While antipsychotic maintenance treatment effectively prevents relapse after a first psychotic episode, many remitted antipsychotic users wish to reduce or discontinue their medication, due to side effects, long‐term health concerns, stigma, or the desire to regain autonomy. Current guidelines suggest gradual tapering, but what the optimal speed of this tapering should be, especially in patients who remitted from a first psychotic episode, remains unclear. Furthermore, D2 receptor affinity of the antipsychotic drug may also affect relapse risk. This study examined relapse risk and time to relapse, within the first 18 months after remission from a first psychotic episode, in 227 individuals who tapered antipsychotic medication. Relapse was defined dichotomously using consensus criteria based on the Positive and Negative Syndrome Scale, hospitalization for psychosis, or explicit clinical judgement of the treating psychiatrist. Tapering speed (in olanzapine equivalents mg/day) was calculated as the difference of antipsychotic dose between the start and the end of tapering, divided by the number of days in between. Antipsychotics were classified into partial D2 agonists, or antagonists with low or high D2 affinity. Logistic and Cox proportional hazards regression analyses were controlled for age, sex, cannabis use, and duration of first psychotic episode, as well as for differences in clinical and sociodemographic characteristics between the three drug D2 affinity groups using inverse probability of treatment weighting. During the follow‐up period, 45.8% (N=104) of participants experienced a relapse after tapering. The average tapering speed was 10 mg olanzapine equivalents over 75 days, with an average tapering duration of 124 days (range: 6‐334 days). Logistic regression analysis showed that the tapering speed did not predict the risk of relapse (z=0.989, p=0.323). Compared with users of high D2 affinity antagonists (N=57), patients using low D2 affinity antagonists (N=116) and partial D2 agonists (N=54) had a lower risk of relapse (respectively, z=−2.104; odds ratio, OR=0.48, p=0.035; and z=−2.278, OR=0.44, p=0.023). Users of high D2 affinity antagonists had a shorter time between the end of tapering and relapse (mean: 280 days) than low D2 affinity antagonist users (mean: 351 days, p=0.027) and partial D2 agonist users (mean: 357 days, p=0.040). Thus, D2 receptor affinity of the antipsychotic was more important than tapering speed in predicting psychotic relapse risk in individuals remitted from a first psychotic episode. Users of high D2 affinity antipsychotics had an about twice higher risk of relapse than users of other types of antipsychotics. This higher risk of relapse after tapering should be regarded as a relevant factor when selecting an antipsychotic drug for people with a first psychotic episode. For patients using strong D2 antagonists after remission from a first psychotic episode, extra monitoring during tapering is required.
INTRODUCTION:This study aimed to evaluate effects of three machine learning based adjustments made to an eHealth intervention for mild alcohol use disorder, regarding (a) early dropout, (b) participation duration, and (c) success in reaching personal alcohol use goals. Additionally, we aimed to replicate earlier machine learning analyses. METHODS:We used three cohorts of observational log data from the Jellinek Digital Self-help intervention. First, a cohort before implementation of adjustments (T0; n = 320); second, a cohort after implementing two adjustments (i.e., sending daily emails in the first week and nudging participants towards a "no alcohol use" goal; T1; n = 146); third, a cohort comprising the prior adjustments complemented with eliminated time constraints to reaching further in the intervention (T2; n = 236). RESULTS:We found an increase in participants reaching further in the intervention, yet an increase in early dropout after implementing all adjustments. Moreover, we found that more participants aimed for a quit goal, whilst participation duration declined at T2. Intervention success increased, yet not significantly. Lastly, machine learning demonstrated reliability for outcome prediction in smaller datasets of an eHealth intervention. CONCLUSION:Strong correlates as indicated by machine learning analyses were found to affect goal setting and use of an eHealth program for alcohol use problems.
Mental healthcare for people with a severe mental illness (SMI) is increasingly being delivered in a deinstitutionalized setting. Community-dwelling, ambulatory care and support, and the associated treatment goals have implications for the roles and experiences of family members and close friends of people with an SMI. This study aims to provide a deeper understanding of what social network members of people with an SMI need to cope with the effects of the illness and possible caregiving responsibilities and remain involved. This qualitative study focusses on the perspectives of social network members of people with an SMI residing in independent or supported housing in an urban setting. Between 2020 and 2023, thirty adult family members, partners, and friends of people with an SMI were interviewed. We used reflexive thematic analysis to analyze the data, resulting in three themes of perceived needs and useful support. (1) Needs related to mental healthcare and support services to the person with an SMI. Quality care and support for the person with an SMI were a priority for participants. They specifically wanted more robust care and support concerning mental health crises, daytime activities and housing support. (2) Needs concerning the way mental healthcare and support services involve the social network. Participants wanted professionals providing care and support to the person with an SMI to structurally acknowledge the role, possibilities and limitations of the social network around that person. (3) Needs resulting from their relationship with a person with an SMI. Many participants wanted information and education about SMI and the care provision, improved interaction skills, financial and practical assistance, social and peer support, the opportunity to (temporarily) take a step back or psychological support for themselves. Creating a closer connection between the worlds of social network members and professionals is crucial. Social network members can experience a profound sense of loss and desperation as they navigate the complexities of being a family member, partner or friend of a person with an SMI. Recognizing how this desperation and deep-felt loss feed into the high hopes and expectations that social network members place on mental healthcare and support services, can help professionals in their interaction with social network members. This study underscores the importance of mental healthcare and support services in structurally extending its attention to social network members of people with an SMI. Considering the impact of the illness on social network members and acknowledging their needs and expectations, can contribute to social network members and professionals finding common ground, fostering a more sustainable support system around people with an SMI.
BACKGROUND:Evidence on psychological side effects (PSEs) of antipsychotic medication after remission from first-episode psychosis (FEP), and their momentary impact on daily life, is limited. This study examined how Dopamine-2 (D2) affinity and antipsychotic dosage relate to momentary PSEs. METHODS:This ecological momentary assessment (EMA) study included baseline data from 56 participants in the ongoing Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment (HAMLETT) trial. Momentary mental states indicative of reduced affect intensity, stability, and variability, as well as avolition and mental fatigue, were assessed 10×/day for eight days (N = 3,005 data points). Since these PSEs may result from D2-receptor actions, antipsychotics were classified by receptor affinity and mechanism of action. Multilevel mixed-effects regression models examined serial cross-sectional associations between D2 affinity or dosage and concurrent PSEs, both overall and separately for mornings, daytimes, and evenings. RESULTS:Higher antipsychotic dosages were associated with reduced affect variability (Beta [B] = -1.40 [95% confidence interval [CI]: -2.52; -0.29]) and decreased positive affect stability (B = 0.23 [95% CI: 0.04; 0.42]) and intensity (B = -1.11 [95% CI: -1.97; -0.24]). The latter was also associated with the use of high-affinity D2 antagonists versus partial D2 agonists (B = 12.98 [95% CI: 2.43; 23.53]) and versus low-affinity D2 antagonists (B = 10.04 [95% CI: 0.59; 19.49]). Other PSEs were not associated with D2 affinity/dosage. Results were relatively consistent across daytimes. CONCLUSIONS:Higher antipsychotic dosage and high-affinity D2 antagonists were associated with decreased positive affect after remission from FEP, which may partly drive the frequently reported blunting of emotional experience.
Service users with severe mental health conditions living in residential care homes or inpatient mental health rehabilitation units suffer from complex and long-term symptoms and disabilities. In order to develop effective novel interventions for this group, it is crucial to involve all stakeholders from the outset, focusing on acceptability and feasibility, adopting principles of co-production. Given the wish to implement recovery-oriented care, and the importance of identity for recovery, one would assume that life stories have an established place in the treatment of this group of service users. However, we observed that a focus on life stories was generally lacking, and stated the intention to improve practice. The aim of current manuscript is (1) to describe our experiences with co-producing a life story intervention and research proposal for people with severe mental health conditions living in inpatient mental health rehabilitation units and residential care homes; (2) to describe the designed intervention (A Shared Story) and the research proposal for the pilot study. By using the Circling Around Your Research methodology (CAYR), we strived for genuine co-production and countering power inequality. CAYR is a working methodology supporting researchers in developing a practice-based research proposal in co-production with stakeholders. We describe the development by co-production of the intervention A Shared Story and a research proposal for a pilot study, and reflect on our experiences. The primary aim of A Shared Story is to contribute to personal recovery by accompanying service users in reflecting on their life story. Our experiences with co-production using the CAYR method are unanimously positive. Our advice for project groups considering working with this or a similar methodology concern the necessity for exercises helping to create trust and equality, the importance of process arrangements on role distribution and on resolving disagreements, and the need for critical reflection on representation.
