A systematic review of longitudinal outcome studies of first-episode psychosis

2006 ◽  
Vol 36 (10) ◽  
pp. 1349-1362 ◽  
Author(s):  
N. M. MENEZES ◽  
T. ARENOVICH ◽  
R. B. ZIPURSKY
Keyword(s):  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Future Research ◽  
Significant Heterogeneity ◽  
Chronic Patients ◽  
Psychosocial Therapy ◽  
Longitudinal Outcome ◽  
Episode Psychosis

Background. Existing outcome literature has had an over-representation of chronic patients and suggested a progressive course and poor outcome for schizophrenia. The current study aimed to recombine data of samples from longitudinal studies of first-episode psychosis (FEP) to describe outcome and its predictors.Method. A literature search (1966–2003) was conducted for prospective studies examining outcome in first-episode non-affective psychosis using the following key words: early, first, incident, episode, admission, contact, psychosis, schizophrenia, psychotic disorders, course, outcome, follow-up, longitudinal, cohort. These were pooled and analyzed using descriptive and regression analyses.Results. Thirty-seven studies met the inclusion criteria, representing 4100 patients with a mean follow-up of 35·1±6·0 months. Studies varied in the categories of outcome used, the most common being ‘good’ (54% of studies) and ‘poor’ (34% of studies), variably defined. In studies reporting these categories, good outcomes were reported in 42·2% (3·5%) and poor outcomes in 27·1% (2·8%) of cases. Predictors associated with better outcome domains were: combination of pharmacotherapy and psychosocial therapy, lack of epidemiologic representativeness of the sample, and a developing country of origin. Use of typical neuroleptics was associated with worse outcome. Stratification analyses suggested that populations with schizophrenia only, and those with prospective design, were associated with worse outcome domains.Conclusions. Outcome from FEP may be more favorable than previously reported, and treatment and methodological variables may be important contributors to outcome. Significant heterogeneity in definitions and methodology limited the comparison and pooling of data. A multi-dimensional, globally used definition of outcome is required for future research.

Relapse After First-Episode Psychosis: A 3-Year Follow-Up

2017 ◽  
Vol 41 (S1) ◽  
pp. S276-S276
Author(s):  
E. Pereira ◽  
M. Mota Oliveira ◽  
R. Guedes ◽  
M.J. Peixoto ◽  
I. Ferraz ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Statistical Significance ◽  
First Episode Psychosis ◽  
Response To Treatment ◽  
First Episode ◽  
Final Sample ◽  
Episode Psychosis ◽  
Competing Interest ◽  
Relapse Rates

IntroductionRelapse after first-episode psychosis (FEP) is a frequent problem, which can lead to patients’ poorer functioning and response to treatment. Its prevention is one of the most important and challenging targets in the treatment of psychotic disorders.ObjectivesTo characterize and evaluate relapse rates after FEP, during the course of 3 years, of a group of patients admitted at a psychiatry department.MethodsA retrospective observational study was conducted. Patients with a FEP between ages 18 to 40, admitted at the Clinic of Psychiatry and Mental Health at São João Hospital Centre between January 1, 2007 and September 30, 2013. Only patients with, at least, 3 years of follow-up at the clinic were included.ResultsFinal sample of 58 patients, 39 of which were male (mean age = 26.4 years). Forty patients were excluded by not completing the 3 years follow-up at our department. The cumulative relapse rates were 32.8% at 12 months, 53.4% at 24 months and 63.8% at 36 months. Patients with at least one relapse were younger (25.78 years vs. 27.52 years) and had shorter periods of first hospitalization (19.25 days vs. 23.52 days). These data did not reach statistical significance. Non-adherence to prescribed medication was described in 73.0% (n = 27) of patients at the time of relapse. Eight of them (21.6%) presented with cannabis use.ConclusionsAlthough no statistical significance was reached, our findings are consistent with other studies. A future study with a bigger sample would be important in achieving statistical significant results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Differential predictors of critical comments and emotional over-involvement in first-episode psychosis

2008 ◽  
Vol 40 (1) ◽  
pp. 63-72 ◽  
Author(s):  
M. Álvarez-Jiménez ◽  
J. F. Gleeson ◽  
S. M. Cotton ◽  
D. Wade ◽  
K. Crisp ◽  
...  
Keyword(s):  
Family Stress ◽  
First Episode Psychosis ◽  
Therapeutic Interventions ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Future Research ◽  
Burden Of Care ◽  
Related Factors ◽  
Episode Psychosis

BackgroundLittle research has focused on delineating the specific predictors of emotional over-involvement (EOI) and critical comments (CC) in the early course of psychosis. The purpose of this study was to investigate the differential relationships of EOI and CC with relevant predictors in relatives of first-episode psychosis (FEP) patients.MethodBaseline patient-related factors including psychotic symptoms, depression and duration of untreated psychosis (DUP) and carer attributes comprising CC, EOI, burden of care and carers' stress and depression were assessed in a cohort of 63 remitted FEP patients and their relatives. Carers were reassessed at 7 months follow-up.ResultsBaseline analysis showed that EOI was more strongly correlated with family stress compared with CC, whereas CC yielded a stronger association with DUP than EOI. Carers' CC at follow-up was not significantly predicted by either baseline family stress, burden of care or patient-related variables. Conversely, baseline EOI predicted both family stress and burden of care at 7 months follow-up. Finally, family burden of care at follow-up was a function of baseline EOI and patients' depressive symptoms.ConclusionsThis study provides preliminary support to the postulate that EOI and CC may be influenced by separate factors early in the course of psychosis and warrant future research and therapeutic interventions as separate constructs. Implications for family interventions in the early phase of psychosis and the prevention of CC and EOI are discussed.

Change in cannabis use, clinical symptoms and social functioning among patients with first-episode psychosis: a 5-year follow-up study of patients in the OPUS trial

2013 ◽  
Vol 44 (1) ◽  
pp. 117-126 ◽  
Author(s):  
L. Clausen ◽  
C. R. Hjorthøj ◽  
A. Thorup ◽  
P. Jeppesen ◽  
L. Petersen ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Clinical Symptoms ◽  
First Episode Psychosis ◽  
Cannabis Use ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Episode Psychosis

BackgroundSeveral studies indicate that cannabis use among patients with psychotic disorders is associated with worse outcome, but only a few studies have controlled for baseline condition and medication.MethodAt 5-year follow-up, interviews were carried out with 314 first-episode psychosis patients included in the OPUS trial. The patients included were in the age range of 18 to 45 years old and 59% were male. Cannabis use was extracted from the Schedule for Clinical Assessment in Neuropsychiatry. At follow-up, the patients were divided into different groups according to the variable cannabis use: abstainers, stoppers, starters and continuers. Psychotic, negative and disorganized dimensions (ranging from zero to five) were calculated for each of the four groups based on the Schedule for the Assessment of Positive and Negative Symptoms in Schizophrenia.ResultsCannabis users were younger (24.6 years v. 27.4 years, p < 0.001) and had a lower level of education. At the 5-year follow-up, users of cannabis had higher scores on the psychotic dimension [difference 0.97, 95% confidence interval (CI) 0.41–1.53, p = 0.001] and lower levels of the Global Assessment of Functioning (difference 8.26, 95% CI 2.13–14.39, p = 0.01). Those who stopped using cannabis between entry and 5-year follow-up had a significantly lower level of psychotic symptoms at 5-year follow-up even after controlling for baseline level of psychotic symptoms and for insufficient antipsychotic medication (adjusted difference in psychotic dimension –1.04, 95% CI –1.77 to –0.31, p = 0.006).ConclusionsContinuous cannabis use was associated with higher levels of psychotic symptoms after 5 years, and this association was only partly explained by insufficient antipsychotic medication.

scholarly journals A review of altered biochemistry in the anterior cingulate cortex of first-episode psychosis

2017 ◽  
Vol 26 (2) ◽  
pp. 122-128 ◽  
Author(s):  
L. Squarcina ◽  
J. A. Stanley ◽  
M. Bellani ◽  
C. A. Altamura ◽  
P. Brambilla
Keyword(s):  
Anterior Cingulate Cortex ◽  
Psychotic Disorders ◽  
Cingulate Cortex ◽  
First Episode Psychosis ◽  
Anterior Cingulate ◽  
First Episode ◽  
Resonance Spectroscopy ◽  
Chronic Patients ◽  
Episode Psychosis

Relevant biochemicals of the brain can be quantified in vivo, non-invasively, using proton Magnetic Resonance Spectroscopy (¹H MRS). This includes metabolites associated with neural general functioning, energetics, membrane phospholipid metabolism and neurotransmission. Moreover, there is substantial evidence of implication of the frontal and prefrontal areas in the pathogenesis of psychotic disorders such as schizophrenia. In particular, the anterior cingulate cortex (ACC) plays an important role in cognitive control of emotional and non-emotional processes. Thus the study of its extent of biochemistry dysfunction in the early stages of psychosis is of particular interest in gaining a greater understanding of its aetiology. In this review, we selected ¹H MRS studies focused on the ACC of first-episode psychosis (FEP). Four studies reported increased glutamatergic levels in FEP, while other four showed preserved concentrations. Moreover, findings on FEP do not fully mirror those in chronic patients. Due to conflicting findings, larger longitudinal ¹H MRS studies are expected to further explore glutamatergic neurotransmission in ACC of FEP in order to have a better understanding of the glutamatergic mechanisms underlying psychosis, possibly using ultra high field MR scanners.

scholarly journals S228. SOCIAL AND OCCUPATIONAL FUNCTIONING AND SATISFACTION WITH CARE IN FINNISH FIRST-EPISODE PSYCHOSIS PATIENTS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S125-S125
Author(s):  
Paula Barrientos ◽  
Jaana Suvisaari ◽  
Tuula Kieseppä
Keyword(s):  
Patient Satisfaction ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Diagnostic Interview ◽  
First Episode ◽  
Satisfaction With Care ◽  
Episode Psychosis ◽  
Psychiatric Staff

Abstract Background Patient satisfaction with care (PSC) is a valuable predictor in both quality of life and treatment outcomes with psychiatric patients. First episode psychosis (FEP) patients are a diverse group of usually young adults. Determining the factors behind PSC in FEP patients could be an important tool in planning better care programs and predictive tools for the outcome of FEP. Many FEP patients are still on the cusp of their adult lives. Achieving better treatment adherence by higher PSC could help many people back to their studies or work lives and enhance their quality of life and social and occupational functioning. Determining background factors and associations with better PSC would help tailoring treatment options for FEP patients. Methods The Helsinki Early Psychosis Study recruited FEP patients (aged 18 to 40 years old) who were having their first treatment of psychosis in the catchment area of the Helsinki University Hospital and the psychiatric services of Helsinki City in the time period from December 2010 to June 2016. The diagnoses of psychotic disorders were later verified using the Structured Diagnostic Interview for DSM-IV, Research Version, as well as a review of all medical records. Substance-induced psychotic disorders and psychotic disorders due to a general medical condition were excluded. Baseline assessment was conducted as soon as the patient had entered treatment and was able to give informed consent according to the treating personnel. Follow ups were conducted at 2 months after baseline. Data was gathered on symptoms, sociodemographic factors, functioning, overall health, aspects of treatment and medication. Duration of untreated psychosis was determined as accurately as possible with the help of patient records and diagnostic interview. Patient satisfaction was evaluated by PSQ (Patient satisfaction questionnaire) developed by Swedish researchers for their early intervention program for first episode psychosis patients. The questionnaire contains ten questions about different aspects of the patients’ care and was part of the 2-month follow-up protocol. Results 97 patients were recruited in the study. Out of those patients, 72 patients participated in the 2-month follow up and 51 filled out the PSC questionnaire. The results of the PSQ were translated into a dichotomist scale of “satisfied” (very or rather satisfied) or “not satisfied” (neither satisfied nor dissatisfied; rather or very dissatisfied). Interestingly, DUP was not associated with higher or lower satisfaction with care unlike in other studies. Conversely, higher SOFAS score at the 2-month follow up was associated with better treatment satisfaction. Especially patients who felt they had been able to influence their care, who felt that the sessions with the psychiatric staff been helpful, and who were satisfied with the concern and understanding the psychiatric staff had shown had significantly higher SOFAS than those who were not satisfied with these aspects of care, whereas e.g. attitudes regarding medication were not significantly associated with SOFAS. A summary score of the PSQ correlated positively with the 2 month SOFAS scores (Spearman rho 0.40, p=0.007). Discussion Unlike in many other studies, longer DUP was not associated with poorer PSC. Instead, satisfaction with qualitative aspects of treatment contact and being able to influence treatment decisions were associated with better functioning. This suggest that the staff-patient relationship and empowering patients in treatment decisions are important in the treatment of FEP.

scholarly journals Metacognitive capacity and negative symptoms in first episode psychosis: Evidence of a prospective relationship over a 3-year follow-up

2019 ◽  
Vol 10 (1) ◽  
pp. 204380871882157 ◽  
Author(s):  
Stephen Fitzgerald Austin ◽  
Paul H. Lysaker ◽  
Jens Einar Jansen ◽  
Anne Marie Trauelsen ◽  
Hanne-Grethe Lyse Nielsen ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Sense Of Self ◽  
First Episode Psychosis ◽  
First Episode ◽  
Future Research ◽  
Syndrome Scale ◽  
Episode Psychosis ◽  
Negative Syndrome

Negative symptoms can be linked to Bleuler’s concept of splitting or fragmentation of thought, affect, and will. Research has shown a link between disturbances in metacognition and negative symptoms, although relatively few studies have examined this relationship longitudinally. The aim of this article is to examine whether metacognitive capacity among patients with first episode psychosis (FEP) predicted negative symptoms after a follow-up period of 3 years. Metacognition was assessed using the Metacognition Assessment Scale abbreviated and symptoms were assessed using Positive and Negative Syndrome Scale among 59 adults with FEP. Symptoms were then reassessed at a 3-year follow-up. Significant correlations were found between baseline metacognitive scores and the expressive component of negative symptoms as well as for individual negative symptoms such as blunted affect, poor rapport, and alogia at 3-year follow-up after controlling for baseline negative symptoms. Self-reflectivity was significantly correlated with the expressive component of negative symptoms at 3-year follow-up. The results are partly consistent with a Bleulerian model which understands the emergence of negative symptoms as a response in part to the experience of fragmentation, particularly in terms of sense of self and others. Future research should clarify the likely role of metacognition in the development and maintenance of negative symptoms.

Diagnostic Stability in Patients with First-Episode Psychosis

2005 ◽  
Vol 13 (4) ◽  
pp. 388-392 ◽  
Author(s):  
Homayoun Amini ◽  
Javad Alaghband-Rad ◽  
Abbas Omid ◽  
Vandad Sharifi ◽  
Rozita Davari-Ashtiani ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
International Classification Of Diseases ◽  
First Episode Psychosis ◽  
Classification Systems ◽  
First Episode ◽  
Episode Psychosis ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Dsm Iv

Objective: To examine the short-term stability of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and International Classification of Diseases (10th revision; ICD-10) diagnoses in a group of patients with first-episode psychosis. Method: Sixty patients with first-episode psychosis admitted consecutively to Roozbeh Hospital, Tehran, were sampled; their illnesses could not be attributed to any medical or substance-induced conditions. Patients were assessed at the time of discharge from the hospital, and at 3, 6and 12 month intervals following admission. Ateach visit, two psychiatrists made consensusDSM-IV and ICD10 diagnoses, based on all available information. Stability was discerned as the consistency between diagnoses at the time of discharge and at 12 month follow up. Results: Forty-eight patients completed follow up. Affective psychotic disorders and schizophrenia in both classification systems were highly stable. In addition, all patients with DSM-IV brief psychotic disorder and ICD-10 acute and transient psychotic disorders remained the same at follow up. Conclusions: Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course ofacute brief psychoses, especially in developing countries.

QUALITY OF INDIVIDUAL AND GROUP LEVEL INTERVENTIONS FOR FIRST EPISODE PSYCHOSIS AT THE TERTIARY PSYCHIATRIC HOSPITAL IN UGANDA.

2020 ◽  
Author(s):  
Emmanuel Kiiza Mwesiga ◽  
Noeline Nakasujja ◽  
Lawrence Nankaba ◽  
Juliet Nakku ◽  
Seggane Musisi
Keyword(s):  
Psychiatric Hospital ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Group Level ◽  
Group Interventions ◽  
Episode Psychosis ◽  
Essential Components ◽  
The Individual

Introduction: Individual and group level interventions have the largest effect on outcomes in patients with the first episode of psychosis. The quality of these individual and group level interventions provided to first-episode psychosis patients in Uganda is unclear.Methods: The study was performed at Butabika National Psychiatric Teaching and referral hospital in Uganda. A retrospective chart review of recently discharged adult in-patients with the first episode of psychosis was first performed to determine the proportion of participants who received the different essential components for individual and group level interventions. From the different proportions, the quality of the services across the individual and group interventions was determined using the first-Episode Psychosis Services Fidelity Scale (FEPS-FS). The FEPS-FS assigns a grade of 1-5 on a Likert scale depending on the proportion of patients received the different components of the intervention. Results: The final sample included 156 first-episode psychosis patients. The median age was 27 years [IOR (24-36)] with 55% of participants of the female gender. 13 essential components across the individual and group interventions were assessed and their quality quantified. All 13 essential components had poor quality with the range of scores on the FEPS-FS of 1-3. Only one essential component assessed (use of single antipsychotics) had moderate quality.Discussion: Among current services at the National psychiatric hospital of Uganda, the essential for individual and group level interventions for psychotic disorders are of low quality. Further studies are required on how the quality of these interventions can be improved.

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