

Early intervention in youth mental health – what does it mean?

Barriers to accessing services

The weaknesses of traditional service age-bands

What would an ideal framework for identifying illness as early as possible and delivering effective youth-friendly services to young people look like?

Clockwork young people-s health service

Jigsaw: specialist mental health services for young people in the Barwon region, Australia

Conclusion

References

Chapter 8: Transiting Out of Child and Adolescent Mental Health Services – Influences on Continuities and Discontinuities in Mental Health Care

Introduction

Child and adolescent mental health disorders

Developmental needs for continuity of care

Service transitions – difficulties at the interface

Managing the interface – ways forward

References

Chapter 9: Adults of Working Age

Why bother with adult preventative medicine?

Why mental illness prevention, now?

What is happiness and well-being anyway?

What is EI in adult mental health services?

Principles of EI services for adults

How to do EI for adults

Future developments for adult EI services

References

Chapter 10: Early Intervention in Older Adults – A Focus on Alzheimer's Dementia

The economic arguments

Moving towards a staging model

Intervening in Alzheimer's disease –

a life course perspective

Disease-modifying drugs: battling the slings and arrows of outrageous fortune

The future

References

Part III: Early Intervention in Specific Settings

Chapter 11: Primary Prevention of Mental Disorders

Introduction

Recent evidence from advances in developmental neuroscience

An ecological developmental approach

Risk factors for mental disorders across the lifespan

Primary prevention interventions

Implications for the practice of primary prevention

Acknowledgement

Note

References

Chapter 12: Early Intervention in Mental Health Problems: The Role of the Voluntary Sector

The voluntary sector and mental health

How the voluntary sector views early intervention

Towards a systematic understanding of early intervention by the voluntary sector

Case studies

Early intervention in the life cycle – individual biological and psychological factors

Early intervention in the course of mental illness – individual psychological factors

Early intervention in the life cycle – family-level interventions

Early intervention in psychosis – community-level interventions

Early intervention in mental illness – community-level interventions

Public mental health interventions

Services offered by the voluntary sector which can contribute to early intervention

What did the systematic data collection show?

What does the voluntary sector have to offer?

Conclusion

Acknowledgements

References

Chapter 13: Why Primary Care Matters for Early Intervention in Psychiatry

Introduction

The value of primary care

The worried well and primary care

Physical health of people with psychosis and primary care

Conclusions

Acknowledgements

References

Chapter 14: Early Intervention in the General Hospital

The physical health of people with severe mental illness

Post-stroke depression

Medically unexplained symptoms

References

Chapter 15: Early Intervention Services versus Generic Community Mental Health Services: A Paradigm Shift

Historical background

The rationale behind EIS

EIS versus CMHS: randomised controlled trials

Discussion: specialist early intervention service teams compared with generic CMHS teams

Conclusion

References

Part IV: Early Intervention in Specific Disorders

Chapter 16: Prevention and Early Intervention in Depression and Anxiety Disorders

Depression and anxiety disorders are common and costly

Course and prognosis: opportunities for prevention and early intervention

Barriers to the presentation of symptoms and the early detection of disorders

Predicting the onset of depression and anxiety disorders

Improving the identification of disorders in primary care

Prevention programmes for common mental disorders

Preventive interventions

Scaled-up delivery of interventions

Early intervention to prevent subthreshold disorders developing

Conclusion

References

Chapter 17: Alcohol and Substance Use Prevention and Early Intervention

Introduction

What causes substance use problems?

School-based prevention for substance use

Internet- and computer-based prevention

Early intervention for substance use disorders

Conclusions

References

Chapter 18: Early Intervention in Childhood Disorders

Introduction

Early identification

Specific disorders

Summary

Conclusion

References

Chapter 19: Early Intervention for Delirium

Key points

Delirium – a key target for early intervention

The impact of delirium on health care outcomes

Primary prevention of delirium

Improving the identification of patients at risk of delirium

Delirium detection

Optimising delirium treatment: secondary prevention

Improving outcomes in delirium

Early intervention in delirium: penetrating the health care agenda

A plan for improved delirium care

References

Chapter 20: Early Intervention for Self-Harm and Suicidality

Introduction

Epidemiology of self-harm

Why intervene early for self-harm?

Evaluating efficacy of interventions

The importance of specialist psychosocial assessment

Guidance: general principles

Interventions: psychological

Interventions: pharmacological

Interventions: ‘contact-based’

Mechanisms of efficacy: evidence from service users

References

Chapter 21: Early Intervention in Bipolar Disorder

Introduction

Clinical and demographic features of BPAD

Natural history of BPAD

The clinical staging model of BPAD

Evidence that EI at different stages in BPAD works

Existing EI services specifically for BPAD

What an ideal model for EI in BPAD would look like

Outcomes expected and how they would be evaluated

Conclusions

References

Chapter 22: Early Intervention in Eating Disorders

Introduction

Anorexia nervosa

Bulimia nervosa

Binge-eating disorder

Conclusion

References

Chapter 23: Early Intervention to Reduce Violence and Offending Outcomes in Young People with Mental Disorders

Introduction

The rationale for early intervention to reduce violence and offending among people with mental disorders

Populations at risk for offending

Service models to enhance prevention and early intervention in forensic mental health

Conclusions

Note

References

Chapter 24: Early Intervention for Borderline Personality Disorder

Introduction

Borderline personality disorder in young people

Prevention and early intervention

Aims of prevention and early intervention

Risk factors

Precursor signs and symptoms

What form should intervention take?

Early detection and intervention

Principles of early intervention

Applied indicated prevention and early intervention: the HYPE program

Remaining barriers and potential risks

Conclusion and future perspectives

Acknowledgements

References

Part V: Conclusions

Chapter 25: Early Intervention and the Power of Social Movements: UK Development of Early Intervention in Psychosis as a Social Movement and its Implications for Leadership

An international context

Early intervention in psychosis:

‘developing the head’

– the knowledge base

EIP:

‘developing the heart’

– the right to social justice

EIP as a social movement

Where next?

Useful resources

Useful websites

Notes

References

Chapter 26: Challenging Stigma

Mental illness stigma: its definition and consequences

Three ‘types’ of stigma

The consequences for people with mental illnesses

Stigma and early intervention

Challenging mental illness stigma

Targeted stigma strategies

Mitigating the impact of self-stigma

Conclusion

Acknowledgements

References

Chapter 27: Conclusion: Towards Standards for Early Prevention and Intervention of Nearly Everything for Better Mental Health Services

Introduction

The definition of and rationale for early intervention across the disorder, stage of life and phases of care spectra

Is early intervention really a new idea?

Should access to early intervention teams be time-limited?

Is early prevention and intervention just for young people with first episode psychosis?

What are the essential ingredients of an early intervention approach?….underlying principles of early intervention provision

Conclusion

References

Afterword for Early Intervention of Nearly Everything for Better Mental Health Services

References

Index

End User License Agreement

List of Tables

Chapter 3

Table 3.1

Table 3.2

Chapter 9

Table 9.1

Table 9.2

Table 9.3

Table 9.4

Chapter 12

Table 12.1

Table 12.2

Chapter 15

Table 15.1

Table 15.2

Chapter 17

Table 17.1

Table 17.2

Table 17.3

Chapter 18

Table 18.1

Chapter 19

Table 19.1

Chapter 22

Table 22.1

Chapter 25

Table 25.1

Table 25.2

Chapter 27

Table 27.1

Table 27.2

Table 27.3

Guide

Cover

Table of Contents

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List of Contributors

Marco Armando 

Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy; School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK

Iyas Assalman 

Newham Centre for Mental Health, London and East London Foundation NHS Trust

Jane Barlow 

Mental Health & Wellbeing, Warwick Medical School, University of Warwick, UK

Arvin Bhana 

School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, Durban, South Africa

Maximilian Birchwood 

YouthSpace; University of Warwick, UK

Sophie Bridger 

Mental Health Foundation, UK

Helen Bruce 

University College London, Institute of Child Health, London, UK; East London NHS Foundation Trust, London, UK; Barts and the London School of Medicine and Dentistry, London, UK

Peter Byrne 

Homerton University Hospital, London; Royal College of Psychiatrists, UK

Tom Callaly 

Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia

Andrew M. Chanen 

Orygen Youth Health Research Centre & Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen Youth Health Clinical Program, Northwestern Mental Health, Melbourne, Australia

Philippe Conus 

Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry CHUV, Lausanne University, Switzerland

Jayne Cooper 

Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK

Patrick Corrigan 

Illinois Institute of Technology, Chicago

Walter Cullen 

Department of General Practice, University of Limerick Medical School, Limerick, Ireland

Franco De Crescenzo 

Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy

Mark Deady 

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

Linda Dowdney 

University College London, Institute of Child Health, London, UK

Gráinne Fadden 

Meriden Family Programme, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; University of Birmingham, Birmingham, UK

Rick Fraser 

Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, Sussex, UK

Isabella Goldie 

Mental Health Foundation, UK

Helen Herrman 

Collaborating Centre for Mental Health, University of Melbourne, Parkville, Melbourne, Victoria, Australia

Rajeev Jairam 

Gna Ka Lun Adolescent Mental Health Unit, South West Sydney Local Health District, Campbelltown, New South Wales, Australia; School of Medicine, University of New South Wales and University of Western Sydney

Nav Kapur 

Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK

Tony Kendrick 

Hull York Medical School, University of York, York, UK

Martin Knapp 

Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Personal Social Services Research Unit, London School of Economics and Political Science, UK

Kristin Kosyluk 

Illinois Institute of Technology, Chicago

Brian Lawlor 

Mercer's Institute for Research on Ageing; Trinity College Dublin; St Patrick's and St James's Hospitals, Dublin, Ireland

Helen Lester 

Primary Care, School of Health and Population Sciences, University of Birmingham, UK

Crick Lund 

Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa

Craig Macneil 

Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry CHUV, Lausanne University, Switzerland

Karl Marlowe

East London NHS Foundation Trust, London, England, UK

Paul McCrone 

Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK

Andrew McCulloch 

Mental Health Foundation, UK

Louise McCutcheon 

Orygen Youth Health Research Centre & Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen Youth Health Clinical Program, Northwestern Mental Health, Melbourne, Australia

Patrick McGorry 

Orygen Youth Health Research Centre, University of Melbourne, Melbourne, Australia

David Meagher 

Department of Psychiatry, University of Limerick Medical School, Limerick, Ireland

Nick Meinhold 

Monash University, Victoria, Australia; University of Queensland, Brisbane, St Lucia, Queensland, Australia; Community Healthfulness Cooperative, Melbourne, Victoria, Australia

Irwin Nazareth 

Department of Primary Care & Population Health, London, UK

Celia O'Hare 

The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Ireland

Nicola C. Newton 

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

Inge Petersen 

School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, Durban, South Africa

Leora Pinhas 

Eating Disorders Program, The Hospital for Sick Children, Toronto, Ontario; Department of Psychiatry, University of Toronto, Toronto, Ontario

Paddy Power 

Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry CHUV, Lausanne University, Switzerland

Rosemary Purcell 

Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia

Alan Rosen

School of Public Health, University of Wollongong; Brain and Mind Research Institute, University of Sydney; Mental Health Commission of New South Wales, Australia

Hannah Schwartz 

St. Mary's Hospital Center, McGill University, Montreal, Canada

Jan Scott 

Newcastle University & Centre for Affective Disorders, Institute of Psychiatry, UK

David Shiers 

National Early Intervention Programme, England; Leek, North Staffordshire, UK; National Mental Health Development Unit, London, UK

Jo Smith 

National Early Intervention Programme, England; Worcestershire Health and Care NHS Trust, Worcester, UK; University of Worcester, Worcester, UK

Martin St-André 

Sainte-Justine University Health Center, Université de Montréal, Montreal, Canada

Sarah Steeg 

Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK

Danny Sullivan 

Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia; Victorian Institute of Forensic Mental Health, Clifton Hill, Victoria, Australia

Maree Teesson 

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

Garry Walter 

Discipline of Psychiatry, University of Sydney; Child and Adolescent Mental Health Services, Northern Sydney Local Health District, New South Wales, Australia

Amy C. Watson 

Jane Addams College of Social Work, University of Illinois at Chicago, Chicago

Jennifer Wong 

Eating Disorders Program, The Hospital for Sick Children, Toronto, Ontario

D. Blake Woodside 

Department of Psychiatry, University of Toronto, Toronto, Ontario; University Health Network, Toronto, Ontario

Keiko Yoshida 

Department of Child Psychiatry, Kyushu University Hospital, Fukuoka City, Japan

Foreword

Prevention of mental illness can take many forms and should be at the heart of mental health services. Traditionally, prevention has been classified into primary, secondary and tertiary. Virtually all psychiatric clinical practice is about secondary and tertiary prevention by treating the symptoms when they have developed and require intervention. In many cases, the development of these symptoms and the accompanying distress will determine where help is sought from and who is approached for intervention. The recognition of early distress has to be achieved carefully, as there is a serious danger that normal responses to stress or distress themselves may be pathologised and medicalised.

Early intervention can be seen at multiple levels – as an intervention at an appropriate stage before symptoms become resistant to intervention or as early recognition of the need to intervene. There are clearly ethical dilemmas which need to be resolved. Primary prevention is not only about mental health promotion and reduction in precipitating factors, but also about improving resilience. Early intervention is about treating people who are at risk of developing disorders as well as intervening at an early stage to improve the possibility of recovery. Clinicians as well as stakeholders need to be aware of the possibilities that early intervention in many conditions may help. We know that children with conduct disorders are more likely to develop personality disorders when they grow up. This development if averted may contribute to huge savings in the long run. One of the major challenges is for health to work with education, the criminal justice system and other departments to achieve this reduction. Another major challenge is where early interventions are based and placed – whether this is in primary care or secondary care. In either case, should they have strict boundaries? In which case, it is inevitable that further fragmentation and exclusion criteria come into play. The advantages of early intervention are many – through early and better engagement of the individuals and their carers and families – such approaches may reduce stigma and enable carers to learn about the illnesses and their consequences. For some psychiatric conditions, early intervention will take place in adolescence, whereas for others it will be in older age. These interventions need to be comprehensive, evidence based and interdisciplinary, no matter where they are placed.

Those individuals and families who may be at risk need to be educated and engaged in understanding what may precipitate certain illnesses, what the predisposing and perpetuating factors may be and how the individual, their families and society at large cope and manage these.

Interventions at antenatal stages, especially maternal support and abstinence from alcohol, smoking and drugs, can help. Postnatal support and educating about maternal and parenting skills will enable the development of better attachment patterns in infants and children. Education about bullying and other factors at school will enable children to manage better in facing these and future adversities. Better physical health, physical exercise and employment all provide strategies for coping with stress and distress. There is compelling evidence that social inequalities, poor public transport, lack of green spaces can contribute to mental ill health.

It is heartening to note that there appears to be an increasing interest in prevention of mental ill health and mental health promotion. It is vital that these issues are taken up at both undergraduate and postgraduate levels. The present volume, with its array of topics and authors, will provide a further platform for ongoing discussion and debate but, more importantly, will contribute to practical advice which mental health professionals across disciplines will find helpful.

Dinesh Bhugra CBEPhD FRCPsychProfessor of Mental Health and Cultural Diversity Health Service and Population Research Department Institute of Psychiatry, King's College London London, UK

IThe Rationale for Early Intervention in Nearly Everything

CHAPTER 1Introduction

Peter Byrne1,2 and Alan Rosen3,4,5

1 Homerton University Hospital, London

2 Royal College of Psychiatrists, UK

3 School of Public Health, University of Wollongong

4 Brain and Mind Research Institute, University of Sydney

5 Mental Health Commission of New South Wales, Australia

Early intervention (EI) is arguably the single most important advance in mental health care of the past decade. In terms of all-time advances in mental health care delivery, EI is up there with the consumer, family, recovery, and human rights for psychiatric disability movements, person-centred and holistic integrated services, effective psychotropic medications and psychotherapeutic interventions, evidence-based psychosocial interventions and mobile assertive community-centred service delivery systems. EI represents a key shift in both theoretical standpoint and service delivery, and marks an end to the first era of community psychiatry – where we set up ‘accessible’ clinical structures by locality, and patients were expected to adapt to these. With EI, practitioners reconfigure how they work to engage, negotiate and agree interventions support and care with their service users. From a general practitioner (GP) perspective, some modern community mental health teams (CMHTs) have ‘raised the bar’ to focus only on those with severe mental illness (SMI), now implicitly or formally defined as established psychotic disorders. Many CMHTs decline people in crisis or in the early stages of illness: by the time their referral is accepted later on, engagement is harder and many interventions have a reduced efficacy. Like all useful ideas, EI is a simple one and has instant appeal to people in early stages of illness (crucially often insight is lost) and to their families. Key clinicians, notably GPs and mental health professionals also have a strong self-interest in designing and supporting efficient EI services. It is both self-evident to them, and increasingly evident from emerging studies, that such timely approaches could save much harder and longer clinical endeavour further down the track. We list the key pioneers later (Chapter 27), many of whom have contributed to this book. Their work, along with impressive citations at the end of each chapter, should persuade readers new to EI that this will be a key component of the twenty-first century mental health care. This book's main aim is to affirm for every clinician, every purchaser of services and other interested parties the high value of EI in most care settings from cradle to grave.