Carer subjective burden after first-episode psychosis: Types and predictors. A multilevel statistical approach

Background: Carer burden at first-episode psychosis is common and adds to the multiple other psychiatric and psychological problems that beset new carers; yet, knowledge of the factors that predict carer burden is limited. Aim: This study sought to investigate the types and predictors of carer burden at first-episode psychosis in the largest, most ethnically diverse and comprehensively characterised sample to date. Method: This study involved a cross-sectional survey of carers of people with first-episode psychosis presenting to Harrow and Hillingdon Early Intervention in Psychosis service between 2011 and 2017. Carers completed self-report measures assessing their illness beliefs, coping styles and caregiving experiences (i.e. burden). Thirty carer and patient sociodemographic and clinical factors were also collected. Mixed effects linear regression modelling was conducted to account for clustering of carers by patient, with carer burden (and its 8 subtypes) investigated as dependent variables. Results: The sample included data on 254 carers (aged 18–74 years) and 198 patients (aged 14–36 years). Regression modelling identified 35 significant predictors of carer burden and its subtypes at first-episode psychosis. Higher total burden was independently predicted by perceiving greater negative consequences of the illness for the patient (B = .014, p < .001, 95% CI: [.010–.018]) and the carer (B = .008, p = .002, 95% CI: [.003–.013]), and engaging in avoidant-focussed coping (B = .010, p = .006, 95% CI: [.003–.016]). Lower burden was independently predicted by patients being in a relationship (B = −.075, p = .047, 95% CI: [−.149 to −.001]). Predictors of the eight burden subtypes (difficult behaviours, negative symptoms, stigma, problems with services, effects on family, dependency, loss and need to backup) are also included in the article. Conclusion: Findings can be used to inform the identification of carers ‘at-risk’ of experiencing burden and highlight potential targets for theraputic intervention to lower carer buden.

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Longitudinal assessment of negative symptoms in early onset first episode psychosis

10.26226/morressier.5b681763b56e9b005965c031 ◽

2018 ◽

Author(s):

Maria Garcia Traverso

Keyword(s):

Early Onset ◽

Negative Symptoms ◽

First Episode Psychosis ◽

First Episode ◽

Longitudinal Assessment ◽

Episode Psychosis

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Conceptual disorganization and redistribution of resting state cortical hubs in untreated first episode psychosis: A 7T MRI study

10.31234/osf.io/rzvby ◽

2020 ◽

Author(s):

Avyarthana Dey ◽

Kara Dempster ◽

Michael Mackinley ◽

Peter Jeon ◽

Tushar Das ◽

...

Keyword(s):

Negative Symptoms ◽

Superior Temporal Gyrus ◽

Brain Regions ◽

First Episode Psychosis ◽

Cortical Reorganization ◽

First Episode ◽

Formal Thought Disorder ◽

Whole Brain ◽

Episode Psychosis ◽

Positive And Negative Symptoms

Background:Network level dysconnectivity has been studied in positive and negative symptoms of schizophrenia. Conceptual disorganization (CD) is a symptom subtype which predicts impaired real-world functioning in psychosis. Systematic reviews have reported aberrant connectivity in formal thought disorder, a construct related to CD. However, no studies have investigated whole-brain functional correlates of CD in psychosis. We sought to investigate brain regions explaining the severity of CD in patients with first-episode psychosis (FEPs) compared with healthy controls (HCs).Methods:We computed whole-brain binarized degree centrality maps of 31 FEPs, 25 HCs and characterized the patterns of network connectivity in the two groups. In FEPs, we related these findings to the severity of CD. We also studied the effect of positive and negative symptoms on altered network connectivity.Results:Compared to HCs, reduced hubness of a right superior temporal gyrus (rSTG) cluster was observed in the FEPs. In patients exhibiting high CD, increased hubness of a medial superior parietal (mSPL) cluster was observed, compared to patients exhibiting low CD. These two regions were strongly correlated with CD scores but not with other symptom scores.Discussion:Our observations are congruent with previous findings of reduced but not increased hubness. We observed increased hubness of mSPL suggesting that cortical reorganization occurs to provide alternate routes for information transfer.Conclusion:These findings provide insight into the underlying neural processes mediating the presentation of symptoms in untreated FEP. A longitudinal tracking of the symptom course will be useful to assess the mechanisms underlying these compensatory changes.

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P.553 Negative symptoms correlate with social functioning in first-episode psychosis: results from a cross-sectional study

European Neuropsychopharmacology ◽

10.1016/j.euroneuro.2020.09.405 ◽

2020 ◽

Vol 40 ◽

pp. S313-S314

Author(s):

L.A. Fernandes ◽

F. Ferreira ◽

I. Figueiredo ◽

R. Gasparinho ◽

F. Viegas ◽

...

Keyword(s):

Social Functioning ◽

Negative Symptoms ◽

Cross Sectional Study ◽

First Episode Psychosis ◽

First Episode ◽

Sectional Study ◽

Cross Sectional ◽

Episode 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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Exploring the relationship between recency and frequency of cannabis use and diminished expression and apathy as two dimensions of negative symptoms in first episode psychosis. A one-year follow-up study

Schizophrenia Research ◽

10.1016/j.schres.2021.08.004 ◽

2021 ◽

Vol 236 ◽

pp. 89-96

Author(s):

Henrik Myhre Ihler ◽

Trine Vik Lagerberg ◽

Siv Hege Lyngstad ◽

Ingrid Melle ◽

Kristin Lie Romm

Keyword(s):

Negative Symptoms ◽

First Episode Psychosis ◽

Two Dimensions ◽

Cannabis Use ◽

First Episode ◽

Follow Up Study ◽

Episode Psychosis ◽

One Year ◽

The Relationship

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Characterising Usage of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: A Cluster Analysis (Preprint)

10.2196/preprints.29211 ◽

2021 ◽

Author(s):

Shaunagh O'Sullivan ◽

Lianne Schmaal ◽

Simon D'Alfonso ◽

Yara J Toenders ◽

Lee Valentine ◽

...

Keyword(s):

Young People ◽

Treatment Outcomes ◽

Social Functioning ◽

Negative Symptoms ◽

User Profile ◽

First Episode Psychosis ◽

First Episode ◽

User Profiles ◽

Episode Psychosis ◽

Social Components

BACKGROUND Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in usage makes it difficult to determine which components lead to improved treatment outcomes. OBJECTIVE This study aimed to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention that incorporates therapeutic content and social networking, along with clinical, vocational and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective was to compare each user profile with young people receiving treatment as usual (TAU). METHODS Participants comprised 82 young people (16-27 years of age) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. Six-month usage data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression and anxiety were assessed at baseline and six-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes, and between each user profile with TAU. RESULTS Three user profiles were identified based on system usage metrics including: (a) low usage; (b) maintained usage of social components; and (c) maintained usage of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F (2, 51) = 3.58; P = .04), negative symptoms (F (2, 51) = 4.45; P = .02) and overall psychiatric symptom severity (F (2, 50) = 3.23; P = .048) compared to the other user profiles. This group also showed improvements in social functioning (F (1, 62) = 4.68; P = .03), negative symptoms (F (1, 62) = 14.61; P = <.001) and overall psychiatric symptom severity (F (1, 63) = 5.66; P = .02) compared to TAU. Conversely, the maintained social group showed increases in anxiety compared to TAU (F (1, 57) = 7.65; P = .01). No differences were found between the low usage group and TAU on treatment outcomes. CONCLUSIONS Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social usage and low usage outcomes were broadly comparable to TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits.

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