Peer Interventions Show Promise for Recent Onset Psychosis

A study from Hong Kong finds peer-facilitated recovery groups outperform treatment as usual for psychosis.

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In a new article published in Schizophrenia Research Wai Tong Chien and colleagues find that peer-facilitated interventions—where people with lived experience of psychosis lead recovery groups, for example—improve outcomes for people with a recent psychotic experience.

The study investigated peer-facilitated self-management interventions (PFSMI) for recent-onset psychosis in Hong Kong. The researchers recruited 180 participants that had recently had their first experience of psychosis and randomly assigned them one of three interventions: a PFSMI group, a psychoeducation group (PEG), or a treatment as usual (TAU) group. They then measured outcomes one week and six months after the intervention was complete.

The PFSMI group reported greater improvement in recovery, functioning, and insight into their illness, as well as reductions in psychotic symptoms and duration of hospital stays compared to the PEG and TAU groups. The peer-facilitated group also enjoyed fewer hospital stays compared to the other groups. The authors conclude that peer-facilitated groups can improve outcomes for people with recent-onset psychosis.

They write:

“The PFSMI participants reported significantly greater improvements in recovery levels at both 1-week and 6-month follow-ups than the TAU and the PEG. This finding supported the primary study hypothesis regarding the effect of the PFSMI on promoting recovery from ROP. The finding makes an important contribution to understanding given that the current evidence regarding such an intervention approach is inconclusive/inconsistent.”

Similar peer-oriented recovery programs have shown promise in the UK, with service users seeing improved quality of life and overall well-being. In addition, research has shown that peer-oriented intervention programs were effective for both clinical and personal recovery, especially for people experiencing “severe mental illness.”

One study found that peer support significantly reduced participants’ risk of being readmitted to an inpatient treatment facility. Research has also found that peer support can help reduce racial disparities in the mental health field. Similarly, some researchers believe peer respites hold promise in keeping people out of mental health institutions.

Treatment of psychosis and schizophrenia often involves the use of antipsychotic medications. However, peer support groups can reduce the need for psychotropic medication, allowing many to forgo the long-term consequences of antipsychotics.

Antipsychotics are often prescribed without informed consent, meaning people taking them are often unaware of the many adverse effects of this kind of drug use. For example, antipsychotics can worsen cognitive functioning when given to people experiencing their first episode of psychosis.

In addition, coming off of antipsychotics improves cognitive functioning, and people diagnosed with schizophrenia demonstrate greater work functioning off of antipsychotics.

Stopping antipsychotic use is associated with recovery rates that are six times higher compared to those still using the drugs. Unfortunately, many users report negative results with antipsychotics, with more than half reporting only adverse effects. Peer support groups can mitigate the need for these medications (especially as long-term solutions) and offer advice on how to successfully withdraw from them, given the lack of guidance on this topic within the psy-disciplines.

The present work begins by explaining the importance the psy-disciplines currently place on early treatment of psychosis. More than half of patients experience a recurrence of psychosis within five years, often accompanied by hospitalization. Clinicians emphasize treating psychosis as early as possible to improve mental health outcomes.

However, there is limited evidence about the usefulness of these early treatments, and accessing them can be problematic for many patients. With self-managed peer-facilitated interventions poised to fill the treatment gap, the current work investigates their efficacy compared to other, likely more difficult-to-access, interventions for recent onset psychosis.

The authors randomly recruited 180 people that had their first experience of psychosis within five years and were experiencing distressful psychotic symptoms. Participants were Hong Kong residents between the ages of 18 and 60, proficient in writing and speaking Chinese/Cantonese, had mild to moderate psychotic symptoms, and were mentally stable enough to comprehend the self-care skills taught as part of the PFSMI group. Participants were excluded due to participation in other psychosocial interventions, the presence of other mental illnesses or clinically significant medical diseases, and due to difficulty in language and communication. Each participant was randomly assigned to either the PFSMI, PEG, or TAU groups.

The PFSMI group received ten weekly/bi-weekly 1.5-hour sessions. These sessions included education about psychosis care, illness self-management, and personal recovery. Peer facilitators assisted participants in reflecting on their current life situation and developing coping strategies. Participants were encouraged to work through the program at their own pace. Participants also completed a recovery workbook in which they recorded recovery goals, plans for reconnecting to their community, and strategies to maintain well-being.

The PEG was led by a psychiatric nurse and otherwise shared many similarities with the PFSMI group. The intervention consisted of 10 weekly/biweekly 1.5 to 2-hour sessions. These sessions dealt with goal setting, a basic understanding of psychosis, symptom and emotion self-care, community support services, self-care skills, and establishing social support.

The TAU group received community mental healthcare services and outpatient treatment. In addition, they had monthly consultations and psychiatrist-prescribed treatments. They also had access to nursing advice on community care, brief education about psychosis, home visits by case workers, and referrals to welfare and employment services.

The PFSMI group showed significantly greater recovery levels than the PEG and TAU groups. The PFSMI group and the PEG showed similar recovery levels at the 1-week follow-up, but the PFSMI group showed significant gains over the PEG at the 6-month follow-up. The PFSMI group showed significantly greater levels of recovery than the TAU group at both the 1-week and 6-month follow-ups.

The PFSMI group also showed greater improvement in overall functioning, psychotic symptoms, and insight into their illness; the number of hospitalizations and duration were greatly reduced in the PFSMI group.

The authors conclude that PFSMI shows promise in treating recent-onset psychosis and suggest that more research is needed to test PFSMI efficacy in different, more diverse populations.

 

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Chien, W. T., Ho, L. K., Gray, R., Bressington, D. . (2022). A randomized control trial of a peer-facilitated self-management program for people with recent-onset psychosis. Schizophrenia Research, 250(2022), 22-30. (Link)

1 COMMENT

  1. Thank You Richard,

    This is good news.

    I attend peer groups all the time (but not for intervention).

    “…Stopping antipsychotic use is associated with recovery rates that are six times higher compared to those still using the drugs….”

    The British Psychological Society claim to be able to successfully treat conditions described as Schizophrenia in the same way as they might treat Social Anxiety or Shyness.

    I believe the Psychologists CAN and I can describe HOW:- Through very careful withdrawal from Psychiatric drugs and the use of Effective Anxiety Reduction Methods.

    A doctor friend of mine told me that he had attempted several times to take patients off ‘antipsychotics’ – but without success.

    Antipsychotic drugs are very difficult to discontinue as they create a type of “drug induced high anxiety” which surfaces on drug withdrawal.

    Antipsychotic drugs are also ‘hyperbolic’ – which means that withdrawing from even low doses can result in problems (bamboozling a person into thinking they’re ‘sick’).

    I was lucky to be able to come off ‘antipsychotics’ – as I was initially satisfied with a reduction in medication that reduced my disabling side effects and allowed me to get on with life.

    I was also able to access effective Non Drug Approaches to overcome my ‘drug withdrawal high anxiety’. Without these Approaches I would NOT have Recovered.

    I was finally prescribed Seroquel at 25mg/day – which had only antihistamine effect, and easy to stop.

    I spent a number of years really struggling in the Psychiatric System even though the original ‘Schizophrenia’ had been “medically game played”.