Lessons from EPINET-TX

Individuals with serious mental illness have been shown to have poorer health and on average die 10 - 25 years earlier than those without SMI. What does the EPINET-TX data tell us about the health of those in care as they enter the CSC program? What are the current health risks that young people are experiencing and how can CSC teams contribute to healthy lifestyles and well-being.

Weight and Blood Pressure: The body mass index for adults (over 20) at baseline (N=126) are presented in Figure 1. Overall, 57.9% of the young adults were considered overweight or obese, with a small percentage considered moderately or severely thin. Many young adults (54.8%) also experienced hypertension or elevated blood pressure, putting them at risk for heart conditions.

Supporting Health and Wellness: CSC participants are asked about their satisfaction with their health. While most participants reflected overall satisfaction with their health, 44.3% indicated neutral ratings to dissatisfaction (<6). Frequencies of health ratings are presented in Figure 3. One way to support health is to ensure that all participants are cared for by a primary care provider (PCP). The majority of adolescents and young adults at program entry either didn't have a PCP (35.7%) or their access was uncertain (27.2%). Only a small proportion of individuals were engaged with a PCP within the LMHA/LBHA (5.3%).

Research Highlights

Sex and Gender Differences in Symptoms of Early Psychosis

Carter, B., Wootten, J., Archie, S., Terry, A. L., & Anderson, K. K. (2022). Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis. Archives of women's mental health, 25(4), 679–691. Access the article.

Background: There is heterogeneity in clinical presentation of the onset of first episode psychosis. Sex and gender of the person experiencing FEP are hypothesized to partially account for these variations in presentation with respect to age of onset, symptom profile, level of functioning, and course of illness. Previous research looking into these factors although extensive has been inconclusive.

Methods: This systematic review and meta-analysis identified 30-peer reviewed articles that compared symptoms of first-episode psychosis or other features of clinical presentation by sex or gender.

Findings: They found that that men with FEP or early psychosis experience greater severity of negative symptoms and a higher likelihood of substance use, whereas women experience greater severity of depressive symptoms and a higher level of functioning. They did not find differences between men and women in positive symptoms or symptoms of general psychopathology.

Implications for Practice

Women with psychotic disorders present with more subtle symptoms than men, due to less severe negative symptoms and higher functioning.
Clinicians can aim to better tailor interventions specifically toward young men or women experiencing early psychosis on the basis of these differences.
Treatments and interventions can shift focus on substance use counseling or depressive symptom management depending on the presence of these symptoms in males and females.
Early detection and intervention efforts can be adapted to better reflect these presentation differences and detect women who may not have as overt signs and symptoms of psychosis in the early course.

Limitations: Many of the studies included in the review had small sample sizes, with more men than women, which may limit the generalizability of the study, especially to women receiving care outside the context of specialized early intervention services.

Definitions of FEP or early psychosis (age of onset, duration since onset, language spoken) varied among the included studies, which may have impacted the clinical presentation noted in each study.

Given that women tend to have a later age of onset, any age restrictions would function to underrepresent women with FEP.

Most of the included studies omitted cognitive symptoms, despite evidence suggesting that men and women with early psychosis may differ in cognitive functioning.

Spotlight on Andrews and West Texas Centers!

Dominque Guthrie and Ana Collazo present on CSC in rural Texas

There is a growing interest across the country in the way that coordinated specialty care (CSC) can be adapted to meet the needs of rural communities, while maintaining or improving upon the outcomes found in research trials. During October, Team Leads Dominique Guthrie (Andrews Center) and Ana Collazo (West Texas Centers) presented on the ways in which their programs are aiming to meet the needs of rural communities in Texas.

What adaptations have been needed to provide CSC in rural regions?

Both West Texas Centers and Andrews Center have unique regions and experiences implementing the model. Some of the areas that they discussed needing to adapt include:

Use of telehealth and face-to-face interventions, but varying by provider role
Provide equipment to support individual access to telehealth
Travel to certain regions on certain days of the week
Utilize agency clinics in different counties
Team ratio limited to 20 individuals due to travel requirements
Creative outreach approaches (e.g., billboard, social media ads)

Upcoming Events and Training Opportunities

Safety Planning Intervention Training—for First Episode Psychosis/Coordinated Specialty Care Teams

Safety Planning is a brief intervention that uses positive coping skills and strategies to decrease the risk of suicidal behavior. This training focuses on learning the steps of the Safety Planning process and how to effectively use this intervention to assist others for FEP and CSC teams.

November 17 at 8:30 AM - 12:00 PM CST | Zoom Registration

Safety Planning Intervention Training—for General Providers

This training focuses on learning the steps of the Safety Planning process and how to effectively use this intervention to assist others for general providers.

December 12 at 8:30 AM - 12:00 PM CST | Zoom Registration

First Episode Psychosis (FEP) Provider Well-Being Community Calls

The purpose of the virtual FEP Provider Well-Being Community Calls is for FEP providers to provide

mutual aid to one another by discussing shared experiences, offering empathy, and facilitating change. Community calls will be structured to include one skill-based practice (e.g. mindfulness, compassion), discussion about relevant topics, and resource sharing.

December 15 at 10:00 - 11:00 AM CST | Zoom Registration

Texas Early Psychosis Consortium

The quarterly meeting of the Texas Early Psychosis Consortium will be held on December 2nd. We look forward to our on-going discussion of early psychosis care in Texas.

December 2 at 1:00 - 3:00 pm CST

EPINET-TX Workgroups

We are starting a series of workgroups focused on improving the care in Texas CSC programs. Initial workgroups will focus on Outreach and Rural CSCs. Join your colleagues in examining opportunities for shared learning and growth! Download the flyer to learn more !

Outreach Workgroup: Next meeting is December 6 at 1:00 - 2:00 pm CST | Join Zoom

Rural Workgroup: Starting November 15 at 1:00 - 2:00 pm CST | Join Zoom

Website: https://sites.utexas.edu/mental-health-institute/projects/epinet-tx/