[Peer support for recovery in early intervention for psychosis: Issues surrounding its implementation in Quebec and the French-speaking world]. / La pair-aidance pour soutenir le rétablissement en intervention précoce pour la psychose : enjeux autour de son implantation au Québec et dans la francophonie.

Objectives To describe the different issues surrounding the integration of peer support workers (PSW) and family peer support workers (FPSW) into early intervention for psychosis services (EIS): their roles, the impacts of these interventions for patients, their families, and treatment teams, as well as the challenges and facilitators of this process. Method This article, co-authored with PSW and FPSW, presents a description and discussion of the experience of implementing peer support and family peer support in EIS in Québec, supported by a perspective of a review of the scientific and grey literature published in French or English in the last twenty years. Results Eight of the 36 scientific articles and two of the 14 grey literature publications selected were specific to early intervention for psychosis; the remainder were on mental health intervention. These publications put into context the experience described by clinicians, PSW and FPSW, and illustrated by clinical vignettes. Different modalities of peer support have demonstrated a positive impact on young people with early psychosis: it contributes to the improvement of self-esteem, quality of life, emotional well-being and can facilitate the rehabilitation process and reduce hospitalizations. Family peer support can reduce the stigma surrounding mental health problems, foster hope and a sense of belonging, increase knowledge of the illness and its treatment, and promote better coping strategies by family members. Nevertheless, many challenges have been identified during the integration of peer support and family peer support within clinical teams: planning and funding the implementation of services, defining their roles in EIS, training, clinical supervision, etc. These challenges need to be identified and addressed quickly in order to optimize care for youth and their families. Various strategies have been proposed for the successful implementation of peer support in EIS, which remains limited in Quebec and in the French-speaking world. It requires the participation and support of all stakeholders, including health professionals, managers and decision makers. Conclusion Peer support and family peer support emphasizes lived experience as expertise, recognizing the contribution of people with psychosis and their families as sources of support and models for recovery. This perspective fits well with the philosophy advocated by EIS. This promising intervention, which has been put forward by various national policies or guides, would benefit from being rapidly implemented on a larger scale in Quebec EIS and in the French-speaking world. This would make it possible to study the positive impacts described for service users and their families with more rigorous research designs and larger samples.

Impact of early use of long-acting injectable antipsychotics on functional outcome in first episode psychosis: a 3-year longitudinal study.

OBJECTIVES: To describe, in a naturalistic setting, the impact of the early use of LAI-AP on functional outcomes of early psychosis patients as compared to oral antipsychotics (OAP). METHODS: Longitudinal prospective 3-year naturalistic study of all consecutive admissions (n = 416) to two Early intervention services (EIS) for psychosis comparing baseline characteristics and the evolution of global functioning, occupation (work and studies), and living arrangements autonomy according to the route of administration of the antipsychotic medication. The cohort was divided into four groups: LAI-AP first (started on LAI-AP and later received OAP), OAP first, LAI-AP only, and OAP only. RESULTS: Global assessment of functioning (GAF) improved in all groups, but our mixed-effect model did not show any significant association between the route of administration and the GAF outcome. The LAI-AP only group was significantly less likely to have extreme residential instability at 3 years than the other groups despite its highest proportion of homeless youth and their poor prognostic factors at baseline. CONCLUSIONS: Our naturalistic study suggests a significant protective effect of LAI-AP on extreme residential instability for the most vulnerable patients, but no impact of the first AP administration route on other functional outcomes was observed at 3 years of follow-up. Key pointsLong-acting injectable antipsychotics seem promising to avoid extreme residential instability in early psychosis.Global assessment of functioning (GAF) improved in all groups.There was no significant association between the first route of administration and global functionning.

Community Treatment Orders use Among Persons With a First Episode of Psychosis in Quebec.

OBJECTIVES: Specialized early intervention for psychosis can reduce the duration of untreated psychosis and improve clinical and functional outcomes. However, poor adherence to treatment is frequent. The literature on community treatment orders (CTOs) use in first-episode psychosis (FEP) as a means to improve treatment adherence is limited. In the context of early intervention for psychosis services (EIS), this study aims to describe (1) the frequency of CTOs utilisation, (2) the trend of CTOs use over time, (3) the timing and reasons for requesting CTOs and (4) the baseline characteristics of FEP patients on CTOs compared to those who were not. METHOD: A 5-year prospective longitudinal study describing the use of CTOs among persons with FEP admitted to two urban EIS in Montreal, Quebec, from 2005 to 2013. At admission, and then annually for 5 years, CTOs data were collected through chart review. Baseline characteristics, assessed by patient interviews, standardized questionnaires and chart review, included socio-demographic data, illness severity, functioning and alcohol and substance use. Descriptive analyses were performed, and FEP patients on CTOs during follow-up and those who were not were compared using analyses of variance, chi-square test and multivariate logistic regression. RESULTS: Among 567 FEP patients, 19.2% were placed on CTOs. The main reasons for requesting CTOs were to prevent further deterioration in mental state, social functioning, harmful behaviours to self and others and homelessness. FEP patients on CTOs had poorer premorbid and baseline functioning, more severe symptoms and social dysfunction at admission, including legal problems and homelessness. CONCLUSIONS: CTOs can be a tool to improve adherence to treatment, which is crucial for relapse prevention in FEP. However, since it is a coercive method that limits a person's fundamental rights, further research is warranted to assess its impact on patients' lives, clinical and functional outcomes, as well as patients' and carers' perception.

Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review.

BACKGROUND: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. OBJECTIVE: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. METHODS: A scoping review of the literature published since 2015 was conducted using the Arksey and O'Malley's framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. RESULTS: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. CONCLUSIONS: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care.

COVID-19 pandemic's effects and telehealth in Early Psychosis Services of Quebec, Canada: Will changes last?

AIM: To explore the impacts of the COVID-19 pandemic first wave in Quebec, Canada on practices in early intervention services (EIS) for first-episode psychosis, including reorganization of clinical and administrative practices and teleconsultation use. METHODS: Adopting a cross-sectional descriptive study design, a 41 questions online survey was sent to the team leaders of all the 33 Quebec EIS, of which 100% responded. Data were collected from 18 May to 4 June 2020 and analysed using descriptive statistics and content analysis. Programmes were categorized as urban/non-urban and results were compared between these. RESULTS: All 33 existing Quebec EIS (16 urban and 17 non-urban) completed the survey. Among them, 85% did not experience redeployment of EIS team staff and 58% reported stable frequency of patient interactions, either in-person or through telemedicine. During the studied period, 64% of programmes reported that all professionals used teleconsultation at least occasionally. However, 73% of programmes, mostly in non-urban areas, reported some limitations regarding clinicians' degree of ease with teleconferencing platforms and half of EIS could not access technical support to use them. The majority of EIS (94%) expressed interest to participate in a training program about the use of technologies for teleconsultations. Many smaller clinics reported interest in offering multiregional/multiclinics group teletherapy, therefore merging their pool of patients and clinical staff workforce. CONCLUSIONS: Further studies are warranted to improve access to and use of technology-mediated treatment, which seems to be a promising alternative to provide high-quality mental healthcare during the COVID-19 pandemic and beyond.