October 10, 2022
By Pablo Gaspar & Rocio Mayol
Dr. Pablo Gaspar, psychiatrist and Dr Rocio Mayol, clinical psychologist both from Chile, share an overview of the development of early intervention in South and Central America
About 80% of patients with a first psychotic episode are found in low- and middle-income countries (LMICs) such as South and Central America (Farooq, 2013). Insufficient resources, stigma, and the lack of mental health public policies in these countries are some of the problems that these patients must face (Singh, 2020). Furthermore, the burden of disease in mental health disorders increased among low- and middle-income countries (LMICs) and developed countries during the COVID-19 pandemic (Robles-Sánchez, 2021).
Most severe mental health disorders develop during adolescence and early adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional impairment are observable (Hartmann et al., 2021). Currently, the COVID-19 crisis has had a significant impact on the mental health of adolescents and young adults in Latin America and the Caribbean (UNICEF, n.d.). As a result, the appearance of a higher incidence of anxiety and depressive disorders in South America has been documented and could lead to the appearance of severe mental health disorders at this stage, affecting personal achievements and causing significant disability (Barbeito et al., 2019).
During the last two decades, different groups in the world have focused their efforts on early detection and intervention of severe mental illnesses (Fusar-poli et al., 2012; Gaspar et al., 2019; McGorry & Yung, 2003; Riecher- ro et al., 2013) with the aim of preventing or delaying the onset of these illnesses and reducing functional impairment. A growing number of early detection programs have been developed and have shown positive results at different stages of prevention, which has resulted in a transition in the clinical characterization of these disorders, moving towards early detection and intervention by describing people with potentially prodromal symptoms (Gaspar et al., 2019; McGorry et al., 2018; Riecher-ro et al., 2013). Evidence has shown that early identification and intervention for these conditions delays or prevents the conversion to severe mental illness (Fusar-Poli et al., 2014), improves prognosis (Lin et al., 2015; Polari et al., 2018) and is a cost-beneficial clinical approach for the countries that occupy this paradigm (Arango et al., 2018; Irarrázaval et al., 2016). However, prevention and early intervention in mental health is a current challenge in Central and South America. Since the last decade, the existence of initiatives in this field has been mapped in Mexico, Brazil, Chile and Argentina, mostly in first episode psychosis programs (Aceituno, 2015). Chile is the only country with an established program for prospective follow-up of participants with at-risk mental states with a transdiagnostic perspective (Gaspar, 2019; Salazar de Pablo, 2021). In addition, a multicenter network for early detection and intervention called RED-EMAR (Gaspar, 2021) has recently been created. The objective of RED-EMAR (www.redemarchile.cl) is to recognize and disseminate the value of the at risk mental stateconcept (abbreviated to EMAR in Spanish), establish agreed therapeutic strategies in this field in LMIC, and establish potential new evidence-based local interventions.
The successful experiences of this network include the monitoring and discussion of clinical cases in telemedicine and the development of clinical guidelines for mental health education for cases and families (Gaspar, 2021). The development and access to early detection and intervention services in LMICs could be a window of opportunity to reduce the impact of severe mental health disorders such as psychosis on the population and move towards an approach aimed atprevention or delaying its onset.
Pablo A. Gaspar is the head of the Psychosis Unit of the Department of Psychiatry at the University of Chile, Director of the Translational Psychiatry Laboratory and founder of the Chilean Network of early detection and intervention in mental health (Red-EMAR-Chile). He acts as an associate researcher of the renowned research Centre, “Millennium Nucleus to improve mental health in adolescents and youths (IMHAY)” and Principal Investigator Chilean site of the PRESCIENT project funded by the NIMH. His line of research is early detection and intervention in psychosis and their biological risk factors. He is a well-recognized expert in the field in Chile. Currently, he is IEPA’s Vice President South and Central America and member of the American College of Neuropsychopharmacology (ACNP) Latin American initiative task force.
Dr. Rocío Mayol, PhD is a clinical psychologist expert in psychosis. Dr. Mayol is affiliated with the Faculty of Psychology of the Alberto Hurtado University and the Psychosis Unit of the University of Chile. She acts as a young researcher of the ¨millennium nucleus for Improving the Mental Health of Adolescents and Youth ¨(IMHAY). She has a scholarship as principal investigator of the National Fund for Scientific and Technological Development (Fondecyt).Dr. Mayol’s line of research is the early stages of psychotic disorders, and she is also interested in the development of early psychotherapeutic interventions of severe mental illnesses.
Aceituno, D, Mena, C, Vera, N, et al. Implementation of early psychosis services in Latin America: A scoping review. Early Intervention in Psychiatry. 2021; 15: 1104– 1114. https://doi.org/10.1111/eip.13060
Arango, C., Díaz-Caneja, C. M., McGorry, P. D., Rapoport, J., Sommer, I. E., Vorstman, J. A., McDaid, D., Marín, O., Serrano-Drozdowskyj, E., Freedman, R., & Carpenter, W. (2018). Preventive strategies for mental health. In The Lancet Psychiatry (Vol. 5, Issue 7, pp. 591–604). Elsevier Ltd. https://doi.org/10.1016/S2215-0366(18)30057-9.
Bassey EE, Gupta A, Kapoor A, Bansal A. COVID-19 and Poverty in South America: the Mental Health Implications. Int J Ment Health Addict. 2022 Jan 24:1-7. doi: 10.1007/s11469-022-00765-6. Epub ahead of print. PMID: 35095354; PMCID: PMC8785692.
Brietzke, E., Araripe Neto, A. G., Dias, A., Mansur, R. B., & Bressan, R. A. (2011). Early intervention in psychosis: A map of clinical and research initiatives in Latin America. Revista Brasileira de Psiquiatria, 33(Suppl 2), s213–s224. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22286569
El impacto del COVID-19 en la salud mental de adolescentes y jóvenes | UNICEF. (n.d.). Retrieved Sept 7, 2022, from https://www.unicef.org/lac/el-impacto-del-covid-19-en-la-salud-mental-de-adolescentes-y-j%C3%B3venes
Farooq S. Public health and physician focused strategies to improve medication adherence in psychotic disorders. World Psychiatry. 2013 Oct;12(3):238-9. doi: 10.1002/wps.20068. PMID: 24096789; PMCID: PMC3799254.
Fusar-poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., Barale, F., Caverzasi, E., & Mcguire, P. (2012). Predicting Psychosis. Arch Gen Psychiatry, 69(3), 220–229.
Fusar-Poli, P., Carpenter, W. T., Woods, S. W., & McGlashan, T. H. (2014). Attenuated Psychosis Syndrome: Ready for DSM-5.1? Annual Review of Clinical Psychology, 10(1), 155–192. https://doi.org/10.1146/annurev-clinpsy-032813-153645
Gaspar PA, Maturana A, Mayol R, Castillo R. (2021). Building a national network of early detection and intervention in Chile: Present and future. Oral Symposium 8th ECSR S-10-002, S-10. National networks for the prevention of psychoses – achievements and challenges.
Gaspar, P. A., Castillo, R. I., Maturana, A., Villar, M. J., Ulloa, K., González, G., … Silva, H. (2019). Early psychosis detection program in Chile: A first step for the south American challenge in psychosis research. Early Intervention in Psychiatry, 13(2), 328–334. https://doi.org/10.1111/eip.12766
Hartmann, J. A., McGorry, P. D., Destree, L., Amminger, G. P., Chanen, A. M., Davey, C. G., Ghieh, R., Polari, A., Ratheesh, A., Yuen, H. P., & Nelson, B. (2021). Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach. Frontiers in Psychiatry, 11, 553578. https://doi.org/10.3389/fpsyt.2020.553578
Irarrázaval, M., Prieto, F., & Armijo, J. (2016). PREVENCIÓN E INTERVENCIONES TEMPRANAS EN SALUD MENTAL: UNA PERSPECTIVA INTERNACIONAL 1. In Acta Bioethica (Vol. 22, Issue 1).
Lin, A., Wood, S. J., Nelson, B., Beavan, A., McGorry, P., & Yung, A. R. (2015). Outcomes of nontransitioned cases in a sample at ultra-high risk for psychosis. American Journal of Psychiatry, 172(3), 249–258. https://doi.org/10.1176/appi.ajp.2014.13030418
McGorry, P. D., & Yung, A. R. (2003). Early intervention in psychosis: An overdue reform. Australian and New Zealand Journal of Psychiatry, 37(4), 393–398. https://doi.org/10.1046/j.1440-1614.2003.01192.x
Polari, A., Lavoie, S., Yuen, H. P., Amminger, P., Berger, G., Chen, E., deHaan, L., Hartmann, J., Markulev, C., Melville, F., Nieman, D., Nordentoft, M., Riecher-Rössler, A., Smesny, S., Stratford, J., Verma, S., Yung, A., McGorry, P., & Nelson, B. (2018). Clinical trajectories in the ultra-high risk for psychosis population. Schizophrenia Research, 197, 550–556. https://doi.org/10.1016/j.schres.2018.01.022
Riecher-ro, A., Birchwood, M., Mcglashan, T., Carpenter, W., Mcgorry, P., & Klosterko, J. (2013). The Psychosis High-Risk State. JAMA Psychiatry, 70(1), 107–120. https://doi.org/10.1001/jamapsychiatry.2013.269
Robles-Sánchez, JI. (2021). Salud Mental en tiempos de pandemia: la pandemia paralela. Sanidad Militar, 77(2), 69-72. Epub 13 de septiembre de 2021.https://dx.doi.org/10.4321/s1887-85712021000200001.
Salazar de Pablo G, Estradé A, Cutroni M, Andlauer O, Fusar-Poli P. Establishing a clinical service to prevent psychosis: What, how and when? Systematic review. Transl Psychiatry. 2021 Jan 13;11(1):43. doi: 10.1038/s41398-020-01165-x. PMID: 33441556; PMCID: PMC7807021.
Singh SP, Javed A; WPA Expert International Advisory Panel for Early Intervention in Psychosis. Early intervention in psychosis in low- and middle-income countries: a WPA initiative. World Psychiatry. 2020 Feb;19(1):122. doi: 10.1002/wps.20708. PMID: 31922694; PMCID: PMC6953594.
Valencia, M., Juarez, F., & Ortega, H. (2012). Integrated treatment to achieve functional recovery for first-episode psychosis. Schizophrenia Research and Treatment, 2012, 962371. https://doi.org/10.1155/2012/962371
Yung AR, Phillips LJ, Yuen HP, McGorry PD (2004): Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features. Schizophrenia Research. 67:131-142.
Declaration of Interests: None
This project was made possible thanks to a sponsorship from H/Lundbeck A/S. The opinions expressed in these materials do not necessarily reflect those of H.Lundbeck.