Social anxiety disorder in first-episode psychosis: incidence,
                        phenomenology and relationship with paranoia

BackgroundSocial anxiety disorder constitutes a significant problem for people with psychosis. It is unclear whether this is a by-product of persecutory thinking.AimsTo compare the phenomenology of social anxiety disorder in first-episode psychosis with that in a group without psychosis. The relationship between social anxiety and psychosis symptoms was investigated.MethodA sample of people with first-episode psychosis (FEP group) was compared with a sample with social anxiety disorder without psychosis (SaD group).ResultsOf the individuals in the FEP group (n = 80) 25% were diagnosed with an ICD–10 social anxiety disorder (FEP/SaD group); a further 11.6% reported severe difficulties in social encounters. The FEP/SaD and SaD groups reported comparable levels of social anxiety, autonomic symptoms, avoidance and depression. Social anxiety in psychosis was not related to the positive symptoms of the Positive and Negative Syndrome Scale (PANSS) including suspiciousness/persecution. However, a significantly greater percentage of socially anxious v. non-socially anxious individuals with psychosis expressed perceived threat from persecutors, although this did not affect the severity of social anxiety within the FEP/SaD group. The majority of those in the FEP/SaD group did not have concurrent persecutory delusions.ConclusionsSocial anxiety is a significant comorbidity in first-episode psychosis. It is not simply an epiphenomenon of psychotic symptoms and clinical paranoia, and it has more than one causal pathway. For a subgroup of socially anxious people with psychosis, anticipated harm is present and the processes that underlie its relationship with social anxiety warrant further investigation.

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P.3.f.011 Social anxiety disorder in first episode psychosis: prevalence, relationship with paranoia and perceived shame from psychosis

European Neuropsychopharmacology ◽

10.1016/s0924-977x(13)70789-2 ◽

2013 ◽

Vol 23 ◽

pp. S497-S498

Author(s):

W.S.D. Chung ◽

S.C. Chan ◽

Y.C. Wong ◽

H.M. Wong

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis

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Understanding the Role of Emotion in Psychosis: Social Anxiety Disorder in First-Episode Psychosis

Handbook of Schizophrenia Spectrum Disorders, Volume II ◽

10.1007/978-94-007-0831-0_4 ◽

2011 ◽

pp. 89-110

Author(s):

Maria Michail ◽

Max Birchwood

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis

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AN INVESTIGATION OF SOCIAL ANXIETY DISORDER IN PEOPLE WITH FIRST-EPISODE PSYCHOSIS AND THOSE AT ULTRA HIGH RISK

Schizophrenia Research ◽

10.1016/s0920-9964(12)70242-6 ◽

2012 ◽

Vol 136 ◽

pp. S65

Author(s):

Maria Michail

Keyword(s):

Anxiety Disorder ◽

High Risk ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Ultra High Risk

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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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Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis

Schizophrenia Research ◽

10.1016/j.schres.2016.10.030 ◽

2017 ◽

Vol 182 ◽

pp. 42-48 ◽

Cited By ~ 36

Author(s):

Regitze Sølling Wils ◽

Ditte Resendal Gotfredsen ◽

Carsten Hjorthøj ◽

Stephen F. Austin ◽

Nikolai Albert ◽

...

Keyword(s):

Antipsychotic Medication ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Episode Psychosis

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iMAgery focused psychological therapy for persecutory delusions in PSychosis (iMAPS): a multiple baseline experimental case series

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465820000168 ◽

2020 ◽

Vol 48 (5) ◽

pp. 530-545

Author(s):

Christopher D.J. Taylor ◽

Penny E. Bee ◽

James Kelly ◽

Richard Emsley ◽

Gillian Haddock

Keyword(s):

Case Series ◽

First Episode Psychosis ◽

Psychological Therapy ◽

Multiple Baseline ◽

Psychotic Symptoms ◽

First Episode ◽

Multiple Baseline Design ◽

Persecutory Delusions ◽

Baseline Design ◽

Episode Psychosis

AbstractBackground:Many people with psychosis experience persecutory delusions and report negative schematic beliefs and intrusive mental images which may be maintaining factors for psychotic symptoms.Aims:This study examined the feasibility and acceptability of a new psychological therapy targeting schemas and images (iMAPS therapy).Method:The study used a randomised multiple baseline design. Participants with first episode psychosis were randomised using a multiple baseline design with 2–5 assessments. Six sessions of therapy, consisting of a combination of imagery techniques and imagery rescripting techniques, was used. In each session, participants completed a Mental Imagery in Psychosis Questionnaire (MIPQ) and imagery interview. Mood and delusional beliefs (PSYRATS) were also measured at each session.Results:Five participants with first episode psychosis completed the baseline visits and attended all therapy sessions. One participant declined the final assessment. Results demonstrated significant reductions in negative schematic beliefs, delusions, imagery distress and other measures of schema (YSQ, SMI). Although multiple baseline randomisation strengthens the study, it lacked a control arm and blind assessments.Conclusions:iMAPS appears a feasible and acceptable treatment for psychosis, and further evaluation is indicated.

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Cannabis use and first-episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation

Psychological Medicine ◽

10.1017/s0033291713000883 ◽

2013 ◽

Vol 44 (3) ◽

pp. 499-506 ◽

Cited By ~ 40

Author(s):

J. M. Stone ◽

H. L. Fisher ◽

B. Major ◽

B. Chisholm ◽

J. Woolley ◽

...

Keyword(s):

Longitudinal Design ◽

First Episode Psychosis ◽

Cannabis Use ◽

Daily Functioning ◽

Psychotic Symptoms ◽

First Episode ◽

Time Points ◽

Manic Symptoms ◽

Episode Psychosis ◽

Early Intervention In Psychosis

BackgroundCannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.MethodClinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points – at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.ResultsLevel of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.ConclusionsEffective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.

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Five-year stability of ICD-10 diagnoses among Chinese patients presented with first-episode psychosis in Hong Kong

Schizophrenia Research ◽

10.1016/j.schres.2009.09.037 ◽

2009 ◽

Vol 115 (2-3) ◽

pp. 351-357 ◽

Cited By ~ 52

Author(s):

Wing Chung Chang ◽

Shirley Lai Kwan Pang ◽

Dicky Wai Sau Chung ◽

Sandra Sau Man Chan

Keyword(s):

Hong Kong ◽

First Episode Psychosis ◽

Chinese Patients ◽

First Episode ◽

Episode Psychosis ◽

Icd 10

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Dilemmas in the treatment of early-onset first-episode psychosis

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125318765725 ◽

2018 ◽

Vol 8 (8) ◽

pp. 231-239 ◽

Cited By ~ 3

Author(s):

Daniel Hayes ◽

Marinos Kyriakopoulos

Keyword(s):

Young People ◽

Early Onset ◽

Clinical Decision Making ◽

Clinical Decision ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Close Monitoring ◽

Optimal Outcomes ◽

Episode Psychosis

Early-onset first-episode psychosis (EOP) is a severe mental disorder that can pose a number of challenges to clinicians, young people and their families. Its assessment and differentiation from other neurodevelopmental and mental health conditions may at times be difficult, its treatment may not always lead to optimal outcomes and can be associated with significant side effects, and its long-term course and prognosis seem to be less favourable compared with the adult-onset disorder. In this paper, we discuss some dilemmas associated with the evaluation and management of EOP and propose approaches that can be used in the clinical decision-making process. A detailed and well-informed assessment of psychotic symptoms and comorbidities, a systematic approach to treatment with minimum possible medication doses and close monitoring of its effectiveness and adverse effects, and multidimensional interventions taking into consideration risks and expectations associated with EOP, are paramount in the achievement of the most favourable outcomes for affected children and young people.

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