University of Oulu

Maj, M., van Os, J., De Hert, M., Gaebel, W., Galderisi, S., Green, M.F., Guloksuz, S., Harvey, P.D., Jones, P.B., Malaspina, D., McGorry, P., Miettunen, J., Murray, R.M., Nuechterlein, K.H., Peralta, V., Thornicroft, G., van Winkel, R. and Ventura, J. (2021), The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry, 20: 4-33. https://doi.org/10.1002/wps.20809

The clinical characterization of the patient with primary psychosis aimed at personalization of management

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Author: Maj, Mario1; van Os, Jim2,3,4; De Hert, Marc5,6;
Organizations: 1Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
2Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
3Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
4Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
5University Psychiatric Centre KU Leuven, Kortenberg, Belgium
6Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
7Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, LVR-Klinikum Düsseldorf, and WHO Collaborating Center on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
8Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
9Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
10Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
11Department of Psychiatry, University of Cambridge and Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
12Department of Psychiatry and Neuroscience, Ichan Medical School at Mount Sinai, New York, NY, USA
13Orygen, Parkville, VIC, Australia
14Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
15Centre for Life Course Health Research, University of Oulu, Oulu, Finland
16Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
17Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine, and Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
18Mental Health Department, Servicio Navarro de Salud, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
19Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
20University Psychiatric Center KU Leuven, Leuven, Belgium
21Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2021121560636
Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2022-01-12
Description:

Abstract

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica­tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves “recovery-oriented”, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient’s needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.

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Series: World psychiatry
ISSN: 1723-8617
ISSN-E: 2051-5545
ISSN-L: 1723-8617
Volume: 20
Issue: 1
Pages: 4 - 33
DOI: 10.1002/wps.20809
OADOI: https://oadoi.org/10.1002/wps.20809
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Subjects:
Copyright information: © 2021 World Psychiatric Association. This is the peer reviewed version of the following article: Maj, M., van Os, J., De Hert, M., Gaebel, W., Galderisi, S., Green, M.F., Guloksuz, S., Harvey, P.D., Jones, P.B., Malaspina, D., McGorry, P., Miettunen, J., Murray, R.M., Nuechterlein, K.H., Peralta, V., Thornicroft, G., van Winkel, R. and Ventura, J. (2021), The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry, 20: 4-33, which has been published in final form at https://doi.org/10.1002/wps.20809. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.