Early Intervention in Psychiatry最新文献

{"title":"Harmony at last: Overcoming arbitrary variation in clinical high risk (CHR) for psychosis assessment","authors":"Patrick McGorry, Lisa Phillips","doi":"10.1111/eip.13492","DOIUrl":"https://doi.org/10.1111/eip.13492","url":null,"abstract":"<p>The concept of the prodrome, imported from the infectious disease field, was a hallmark of the deterministic and pessimistic mindsets that had characterized the field of schizophrenia since the time of Kraepelin. It was a clinical perspective dependent on the benefit of hindsight and hence reinforced the illusion of inevitability of onset and deterioration in people ‘destined’ to develop schizophrenia. In the early 1990s, the emergence of the early psychosis paradigm challenged this sense of destiny and inevitability and shifted the clinical gaze from hindsight to foresight and future. In the context of implementing the EPPIC program (McGorry, <span>1993</span>; McGorry et al., <span>1996</span>) and greatly reduced treatment delay, our formulation of the ‘at risk mental state’ or ‘ARMS’ (McGorry & Singh, <span>1995</span>) and subsequently the more specific and operationally defined Ultra High Risk (UHR) state (Yung & McGorry, <span>1996</span>) transformed the field of schizophrenia and psychosis research and, subsequently, systems of clinical care. This prototypical approach has also evolved into a transdiagnostic clinical staging model, which is adding heuristic value to research and clinical care, particularly in young people with emerging mental disorders (McGorry & Hickie, <span>2019</span>).</p><p>The operational definition of this initial stage of psychotic illness and the development of assessment instruments to measure and monitor this have been outlined in Addington et al. (<span>2024</span>). A seminal event in this process was the visit of Dr Thomas McGlashan to Melbourne in 1994 to the PACE clinic in Melbourne where he was exposed to the development of the Comprehensive Assessment of At Risk Mental States (CAARMS) by Yung et al. (<span>2005</span>). He successfully introduced these new ideas into North American psychiatry and, with colleagues Scott Woods and Tandy Miller, developed a very similar set of criteria and instruments (the Structured Interview for Psychosis-Risk Syndromes (SIPS) (McGlashan et al., <span>2010</span>) and Scale of Psychosis-risk Symptoms (SOPS)) (Miller et al., <span>2002</span>; Miller et al., <span>2003</span>). These evolved to align more closely with the North American ecosystem, being influenced by the DSM system and the structure of the Positive and Negative Symptom Scale (Kay et al., <span>1987</span>). The CAARMS by contrast was more agnostic to standard classification systems such as the DSM and ICD and more empirical. This all resulted in a modest yet potentially significant divergence in some areas, which are covered in the papers in this special issue. Terminology shifted as well with North America adopting the term ‘clinical high risk’ (CHR) rather than ‘ultra high risk’ for this stage of illness and two sets of instruments became embedded with North America broadly going with the SIPS and Australia, Asia and Europe mostly sticking with the CAARMS. Generally speaking, this has no","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 4","pages":"288-289"},"PeriodicalIF":2.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.13492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140537921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the PSYCHS: Positive SYmptoms and diagnostic criteria for the CAARMS Harmonized with the SIPS","authors":"Will Carpenter","doi":"10.1111/eip.13479","DOIUrl":"https://doi.org/10.1111/eip.13479","url":null,"abstract":"","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 4","pages":"283"},"PeriodicalIF":2.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140537602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does recency of prodromal symptom onset or worsening matter for psychosis prediction?","authors":"Tyrone D. Cannon","doi":"10.1111/eip.13459","DOIUrl":"https://doi.org/10.1111/eip.13459","url":null,"abstract":"","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 4","pages":"273-274"},"PeriodicalIF":2.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140537924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a family history of mental disorders on the characteristics of patients with early psychosis","authors":"Barbara Pöthe,&nbsp;Philippe Conus,&nbsp;Philippe Golay","doi":"10.1111/eip.13525","DOIUrl":"10.1111/eip.13525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Children of parents with psychiatric illness have a higher risk of developing psychiatric disorders. This is particularly the case for psychoses and the evolution of these disorders could likely differ. The aim of this study was to study the impact of a first-degree and second-degree family history of psychiatric disorders (FHPD) on the characteristics of patients with early psychosis in a specialized programme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This research is a prospective study based on 408 patients aged 18–35 years enrolled in the Treatment and Early Intervention in Psychosis Program (TIPP) with a three-years follow-up. Various characteristics were compared between patients with first-degree-FHPD and those without, then between patients with 2nd degree-FHPD and those without. The influence of the number of parents with first or second degree FHPD on clinical characteristics was also studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our results showed an influence of FHPD on the characteristics of patients presenting a first episode of psychosis. Over the 3 years of follow-up, patients with at least one second-degree relative showed more negative and depressive symptoms and poorer general functioning than patient who did not. The number of parents with first or second degree FHPD was also negatively associated with several clinical variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results of this study confirm the existence of a distinct premorbid profile and a different evolution in patients with FHPD, which is not limited to first-degree relatives. This suggests the importance of specific needs that should be addressed during treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 10","pages":"848-858"},"PeriodicalIF":2.1,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.13525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140594235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing brief video interventions to reduce public and self-stigma: Randomized control trial","authors":"Doron Amsalem,&nbsp;Samantha E. Jankowski,&nbsp;John C. Markowitz,&nbsp;T. Scott Stroup,&nbsp;Lisa B. Dixon,&nbsp;Leah G. Pope","doi":"10.1111/eip.13524","DOIUrl":"10.1111/eip.13524","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Stigma is a major mental healthcare barrier. This study compares the efficacy of two types of brief video interventions, targeting public and self-stigma, in reducing public stigma towards people living with psychosis. We hypothesized both interventions would similarly reduce public stigma and outperform the control group. As a secondary analysis, we explored the effect of familiarity with a person living with serious mental illness (SMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants (<i>N</i> = 1215) aged 18–35 recruited through crowdsourcing were assessed pre- and post-intervention and at 30-day follow-up regarding five public stigma domains: social distance, stereotyping, separateness, social restriction and perceived recovery. Both videos present individual narratives using different approaches: the self-stigma video was created through focus groups, while the public stigma video portrays a single person's journey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A 3 × 3 analysis of variance (ANOVA) revealed a significant group-by-time interaction across all five stigma-related domains (<i>p</i>'s &lt; .001). Effect sizes (Cohen's <i>d</i>) ranged from 0.29 to 0.52 (baseline to post-intervention), and 0.18 to 0.45 (baseline to 30-day follow-up). The two video interventions did not significantly differ. Linear mixed modelling showed a significant difference between participants familiar and unfamiliar with people living with SMI for the public stigma video, with greater stigma reductions for unfamiliar participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study corroborates previous findings on the positive influence of social contact-based interventions on youth mental health perceptions. Results provide insights into the relationship between public and self-stigma and the impact that familiarity with SMI may have on the efficacy of stigma reduction efforts further validation in diverse groups is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 10","pages":"839-847"},"PeriodicalIF":2.1,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140594283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using implementation science to operate as a learning health system to improve outcomes in early psychosis","authors":"Bo Kim,&nbsp;Margaret Guyer,&nbsp;Matcheri Keshavan","doi":"10.1111/eip.13496","DOIUrl":"10.1111/eip.13496","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Early interventions are well understood to improve psychosis outcomes, but their successful implementation remains limited. This article introduces a three-step roadmap for advancing the implementation of evidence-based practices to operate as a learning health system, which can be applied to early interventions for psychosis and is intended for an audience that is relatively new to systematic approaches to implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The roadmap is grounded in implementation science, which specializes in methods to promote routine use of evidence-based innovations. The roadmap draws on learning health system principles that call for commitment of leadership, application of evidence, examination of care experiences, and study of health outcomes. Examples are discussed for each roadmap step, emphasizing both data- and stakeholder-related considerations applicable throughout the roadmap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early psychosis care is a promising topic through which to discuss the critical need to move evidence into practice. Despite remarkable advances in early psychosis interventions, population-level impact of those interventions is yet to be realized. By providing an introduction to how implementation science principles can be operationalized in a learning health system and sharing examples from early psychosis care, this article prompts inclusion of a wider audience in essential discourse on the role that implementation science can play for moving evidence into practice for other realms of psychiatric care as well. To this end, the proposed roadmap can serve as a conceptual guiding template and framework through which various psychiatric services can methodically pursue timely implementation of evidence-based interventions for higher quality care and improved outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 5","pages":"374-380"},"PeriodicalIF":2.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"soulspace: Integrated youth mental health care in Berlin, Germany—An introduction to the program and a description of its users","authors":"Andreas Bechdolf,&nbsp;Sinah Hanser,&nbsp;Johanna Baumgardt,&nbsp;Annette Brose,&nbsp;Dorothea Jäckel,&nbsp;Sophia Döring,&nbsp;Laura Holzner,&nbsp;Navid Aliakbari,&nbsp;Laura von Hardenberg,&nbsp;Olga Shmuilovich,&nbsp;Dilek Gencaggi,&nbsp;Mario Schellong,&nbsp;Yonca Izat,&nbsp;Stephanie Leopold,&nbsp;Begoña Petuya Ituarte,&nbsp;Karolina Leopold","doi":"10.1111/eip.13522","DOIUrl":"10.1111/eip.13522","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe <i>soulspace</i> as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We introduce <i>soulspace</i> as easily accessible mental health care for young people, and we characterize <i>soulspace</i> along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). <i>Soulspace</i> is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community-based counselling service. It provides initial contact, counselling, diagnostics, and treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analyses of the pathways to <i>soulspace</i> and the characteristics of the <i>soulspace</i> users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth-facing counselling service as was done in <i>soulspace</i> seems to have reduced the threshold to seek help for families and for young people in need for support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In summary, with <i>soulspace</i>, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 7","pages":"571-577"},"PeriodicalIF":2.1,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.13522","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting the early recognition inventory ERIraos to Estonian: A validation study","authors":"Kairit Sirts,&nbsp;Kätlin Anni,&nbsp;Roman Balõtšev,&nbsp;Siim Jakobsoo,&nbsp;Kirti-Ly Jaanson,&nbsp;Liina Haring","doi":"10.1111/eip.13519","DOIUrl":"10.1111/eip.13519","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Validated assessment tools are needed to identify clinically high risk for psychosis. This study aimed to validate the early recognition inventory ERIraos, which consists of the ERIraos Checklist for risk screening and the ERIraos Symptom List for a more thorough risk assessment in the Estonian language to detect psychotic prodromal symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cohort study provided an opportunity to evaluate the characteristics of the ERIraos instrument in predicting the increased risk of a psychotic disorder in the future. The 177 study participants, aged 13–42 years old, were divided into groups without an increased risk and three risk groups with different risk severity levels based on the ERIraos Symptom List assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results indicated excellent inter-rater reliability for the ERIraos Symptom List total score. The ability of the ERIraos checklist to screen persons with an elevated psychosis risk was very good (ROC-AUC = 0.86). The capability of the ERIraos Symptom List scores to predict the probability of transitioning to psychosis within 2 years was very good (ROC-AUC = 0.83). Brief limited intermittent psychotic symptoms and observable behavioural and affective symptoms were statistically significant predictors of transition to psychosis. There were strong and statistically significant correlations between the ERIraos Symptom List scores and other clinical measures assessing functioning and psychopathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results of this study demonstrate the reliability and validity of the Estonian version of the ERIraos instrument and support the usability of ERIraos as a two-step tool for the early recognition of psychosis risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 10","pages":"828-838"},"PeriodicalIF":2.1,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Italian version of the 16-item Prodromal Questionnaire (PQ-16) and its psychometric features in help-seeking ultra-high-risk subjects and in the general population","authors":"Alberto Parabiaghi,&nbsp;Alessandro Alberto Rossi,&nbsp;Anna Castelnovo,&nbsp;Lorenzo del Fabro,&nbsp;Stefania Mannarini,&nbsp;Mauro Emilio Percudani,&nbsp;for the CCM2013 Project team (corporate authorship)","doi":"10.1111/eip.13516","DOIUrl":"10.1111/eip.13516","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Increasing attention to the early stages of psychosis and the identification of symptomatic prodromal states have led to the development of a growing number of screening tools. The 16-item version of the Prodromal Questionnaire (PQ-16) is a worldwide used self-administered tool for this purpose. However, to date, fundamental psychometric properties of PQ-16 were not thoroughly investigated. This study aimed to examine the structural validity, measurement invariance, reliability and other psychometrical properties of the Italian version of the PQ-16 (iPQ-16) in help-seeking individuals and in the general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The iPQ-16 was administered to 449 young outpatients attending six community mental health services and to 318 control participants enrolled in educational environment. Confirmatory factor analyses (CFAs), measurement invariance (MI) between the help-seeking group and the general population sample, convergent validity, test–retest reliability, internal consistency, and prevalence analyses were performed. Lastly, the validity of the adopted PQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses was also tested.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CFAs confirmed the single-factor structure for the iPQ-16 and scalar MI was reached. The iPQ-16 showed high internal consistency, test–retest reliability, convergent validity, and acceptable diagnostic accuracy. ROC analysis suggested a score of ≥4 as best cut-off.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The iPQ-16 represents a valid and reliable questionnaire for the assessment of high mental risk in both Italian outpatients and general student population. It has good psychometric properties and is easy to implement as UHR screening for clinical as well as research purposes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 10","pages":"814-827"},"PeriodicalIF":2.1,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eip.13516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139905345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural barriers to help-seeking in first-episode psychosis: A systematic review and thematic synthesis","authors":"Chiara Causier,&nbsp;Felicity Waite,&nbsp;Nithura Sivarajah,&nbsp;Matthew T. D. Knight","doi":"10.1111/eip.13497","DOIUrl":"10.1111/eip.13497","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Access to timely treatment is key to early intervention in psychosis. Despite this, barriers to treatment exist. In this review, we aimed to understand the structural barriers that patients and caregivers face in help-seeking for first-episode psychosis, and the recommendations provided to address these.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review (PROSPERO: CRD42021274609) of qualitative studies reporting structural barriers to help-seeking from the patient or caregiver perspective. Searches were performed in September 2023, restricted to studies published from 2001. Study quality was appraised using Critical Appraisal Skills Programme. Data were analysed using thematic synthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nineteen papers from 11 countries were included. Across all papers, participants reported experiencing structural barriers to receiving healthcare. For many patients and caregivers, the process of accessing healthcare is complex. Access requires knowledge and resources from parents, caregivers and healthcare providers, yet too often there is a misalignment between patients' needs and service resources. Expertise amongst healthcare providers vary and some patients and caregivers experience negative encounters in healthcare. Patients highlighted earlier caregiver involvement and greater peer support as potential routes for improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients and caregivers face multiple structural barriers, with legislative practices that discourage family involvement, and healthcare and transport costs found to be particularly problematic. Understanding these barriers can facilitate the co-design of both new and existing services to provide easier access for patients and caregivers. Further research is needed focusing not only on the perspectives of patients and caregivers who have accessed professional help but also crucially on those who have not.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":"18 5","pages":"293-311"},"PeriodicalIF":2.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139734717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}