Prevention & Early Intervention Program for Psychoses (PEPP) Research
Overview
PEPP Research is one of the world’s leading research programs in early phases of psychoses, especially in relation to early detection and outcome.
Research Streams
Psychotic disorders are amongst the most serious of psychiatric illnesses and usually have their onset in late adolescence or early adulthood. They can lead to major disruptions of people’s lives and substantial health care and social costs. It appears that a complex set of factors contribute to the occurrence of psychotic disorders. PEPP is a part of an international effort to improve outcomes for individuals with these disorders through earlier and better treatment. We are committed to an active research program to improve our understanding of factors that influence recovery from these disorders including biological, psychological and social mechanisms. In our work, we recognize that recovery is more than remission of the defining symptoms of psychosis, and includes social and vocational functioning and personal empowerment. We focus on research that can directly inform interventions and service delivery models to improve the lives of our clients and others with psychotic disorders.
Areas of Research
Outcomes in Psychosis Research - Dr. Ross Norman
Outcome Research
A major research focus within PEPP has been longitudinal studies of the course of first episode psychosis from the time of initial treatment. This work has included studies of the benefits of early intervention programs; potentially malleable predictors of outcome, such as treatment delay, social support and self-concept; interrelationships between treatment outcomes; and identification of correlates of differing components of outcomes in order to gain insight into underlying pathologies.
Recovery Research
Research within PEPP demonstrates that recovery from psychotic illness involves more than the reduction or elimination of clinical symptoms. Recovery is a process that involves reclaiming autonomy and self-determination regardless of whether one does or does not “clinically” recover from the illness. Constructs such as hope, belief in a positive future self, self-esteem, sense of purpose and perceived positive social value and role are all critical to the recovery process. Novel recovery-oriented interventions include a youth-oriented mindfulness group and a participatory video narrative group are currently being developed and studied at PEPP.
TransPEPP - Dr. Lena Palaniyappan
Psychiatric disorders such as psychosis and depression are one of the largest contributors to human suffering across the globe. This large burden is attributed to two vicious aspects of many psychiatric disorders: (1) they start at a young age and (2) they are recurrent in nature. TransPEPP utilizes the state-of-art neuroimaging facilities at Robarts Research Institute and Lawson Imaging to enhance early intervention and address relapsing and recurring nature of mental disorders. The broader focus of TransPEPP is to put neuroscience to clinical use for the benefit of patients and clinicians fighting mental illnesses.
We are engaged in three major areas of research: developing tools to predict outcome after first-episode psychosis. Understanding the brain mechanism behind mental states such as depression, mania and hallucinations, developing noninvasive treatment approaches to reduce the severity of psychiatric disorders.
Recovery Oriented Research in Psychosis - Drs. Arlene MacDougall & Ross Norman
Stigma Research
In affiliation with members of the Department of Psychology at Western University, researchers in PEPP have been leading a research program to better understand the determinants of the stigma of mental illness, particularly schizophrenia, and the identification of effective intervention themes for its reduction. Particular foci have been on the role of values, perceived social norms and specific beliefs on social distance toward people identified as having schizophrenia; and the potential power of values based interventions and personal narratives by patients in improving reactions.
Recovery Research
Research within PEPP demonstrates that recovery from psychotic illness involves more than the reduction or elimination of clinical symptoms. Recovery is a process that involves reclaiming autonomy and self-determination regardless of whether one does or does not “clinically” recover from the illness. Constructs such as hope, belief in a positive future self, self-esteem, sense of purpose and perceived positive social value and role are all critical to the recovery process. Novel recovery-oriented interventions include a youth-oriented mindfulness group and a participatory video narrative group are currently being developed and studied at PEPP.
Contact Us
For additional information about research being conducted at PEPP, please email PEPPresearch@lhsc.on.ca.
Current Studies at PEPP
A Comparison of Users and Non-Users of Early Intervention Services for Psychosis on Trajectories of Health Services Utilization and Long-Term Outcomes (EPI Project)
This project is aimed at comparing users and non-users of early psychosis intervention services on trajectories of service use and long-term outcomes. We are linking data from the PEPP program to health administrative data to estimate the number of patients who are not using these specialized programs, as well as what happens to people once they drop-out or are discharged from these intensive services. The findings from this program of research will allow us to identify where gaps in service provision exist for people with first-episode mental disorders, as well as to identify particular groups who might have greater difficulties accessing care.
Assessment of 10 year Outcomes for the Clients of the Prevention and Early Intervention Program for Psychoses Program
There is considerable evidence that early intervention programs for psychotic disorders result in better outcomes for patients while they are receiving care in these services. In recent years there has been controversy concerning how lasting these benefits are. The current project focuses on assessment of 10 year symptimatic functioning and outcomes of 69 patients who have received treatment in PEPP and will allow researchers to (1)compare these outcomes to others reported in the literature; (2) examin early predictors of 10 year outcomes; (3) examine the relationship between symptomatic, functional and subjective recovery measures of outcome; and (4) examine in greater detail the nature and predictors of negative symptoms (such a decreased motivation, social withdrawl, and emotional flatness) at 10- year follow-up.
Community REcovery Achieved Through Entrepreneurism (CREATE): A new paradigm for recovery from serious mental illness in low resource settings
People with serious mental illness (PWSMI) living in low income contexts often lack access to opportunities for meaningful employment and psychosocial rehabilitation (PSR) services. To address this gap, we are developing and evaluating ‘CREATE’: a new paradigm of recovery that couples social businesses (SB) with focused PSR practices in Machakos, Kenya. SB are commercially-viable businesses that provide training & real employment opportunities for PWSMI in their community. Research suggests SB employment leads to reduced symptoms and health services utilization, as well as improved employment outcomes and psychological well-being. To support employee functioning, we are piloting a low-cost toolkit of PSR best practices that can be used by local community health workers & PWSMI themselves. As such, this study is an examination of the feasibility and potential outcomes of this rehabilitative approach for PWSMI living in low income contexts. For more information please visit CREATE Kenya.
Depression- Inflammation Mediated Excitotoxicity (DiME)
Treatment resistant depression affects a large number of individuals. In collaboration with the Mood Disorder Program at Parkwood (Dr. Burhan, Dr. Sharma) and the PET imaging team (Dr. St.Lawrence, Dr. Finger) and NeuroPiL imaging team (Dr. Theberge) at Lawson, we are undertaking a study that examines the role of neuroinflammation and excitotoxic brain damage in the phenomenon of treatment resistance depression. Knowledge from this study will help us to conduct further investigations into the phenomenon of treatment resistance in schizophrenia. This study is funded by Lawson Strategic Research Funding.
Mindfulness-Based Group Intervention for Early Psychoses
Research has found evidence that mindfulness may be an effective treatment for psychosis. However, the majority of research on mindfulness for psychosis has been conducted in people with long-standing psychosis. Little is known about the use of mindfulness based interventions for young people recovering from early psychosis.The purpose of this study is to investigate whether a new group-based mindfulness intervention specifically designed for youth is an acceptable form of treatment for people with early psychosis. We will also be examining whether this intervention demonstrates beneficial effects on symptoms, cognitive and social skills, functioning and other important aspects of recovery for approximately 28 patients in PEPP. Information gained from this initial pilot study will help guide the design and implementation of a larger study of this mindfulness intervention for people with early psychosis.
The Determinants of Health Service Use and Outcomes for Young People with First-Episode Psychosis (ICES-FEP)
This project is examining the use of health services and long-term outcomes for young people with first-episode psychosis in Ontario. We are using health administrative data from across the province to assess the follow-up that people receive after their first episode of psychosis. The findings from this program of research will allow us to identify where gaps in service provision exist for people with first-episode psychosis, as well as to identify particular groups who might have greater difficulties accessing care.
The Novel Use of Participatory Video as a Recovery-Oritented Intervention in Early Psychosis
Prior research has shown that people with psychotic illnesses, like schizophrenia, who make sense of and meaningfully integrate their psychotic experiences into their life story are more likely to recover from their illness. This process of developing a coherent narrative seems especially relevant for young people who are experiencing their first episode of psychosis. There is a need for interventions that can help facilitate the formation of recovery-oriented narratives, particularly in the early stage of illness. We are therefore proposing the novel use of participatory video as an intervention to facilitate narrative development and promote recovery for individuals with early psychosis. Participatory video is a group process that involves the facilitated creation of short documentary-style videos in which individuals are supported to reflect on and tell their personal stories. In our pilot study, a small group of clients from the early intervention program for psychosis will undergo 12 semi-structured facilitated workshops over a period of 6 months in which they will learn how to plan, film and produce a documentary-style video of their experiences with psychosis. The goals of our study are to gain experience with the use of participatory video in a clinical setting, assess whether the participatory video process is acceptable to our clients, and begin to look at its potential benefits in the early psychosis population. We are particularly interested in exploring its impact on narrative development, symptoms, self-perceived recovery, self-esteem, self-stigma, social functioning and hope.
TOPSY: Tracking Outcomes of Psychosis
TOPSY is a longitudinal neuroimaging project that aims to capture the dynamic changes in the structure, function and chemical profile of the brain during early stages of psychosis and relate these changes to the variations in the symptoms and quality of life over the course of treatment. This study is conducted in collaboration with Prof. Williamson and Prof. Neufeld (Neuropsychiatry) and Dr. Theberge (NeuroPiL team, Lawson imaging). TOPSY is supported by funds from the Academic Medical Organisation of Southwestern Ontario.
Understanding Negative Symptoms in Patients of an Early Intervention Program for Psychotic Disorders
In the past, positive symptoms (e.g., hallucinations and delusions) of psychotic disorders have been the focus of most treatments and research, but negative symptoms (e.g., lower motivation, reduced emotional expression, reduced social engagement) are actually more predictive of later functioning in patients treated for schizophrenia related psychosis. In the current study researchers are examining the extent to which neuropsychological functioning, social anxiety and dysfunctional thinking predict individual variation of severity of negative symptoms in approximately 100 patients in an early intervention program of psychotic disorders.
Student Research Projects
Cumulative Dosing of Anti-Psychotic Medications as a Predictor of Patient Outcomes
Annie Li (Medical Student 2018, Schulich School of Medicine and Dentistry, Western University) is conducting research at PEPP through the Summer Research Training Program (SRTP). Annie is looking at dose equivalency conversion methods for anti-psychotic medication in a first-episode psychosis patient population. (Data is obtained from our 10 year longitudinal PEPP study.) This sets the foundation for further analysis between cumulative anti-psychotic dosing and patient outcome over time.
