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  1. Article: L’évolution de la masse maigre après chirurgie bariatrique : les données actuelles dans la littérature

    Graillat, L. / Ritz, P. / Montastier, E. / Estrade, A. / Bertrand, M. / Tuyeras, G. / Brinas, P.

    Nutrition clinique et métabolisme. 2022 Feb., v. 36, no. 1

    2022  

    Abstract: Connaître l’évolution de la composition corporelle après la chirurgie bariatrique est un enjeu important car cela influe sur les fonctions musculaires et sur la dépense d’énergie, et probablement sur la perte de poids. Cette évolution a été étudiée par ... ...

    Abstract Connaître l’évolution de la composition corporelle après la chirurgie bariatrique est un enjeu important car cela influe sur les fonctions musculaires et sur la dépense d’énergie, et probablement sur la perte de poids. Cette évolution a été étudiée par de nombreuses équipes. Toutefois, les résultats ne sont pas toujours exprimés selon les mêmes paramètres. L’objectif de ce travail était d’identifier l’évolution de la masse maigre chez des patients opérés de sleeve gastrectomie (SG), bypass en Y (BPG) ou en oméga (BPO), en fonction de la perte de poids totale, et en fonction de la masse maigre initiale. Une recherche bibliographique a été réalisée sur PubMed en utilisant les mots-clés « bariatric » « bariatric medicine » « bariatric surgery » « gastric by pass » « gastrectomy » « body composition ». Les données concernant l’évolution pondérale totale, la masse maigre initiale, et à un an, devaient être renseignées, afin de pouvoir calculer la perte de masse maigre à un an en pourcentage du poids total perdu, et de l’exprimer également en pourcentage de la masse maigre initiale. Vingt études, concernant des chirurgies de type bypass en Y, sleeve gastrectomie, bypass en oméga, 15 prospectives et 5 rétrospectives, conduites entre 2003 et 2020, ont été retenues, représentant au total 5433 patients. L’étude des compositions corporelles était réalisée, selon les études, par absorptiométrie biphotonique (DEXA), bioimpédancemétrie électrique, ou mesure de la densité corporelle par pléthysmographie. La moyenne de perte de masse maigre perdue représente 22,6 % de la perte de poids totale (valeurs extrêmes : 12 et 44 %), et 14 % de la masse maigre initiale (valeurs extrêmes : 8 % et 22 %). L’utilisation de ces chiffres en routine pourrait permettre d’identifier une perte de masse maigre inhabituelle à un an de la chirurgie, de rechercher d’éventuelles étiologies, et de proposer une stratégie adaptée. Concernant les leviers de préservation de la masse musculaire, pour l’heure il n’y a pas d’autre recommandation officielle sur le plan diététique que de viser un apport protéique à 60g minimum par jour, et jusqu’à 1,5g/kg/j de poids idéal. Concernant l’activité physique une récente revue de la littérature souligne la relation entre la préservation de la force musculaire, parfois d’une moindre diminution de la masse maigre, et la pratique d’exercices de renforcement musculaire. Aux États-Unis, les recommandations de 2010 préconisent une activité aérobie d’intensité modérée d’un minimum de 150 minutes par semaine, avec pour objectif d’atteindre 300 minutes par semaine, incluant 2 à 3 séances de renforcement musculaire par semaine.
    Keywords forces ; nutrition ; patients
    Language English
    Dates of publication 2022-02
    Size p. S24.
    Publishing place Elsevier Masson SAS
    Document type Article
    ZDB-ID 1131758-9
    ISSN 0985-0562
    ISSN 0985-0562
    DOI 10.1016/j.nupar.2021.12.043
    Database NAL-Catalogue (AGRICOLA)

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  2. Article: Mapping the implementation and challenges of clinical services for psychosis prevention in England.

    Estradé, Andrés / Spencer, Tom John / De Micheli, Andrea / Murguia-Asensio, Silvia / Provenzani, Umberto / McGuire, Philip / Fusar-Poli, Paolo

    Frontiers in psychiatry

    2023  Volume 13, Page(s) 945505

    Abstract: Introduction: Indicated primary prevention of psychosis is recommended by NICE clinical guidelines, but implementation research on Clinical High Risk for Psychosis (CHR-P) services is limited.: Methods: Electronic audit of CHR-P services in England, ... ...

    Abstract Introduction: Indicated primary prevention of psychosis is recommended by NICE clinical guidelines, but implementation research on Clinical High Risk for Psychosis (CHR-P) services is limited.
    Methods: Electronic audit of CHR-P services in England, conducted between June and September 2021, addressing core implementation domains: service configuration, detection of at-risk individuals, prognostic assessment, clinical care, clinical research, and implementation challenges, complemented by comparative analyses across service model. Descriptive statistics, Fisher's exact test and Mann-Whitney
    Results: Twenty-four CHR-P clinical services (19 cities) were included. Most (83.3%) services were integrated within other mental health services; only 16.7% were standalone. Across 21 services, total yearly caseload of CHR-P individuals was 693 (average: 33; range: 4-115). Most services (56.5%) accepted individuals aged 14-35; the majority (95.7%) utilized the Comprehensive Assessment of At Risk Mental States (CAARMS). About 65% of services reported some provision of NICE-compliant interventions encompassing monitoring of mental state, cognitive-behavioral therapy (CBT), and family interventions. However, only 66.5 and 4.9% of CHR-P individuals actually received CBT and family interventions, respectively. Core implementation challenges included: recruitment of specialized professionals, lack of dedicated budget, and unmet training needs. Standalone services reported fewer implementation challenges, had larger caseloads (
    Discussion: While implementation of CHR-P services is observed in several parts of England, only standalone teams appear successful at detection of at-risk individuals. Compliance with NICE-prescribed interventions is limited across CHR-P services and unmet needs emerge for national training and investments.
    Language English
    Publishing date 2023-01-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564218-2
    ISSN 1664-0640
    ISSN 1664-0640
    DOI 10.3389/fpsyt.2022.945505
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Évaluation d’une semaine à thème d’éducation thérapeutique destinée à des patients ayant repris du poids après une chirurgie bariatrique au CHU de Toulouse

    Graillat, L. / Ritz, P. / Estrade, A. / Bertrand, M. / Montastier, E. / Tuyeras, G. / Lijeron, J.

    Nutrition clinique et métabolisme. 2021 Apr., v. 35, no. 1

    2021  

    Abstract: La définition de la reprise de poids après chirurgie bariatrique est hétérogène dans la littérature. Une semaine d’éducation thérapeutique (ETP) au CHU de Toulouse est dédiée à cette thématique. L’objectif principal est de tracer l’évolution pondérale ... ...

    Abstract La définition de la reprise de poids après chirurgie bariatrique est hétérogène dans la littérature. Une semaine d’éducation thérapeutique (ETP) au CHU de Toulouse est dédiée à cette thématique. L’objectif principal est de tracer l’évolution pondérale des patients six mois après leur participation à la semaine. Les données sont issues du compte rendu d’hospitalisation rétrospectivement. Le poids a été collecté 6 mois après la participation. Soixante-sept patients ont participé à la semaine entre 01/01/2018 et le 31/12/2019. Tous patients confondus, le poids moyen des patients lors de la semaine d’ETP était de 104,8kg±20,0 et à 6 mois, de 104,9 kg±19,3 (p=0,98). Trente-huit pour cent des patients ont perdu du poids, et 17,9 % avaient un poids stable à 6 mois. Chez les patients ayant perdu du poids, la perte pondérale moyenne était de 5,5kg±5,8, soit 4,7 %±3,6 du poids corporel. Le montage chirurgical a été retrouvé dilaté chez 16 patients, soit chez 34 % des patients ayant eu une exploration radiologique. Le pourcentage des patients ayant perdu du poids n’est pas statistiquement différent, selon que le montage chirurgical ait été retrouvé dilaté (43,8 %) ou non (29 %) à l’imagerie (p =0,42). Les principaux facteurs identifiés chez les patients, et retrouvés dans la littérature, étaient comportementaux alimentaires (compulsions : 40,1 %, grignotages : 26,8 %, alimentation émotionnelle : 7,4 %, restriction cognitive : 5,9 %), l’insuffisance de pratique d’activité physique (64 %) et psychologiques (troubles anxieux, épisode dépressif : 11,9 %). La prise en charge des patients présentant une reprise de poids après chirurgie doit être pluridisciplinaire, et personnalisée. L’approche par l’éducation thérapeutique est une des ressources à envisager.
    Keywords cognition ; nutrition ; patients ; tracer techniques
    Language English
    Dates of publication 2021-04
    Size p. 33.
    Publishing place Elsevier Masson SAS
    Document type Article
    ZDB-ID 1131758-9
    ISSN 0985-0562
    ISSN 0985-0562
    DOI 10.1016/j.nupar.2021.01.029
    Database NAL-Catalogue (AGRICOLA)

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  4. Article ; Online: Establishing a clinical service to prevent psychosis: What, how and when? Systematic review.

    Salazar de Pablo, Gonzalo / Estradé, Andrés / Cutroni, Marcello / Andlauer, Olivier / Fusar-Poli, Paolo

    Translational psychiatry

    2021  Volume 11, Issue 1, Page(s) 43

    Abstract: The first rate-limiting step to successfully translate prevention of psychosis in to clinical practice is to establish specialised Clinical High Risk for Psychosis (CHR-P) services. This study systematises the knowledge regarding CHR-P services and ... ...

    Abstract The first rate-limiting step to successfully translate prevention of psychosis in to clinical practice is to establish specialised Clinical High Risk for Psychosis (CHR-P) services. This study systematises the knowledge regarding CHR-P services and provides guidelines for translational implementation. We conducted a PRISMA/MOOSE-compliant (PROSPERO-CRD42020163640) systematic review of Web of Science to identify studies until 4/05/2020 reporting on CHR-P service configuration, outreach strategy and referrals, service user characteristics, interventions, and outcomes. Fifty-six studies (1998-2020) were included, encompassing 51 distinct CHR-P services across 15 countries and a catchment area of 17,252,666 people. Most services (80.4%) consisted of integrated multidisciplinary teams taking care of CHR-P and other patients. Outreach encompassed active (up to 97.6%) or passive (up to 63.4%) approaches: referrals came mostly (90%) from healthcare agencies. CHR-P individuals were more frequently males (57.2%). Most (70.6%) services accepted individuals aged 12-35 years, typically assessed with the CAARMS/SIPS (83.7%). Baseline comorbid mental conditions were reported in two-third (69.5%) of cases, and unemployment in one third (36.6%). Most services provided up to 2-years (72.4%), of clinical monitoring (100%), psychoeducation (81.1%), psychosocial support (73%), family interventions (73%), individual (67.6%) and group (18.9%) psychotherapy, physical health interventions (37.8%), antipsychotics (87.1%), antidepressants (74.2%), anxiolytics (51.6%), and mood stabilisers (38.7%). Outcomes were more frequently ascertained clinically (93.0%) and included: persistence of symptoms/comorbidities (67.4%), transition to psychosis (53.5%), and functional status (48.8%). We provide ten practical recommendations for implementation of CHR-P services. Health service knowledge summarised by the current study will facilitate translational efforts for implementation of CHR-P services worldwide.
    MeSH term(s) Antipsychotic Agents ; Delivery of Health Care ; Humans ; Psychotherapy ; Psychotic Disorders/epidemiology ; Psychotic Disorders/prevention & control
    Chemical Substances Antipsychotic Agents
    Language English
    Publishing date 2021-01-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
    ZDB-ID 2609311-X
    ISSN 2158-3188 ; 2158-3188
    ISSN (online) 2158-3188
    ISSN 2158-3188
    DOI 10.1038/s41398-020-01165-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Public health primary prevention implemented by clinical high-risk services for psychosis.

    Estradé, Andrés / Salazar de Pablo, Gonzalo / Zanotti, Alice / Wood, Scott / Fisher, Helen L / Fusar-Poli, Paolo

    Translational psychiatry

    2022  Volume 12, Issue 1, Page(s) 43

    Abstract: Clinical High Risk for Psychosis (CHR-P) services have been primarily developed to support young people with attenuated symptoms (indicated prevention). No evidence-based appraisal has systematically investigated to what extent these clinics may ... ...

    Abstract Clinical High Risk for Psychosis (CHR-P) services have been primarily developed to support young people with attenuated symptoms (indicated prevention). No evidence-based appraisal has systematically investigated to what extent these clinics may implement other preventive approaches. PRISMA 2020-compliant systematic review of Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO, from inception until 14th June 2021, identifying original studies describing public health strategies: (a) service characteristics (configuration of mental health service, outreach, pathways to care); (b) universal interventions (general population); (c) selective interventions targeting CHR-P service-users or family/carers. Public health preventive initiatives were systematically stratified according to core social determinants of mental disorders associated with the 2030 Sustainable Development Goals promoted by the United Nations Member States (UN 2030 SDG) and good mental health outcomes. A total of 66 publications were included, providing data on 13 standalone, 40 integrated, three networks, and six regional or international surveys of CHR-P services across Europe, Asia, Oceania, Africa, North and South America, providing care to >28 M people. CHR-P services implement numerous public health initiatives targeting social and cultural (16 initiatives), economic (seven initiatives), demographic (six initiatives), environmental events (four initiatives) and neighbourhood (three initiatives) UN 2030 SGD determinants of mental disorders. There is additional evidence for CHR-P services promoting good mental health. The main barriers were the lack of resources for expanding public health prevention at a large scale. CHR-P services implement numerous public health prevention initiatives and promotion of good mental health beyond indicated prevention of psychosis.
    MeSH term(s) Adolescent ; Humans ; Mental Health ; Mental Health Services ; Primary Prevention ; Psychotic Disorders/diagnosis ; Psychotic Disorders/prevention & control ; Public Health
    Language English
    Publishing date 2022-01-28
    Publishing country United States
    Document type Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 2609311-X
    ISSN 2158-3188 ; 2158-3188
    ISSN (online) 2158-3188
    ISSN 2158-3188
    DOI 10.1038/s41398-022-01805-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: A Case Report of Myotonic Disease and Gastric Bypass and a Literature Review.

    Gohier, H / Cintas, P / Montastier, E / Bertrand, M / Tuyeras, G / Chalret du Rieu, M / Estrade, A / Ritz, P

    Obesity surgery

    2019  Volume 29, Issue 7, Page(s) 2355–2356

    Abstract: We report the case of a woman with myotonic dystrophy type 1, followed for 8 years after a Roux-en-Y gastric bypass. Weigh loss was substantial (53% of initial body weight) with functional improvement in spite of the natural course of the pathology. Five ...

    Abstract We report the case of a woman with myotonic dystrophy type 1, followed for 8 years after a Roux-en-Y gastric bypass. Weigh loss was substantial (53% of initial body weight) with functional improvement in spite of the natural course of the pathology. Five other cases have been published and have reported a relatively positive benefit/risk ratio. Precautions are to be taken at the time of anesthesia and follow-up in order to detect possible degradation of muscle function.
    MeSH term(s) Female ; Gastric Bypass ; Humans ; Middle Aged ; Myotonic Dystrophy/complications ; Obesity/complications ; Obesity/surgery
    Language English
    Publishing date 2019-05-01
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-019-03913-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: A MOOC About Bariatric Surgery Improves Knowledge and Promotes Patients' Soft Skills.

    Pottier, E / Boulanouar, L / Bertrand, M / Estrade, A / Croiset, A / Martineau, C / Plantec, J Y / Escourou, B / Ritz, P

    Obesity surgery

    2019  Volume 30, Issue 4, Page(s) 1600–1604

    Abstract: The ASMBS recommends that patients should be provided with educational materials to improve informed consent about bariatric surgery. Massive online open courses (MOOCs) are learning sources which are free, online, and available to people in remote ... ...

    Abstract The ASMBS recommends that patients should be provided with educational materials to improve informed consent about bariatric surgery. Massive online open courses (MOOCs) are learning sources which are free, online, and available to people in remote situations. A French language MOOC regarding preparation for obesity surgery targets patients, as well as HCP, and people curious about this treatment. The patients' knowledge and skills after completion of the 5-week learning sessions (evaluated with semi-direct interviews) improved. Soft skills such as feeling empowered to ask questions to their HCP and explaining their plan to their relatives improved. This study suggests that MOOC can be a resource to improve knowledge and soft skills in patients for a better consent to surgery and follow-up.
    MeSH term(s) Bariatric Surgery ; Education, Distance ; Humans ; Learning ; Obesity, Morbid/surgery
    Language English
    Publishing date 2019-08-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-019-04143-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The case for improved transdiagnostic detection of first-episode psychosis: Electronic health record cohort study.

    Fusar-Poli, Paolo / Oliver, Dominic / Spada, Giulia / Estrade, Andres / McGuire, Philip

    Schizophrenia research

    2020  Volume 228, Page(s) 547–554

    Abstract: Background: Improving outcomes of a First Episode of Psychosis (FEP) relies on the ability to detect most individuals with emerging psychosis and treat them in specialised Early Intervention (EI) services. Efficacy of current detection strategies is ... ...

    Abstract Background: Improving outcomes of a First Episode of Psychosis (FEP) relies on the ability to detect most individuals with emerging psychosis and treat them in specialised Early Intervention (EI) services. Efficacy of current detection strategies is undetermined.
    Methods: RECORD-compliant clinical, 6-year, retrospective, transdiagnostic, lifespan-inclusive, Electronic Health Record (EHR) cohort study, representing real-world secondary mental healthcare in South London and Maudsley (SLaM) NHS. All individuals accessing SLaM in the period 2007-2017 and receiving any ICD-10 diagnosis other than persistent psychosis were included. Descriptive statistics, Kaplan-Meier curves, logistic regression, epidemiological incidence of psychosis in the general population were used to address pathways to care and detection power of EI services for FEP.
    Results: A total of 106,706 individuals underwent the 6-year follow-up: they were mostly single (72.57%) males (50.51%) of white ethnicity (60.01%), aged on average 32.96 years, with an average Health Of the Nation Outcome Scale score of 11.12 and mostly affected with F40-48 Neurotic/stress-related/somatoform disorders (27.46%). Their transdiagnostic risk of developing a FEP cumulated to 0.072 (95%CI 0.067-0.077) at 6 years. Those individuals who developed a FEP (n = 1841) entered healthcare mostly (79.02%) through inpatient mental health services (29.76%), community mental health services (29.54%) or accident and emergency departments (19.50%); at the time of FEP onset, most of them (46.43%) were under the acute care pathway. Individuals contacting accident and emergency departments had an increased risk of FEP (OR 2.301, 95%CI 2.095-2.534, P < 0.001). The proportion of SLaM FEP cases that were eligible and under the care of EI services was 0.456 at any time. The epidemiological proportion of FEP cases in the sociodemographically-matched general population that was detected by EI service was 0.373.
    Conclusions: More than half of individuals who develop a FEP remain undetected by current pathways to care and EI services. Improving detection strategies should become a mainstream area in the future generation of early psychosis research.
    MeSH term(s) Aged ; Cohort Studies ; Electronic Health Records ; Humans ; London/epidemiology ; Male ; Psychotic Disorders/diagnosis ; Psychotic Disorders/epidemiology ; Psychotic Disorders/therapy ; Retrospective Studies
    Language English
    Publishing date 2020-11-22
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639422-x
    ISSN 1573-2509 ; 0920-9964
    ISSN (online) 1573-2509
    ISSN 0920-9964
    DOI 10.1016/j.schres.2020.11.031
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The Lived Experiences of Family Members and Carers of People with Psychosis: A Bottom-Up Review Co-Written by Experts by Experience and Academics.

    Estradé, Andrés / Onwumere, Juliana / Venables, Jemma / Gilardi, Lorenzo / Cabrera, Ana / Rico, Joseba / Hoque, Arif / Otaiku, Jummy / Hunter, Nicholas / Kéri, Péter / Kpodo, Lily / Sunkel, Charlene / Bao, Jianan / Shiers, David / Bonoldi, Ilaria / Kuipers, Elizabeth / Fusar-Poli, Paolo

    Psychopathology

    2023  Volume 56, Issue 5, Page(s) 371–382

    Abstract: Informal caregivers of individuals affected by psychotic disorder can play a key role in the recovery process. However, little research has been conducted on the lived experiences of carers and family members. We conducted a bottom-up (from lived ... ...

    Abstract Informal caregivers of individuals affected by psychotic disorder can play a key role in the recovery process. However, little research has been conducted on the lived experiences of carers and family members. We conducted a bottom-up (from lived experience to theory) review of first-person accounts, co-written between academics and experts by experience, to identify key experiential themes. First-person accounts of carers, relatives, and individuals with psychosis were screened and discussed in collaborative workshops involving individuals with lived experiences of psychosis, family members, and carers, representing various organizations. The lived experiences of family members and carers were characterized by experiential themes related to dealing with the unexpected news, the search for a reason behind the disorder, living with difficult and negative emotions, dealing with loss, feeling lost in fragmented healthcare systems, feeling invisible and wanting to be active partners in care, struggling to communicate with the affected person, fighting stigma and isolation, dealing with an uncertain future, and learning from one's mistakes and building resilience and hope. Our findings bring forth the voices of relatives and informal carers of people with psychosis, by highlighting some of the common themes of their lived experiences from the time of the initial diagnosis and throughout the different clinical stages of the disorder. Informal carers are key stakeholders who can play a strategic role, and their contributions in the recovery process merit recognition and active support by mental health professionals.
    MeSH term(s) Humans ; Caregivers/psychology ; Psychotic Disorders/psychology ; Family/psychology
    Language English
    Publishing date 2023-01-23
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 605604-0
    ISSN 1423-033X ; 0254-4962
    ISSN (online) 1423-033X
    ISSN 0254-4962
    DOI 10.1159/000528513
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Establishing a business case for setting up early detection services for preventing psychosis.

    Napoletano, Flavia / Andlauer, Olivier / Murguia-Asensio, Silvia / Eranti, Savithasri V / Akyuz, Elvan / Estradé, Andrés / Buhagiar, Jonathan / David, Christine / Fusar-Poli, Paolo / Gupta, Susham

    BJPsych bulletin

    2022  Volume 47, Issue 3, Page(s) 156–165

    Abstract: Under standard care, psychotic disorders can have limited response to treatments, high rates of chronicity and disability, negative impacts on families, and wider social and economic costs. In an effort to improve early detection and care of individuals ... ...

    Abstract Under standard care, psychotic disorders can have limited response to treatments, high rates of chronicity and disability, negative impacts on families, and wider social and economic costs. In an effort to improve early detection and care of individuals developing a psychotic illness, early intervention in psychosis services and early detection services have been set up in various countries since the 1980s. In April 2016, NHS England implemented a new 'access and waiting times' standard for early intervention in psychosis to extend the prevention of psychosis across England. Unfortunately, early intervention and early detection services are still not uniformly distributed in the UK, leaving gaps in service provision. The aim of this paper is to provide a business case model that can guide clinicians and services looking to set up or expand early detection services in their area. The paper also focuses on some existing models of care within the Pan-London Network for Psychosis Prevention teams.
    Language English
    Publishing date 2022-03-15
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2816886-0
    ISSN 2056-4708 ; 2056-4694
    ISSN (online) 2056-4708
    ISSN 2056-4694
    DOI 10.1192/bjb.2022.7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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