Family involvement in first-episode psychosis

2019 ◽  
pp. 117-130
Author(s):  
Greeshma Mohan ◽  
R. Padmavati ◽  
R. Thara
Keyword(s):  
Treatment Adherence ◽  
Family Involvement ◽  
First Episode Psychosis ◽  
First Episode ◽  
Rapid Urbanization ◽  
Episode Psychosis ◽  
The Family ◽  
Expanding Population

In the Indian secular, pluralistic, and collectivist society, the family is the oldest and the most important institution that has survived through the ages. With rapid urbanization and an ever-expanding population, there is a scarcity of financial and human resources in the area of mental health. Though progressively decreasing in size, families continue to provide a valuable support system, which can be helpful in the management of various stressful situations. Yet, very often this resource is not adequately and appropriately utilized. This chapter describes the role of family involvement in first-episode psychosis, drawing from various research projects carried out by the Schizophrenia Research Foundation (SCARF) and from other Indian centres. It deals with the identification of prodromes, access to care, treatment adherence and follow-up, and stigma.

scholarly journals Understanding the role of the family physician in early psychosis intervention

BJPsych Open ◽  
2018 ◽  
Vol 4 (6) ◽  
pp. 447-453 ◽  
Author(s):  
Kelly K. Anderson ◽  
Suzanne Archie ◽  
Richard G. Booth ◽  
Chiachen Cheng ◽  
Daniel Lizotte ◽  
...  
Keyword(s):  
Primary Care ◽  
Administrative Data ◽  
Family Physician ◽  
Psychiatric Treatment ◽  
First Episode Psychosis ◽  
First Episode ◽  
Health Administrative Data ◽  
Episode Psychosis ◽  
The Family

BackgroundThe family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.AimsOur objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.MethodWe will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.DiscussionThese findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.Declaration of interestNone.

The role of treatment delay in predicting 5-year outcomes in an early intervention program

2011 ◽  
Vol 42 (2) ◽  
pp. 223-233 ◽  
Author(s):  
R. M. G. Norman ◽  
R. Manchanda ◽  
D. Windell ◽  
R. Harricharan ◽  
S. Northcott ◽  
...  
Keyword(s):  
Disability Pension ◽  
Intervention Program ◽  
Negative Symptoms ◽  
Treatment Delay ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Program ◽  
Episode Psychosis

BackgroundPast research on the relationship between treatment delay and outcomes for first-episode psychosis has primarily focused on the role of duration of untreated psychosis (DUP) in predicting symptomatic outcomes up to 2 years. In the current study we examine the influence of both DUP and duration of untreated illness (DUI) on symptoms and functioning at 5 years follow-up while controlling for other early characteristics.MethodA total of 132 patients with first-episode psychosis and treated in an early intervention program were prospectively followed up for 5 years. Outcomes assessed included positive and negative symptoms, overall functioning, weeks on disability pension and weeks of full-time competitive employment.ResultsWhile DUP showed a significant correlation with level of positive symptoms at follow-up, this was not independent of pre-morbid social adjustment. DUI emerged as a more robust independent predictor of negative symptoms, social and occupational functioning and use of a disability pension.ConclusionsDelay between onset of non-specific symptoms and treatment may be a more important influence on long-term functioning for first-episode patients than DUP. This suggests the possible value of treating such signs and symptoms as early as possible regardless of the effectiveness of such interventions in reducing likelihood or severity of psychotic symptoms.

scholarly journals Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up

2014 ◽  
Vol 205 (1) ◽  
pp. 60-67 ◽  
Author(s):  
A. I. Gumley ◽  
M. Schwannauer ◽  
A. Macbeth ◽  
R. Fisher ◽  
S. Clark ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Attachment Security ◽  
First Episode Psychosis ◽  
Adult Attachment Interview ◽  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
Episode Psychosis ◽  
The Relationship

BackgroundIncreasing evidence shows attachment security influences symptom expression and adaptation in people diagnosed with schizophrenia and other psychoses.AimsTo describe the distribution of secure and insecure attachment in a cohort of individuals with first-episode psychosis, and to explore the relationship between attachment security and recovery from positive and negative symptoms in the first 12 months.MethodThe study was a prospective 12-month cohort study. The role of attachment, duration of untreated psychosis (DUP), baseline symptoms and insight in predicting and mediating recovery from symptoms was investigated using multiple regression analysis and path analysis.ResultsOf the 79 participants, 54 completed the Adult Attachment Interview (AAI): 37 (68.5%) were classified as insecure, of which 26 (48.1%) were insecure/dismissing and 11 (20.4%) insecure preoccupied. Both DUP and insight predicted recovery from positive symptoms at 12 months. Attachment security, DUP and insight predicted recovery from negative symptoms at 12 months.ConclusionsAttachment is an important construct contributing to understanding and development of interventions promoting recovery following first-episode psychosis.

scholarly journals The role of premorbid personality and social cognition in suicidal behaviour in first-episode psychosis: A one-year follow-up study

2017 ◽  
Vol 256 ◽  
pp. 13-20 ◽  
Author(s):  
Manuel Canal-Rivero ◽  
J.D. Lopez-Moriñigo ◽  
M.L. Barrigón ◽  
S. Perona-Garcelán ◽  
C. Jimenez-Casado ◽  
...  
Keyword(s):  
Social Cognition ◽  
Suicidal Behaviour ◽  
First Episode Psychosis ◽  
First Episode ◽  
Premorbid Personality ◽  
Follow Up Study ◽  
Episode Psychosis ◽  
One Year

Longitudinal changes of insight in first episode psychosis and its relation to clinical symptoms, treatment adherence and global functioning: One-year follow-up from the Eiffel study

2012 ◽  
Vol 27 (1) ◽  
pp. 43-49 ◽  
Author(s):  
R. Segarra ◽  
N. Ojeda ◽  
J. Peña ◽  
J. García ◽  
A. Rodriguez-Morales ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Treatment Adherence ◽  
Rating Scales ◽  
Clinical Symptoms ◽  
Clinical Course ◽  
First Episode Psychosis ◽  
First Episode ◽  
Global Functioning ◽  
Episode Psychosis

AbstractObjectivesThe Eiffel study is a longitudinal, naturalistic study of patients with first episode psychosis (FEP) designed to evaluate the predictive value of defective insight on treatment adherence and global functioning.MethodsFive hundred seventy-seven patients with FEP were assessed at baseline and at a 1-year follow-up. They were compared in terms of sociodemographic factors, psychopathology, insight, treatment adherence and functional outcome. Longitudinal functionality was prospectively assessed with the clinical global impression (CGI) and global assessment of functioning (GAF) rating scales.ResultsAt baseline, up to 50% of our sample presented with a lack of insight. Most clinical symptoms, including insight, improved over the follow-up period. Insight, education and social withdrawal significantly predicted CGI and GAF at follow-up. Insight and level of education were predictive of treatment adherence.ConclusionsInsight significantly predicted the general clinical course, treatment adherence and functional outcome in our FEP sample after 1 year. Only education additionally accounted for the longitudinal course. Since our results suggest that better insight improves treatment adherence and consequently clinical course and functional outcome, insight could be a specific target of treatment in early intervention programs.

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.

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