Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories

BackgroundFew studies have examined the underlying factor structure of signs and symptoms occurring before the first psychotic episode. Our objective was to determine whether factors derived from early signs and symptoms are differentially associated with non-affective versus affective psychosis.MethodA principal components factor analysis was performed on early signs and symptoms reported by 128 individuals with first-episode psychosis. Factor scores were examined for their associations with duration of untreated illness, drug abuse prior to onset of psychosis, and diagnosis (schizophrenia versus affective psychosis).ResultsOf the 27 early signs and symptoms reported by patients, depression and anxiety were the most frequent. Five factors were identified based on these early signs and symptoms: depression, disorganization/mania, positive symptoms, negative symptoms and social withdrawal. Longer duration of untreated illness was associated with higher levels of depression and social withdrawal. Individuals with a history of drug abuse prior to the onset of psychosis scored higher on pre-psychotic depression and negative symptoms. The two mood-related factors, depression and disorganization/mania, distinguished the eventual first-episode diagnosis of affective psychosis from schizophrenia. Individuals with affective psychosis were also more likely to have a ‘mood-related’ sign and symptom as their first psychiatric change than individuals later diagnosed with schizophrenia.ConclusionsFactors derived from early signs and symptoms reported by a full diagnostic spectrum sample of psychosis can have implications for future diagnostic trajectories. The findings are a step forward in the process of understanding and characterizing clinically important phenomena to be observed prior to the onset of psychosis.

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Patterns and predictors of hospitalisation in first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.178.6.518 ◽

2001 ◽

Vol 178 (6) ◽

pp. 518-523 ◽

Cited By ~ 47

Author(s):

Attila Sipos ◽

Glynn Harrison ◽

David Gunnell ◽

Shazad Amin ◽

Swaran P. Singh

Keyword(s):

Negative Symptoms ◽

First Episode Psychosis ◽

Psychiatric Services ◽

First Episode ◽

Psychotic Episode ◽

Duration Of Untreated Illness ◽

Specialist Services ◽

Increased Risk ◽

Episode Psychosis

BackgroundLittle is known about predictors of hospitalisation in patients with first-episode psychosis.AimsTo identify the pattern and predictors of hospitalisation of patients with a first psychotic episode making their first contact with specialist services.MethodThree-year follow-up of a cohort of 166 patients with a first episode of psychosis making contact with psychiatric services in Nottingham between June 1992 and May 1994.ResultsEighty-eight (53.0%) patients were admitted within 1 week of presentation; 32 (19.3%) were never admitted during the 3 years of follow-up. Manic symptoms at presentation were associated with an increased risk of rapid admission and an increased overall risk of admission; negative symptoms and a longer duration of untreated illness had an increased risk of late admission.ConclusionsCommunity-oriented psychiatric services might only delay, rather than prevent, admission of patients with predominantly negative symptoms and a longer duration of untreated illness. First-episode studies based upon first admissions are likely to be subject to selection biases, which may limit their representativeness.

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The role of social relatedness and self-beliefs in social functioning in first-episode psychosis: Are we overestimating the contribution of illness-related factors?

European Psychiatry ◽

10.1192/j.eurpsy.2020.90 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

César González-Blanch ◽

Leonardo A. Medrano ◽

Sarah Bendall ◽

Simon D’Alfonso ◽

Daniela Cagliarini ◽

...

Keyword(s):

Social Cognition ◽

Social Functioning ◽

Negative Symptoms ◽

First Episode Psychosis ◽

Equation Modeling ◽

First Episode ◽

Related Factors ◽

Social Relatedness ◽

Episode Psychosis ◽

Fit Index

Abstract Objective Numerous research studies have demonstrated an association between higher symptom severity and cognitive impairment with poorer social functioning in first-episode psychosis (FEP). By contrast, the influence of subjective experiences, such as social relatedness and self-beliefs, has received less attention. Consequently, a cohesive understanding of how these variables interact to influence social functioning is lacking. Method We used structural equation modeling to examine the direct and indirect relationships among neurocognition (processing speed) and social cognition, symptoms, and social relatedness (perceived social support and loneliness) and self-beliefs (self-efficacy and self-esteem) in 170 individuals with FEP. Results The final model yielded an acceptable model fit (χ2 = 45.48, comparative fit index = 0.96; goodness of fit index = 0.94; Tucker–Lewis index = 0.94; root mean square error of approximation = 0.06) and explained 45% of social functioning. Negative symptoms, social relatedness, and self-beliefs exerted a direct effect on social functioning. Social relatedness partially mediated the impact of social cognition and negative symptoms on social functioning. Self-beliefs also mediated the relationship between social relatedness and social functioning. Conclusions The observed associations highlight the potential value of targeting social relatedness and self-beliefs to improve functional outcomes in FEP. Explanatory models of social functioning in FEP not accounting for social relatedness and self-beliefs might be overestimating the effect of the illness-related factors.

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Family history of psychosis negatively impacts age at onset, negative symptoms, and duration of untreated illness and psychosis in first-episode psychosis patients

Psychiatry Research ◽

10.1016/j.psychres.2012.03.001 ◽

2012 ◽

Vol 197 (1-2) ◽

pp. 23-28 ◽

Cited By ~ 20

Author(s):

Michelle Esterberg ◽

Michael Compton

Keyword(s):

Family History ◽

Negative Symptoms ◽

Age At Onset ◽

First Episode Psychosis ◽

First Episode ◽

Duration Of Untreated Illness ◽

Episode Psychosis ◽

History Of

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Clinical correlates of first episode schizophrenia-a comparative study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180296 ◽

2018 ◽

Vol 6 (2) ◽

pp. 551

Author(s):

Kathir M. ◽

Pugazhendhi K. ◽

Ravishankar J.

Keyword(s):

Family History ◽

Negative Symptoms ◽

Suicide Attempts ◽

Social Withdrawal ◽

First Episode ◽

Positive Symptoms ◽

Major Mental Disorder ◽

History Of ◽

Drug Naïve ◽

First Episode Schizophrenia

Background: Schizophrenia is a major mental disorder which has to be assessed early and managed actively even though long term functional outcome remains relatively poor. The aim of the study is to analyze negative symptoms, suicidal risk and substance use in first episode schizophrenics in comparison with multi-episode schizophrenics.Methods: 30 patients with drug naive first episode schizophrenia and 30 patients with multi episode schizophrenia, who attended the outpatient department of Psychiatry, Government Stanley Medical College, Chennai, Tamilnadu, India were studied to compare predisposing factors and spectrum of symptoms for Schizophrenia for a period of one year (January 2010-December 2010). Psychiatric questionnaire by Michael C. Hilton, DAST by Harvey A. Skinner, AUDIT by WHO, Suicide risk scale by National Health and Medical Research Council, PANSS by SR Kay were used to assess patients.Results: Unemployment and family history of suicide attempts were observed more in drug naive first episode schizophrenics. 90% of these patients had completed their primary education while 47% of multi-episode schizophrenics were illiterates. Positive symptoms (delusions, hallucinatory behaviour and suspiciousness) and negative symptoms (blunted affect, emotional withdrawal and social withdrawal) were observed more in first episode schizophrenics while PANSS, DAST, AUDIT scores did not find any differences between both the groups.Conclusions: In our study, the first episode schizophrenia patients were more educated, more unemployed and had more family history of suicide, elevated sub score of positive symptoms as measured by PANSS. Relative assessment of violence and serious behavior problems that are related to positive symptoms must be done and managed with anti psychotics.

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Analysis of the duration of untreated illness (DUI) in the first episode psychosis Program (FEP) in AGS South Granada

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2140 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S577-S578

Author(s):

B. Girela Serrano ◽

M. Guerrero Jiménez ◽

C.M. Carrillo de Albornoz Calahorro ◽

J.A. Rodrigo Manzano ◽

O.B. Martínez García

Keyword(s):

Social Functioning ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Average Score ◽

First Episode ◽

Toxic Substances ◽

Relevant Variable ◽

Duration Of Untreated Illness ◽

Social Functioning Scale ◽

Competing Interest

IntroductionDuration of untreated illness (DUI) has been considered as a relevant variable used to measure the degree of disabilities that are associated with psychotic disorders. In this paper we describe a cluster of patients with a DUI superior to 1 year according to their symptoms and sociofamiliar functioning.MethodsWe compare a group with a DUI superior to 1 year (n = 7) against a group with a DUI inferior to 1 year (n = 17).ResultsThe group with a DUI superior to 1 year showed an average age of 4 years younger (21) as the duration of untreated psychosis (DUP) of 1 to 3 months in the 80% of cases and higher percentage of unemployed or without occupation. The 60% were derived from primary care, compared to the 17% of the other group. Although the consumption of toxic substances was similar in both groups, no toxic psychosis were found in comparison with the 35% present in the group with a DUI inferior to 1 year. PANSS’ profile scored more positive and less negative symptoms. Both have similar general psychopathology. There were group differences in the Social Functioning Scale (SFS) with lower scores in the superior to 1 year DUI, in the following scales: Prosocial, Autonomy, Execution and Employment. The Global Assessment of Functioning (GAF) gives an average of almost 8 points higher.DiscussionWhile the SFS shows significant differences in several areas of social functioning, both PANSS’ profile and the family questionnaire do not support greater deterioration, as evidenced in the GAF's average score.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Characteristics and duration of untreated illness in correlation with insight level of first time diagnosed schizophrenia patients in rural region of Latvia

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1554 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s804-s804

Author(s):

L. Berze ◽

K. Pavlovs ◽

K. Slikova ◽

V. Bodins ◽

I. Samule ◽

...

Keyword(s):

Negative Symptoms ◽

Depression Scale ◽

First Episode ◽

Inclusion Criteria ◽

Symptoms Of Depression ◽

Duration Of Untreated Illness ◽

Schizophrenia Spectrum ◽

Competing Interest ◽

First Time ◽

Written Informed Consent

IntroductionImproved insight level among schizophrenia patients is predictive for better illness prognosis.ObjectiveExplore factors connected to insight.AimEvaluate the insight level and clinical characteristics of first time hospitalized schizophrenia spectrum patients.MethodsAll consecutive first time hospitalized schizophrenia spectrum patients in a psychiatric hospital from 01.01.2016–26.09.2016. Patients were interviewed upon hospitalization and at the discharge with Scale for the assessment of positive symptoms (SAPS) and negative symptoms (SANS), Schedule of assessment of insight-extended (SAI-E), The Calgary depression scale for schizophrenia (C-sch), sociodemographic and clinical data were collected. All participants signed written informed consent and the study was approved by the Riga Stradins University Ethics committee.ResultsFrom 45 first episode patients, 38 met the inclusion criteria. Mean age was 37.66 years (SD: 11.48 years), the average duration of untreated illness (DUI) was 40.5 months (SD: 57.35 months). Psychopathologic symptoms and insight levels evaluated in scores in the 1st and 2nd interviews were as follows: SAPS 69.11 (SD: 20.78) and 33.61 (SD: 18.04), SANS 63.21 (SD: 25.30) and 40.95 (SD: 24.47), SAI-E 15.50 and 27.24 (SD: 13.24), P < 0.001, C-sch 8.50 (SD: 5.31) and 4.27 (SD: 2.86), P < 0.05. There was no statistically significant correlation between DUI and insight level. A higher level of insight at hospitalization correlated with higher levels of depression: r = 0.569, P < 0.001.ConclusionsWe noticed a tendency that lower insight levels might correlate with longer periods of untreated illness. We found that higher insight levels correlated with higher symptoms of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Premorbid adjustment in first-episode non-affective psychosis: Distinct patterns of pre-onset course

The British Journal of Psychiatry ◽

10.1192/bjp.185.2.108 ◽

2004 ◽

Vol 185 (2) ◽

pp. 108-115 ◽

Cited By ~ 104

Author(s):

Tor K. Larsen ◽

Svein Friis ◽

Ulrik Haahr ◽

Jan Olav Johannessen ◽

Ingrid Melle ◽

...

Keyword(s):

Cluster Analysis ◽

Negative Symptoms ◽

First Episode Psychosis ◽

First Episode ◽

Duration Of Untreated Psychosis ◽

Affective Psychosis ◽

Premorbid Adjustment ◽

Episode Psychosis ◽

Premorbid Functioning ◽

Shed Light

BackgroundKnowledge about premorbid development in psychosis can shed light upon theories about aetiology and schizophrenic heterogeneity, and form a basis for early detection initiatives.AimsTo identify and validate patterns of premorbid functioning in first-episode psychosis.MethodThe Premorbid Adjustment Scale was used to examine 335 patients.ResultsSocial and academic function constituted fairly independent dimensions. Cluster analysis identified groups varying both in level and course. Patients with a stable social course compared with a deteriorating one had a shorter duration of untreated psychosis, were older, had more friends and less negative symptoms. Good childhood academic function correlated with more education, more meaningful activities and better working memory. Patients with a stable academic course were older at admission.ConclusionsPatterns of premorbid development suggest both neuro-developmental and neuroregressive pathways to illness.

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Cognitively-oriented psychotherapy for early psychosis (COPE): Preliminary results

The British Journal of Psychiatry ◽

10.1192/s0007125000297730 ◽

1998 ◽

Vol 172 (S33) ◽

pp. 93-100 ◽

Cited By ~ 76

Author(s):

H. Jackson ◽

P. McGorry ◽

J. Edwards ◽

C. Hulbert ◽

L. Henry ◽

...

Keyword(s):

Negative Symptoms ◽

Rating Scale ◽

Controlled Trial ◽

Early Psychosis ◽

First Episode ◽

Psychotic Episode ◽

Control Group ◽

Psychiatric Rating ◽

Psychiatric Rating Scale ◽

Randomised Controlled

Background The present study describes the results of the pilottesting of a therapy we have developed for people with first-episode psychosis. Cognitively-oriented psychotherapy for early psychosis (COPE) is aimed at facilitating the adjustment of the person, and at preventing or alleviating secondary morbidity in the wake of the first psychotic episode.Method Eighty people formed three groups: those who were offered and accepted COPE (COPE subjects); those who refused COPE (refusal subjects); and those who were offered neither COPE nor any other continuing treatment from our service (control subjects). The individuals were assessed prior to, and at the end of, COPE treatment (a 12-month period) on the Integration/Sealing Over, Explanatory Model, Scale for the Assessment of Negative Symptoms, Brief Psychiatric Rating Scale, Quality of Life, SCL–90–R, and Beck Depression Inventory measures.Results People who received COPE obtained significantly superior scores (P < 0.05) to the control group on four of the seven measures but only significantly out-performed the refusal group on one of the seven measures (P<0.05). The COPE group performed significantly worse on the BDI than the refusal group (P < 0.05). Effect sizes are also provided for each measure.Conclusions There seems to be a place for psychological therapy in this group of people butour results need to be replicated in a more definitive randomised controlled trial and such a study is now in progress.

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