WellSpace: Peer-led groups for first-episode psychosis before and during the COVID era.

AIM: Coordinated specialty care (CSC) is a collaborative-team based approach that has been shown to be helpful for patients with first-episode psychosis. Peer support is an important component of CSC. Here, we describe the development and implementation of peer-led group programming (McLean WellSpace) that was loosely affiliated with a CSC (McLean OnTrack). We discuss how we adapted this program to the challenges imposed by COVID-19. METHODS: WellSpace was developed to have minimal barriers to entry other than a self-reported history of recent onset of psychosis. It is free for participants with minimal restrictions about who may attend. WellSpace and WellSpace groups are largely administered by peer specialists who align with the recovery movement. WellSpace has been a virtual program since March 2020. RESULTS: McLean WellSpace participants include many people who are not patients of McLean OnTrack, suggesting that such programs may have greater reach than standard medical programs. We transitioned to virtual programming and saw average group attendance and unique participants increase during the pandemic. CONCLUSIONS: Our experience suggests that peer-led group programming for first-episode psychosis is well-accepted by patients, including many who are not engaged with a CSC. This may be related to our efforts to minimize barriers to entry and our peer-led, non-medical orientation.

The Intersection Between Childhood Trauma, the COVID-19 Pandemic, and Trauma-related and Psychotic Symptoms in People With Psychotic Disorders.

INTRODUCTION: People with psychotic disorders may be disproportionately affected by the traumatic effects of the COVID-19 pandemic. Childhood trauma, which also increases vulnerability to subsequent stressors, is common in individuals with psychosis. In this study, we investigated the intersection of the pandemic, childhood trauma, and psychotic and trauma-related symptoms in individuals with psychotic disorders. METHODS: We administered a cross-sectional survey to 151 participants [47 schizophrenia (SZ), 53 psychotic bipolar disorder (BP)], 51 healthy control (HC)] during the COVID-19 pandemic. Participants were asked about exposure to the pandemic's impacts, childhood trauma, and post-traumatic stress, dissociative, and psychotic symptoms. RESULTS: BP reported greater negative impacts to emotional health than SZ and HC and to non-COVID physical health than HC. SZ reported less impact on work and employment during the pandemic. There were no other group differences in pandemic-related adversities. We also found that cumulative exposure to the pandemic's negative impacts was significantly associated with PTSD symptoms but not psychotic or dissociative symptoms. Moreover, the number of adversities an individual experienced during the pandemic was strongly associated with the cumulative number of traumatic experiences they had in childhood. DISCUSSION: Our results suggest that having a psychotic disorder does not, in and of itself, increase susceptibility to the pandemic's negative impacts. Instead, we provide evidence of a graded relationship between cumulative exposure to the pandemic's negative impacts and PTSD symptom severity, as well as a graded relationship between cumulative childhood traumatic experiences and the number pandemic adversities, across diagnoses.

Impact of the COVID-19 Pandemic on the Employment and Educational Outcomes of Individuals in a First-Episode Psychosis Clinic.

OBJECTIVE: A central objective of early psychosis therapy is to restore social functioning (e.g., through employment and education). Employment and educational outcomes during the COVID-19 pandemic were examined in a well-defined cohort of patients receiving care in an early psychosis clinic. METHODS: Data were extracted from the electronic health records of 128 patients receiving care at McLean Hospital's first-episode psychosis (FEP) clinic between January 1 and September 21 in 2019 and 2020. Using a generalized linear model with a Gaussian distribution and robust standard errors, the authors compared the average changes in the weekly employment and education proportions before and after COVID-19 lockdowns with the same changes in 2019. RESULTS: Employment losses among patients with FEP were greater than among the general population and persisted through the end of follow-up. In 2020, average employment after a stay-at-home order was instituted was 33% lower than before the order compared with the change in employment during the same period in 2019. The effect was stronger among men and those who identified as non-White, were age <21 years, or did not have a college education. Although educational engagement recovered in the fall of 2020, it still remained below the 2019 levels. CONCLUSIONS: Employment disruptions were major and persistent among the FEP population, which might affect short- and long-term outcomes. Innovative approaches are needed to help patients transition to remote employment, file unemployment claims, and use online hiring platforms to ameliorate the indirect effects of the COVID-19 pandemic.

Effects of COVID-19 pandemic on mental health outcomes in a cohort of early psychosis patients.

AIM: To evaluate the impact of the COVID-19 pandemic on clinical outcomes, we used data from Electronic Health Records from 128 patients receiving care at a First Episode Psychosis clinic. METHODS: Rates of admission or emergency room (ER) visits from January 2020 to July 2020 were analysed using difference-in-difference regression. We used the same weeks in 2019 to control for seasonality. RESULTS: We found 17 hospitalizations or ER visits between 1 January 2020 and 13 March 2020 (incidence rate: 71.4 events/1000 person-weeks) and 6 between 14 March 2020 and 20 June 2020 (incidence rate: 18.5 events/1000 person-weeks) for an incidence rate ratio of 0.26. The severity of presentation worsened after transition to telemedicine. No signs of significant interruptions of care were found. CONCLUSIONS: We report that patients have avoided accessing higher levels of care, except in extreme cases. We argue that this is not a sustainable trajectory and that public health actions are required.

A projection for psychiatry in the post-COVID-19 era: potential trends, challenges, and directions.

The COVID-19 pandemic has transformed the face of psychiatry over a very short time period. Given the detrimental impact of the pandemic on mental health and the economy, more difficult days are ahead for psychiatry. The rising public health burden of mental illnesses will inevitably exceed the capacity of psychiatric services in the United States and worldwide. The pandemic has also profoundly affected psychiatric research due to safety concerns and containment efforts. Intermediate and long-term ramifications may even be more serious. In addition to the effects of the economic downturn on available research funding, existing research tools and protocols may not meet the emerging needs in the post-COVID-19 era. This paper discusses potential trends and challenges that psychiatric practice and research may encounter in this period from the viewpoint of workers in the field. We outline some measures that clinicians and researchers can implement to adapt to the emerging changes in psychiatry and to mitigate the forthcoming effects of the crisis.