Dynamic association of the first identifiable symptom with rapidity of progression to first-episode psychosis

Abstract Background Rapid progression from the first identifiable symptom to the onset of first-episode psychosis (FEP) allows less time for early intervention. The aim of this study was to examine the association between the first identifiable symptom and the subsequent speed of illness progression. Methods Data were available for 390 patients attending a catchment-based early intervention service for FEP. Exposure to non-psychotic and subthreshold psychotic symptoms was retrospectively recorded using semi-structured interviews. Outcomes following the onset of the first identifiable symptom were (1) time to onset of FEP and (2) symptom incidence rate (i.e. number of symptoms emerging per person-year until FEP onset). These outcomes were respectively analyzed with Cox proportional hazards and negative binomial regressions. Results After Bonferroni correction, having a subthreshold psychotic (v. non-psychotic) symptom as the first symptom was not associated with time to FEP onset [hazard ratio (HR) = 1.39; 95% CI 0.94–2.04] but was associated with higher symptom incidence [incidence rate ratio (IRR) = 1.92; 95% CI 1.10–3.48]. A first symptom of suspiciousness was associated with shorter time to FEP onset (HR = 2.37; 95% CI 1.38–4.08) and higher symptom incidence rate (IRR = 3.20; 95% CI 1.55–7.28) compared to other first symptoms. In contrast, a first symptom of self-harm was associated with lower symptom incidence rate (IRR = 0.06; 95% CI 0.01–0.73) compared to other first symptoms. Several associations between symptoms and illness progression were moderated by the age at symptom onset. Conclusions Appreciating the content and timing of early symptoms can identify windows and treatment targets for early interventions in psychosis.

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A Multicentre, Randomised, Controlled Trial of a Combined Clinical Treatment for First-Episode Psychosis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147239 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7239

Author(s):

Itxaso González-Ortega ◽

Patricia Vega ◽

Enrique Echeburúa ◽

Susana Alberich ◽

Jessica Fernández-Sevillano ◽

...

Keyword(s):

Early Intervention ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

First Episode Psychosis ◽

Clinical Treatment ◽

Post Treatment ◽

Psychotic Symptoms ◽

First Episode ◽

Episode Psychosis ◽

Randomised Controlled

Introduction: There is evidence that early intervention contributes to improving the prognosis and course of first-episode psychosis (FEP). However, further randomised treatment clinical trials are needed. Objectives: The aim of this study was to compare the efficacy of a combined clinical treatment involving Cognitive Behavioural Therapy (CBT) as an adjunctive to treatment-as-usual (TAU) (CBT+TAU) versus TAU alone for FEP. Patients and methods: In this multicentre, single-blind, randomised controlled trial, 177 participants were randomly allocated to either CBT+TAU or TAU. The primary outcome was post-treatment patient functioning. Results: The CBT+TAU group showed a greater improvement in functioning, which was measured using the Global Assessment Functioning (GAF) and Functioning Assessment Short Test (FAST), compared to the TAU group post-treatment. The CBT+TAU participants exhibited a greater decline in depressive, negative, and general psychotic symptoms; a better awareness of the disease and treatment adherence; and a greater increase in brain-derived neurotrophic factor levels than TAU participants. Conclusions: Early intervention based on a combined clinical treatment involving CBT as an adjunctive to standard treatment may improve clinical and functional outcomes in FEP.

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Prolonged recovery in first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/s0007125000297754 ◽

1998 ◽

Vol 172 (S33) ◽

pp. 107-116 ◽

Cited By ~ 69

Author(s):

Jane Edwards ◽

Dana Maude ◽

Patrick D. McGorry ◽

Susan M. Harrigan ◽

John T. Cocks

Keyword(s):

Early Intervention ◽

Psychosocial Functioning ◽

Rating Scale ◽

Clinical Care ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Positive Symptoms ◽

Course Of Illness ◽

Episode Psychosis

Background Early identification and specialised treatment of individuals with enduring positive symptoms may assist in alleviating symptoms and has the potential to change the course of illness.Method Prevalence and descriptive data on enduring positive symptoms in two first-episode samples are outlined. Attempts to incorporate the focus of early intervention for persisting psychosis into routine clinical care of individuals with first-episode psychosis are described.Results Of the 227 individuals with first-episode psychosis who were assessed using the Brief Psychiatric Rating Scale at 3/6 months and 12 months following initial stabilisation (from a total sample of 347), 6.6% experienced enduring positive symptoms at all three time points. When the analysis was restricted to schizophrenia, schizophreniform and schizoaffective disorders (n=158) the percentage increased to 8.9%. These patients had significantly longer mean duration of untreated psychosis prior to initiation of treatment and, at 12-month follow-up, significantly higher depression and poorer psychosocial functioning.Conclusions The association of untreated psychosis with treatment resistance supports the argument for early intervention as soon as possible following the onset of psychotic symptoms.

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Prescribing pattern of clozapine and other antipsychotics for patients with first-episode psychosis: a cross-sectional survey of early intervention teams

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125316683151 ◽

2016 ◽

Vol 7 (3) ◽

pp. 103-111 ◽

Cited By ~ 9

Author(s):

Tongeji E. Tungaraza ◽

Wakil Ahmed ◽

Chinonyelum Chira ◽

Erin Turner ◽

Susan Mayaki ◽

...

Keyword(s):

Early Intervention ◽

First Episode Psychosis ◽

Response To Treatment ◽

Psychotic Symptoms ◽

First Episode ◽

High Dose ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Episode Psychosis ◽

Antipsychotic Prescribing

Objective: To describe the pattern of antipsychotic drug prescribing in patients with first episode psychosis, with more emphasis in the use of clozapine in this group of patients. Method: A cross-sectional survey involving six early intervention service (EIS) teams in the West Midlands was conducted. Data was extracted from case notes and electronic records by clinicians working in each participating team. The pattern of antipsychotic prescribing and the changes that took place after being accepted in EIS, including the use of clozapine, was established. Clinicians involved in the treatment of patients in each team rated the overall clinical response to treatment based on the presence or absence of positive psychotic symptoms. Result: 431 patients with FEP were included in the final analysis. Low antipsychotic discontinuation rate was observed, with the majority (88.2%) still being prescribed antipsychotics. Most (77.3%) were prescribed second-generation antipsychotic drugs, with olanzapine (21.8%) and aripiprazole (19.7%) being the most frequently prescribed antipsychotics. There was low rate use of antipsychotic combinations (7.4%), high dose antipsychotic regime (3.9%), low depot antipsychotic prescribing (9.3%), and clozapine use was low (9.7%). On average, three antipsychotics were tried before clozapine was initiated and it took on average 19.5 months from being accepted into EIS to clozapine being initiated. Conclusion: The majority of patients were prescribed antipsychotics within the guidelines. EIS was associated with an overall low antipsychotic discontinuation. There was also a short waiting time before clozapine was initiated following patients being accepted into EIS.

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Views of Young People in Early Intervention Services for First-Episode Psychosis in England

Psychiatric Services ◽

10.1176/ps.62.8.pss6208_0882 ◽

2011 ◽

Vol 62 (8) ◽

pp. 882-887 ◽

Cited By ~ 41

Author(s):

Helen Lester ◽

Max Marshall ◽

Peter Jones ◽

David Fowler ◽

Tim Amos ◽

...

Keyword(s):

Early Intervention ◽

Young People ◽

First Episode Psychosis ◽

First Episode ◽

Early Intervention Services ◽

Episode Psychosis ◽

Intervention Services

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Aggressive incidents in first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.178.5.433 ◽

2001 ◽

Vol 178 (5) ◽

pp. 433-440 ◽

Cited By ~ 64

Author(s):

John Milton ◽

Shazad Amin ◽

Swaran P. Singh ◽

Glynn Harrison ◽

Peter Jones ◽

...

Keyword(s):

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Increased Risk ◽

Episode Psychosis ◽

Clinical Associations ◽

Independent Effects ◽

One Act ◽

Service Contact

BackgroundRecent research has reported increased risk of aggressive incidents by individuals with psychotic illness.AimsTo examine acts of aggression in first-episode psychosis.MethodSubjects with a first-episode psychosis were ascertained from a defined catchment area (Nottingham, UK) and reassessed at 3 years (n=166) using clinical interview, informants, health care and forensic records.ResultsOf the subjects, 9.6% demonstrated at least one act of serious aggression (defined as weapon use, sexual assault or victim injury) during at least one psychotic episode and 23.5% demonstrated lesser acts of aggression (defined as all other acts of aggression). For all aggressive subjects (33.1%), unemployment (OR=3.6, 95%CI 1.6–8.0), comorbid substance misuse (OR=3.1, CI 1.1–8.8) and symptoms of overactivity at service contact (OR=6.9, CI 2.7–17.8) had independent effects on risk of aggression.ConclusionsWe confirmed some previously reported demographic and clinical associations with aggression in first-episode psychosis but no relationship with specific psychotic symptoms or diagnostic groups was observed.

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Suicide Prevention in First Episode Psychosis: The Development of a Randomised Controlled Trial of Cognitive Therapy for Acutely Suicidal Patients With Early Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2003.01209.x ◽

2003 ◽

Vol 37 (4) ◽

pp. 414-420 ◽

Cited By ~ 94

Author(s):

P.J.R. Power ◽

R.J. Bell ◽

R. Mills ◽

T. Herrman-Doig ◽

M. Davern ◽

...

Keyword(s):

Early Intervention ◽

Treatment Group ◽

Young People ◽

Controlled Trial ◽

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Randomised Controlled ◽

Suicidal Patients

Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.

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