PEPPNET Quarterly Newsletter /
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WINTER 2016 | Issue:No. 04
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In Their Own Words
Engagement Comics
The Felton Client Centered Outcomes Research (CCOR)’s goal is to develop materials that reflect the state-of-the-science but are also explicitly progressive, recovery-oriented and peer/client-centered. They have recently developed a series of “engagement comics” designed and produced by youth and peers to promote engagement with peer support and supported education/employment within early intervention programs. The comics can also help foster a better understanding of the experiences of youth experiencing symptoms of psychosis. You can find the comics here:
International Peer Listserv
In collaboration with colleagues Dina Tyler (Director of Peer & Family Support at Felton Institute PREP) and Sascha Altman DuBrul (Recovery Specialist and Trainer at OnTrackNY), Nev Jones (Research Director at the Felton Institute) recently announced the launch of a new discussion-oriented listserv for peers working in Coordinated Specialty Care/Early Intervention in Psychosis (EIP) settings. In this case, peer staff refers to staff who identify as peers regardless of their role. The goal is to provide a forum for resource and idea sharing and dialogue about the role of peer support in EIP services, and peer-to-peer support. The listserv is international in reach and expected to include peer members from Australia, Canada, the U.K and the U.S. To join the listserv, email Nev Jones at

Spotlight On

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Pathways Kickstart

By: Joseph Edwards, LMFT

Starting in 2010 in San Diego, and funded by the Mental Health Services Act, Pathways-Kickstart provides services designed to help prevent the onset of psychotic illness, or intervene early to improve prognoses for individuals and families struggling with psychosis. Kickstart first began serving communities in Central San Diego County, but has since been expanded to provide treatment to residents of San Diego County in its entirety. The treatment format under which Kickstart operates is the Portland Identification and Early Referral (PIER) model, developed by William McFarlane M.D. The constellation of therapeutic treatment and multidisciplinary services which PIER model programs provide are shown to be effective, with Kickstart being no exception. The outcome measures generated by the Kickstart program itself indicate significant benefit for participants and their families, both in terms of reducing symptom severity, and improving functioning in all areas of life.

As a PIER model program, Kickstart offers individual treatment planning for each participant, including family members and other support individuals in the participant’s life as integral collaborators in recovery. Kickstart reaches out to educate community members and mental health professionals about psychosis and psychosis-risk, and then offers 18-24 months of services to individuals ages 10-25 who are experiencing symptoms of high clinical risk for psychosis, or who have had a full psychotic break from reality within the last 6 months. Shortly after admission to Kickstart, participants and family members attend a 4 hour psychoeducation workshop that includes orientation to the program, introduction to the concept of psychotic mental illness, and training to begin managing symptoms immediately as a family. At the center of each treatment plan is participation in a Multiple Family Group, or MFG, where participants and their families support one another and work together in a structured problem solving process to improve participants’ cognitive processes and reduce stress in the family systems. Participants are also assigned a team of specialists led by a Clinician/Care coordinator to conduct individual and/or family therapy and direct services according to the treatment plan.

Program services may include any or all of the following: Education/Employment Support, Medication Management, Peer Support, Nursing Services, Occupational Therapy, and Case Management. These services can be provided in the participant’s home, school, or community setting. The Kickstart team is available 24 hours a day, and services are free for all individuals who are eligible. Eligibility is determined through in depth assessment, including the Structured Interview for Psychosis-Risk Syndromes. Nearly half of Kickstart’s culturally diverse staff are bilingual in English and Spanish, and the program is contracted with an interpreter service for families speaking other languages. This makes the Kickstart team well equipped to navigate the cultural diversity found throughout the communities of San Diego County.

Kickstart is currently providing services to over 150 clients/families, and is running 12 MFG’s both on and off site, in both English and Spanish. This is more MFGs than any one program has active in the country! As Kickstart continues to grow, it can help more and more people to prevent and manage mental illness, improve the quality of their lives, and keep hope alive. Learn more:

From the Research Front

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By: Melissa Yanovitch, MSc, MS

Predictors of relapse in patients with first-episode psychosis following discontinuation of antipsychotic medication
In a study examining the socio-demographic and clinical risk factors associated with risk of relapse after first-episode psychosis (FEP), researchers Di Capite, Upthegrove and Mallikarjum (2016) looked at the relationship between relapse and discontinuation of antipsychotic medication. The focus on medication discontinuation stems from both patient and clinician uncertainty surrounding the optimum duration for treatment with antipsychotics. The authors commented on patient reluctance to continue antipsychotic medication indefinitely, as well as mixed results from research in this area.

In the present study, relapse was defined as a return of symptoms following FEP, “requiring hospitalization, home treatment, or based on clinical team decision.” Participants were patients ages 16-35 in the Birmingham Early Intervention Service (EIS) between 2012 and 2015 with FEP. The research took place over a 12-month period and included 63 participants. All participants had documented discontinuation of antipsychotic medication. Results from the study found the 12-month relapse estimate to be 67%, and the median time to relapse to be 8 months.

Results of the study did not find relapse rate to be related to length of treatment with antipsychotic medication, indicating that longer duration of treatment with antipsychotic medication after FEP does not reduce risk of relapse in the case of discontinuation. The authors discussed how these results point to the need for closer follow-up of patients after discontinuation of antipsychotic medications to help identify relapse earlier. Finally, the study suggests that male patients with NEET (not being in education, employment or training) status and previous psychiatric hospitalizations should be considered as being at higher risk for relapse, and therefore continued treatment with antipsychotic medication may be indicated in these patients.

Di Capite, S., Upthegrove, R. & Mallikarjun, P. (2016). The relapse rate and predictors of relapse in patients with first-episode psychosis following discontinuation of antipsychotic medication. Early Intervention in Psychiatry, 9999, 1-7. DOI 10.1111/eip.12385

Caution Needed Around Long-Term Prophylactic Use of Antipsychotics
Murray, Quattrone, Natesan, van Os, Nordentoft, Howes, Di Forti, & Taylor (2016) looked at the research on long-term side effects of prophylactic use of antipsychotics after an acute episode of psychosis. First, the authors focused on potential effects on physical health and brain structures and found that results in these domains were variable depending on whether the medications are first-generation or second-generation antipsychotics. Second, they examined research on the long-term effectiveness of prophylactic antipsychotic medication. Similarly, they found mixed results in this area, but determined that there is little evidence for effectiveness in preventing relapse in patients with schizophrenia after 2 years. Third, they researched supersensitivity to dopamine D2 receptor that may result in decreased effectiveness of antipsychotics as a consequence of long-term use. They found some evidence to support this, but concluded that, at this point in time, results continue to be varied. The authors argue that this is an area for urgent future study using neurochemical imagining. Finally, the authors examined available research and determined that some patients diagnosed with treatment-resistant schizophrenia (TRS) do not show dopamine dysregulation and therefore the author emphasizes that these patients should not be prescribed D2 blockers.

In conclusion, the authors suggest that after treating acute symptoms of psychosis with the minimum effective dose, psychiatrists should reduce the long-term dose to the lowest that is effective at preventing symptoms. Along with treatment with antipsychotic medication, patients should have access to non-pharmacological treatment.

Murray, R. M., Quattrone, D., Natesan, S., van Os, Nordentoft, M., Howes, O, Di Forti, M. & Taylor, D. (2016). Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? The British Journal of Psychiatry, 209, 361-365. doi: 10.1192/bjp.bp.116.182683

In the News

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IMHRO Changes Name to One Mind Institute

IMHRO (One Mind Institute) has dropped the dba (doing business as) “IMHRO” and is now simply known as “One Mind Institute.” One Mind Institute’s vision is to rapidly reduce the burden of all brain disease worldwide, through open science and collaboration. Read more about this news here.

New Resources

The Substance Abuse and Mental Health Services Administration (SAMHSA) has sponsored the development of numerous resource materials and activities on addressing the needs of people experiencing a first episode of psychosis. Below is a listing of the available resources developed over the past two years.

CMHS-Sponsored Resources on the Set-Aside that were Released in 2015:
  • Resource Guide: Inventory and Environmental Scan of Evidence Based Practices for Treating Persons in Early Stages of Serious Mental Disorders (November 2015)
  • Guidance Manual: Peer Involvement and Leadership in Early Intervention in Psychosis Services
  • Fact Sheet: Building upon Existing Programs and Services to Meet the Needs of Persons with First Episode Psychosis
  • Fact Sheet: Implementation of Coordinated Specialty Services for First Episode Psychosis in Rural and Frontier Communities
  • Issue Brief: Supported Education for a Person Experiencing a First Episode of Psychosis
  • Information Guide: Steps and Decision Points in Starting an Early Psychosis Program
  • Web-Based Tutorial: Early Intervention in Psychosis: A Primer

CMHS Sponsored Resources that were Released in 2016:

  • Policy Brief: The Business Care for Coordinated Specialty Care for First Episode Psychosis
  • Toolkits: Supporting Full Inclusion of Students with Early Psychosis in Higher Education
    • Back to School Toolkit for Students and Families
    • Back to School Toolkit for Campus Staff & Administrators
  • Fact Sheet: Supporting Student Success in Higher Education
  • Web Based Course: A Family Primer on Psychosis
  • Brochures: Optimizing Medication Management for Persons who Experience a First Episode of Psychosis
    • Shared Decision Making for Antipsychotic Medications – Option Grid
    • Side Effect Profiles for Antipsychotic Medication
    • Some Basic Principles for Reducing Mental Health Medicine
  • Issue Brief: What Comes After Early Intervention?
  • Issue Brief: Age and Developmental Considerations in Early Psychosis
  • Information Guide : Snapshot of State Plans for Using the Community Mental Health Block Grant (MHBG) Ten Percent Set-Aside for Early Intervention Programs (as of September2016)
  • Information Guide: Use of Performance Measures in Early Intervention Programs
All of these products are available here:
First Episode Bulletin is a quarterly newsletter produced by the Prodrome and Early Psychosis Program Network (PEPPNET).

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