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.

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.

scholarly journals Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

2019 ◽  
Vol 50 (6) ◽  
pp. 991-1001 ◽  
Author(s):  
Olesya Ajnakina ◽  
Brendon Stubbs ◽  
Emma Francis ◽  
Fiona Gaughran ◽  
Anthony S. David ◽  
...  
Keyword(s):  
Systematic Review ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Hospitalised Patients ◽  
Episode Psychosis ◽  
Over Time

AbstractBackgroundReducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.MethodsStudies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.Results81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.ConclusionOne in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.

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.

Short-term compliance in first-episode psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. s254-s255 ◽  
Author(s):  
N. Iriarte Yoller ◽  
J. Vicente García ◽  
F. Rico Villademoros
Keyword(s):  
Mental Health Professionals ◽  
First Episode Psychosis ◽  
First Episode ◽  
Bivariate Analysis ◽  
Short Term ◽  
Related Factors ◽  
Episode Psychosis ◽  
Competing Interest ◽  
Management Issues

IntroductionNon-compliance is a significant problem in patients with first-episode psychosis (FEP), representing a challenge for mental health professionals due to the heterogeneous course and functional outcomes.ObjectivesThe aim was to describe the short-term compliance in FEP and analyze the demographics, clinical features, and management issues potentially associated with non-compliance.MethodsThis observational and retrospective study included all consecutive FEP admitted to our psychiatry unit from January to June 2015, belonging to our catchment area. To be categorized as compliant, patients had to attend month-1 and month-3 follow-up visits. Characteristics of compliant and non-compliant were compared using a bivariate analysis.ResultsWe included 18 patients whose characteristics are shown in the table. Overall, 8 (44.4%) were non-compliant. Patients who were non-compliant had a significantly shorter length of stay (10.3 [6.3] vs. 18.5 [8.9] days). Most patients (66.7%) had cannabis abuse, being slightly more frequent among non-compliant (75% vs. 60%, P = NS); in addition, the diagnosis of substance-induced psychotic disorder was also more common among non-compliant (50% vs 20%, P = NS). There were 2 patients who were readmitted, both in the non-compliant group (Table 1).ConclusionsShort-term non-compliance is high among patients with FEP. Despite the limitations of our study, our results suggest that, beside other factors (e.g. substance abuse), non-compliance could be associated with management-related factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial

2007 ◽  
Vol 191 (S51) ◽  
pp. s140-s146 ◽  
Author(s):  
Mette Bertelsen ◽  
Pia Jeppesen ◽  
Lone Petersen ◽  
Anne Thorup ◽  
Johan ⊘hlenschlæger ◽  
...  
Keyword(s):  
High Risk ◽  
Suicidal Behaviour ◽  
Rating Scales ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Suicidal Thoughts ◽  
Episode Psychosis ◽  
Suicidal Plans

BackgroundThose with first-episode psychosis are at high-risk of suicideAimsTo identify predictive factors for suicidal thoughts, plans and attempts, and to investigate the rate of suicides and other deaths during the 5 years after first diagnosis and initiation of treatmentMethodA longitudinal, prospective, 5-year follow-up study of 547 individuals with first-episode schizophrenia spectrum psychosis. Individuals presenting for their first treatment in mental health services in two circumscribed urban areas in Denmark were included in a randomised controlled trial of integrated v. standard treatment. All participants were followed in the Danish Cause of Death Register for 5 years. Suicidal behaviour and clinical and social status were assessed using validated interviews and rating scales at entry, and at 1- and 2-year follow-upsResultsSixteen participants died during the follow-up. We found a strong association between suicidal thoughts, plans and previous attempts, depressive and psychotic symptoms and young age, and with suicidal plans and attempts at 1- and 2-year follow-upConclusionsIn this first-episode cohort depressive and psychotic symptoms, especially hallucinations, predicted suicidal plans and attempts, and persistent suicidal behaviour and ideation were associated with high risk of attempted suicide

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.

Stability and development of psychotic symptoms and the use of antipsychotic medication – long-term follow-up

2017 ◽  
Vol 47 (12) ◽  
pp. 2118-2129 ◽  
Author(s):  
D. R. Gotfredsen ◽  
R. S. Wils ◽  
C. Hjorthøj ◽  
S. F. Austin ◽  
N. Albert ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Illness ◽  
Multi Centre Study ◽  
Episode Psychosis ◽  
Long Term Treatment

BackgroundFew studies have evaluated the development in the use of antipsychotic medication and psychotic symptoms in patients with first-episode psychosis on a long-term basis. Our objective was to investigate how psychotic symptoms and the use of antipsychotic medication changed over a 10-year period in a cohort of patients with first-episode psychosis.MethodThe study is a longitudinal prospective cohort study over 10 years with follow-ups at years 1, 2, 5 and 10. A total of 496 patients with first-episode psychosis were included in a multi-centre study initiated between 1998 and 2000 in Copenhagen and Aarhus, Denmark.ResultsAt all follow-ups, a large proportion (20–30%) of patients had remission of psychotic symptoms without use of antipsychotic medication at the time of the follow-up. Patients who were in this group at the 5-year follow-up had an 87% [95% confidence interval (CI) 77–96%] chance of being in the same group at the 10-year follow-up. This stability was also the case for patients who had psychotic symptoms and were treated with antipsychotic medication at year 5, where there was a 67% (95% CI 56–78%) probability of being in this group at the consecutive follow-up.ConclusionsA large group of patients with psychotic illness were in remission without the use of antipsychotic medication, peaking at year 10. Overall there was a large degree of stability in disease courses over the 10-year period. These results suggest that the long-term outcome of psychotic illness is heterogeneous and further investigation on a more individualized approach to long-term treatment is needed.

scholarly journals The iHOPE-20 study: Relationships between and prospective predictors of remission, clinical recovery, personal recovery and resilience 20 years on from a first episode psychosis

2019 ◽  
Vol 53 (11) ◽  
pp. 1080-1092 ◽  
Author(s):  
Donal O’Keeffe ◽  
Ailish Hannigan ◽  
Roisin Doyle ◽  
Anthony Kinsella ◽  
Ann Sheridan ◽  
...  
Keyword(s):  
Mental Health ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Full Time ◽  
Personal Recovery ◽  
Clinical Recovery ◽  
Episode Psychosis

Objective: Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap. Method: iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort ( N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them. Results: At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5–11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores. Conclusion: Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services.

Pattern and Correlates of Inpatient Admission During the Initial Acute Phase of First-Episode Psychosis

2006 ◽  
Vol 40 (5) ◽  
pp. 429-436 ◽  
Author(s):  
Darryl Wade ◽  
Susy Harrigan ◽  
Meredith G. Harris ◽  
Darryl Wade ◽  
Susy Harrigan ◽  
...  
Keyword(s):  
Service Use ◽  
Young Patients ◽  
First Episode Psychosis ◽  
Inpatient Admission ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Inpatient Service ◽  
Functional Disturbance ◽  
Episode Psychosis

Objectives: The first aim of this study was to examine the rate, pattern and correlates of inpatient admission during the first 3 months of treatment for first-episode psychosis (FEP). The second aim was to determine whether the pattern of inpatient admission during this period was associated with remission of psychotic symptoms or inpatient service use at 15-month follow-up. Method: One hundred and four consecutive patients with FEP at a specialist treatment service were approached to participate in a follow-up study. Patients were grouped on the basis of the pattern of inpatient admission (none, one, or multiple) during the first 3 months of treatment. Clinical ratings at baseline and 3-month follow-up, and ratings of remission of psychotic symptoms at 3 and 15-month follow-up, were available for two-thirds of the patients. Inpatient data for the 15-month follow-up period were derived from an electronic database for most patients (n = 98). Results: Eighty (76.9%) of the 104 patients were admitted to an inpatient unit during the first 3 months of treatment. Fifty-nine (56.7%) patients had a single admission and 21 (20.2%) had multiple admissions. At baseline, inpatient admission was associated with a diagnosis of affective psychosis and more severe behavioural and functional disturbance but not positive psychotic symptoms. Multiple admissions were associated with risks to self or others at baseline and 3-month follow-up, and lack of remission of positive symptoms at 3 and 15-month follow-up. There was no association between the pattern of inpatient admission during the initial 3-month period and inpatient service use during the following 12-month period. Conclusions: The substantial proportion of young patients with FEP admitted to hospital emphasizes the need for youth-friendly treatment environments and practices. Although patients with multiple admissions during the initial treatment period are less likely to achieve remission, these patients are no more likely to establish a pattern of revolvingdoor hospitalizations compared with other patients.

scholarly journals Treatment for the initial acute phase of first-episode psychosis in a real-world setting

2006 ◽  
Vol 30 (4) ◽  
pp. 127-131 ◽  
Author(s):  
Darryl Wade ◽  
Susy Harrigan ◽  
Meredith G. Harris ◽  
Jane Edwards ◽  
Patrick D. McGorry
Keyword(s):  
Acute Phase ◽  
Treatment Strategies ◽  
First Episode Psychosis ◽  
Community Treatment ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Recommended Treatment ◽  
Episode Psychosis ◽  
Treatment Order

Aims and MethodThe aim of the study was to examine treatment for the initial acute phase of first-episode psychosis at the Early Psychosis Prevention and Intervention Centre. Information regarding treatment was collected from file notes for all patients (n=112). For a subsample of patients (n=68), remission of positive psychotic symptoms was assessed using standardised ratings at 3-month follow-up.ResultsTreatment provided was largely in accordance with recommended treatment strategies. The majority (72%) of patients achieved rapid remission of positive symptoms.Clinical ImplicationsRestrictive practices other than in-patient admission, such as in-patient seclusion, police transport or a community treatment order, can be minimised. The use of low-dose antipsychotic medication is an effective treatment strategy for the initial acute phase of first-episode psychosis.

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