John R. Bola

Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project.

The Soteria project (1971–1983) compared residential treatment in the community and minimal use of antipsychotic medication with “usual” hospital treatment for patients with early episode schizophrenia spectrum psychosis. Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively (1971 to 1976, N = 79) or randomly (1976 to 1979, N = 100) to the hospital or Soteria and followed for 2 years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways: for endpoint subjects (N = 160), for completing subjects (N = 129), and for completing subjects corrected for differential attrition (N = 129). Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size at Soteria (+.47 SD, p = .03). Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment (+.81 SD, p = .02), particularly in domains of psychopathology, work, and social functioning. Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia. In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications.

Cross-Validation of Mental Health Recovery Measures in a Hong Kong Chinese Sample

Objectives: The concept of recovery has begun shifting mental health service delivery from a medical perspective toward a client-centered recovery orientation. This shift is also beginning in Hong Kong, but its development is hampered by a dearth of available measures in Chinese. Method: This article translates two measures of recovery (mental health recovery measure and the recovery subscale of peer outcomes protocol) and one measure of recovery-promoting environments (recovery self-assessment) into Chinese and investigates their psychometric properties among 206 Hong Kong Chinese people with severe mental illness. Result: Multifactor solutions from earlier studies were not replicated; our evidence pointed to one-factor solutions. Since all recovery measures demonstrated high internal consistency reliability (.92 to .96), we analyzed total scale scores. Conclusion: Moderately high correlations among the recovery measures (.33 to .56) provide some support for construct validity, yet further investigation of recovery measures in a Chinese population is needed.

Reassessing the high proportion of involuntary psychiatric hospital admissions in South Korea.

The 2007 WHO-AIMS report on the mental health system of South Korea documented progress towards a national mental health plan, protection of human rights, and growth of community based services. Yet concern was expressed that the high proportion of involuntary to total psychiatric hospitalizations (92%) may indicate an excessively coercive system. Involuntary hospitalization in Korea rose from 117 to 132 (per 100,000) between 2000 and 2006. In 2000, the median rate in the European Union (EU) was 74 per 100,000 (Range: 6–218). While Korea’s involuntary hospitalization rate is within the EU range, its proportion of involuntary hospitalizations is three times that of the highest EU country (30%, Sweden). Underdevelopment of voluntary psychiatric services and culturally mandated family referrals resulting in involuntary hospitalization are apparent reasons for the high proportion of involuntary hospitalizations. Population-based rates per 100,000 more accurately describe involuntary hospitalization than the proportion (ratio) measure used in the WHO-AIMS reports.

Psychosocial Acute Treatment in Early-Episode Schizophrenia Disorders.

Objective: This article reviews evidence on the treatment of early episode schizophrenia spectrum disorders that contradicts, in some cases, the American Psychiatric Association’s generic recommendation of antipsychotic medication treatment for at least a year. Method: Evidence on lack of diagnostic validity, absence of demonstrated long-term benefit from initial antipsychotic treatment, and existence of a large subgroup of early episode clients that may be successfully treated without antipsychotic medications is reviewed. Results: A time-limited initial trial of psychosocial intervention without antipsychotics may benefit many clients, especially by reducing long-term medication dependence and side effect exposure. Evidence suggests this can be done without substantial risk to those later found to need medications. A risk-benefit comparison of current practice to two alternate treatment protocols is presented. Conclusions: Developing and evaluating a psychosocial intervention for early episode psychosis presents a unique opportunity for social work to take leadership in acute mental health treatment.

Cross-Validating Chinese Language Mental Health Recovery Measures in Hong Kong

Objectives: Promoting recovery in mental health services is hampered by a shortage of reliable and valid measures, particularly in Hong Kong. We seek to cross validate two Chinese language measures of recovery and one of recovery-promoting environments. Method: A cross-sectional survey of people recovering from early episode psychosis (n = 121) and family members (n = 49) was taken. Two recovery measures, the Mental Health Recovery Measure and the recovery subscale of the Peer Outcomes Protocol, and one measure of recovery-promoting environments, the Recovery Self-Assessment, were used. The Psychosis Recovery Inventory was incorporated to assess construct validity. Results: Internal consistency reliability for each measure was high (r = .71–.94); one-factor solutions were parsimonious. People in recovery rated their risk for relapse lower than did their family members. Conclusions: Moderately strong positive correlations among recovery measures lend support to construct validity. Several “recovery-promoting environment” items should be reassessed for cultural fit in Hong Kong.

Book Review: Neuroscience for psychologists and other mental health professionalsLittrellJ. (2015). Neuroscience for psychologists and other mental health professionals. New York, NY: Springer, 2015. 426 pp.,

Jill Littrell’s Neuroscience for Psychologists and Other Mental Health Professionals (Neuroscience, Springer, 2015) opens a fascinating new vista not unlike flying through interstellar space at warp speed: exciting, mysterious, and intensely detailed. Yet this frontier is in inner space, in the structure and function of the brain, the human nervous system, perception, cognition, and emotion. Imbedded in this purview is the recognition of a fundamental principle of the medical model: biology mediates behavior. Yet the detailed workings described in Neuroscience are so much more intricate than the simplistic ‘‘chemical imbalance’’ mantra embraced by much of psychiatry. Engel’s (1977) 40-year-old challenge to create a biopsychosocial medical model may finally be coming to fruition, in the unlikely area of neurobiology. In this amazingly intricate and interconnected neuronal network that we are just beginning to glimpse are the clear physiological effects of social interactions, psychological attitudes, spiritual orientations, and even the fundamental human activities of eating, digesting, and moving. The view that the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5; American Psychiatric Association [APA], 2013) contains a collection of behaviorally (not medically) diagnosed illnesses that will gradually be reclassified as neurological disorders comes to mind. As the underlying causes of these illnesses are elucidated, they may well move to the realm of physical medicine, accompanied by laboratory tests for diagnosis and empirically supported treatments based on knowledge of what causes the illness(es). Neuroscience also sheds some light on the conundrum of why developed societies are seeing an exponential increase in mental disorders, with lifetime prevalence rates approaching 50% (Kessler, Berglund, Demler, Jin, & Walters, 2005). Along with Frances’ (2013, subtitle) critique on ‘‘out-of-control psychiatric diagnosis . . . and the medicalization of ordinary life,’’ Hafner (1985) suggests that, in addition to an accelerating diagnosis of ‘‘normal’’ problems, society may also be becoming sicker, with people less willing to tolerate discomfort. In the context of a fast-food culture with increasing rates of obesity (Garcia, Sunil, & Hinojoso, 2012), insights from Neuroscience are pointing to ways we are making ourselves sick and how to make ourselves better. Diet, Digestion, and (lack of) Exercise