A Brief Literature Review of Racial Differences in Psychosis Interventions

Cameron Wu (1), Heather Thibeau (2), Emily He (3)

1. University of California, Santa Cruz
2. Boston Medical Center
3. Clark University

Abstract

Background: Psychosis research has had recent advances in understanding risk factors for psychosis development and treatment engagement issues (e.g. long duration of untreated psychosis). However, disparities between racial groups in psychosis treatment uptake and in disengagement have suggested inadequate support to minority groups. Therefore, examining how treatment occurs in other countries in a post-COVID world can yield more information on racial disparities and potential ways to provide more equitable treatment.

Method: Medical and psychology databases (e.g. PubMED, PsychINFO) were searched for peer-reviewed articles on psychosis treatment and care. Articles selected for review were recently published (2018-2022) and included analyses of social determinants (e.g. racial and ethnic minority status, immigrant generational status).

Results: The literature suggests that experience of adversity can moderate the relationship between immigrant generational status and psychosis treatment engagement. There were relatively few investigations of disparities by racial and ethnic minority status and immigrant generational status in U.S. samples. Disparities in race do appear to be less significant in certain countries, where healthcare is less privatized and thus, more equitable.

Conclusion: By engaging with institutions outside of Massachusetts in examining the causes of racial disparities in psychosis treatment disengagement, a more equitable early intervention program can be implemented into the Early Intervention Roadmap for Psychosis in Massachusetts, promoting further international collaboration in tackling the disparity in psychosis treatment amongst racial groups.

Brain morphometry points to emerging patterns of psychosis, depression, and anxiety vulnerability over a 2-year period in childhood

T. G. Vargas (1), V.A. Mittal (2)

1. Northwestern University Psychology Department, Evanston, IL
2. Northwestern University Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, and Institute for Innovations in Developmental Sciences, Evanston, IL

Abstract

Background: Gray matter morphometry studies have lent seminal insights into the etiology of mental illness. Existing research has primarily focused on adults and then, typically on a single disorder. Examining brain characteristics in late childhood, when the brain is preparing to undergo significant adolescent reorganization and various forms of serious psychopathology are just first emerging, may allow for a unique and highly important perspective of overlapping and unique pathogenesis.

Methods: A total of 8645 youth were recruited as part of the Adolescent Brain and Cognitive Development study. Magnetic resonance imaging scans were collected, and psychotic-like experiences (PLEs), depressive, and anxiety symptoms were assessed three times over a 2-year period. Cortical thickness, surface area, and subcortical volume were used to predict baseline symptomatology and symptom progression over time.

Results: Some features could possibly signal common vulnerability, predicting progression across forms of psychopathology (e.g. superior frontal and middle temporal regions). However, there was a specific predictive value for emerging PLEs (lateral occipital and precen- tral thickness), anxiety (parietal thickness/area and cingulate), and depression (e.g. parahip- pocampal and inferior temporal).

Conclusion: Findings indicate common and distinct patterns of vulnerability for varying forms of psychopathology are present during late childhood, before the adolescent reorganiza- tion, and have direct relevance for informing novel conceptual models along with early prevention and intervention efforts.

Gaps in Clinical Access for Individuals with a New Onset Psychotic Disorder: A Spatial Analysis

Shruti Bahukudumbi, Kelsey Johnson (MPH)

Abstract

Background: First episode psychosis (FEP), or the first time a person experiences a psychotic disorder, is a debilitating condition for which early intervention improves longer-term outcomes. Intervention within the first 2 to 5 years can limit the negative effects of psychotic symptoms, lower the risk of relapse, preserve psychosocial skills and facilitate a rapid recovery. 1,2 Many individuals face challenges in accessing psychosis specialty clinics and other mental health services because of out-of-pocket costs, transportation difficulties, lack of appointment availability, disparities in access to care, and social stigma. 3,4 This project utilizes data from the Massachusetts Psychosis Network for Early Treatment (MAPNET) program at Beth Israel Deaconess Medical Center to identify the extent of reach of psychosis specialty programs in Massachusetts. This study aims to (A) Identify the proximity of patients with new onset psychotic disorders to existing psychosis specialty clinics in order to locate gaps in treatment provision and (B) Identify the socio-economic breakdown of patients with new onset psychotic disorders to identify potential demographics that are being systematically under- served.

Methods: Deidentified data obtained was from 2016-2021, primarily from MASS.GOV, CENSUS tracts, and the MAPNET database. All categories were converted from point to vector data. Tabular data was geocoded using Zip Codes and XY coordinates. Dot-density maps were created to visualize the spatial spread of exist- ing psychosis-specialty programs in proximity with the population distribution in Massachusetts. Further maps are being created to depict the drive-time to psychosis-specialty programs, and locations of upcoming clinics.

Barriers and Facilitators to Work and School Motivation in First Episode Psychosis

Nicole R. DeTore, PhD. (1,2) Oyenike Balogun-Mwangi, PhD. (3) Miriam Tepper, MD. (4)
Corrine Cather, PhD. (1,2) Margaret Lanca, PhD. (2,5) Kim T. Mueser, PhD. (6,7) & Zlatka Russinova, PhD (6)

1. Department of Psychiatry, Massachusetts General Hospital
2. Department of Psychiatry, Harvard Medical School
3. Department of Psychology, Salve Regina University
4. Department of Psychiatry, Columbia University
5. Department of Psychiatry, Cambridge Health Alliance
6. Center for Psychiatric Rehabilitation, Boston University
7. Department of Occupational Therapy, Boston University

Abstract

Background: Despite targeted interventions, work and school outcomes in first episode psychosis (FEP) remain low, still often only reaching 50%. Amotivation has been identified as one of the strongest predictors of poor work or school functioning in FEP, with this lack of motivation often beginning immediately following illness onset. Motivation has been shown to be an essential aspect of work and school outcome and should therefore be an intervention target, though little is understood about the specific barriers and facilitators impacting motivation in those with FEP.

Method: A total of 40 participants were recruited from two FEP programs located in Boston, Massachusetts to complete a qualitative assessment. Inclusion criteria included 1) 18 years of age or older; and 2) diagnosis of a primary psychotic disorder within 5 years of onset. The qualitative interview utilized a guide consisting of open-ended questions covering: 1) plans for work or school; 2) how those plans have changed since diagnosis; 3) motivation enhancers; and 4) de-motivators. Notes were taken during each interview and all interviews were audio taped, then transcribed verbatim. Using a thematic analyzing approach, all transcripts were coded individually by three PhD level psychologists.

Results: Our findings revealed that participants were faced with several barriers that decreased their motivations for work and school including a) mental health symptoms; b) mental health treatment; c) awareness of functional limitations; and d) fear of relapse. Conversely, participants described several motivational facilitators for work and school: a) mental health symptoms; b) mental health treatment; and c) positive attitudes about mental health. Direct participant quotes accurately describe each domain.

Conclusion: These findings elucidate the underlying motivators and demotivators of those with FEP in concerns to returning to or continuing with work or school goals. This information is critical to the development and dissemination of interventions targeting functional outcome.

Adverse Life Events by Immigrant Generational Status in a FEP Sample in Massachusetts

Emily He (1), Heather Thibeau (2), Emily Kline (2,3), Matcheri Keshavan (4,5)

1. Clark University
2. Boston Medical Center
3. Boston University School of Medicine
4. Beth Israel Deaconess Medical Center
5. Harvard Medical School

Abstract

Background: There is a higher incidence of psychosis in first-and second-generation immigrants to countries with predominantly white/European populations, this might be linked to disproportionate exposure to childhood and adult adverse experiences. This suggests that immigrant generational status may be a proxy for difficult life circumstances which contribute to an individual’s psychosis vulnerability in addition to biological and heritable risk factors. Utilizing clinician written case reports of intake interviews may provide insight to difficult life experiences for individuals experiencing early psychosis.

Methods: Research staff coded (N=70) case reports collected for a longitudinal U.S. study on outpatient psychosis specialty care specifically recruited from Boston, MA First Episode Psychosis clinics. Twenty-eight parent themes were identified with additional subthemes. The themes reflect life events related to changes in mental health status/symptomatology, pathways to care, or adverse life experiences. Frequency of the themes was analyzed by immigration status (N=36 born in the USA, N=14 1st generation, N=20 2nd generation).

Results: Frequency analysis reveals that the top common theme among the entire sample was substance misuse (51.4%). When broken up into immigration status, different themes emerged and commonly endorsed themes occurred at different frequencies.

Discussion: Identifying adverse life experiences for individuals with early psychosis can provide insight into common stressors that can contribute to psychosis development and its treatment. Adverse life experiences may further impact engagement with care and timely treatment. Additionally, identifying variation in adverse life experiences by immigrant generational status can provide context for understanding disparities that disproportionately impact those belonging to minority groups.