Characterization and prediction of individual functional outcome trajectories in schizophrenia spectrum disorders (PREDICTS study): Study protocol.

Schizophrenia spectrum disorders (SSDs) are associated with significant functional impairments, disability, and low rates of personal recovery, along with tremendous economic costs linked primarily to lost productivity and premature mortality. Efforts to delineate the contributors to disability in SSDs have highlighted prominent roles for a diverse range of symptoms, physical health conditions, substance use disorders, neurobiological changes, and social factors. These findings have provided valuable advances in knowledge and helped define broad patterns of illness and outcomes across SSDs. Unsurprisingly, there have also been conflicting findings for many of these determinants that reflect the heterogeneous population of individuals with SSDs and the challenges of conceptualizing and treating SSDs as a unitary categorical construct. Presently it is not possible to identify the functional course on an individual level that would enable a personalized approach to treatment to alter the individual's functional trajectory and mitigate the ensuing disability they would otherwise experience. To address this ongoing challenge, this study aims to conduct a longitudinal multimodal investigation of a large cohort of individuals with SSDs in order to establish discrete trajectories of personal recovery, disability, and community functioning, as well as the antecedents and predictors of these trajectories. This investigation will also provide the foundation for the co-design and testing of personalized interventions that alter these functional trajectories and improve outcomes for people with SSDs.

Building Complex Care Capacity in Primary Care: An Educational Evaluation of Project ECHO Ontario Integrated Mental and Physical Health.

BACKGROUND: Project Extension for Community Healthcare Outcomes (ECHO) is a virtual training and capacity building model that uses videoconferencing to link expert interdisciplinary teams with primary care clinicians in local communities. In this study, we evaluated ECHO Ontario Integrated Mental and Physical Health (ECHO-IMPH). This is the first consultation-liaison psychiatrist-led Project ECHO explicitly designed to support health care providers (HCPs) within primary care in delivering better care for patients with co-occurring mental and physical health needs. We assessed the impact of ECHO-IMPH on HCP engagement, learning, and practice change. METHODS: Using Moore's Evaluation Framework, we used attendance logs and weekly surveys to investigate HCP engagement and satisfaction with ECHO-IMPH, as well as questionnaires to assess impact on their learning, self-efficacy, and practice change with respect to patient care. A pre-post design was used to assess change in the latter. RESULTS: A total of 322 HCPs participated in ECHO-IMPH across five cycles. High mean ratings were observed for satisfaction across all five cycles (4.35 ± 0.59). Precycle and postcycle questionnaires were available for 145 participants, allowing for paired comparison. Mean self-efficacy scores were significantly higher after the cycle than that before (64.26 ± 15.63 to 78.15 ± 11.44; t(144) = 11.61, P < 0.001, d = 1.03). Over 80% of participants reported changes in their professional practice post ECHO-IMPH. CONCLUSIONS: This is the first study to describe the impact of a Project ECHO led by consultation-liaison psychiatrists focused on integrated mental and physical health care and to demonstrate that this can be effective in changing HCP professional practice and self-efficacy, with high engagement and satisfaction.

Factor Structure of Repetitive Behaviors Across Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.

Restricted interests and repetitive behaviors (RRBs) are core symptoms of autism spectrum disorder (ASD), and commonly occur in attention-deficit/hyperactivity disorder (ADHD). Little is known about how RRBs manifest in ADHD. We quantified and compared factor structures of RRBs in children with ASD (n = 634) or ADHD (n = 448), and related factors to sex and IQ. A four-factor solution emerged, including Stereotypy, Self-Injury, Compulsions, and Ritualistic/Sameness. Factor structures were equivalent across diagnoses, though symptoms were more severe in ASD. IQ negatively correlated with Stereotypy, Self-Injury, and Compulsions in ASD, and negatively correlated with Compulsions and Ritualistic/Sameness behaviors in ADHD. In ASD only, females exhibited higher Self-Injury. Thus, patterns of RRBs are preserved across ASD and ADHD, but severity and relationship with IQ differed.