Exploring Early Intervention in Psychosis

Chapter 1

Introduction

My determination to explore the effects of mental health and wellbeing of treating first episode psychosis with early intervention psychological therapy in adults started when I was 20 years old in Nigeria. I took care of my relatives who suffered from psychosis after he lost his job. During this period, my relative was having marital problems with his wife which later led to their separation. He was experiencing a lot of simultaneous difficulties in his life and he was unable to cope with these which lead to the deterioration of his mental health. He was diagnosed by psychiatrists as psychotic, seeing things and hearing voices that other people could not see or hear. During this period, I had little or no knowledge of what mental health problems are. Coming from Africa, where it was a believed that people with mental health problems offended the gods and as such mental health disorder are a kind of punishment (Kishore et al., 2011), while others believed that it was self-inflicted due to lifestyle choices such as drug and alcohol use (Kishore et al., 2011). I supported my relative during the period when he was admitted in a psychiatric hospital. The experience opened my eyes to the world of mental health and illness and the need to care and nurture vulnerable people who are mentally unwell, this motivated me to explore this issue of using a narrative literature review. Although, the use of antipsychotic medication is effective for the treatment of psychosis, especially in the first episode psychosis (FEP) cases and it appears to suppress psychotic disorders symptoms and prevent it it from recurring. (National Institute of Health Psychopharmacology Service Centre Collaborative Study Group, 1964). Antipsychotic medication has been shown to improve cognitive performance in first episode psychosis (Keefe et al., 2004). However, the negative impact of medical treatment for FEP presents numerous concerns about patient well-being due to medication related factors, patient related factors and environmental factors (Fento et al., 1999). Shiers et al., (2015) stated that medical treatment has an impact on mortality and morbidity to patients with first FEP. This exploration may also benefit from insights provided by healthcare dissertation help.

That is why the National Institute for Health Care Excellence (NICE) and other health organisations pay attention to make sure patients recuperate to gain a good quality of life and well-being (National Collaborating Centre for Mental Health, 2016; Garety, et al., 2006; Craig et al., 2004). Upon the attention, in recent research work, early intervention psychological therapy has been measured due to its effects on patients FEP well-being (Knapp et al., 2013; Bertelsen et al., 2008). However, the negative effect causes important deterioration in existing symptoms (Barlow D, 2010). The narrative literature review explores the effects on mental health and well-being of treating First episode psychosis with early intervention psychological therapy in adults in the UK, before considering the background which explains the causes and the incidence of FEP. Further, the aim and objectives of the research, statement of the problem, research questions, rationale and research methods (Quantitative and Qualitative). The methods segment includes, study design, collection of data, analysis and interpretation of data. An in-depth understanding pertaining to the topic will be presented in a way of findings and would be discussed then . Finally, the research will make some recommendations and outline implications for future research which could be noticed as gap in literature and conclusions.

Background

FEP refers to when an individual first experience signs of starting to lose contact with reality leaving the individual confused and distressing for a short period of time (Kirch and Holland, 2018). In the United Kingdom, there is evidence that drug misuse, environment and social act as a causing factor to FEP and, in fact, a reduction in drug abuse after diagnosis has been linked with the depletion in FEP (Crebbin, et al., 2008). Over the past decade, the British government has supported developing Early Intervention in psychosis as an essential aspect of standard Mental Health services all over the country (Pelosi & Birchwood, 2003). The purpose is to provide effective and prompt treatment to individuals under the age of 36 years. In addition, the National Institute for Health and Care Excellence and other guidelines approved the use of psychological therapies for FEP for patients’ recovery (Schizophrenia commission 2012; Nice 2014).

Several studies have proven that the combination of medical and psychological treatments for FEP are linked with improved social functioning and well-being, reduced periods of untreated psychosis, reduced time spent in the hospital, decreased self-harm behaviours, improved cognitive functioning and decreased levels of satisfaction with treatment (Addington et al., 2003; Malla et al., 2001a; Malla et al., 2001b). A similar view by Young, et al., (2003) emphasises that these multielement of treatment and specialised first episode services results in higher-level of outcomes.

Early intervention

Early intervention is defined as an avenue to improve long and short-term outcomes by reducing the period of psychosis which could have not been treated, thereby protecting social support navigations, involving families into care and providing prompt and psychological and pharmacological treatment (Neale & Kinnair 2017). Peer reviewed journal articles published from 2009 to 2019 will be used because of what happen in England over the past ten years in the economic perceptive of early intervention in psychosis. The UK reforms were thoughtfully evaluated and were shown to be highly cost effective in mental health services treatment (Macron et al., 2010) and there have been extensive reduction to mental health services in England. The 2009 reform shows the maximum evidence of early intervention services to minimise the amount which have been spent which resulted in the adoption of numerous early intervention services into the system of generic care (McGorry, 2015). Which particularly led the UK government to invest again modestly in early intervention and to consider a comprehensive mental health strategy in some areas in England (McGorry, 2015).

Psychological intervention

Psychological therapy is defined as an intention of improving biopsychosocial functioning and delivered through a therapeutically structured relationship (Pale and shapiro, 2001). Similarly, psychological therapy is the most common use for treatment for mental disorders, most frequent application of psychotherapy have a greater direct focus on a person’s social environment in interaction with their psychological functioning (Thompson et al., 2008).

Statement of the problem

I defined the problem as a rising concern of integrating medical treatments to psychological treatments to address the different challenges which patients with first episode psychosis experienced (Peen,et al., 2005), on the basis of not only my personal experience but the literature search gap because I believe that there is a need for undertaking of further work on the effects of mental health and well-being on treating first episode psychosis with early intervention psychological therapy in adults in the UK. According to World Health Organisation (WHO, 2018), about 23 million people are affected with psychosis including Schizophrenia. In the United Kingdom, it is estimated that the incidence of psychosis is 31.7 per 100,000 people possibly resulted from risks factors (James, et al., 2012). Also, it is estimated that the cost of psychosis to the society is £11.8 billion per annual (NICE 2014).

Aim

The aim of this narrative literature review is to explore the effects on mental health and wellbeing of treating first episode psychosis with early intervention psychological therapy in adults in UK.

Objective

To identify the effects of psychological therapy on mental health and well-being on patients with FEP.

Rationale of Research

The purpose of this study is to review existing literature on the effects on mental health and well-being of treating first episode psychosis with early psychological therapy in adults in UK

Research Question (RQ1)

What are the effects on mental health and wellbeing of psychological therapy delivered early in first episode psychosis, for adults in the UK?

Research Question (RQ2)

How do these effects compare with the results of treatment using anti-psychotic medication?

Chapter 2

Study design

Search for literature was conducted using electronic database for quantitative and qualitative primary studies. This study design is a narrative literature review which is a critical comprehensive and objective analysis of the present knowledge on the selected topic (Onwuegbuzie & frels, 2016). It is mainly descriptive, meaning it is highly likely to contain quantitative and qualitative analysis and cover the content in a relatively general way and does not get involved in a systematic search of the literature (Green et al., 2006). Narrative review tends to include element of selection biases and count more on expert opinion rather than clinical evidence. The motive of a narrative literature review is to report the current knowledge on a topic and base the summary on previously published research in a way that is not influenced by personal feelings (Helewa and Walker, 2000).

Method

This chapter will explain in details the chosen study which include the rationale for selection and the process involved in this review including sources of data, extraction of data, inclusion and exclusion criteria, keywords, analysis, data interpretation, quality assessments, quality appraisal, critical appraisal checklist and search results. This section refers to systematic approach where I answered my well-focused questions (Cronin, et al., 2018). A Systematic approach states that the time frame in which the literature was selected should be detailed (Parahoo, 2006).

Search strategy / Data collection methods

Data used for this study were obtained from electronic databases of websites; EBSCOhost, PubMed and Google Scholar. The electronic database search involved references and citations from reviews of important research articles and studies. Keywords used in the Boolean search operator and facet analysis method are; AND, OR, and NOT to generate a broad and narrow search. Faceted search strategy is designed to be used in accessing information to explore a collection with multiple filters which could be accessed and ordered in multiple ways. It can be a several defined attributes such as data, tittle, keyword, size and so on. The benefits of this is that search results are more useful and easier to find data and eliminate unnecessary results indexing. The weakness of facet method lacks empirical basis and look to be a problematic assumption (Hjorland, 2013).

Out of the 382 articles selected for review, 363 went full abstract screening, 19 went through full articles and 14 were selected for inclusion criteria for literature review study in Prisma table Appendix 4.

Inclusion criteria

Inclusion criteria are characteristics of the subject which must qualify for the study. Inclusion criteria were peer reviewed journal articles written in English language, published with the range date between the year 2009 and 2019, and must include evidence of subjects who could be adult with the age range of 18 above. Studies which focus on first episode psychosis, schizophrenia, psychological therapy and medical treatment and which are based in the UK were included.

Exclusion

Exclusion criteria are the characteristics that disqualify the subject. Articles that were not published in English, do not have the keywords and were not published between ten years from 2009 to 2019 were not considered. Studies which had been not written and published in English language because the author does not speak English language, were not accepted.

Keywords

Selected keywords of the articles are Psychological therapy, adults, first episode psychosis, antipsychotic medication, well-being and UK.

Data analysis

All the data analysis carried out considered all searched literature into paragraphs of information and every single research question in accordance of common themes and findings.

Data interpretation

Data interpretation is the post data analysis phase of the findings in the discussion part to agree or disagree with the research questions. The reviewer reads to study in context of the findings, provides ways for further research and provide suggestions for the field of study (Onwuegbuzie &Frels, 2016)

Quality assessment

The critical appraisal skills programme (CASP) in this study used is the assessment of methodological quality, this is the quality with which a research study was undertaken (CASP, 2017). According to Singh (2013), CASP is a promulgated and a systematic process to identify the strengths and weakness of a research study.

Quality appraisal

A quality appraisal was conducted on every single article identified which improved the researcher’s understanding of the articles, it’s weakness, strengths and relevance. Out of the 14 research articles selected, 11 articles were from (RQ1), 6 studies were quantitative method and 5 were qualitative method based studies. Out of 3 articles for (RQ2), 2 articles were qualitative and 1 quantitative study. All qualitative and quantitative studies were screened using questions in Appendix 1 in Table 1 and a score was stated to each of the question. The results of all literature quality appraisals are in Appendix 3 and 4.

Search results

Out of the 382 articles from EBSChost, PubMed and Google Scholar, initial searches of studies In Appendix 3 shows the initial search strategy for literature selection to answer (RQ1) which contained 363 abstracts while, Appendix 4 shows 19 for literature selection for (RQ2). Appendix 5 is a summary of articles selected for (RQ1) on psychological therapy for first -episode psychosis. Appendix 6 is the break down search results for (RQ2) on the effect of treatment using antipsychotic medication. However, this search resulted in identification of 14 articles which were applicable to this literature review study, mostly because they met the search criteria and answered the research questions of the study. PRISMA diagram illustrated how articles met search criteria based on inclusion criteria in Appendix 2.

Chapter 3

Research question 1 sought to understand if using psychological therapy could have early effect on the first episode psychosis in adults. The following themes from the research studies were:

Concerning the effects of psychological therapy, Bechdolf et al., (2012) explore preventing progression to first episode psychosis in early initial prodromal states. This randomised controlled trial showed that integrated psychological intervention improves the quality of therapies to enhance patient`s well-being at the onset of the illness. Concerning the prevention of progression, numerous studies report that the use of checklist improves patients` well-being in FEPs more than patient in later stage of the illness. Also, majority of the participants in the research confirmed at the end of the treatment that interventions in the EIPS prevent psychosis due to the safety of it because it does not produce unpleasant side effects. Although, Bechdolf et al., (2012) did not detailed their research question but the research results and topic clearly specify the intention that the study design was analytic because it used 12 months randomised controlled trial in a sample of 128 participant and the findings of the study was generalised.

Similarly, Goldsmith, et al., (2015) conducted a research study that examined psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance in a randomised controlled trial. The overall findings revealed that a good therapeutic alliance caused improvement to patient’s well-being and reduced positive symptoms also, it helps in reducing wrong positive symptoms. However, it states that lack of good relationship between the clients and therapists has a detrimental effect. Goldsmiths et al., (2015) identified a lot of efficacies of psychological therapy for early psychosis. Hence the findings showed a strong fact that therapeutic alliance was a popular casual factor contributing to the outcome of patients undertaking treatment of therapies. Although, the findings of the study do not represent the general therapies. The study design included a large sample of 308 participants with a frequent follow up rate. Therefore, the study was reliable. Ethical approval was secured from relevant institutional committees because the research involved human experimentation. Additionally, participants were self-confident of the confidentiality of their personal information. However, RCTs seems not to be appropriate specifically since the research was not a pharmacological trial. In addition, Lecomte et al., (2014), explore the understanding process in group behaviour therapy for psychosis in United Kingdom. This study finds out that psychological therapy improved patients` functioning and well-being in terms of coping and feeling to what lead to the illness, support the patients ` to be more confident in overcoming obstacles, dealing with stress and symptoms. They state emphatically that psychological therapy enables the patients` to change their behaviour and seek alternatives for belief.

It is possible to reach an agreement that this research is a representative of other researches as well. In the first place, it states that psychological therapy (CBT) has shown to be effective in reducing symptoms. It has been well-known that truths outcome from an accumulation of fact beyond any uncertainty. Therefore, the study can be qualified as a representative. An analytic research design was used by the researcher. In the introduction, the researchers state that their main objectives were to investigate the process of psychological effects during and again at post treatment phases. By implication, the study design was a longitudinal study and since the intervention was presented to the public, it has become an observational research because a longitudinal study is an observational research. Additionally, the outcomes were determined after the intervention.

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