Group programmes for recovery from early psychosis

BackgroundWe evaluate the impact of a group-based, transitional, psychosocial programme, within a comprehensive service (the Early Psychosis Prevention and Intervention Centre, EPPIC), on recovery from first-episode psychosis.MethodIndividuals using the service (and meeting study criteria) were assessed on a range of symptom and functioning instruments at entry, after 6 weeks and 6 months. Participants received comprehensive case management and services according to their identified needs. Thirty-four people who had attended the group programme were compared at 6 month follow-up with 61 EPPIC patients who had not attended.ResultsThe people attending the group programme had a lower level of premorbid adjustment than the comparison group, and a trend towards exhibiting a higher level of negative symptoms, prior to commencing the group programme. However, at 6 month follow-up, no significant differences were found between the groups.ConclusionsInvolvement in the group programme may have had a positive impact on a subgroup of EPPIC subjects with poor level of premorbid adjustment, by providing a ‘holding pattern’ in the critical period following the emergence of first-onset psychosis, and thus prevented deterioration and the development of disability.

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Predictors of Remission and Recovery in a First-Episode Schizophrenia Spectrum Disorder Sample: 2-Year Follow-up of the OPUS Trial

The Canadian Journal of Psychiatry ◽

10.1177/070674370805301005 ◽

2008 ◽

Vol 53 (10) ◽

pp. 660-670 ◽

Cited By ~ 61

Author(s):

Lone Petersen ◽

Anne Thorup ◽

Johan Øqhlenschlæger ◽

Torben Øqstergaard Christensen ◽

Pia Jeppesen ◽

...

Keyword(s):

Substance Abuse ◽

Negative Symptoms ◽

Spectrum Disorder ◽

First Episode ◽

Schizophrenia Spectrum Disorder ◽

Adherence To Medication ◽

Premorbid Adjustment ◽

Schizophrenia Spectrum ◽

First Episode Schizophrenia

Objective: To examine the frequency and predictors of good outcome for patients with first-episode schizophrenia spectrum disorder (SSD). Method: We conducted a 2-year follow-up of a cohort of patients ( n = 547) with first-episode SSD. We evaluated the patients on demographic variables, diagnosis, duration of untreated psychosis (DUP), premorbid functioning, psychotic and negative symptoms, substance abuse, adherence to medication, and service use. ORs were calculated with logistic regression analyses. Results: A total of 369 patients (67%) participated in the follow-up interview. After 2 years, 36% remitted and 17% were considered fully recovered. Full recovery was associated with shorter DUP, better premorbid adjustment, fewer negative symptoms at baseline, no substance abuse at baseline, and adherence to medication and OPUS treatment. Conclusions: Several predictive factors were identified, and focus should be on potentially malleable predictors of outcome, for example, reducing DUP and paying special attention to patients who are unlikely to achieve good outcome, for example, patients with a substance abuse problem and poor premorbid adjustment.

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Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study

Psychological Medicine ◽

10.1017/s0033291707000797 ◽

2007 ◽

Vol 38 (1) ◽

pp. 79-88 ◽

Cited By ~ 54

Author(s):

I. Harrison ◽

E. M. Joyce ◽

S. H. Mutsatsa ◽

S. B. Hutton ◽

V. Huddy ◽

...

Keyword(s):

Substance Use ◽

Depressive Symptoms ◽

Negative Symptoms ◽

Spatial Working Memory ◽

Problem Drinking ◽

Specific Treatment ◽

First Episode ◽

First Episode Schizophrenia ◽

The Impact

BackgroundThe impact of co-morbid substance use in first-episode schizophrenia has not been fully explored.MethodThis naturalistic follow-up of a cohort of 152 people with first-episode schizophrenia examined substance use and clinical outcome in terms of symptoms and social and neuropsychological function.ResultsData were collected on 85 (56%) of the patient cohort after a median period of 14 months. Over the follow-up period, the proportion of smokers rose from 60% at baseline to 64%. While 30% reported lifetime problem drinking of alcohol at baseline, only 15% had problem drinking at follow-up. Furthermore, while at baseline 63% reported lifetime cannabis use and 32% were currently using the drug, by the follow-up assessment the latter figure had fallen to 18.5%. At follow-up, persistent substance users had significantly more severe positive and depressive symptoms and greater overall severity of illness. A report of no lifetime substance use at baseline was associated with greater improvement in spatial working memory (SWM) at follow-up.ConclusionsPast substance use may impede recovery of SWM performance in people with schizophrenia in the year or so following first presentation to psychiatric services. The prevalence of substance use other than tobacco tends to diminish over this period, in the absence of specific interventions. Persistent substance use in first-episode schizophrenia is associated with more severe positive and depressive symptoms but not negative symptoms, and should be a target for specific treatment intervention.

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Three-Year Outcome of Treatment in an Early Psychosis Program

The Canadian Journal of Psychiatry ◽

10.1177/070674370905400907 ◽

2009 ◽

Vol 54 (9) ◽

pp. 626-630 ◽

Cited By ~ 10

Author(s):

Jean Addington ◽

Donald Addington

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Negative Symptoms ◽

Family Physicians ◽

Early Psychosis ◽

First Episode ◽

Significant Group ◽

Specialized Mental Health

Objective: Studies defining the course and outcome of people experiencing their first episode psychosis (FEP) generally report an improvement in symptoms and functioning. Little is known about the follow-up arrangements offered topatients when their timein a FEP comes to an end. Method: Our study focuses on a sample of FEP patients ( n = 292) who were followed for up to 3 years in a multi-element specialized FEP service. Results: Improvement in positive symptoms and social functioning, but not negative symptoms, was observed in this sample both for people who completed 3 years in the program and for those who left early. About 40% were referred to specialized mental health services, whereas 24% were followed by their family physician. Patients who were followed by family physicians had decreased symptoms and improved functioning. Conclusion: Most patients treated in an early psychosis program will need follow-up, the largest group will require specialized mental health services in the community, but a significant group can be followed by family physicians.

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The relationship of early premorbid adjustment with negative symptoms and cognitive functions in first-episode schizophrenia: A prospective three-year follow-up study

Psychiatry Research ◽

10.1016/j.psychres.2013.02.014 ◽

2013 ◽

Vol 209 (3) ◽

pp. 353-360 ◽

Cited By ~ 37

Author(s):

Wing Chung Chang ◽

Jennifer Yee Man Tang ◽

Christy Lai Ming Hui ◽

Gloria Hoi Yan Wong ◽

Sherry Kit Wa Chan ◽

...

Keyword(s):

Cognitive Functions ◽

Negative Symptoms ◽

First Episode ◽

Follow Up Study ◽

Premorbid Adjustment ◽

First Episode Schizophrenia ◽

Relationship Of ◽

The Relationship

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The impact of cognitive reserve, cognition and clinical symptoms on psychosocial functioning in first-episode psychoses

Psychological Medicine ◽

10.1017/s0033291720002226 ◽

2020 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Silvia Amoretti ◽

Adriane R Rosa ◽

Gisela Mezquida ◽

Bibiana Cabrera ◽

María Ribeiro ◽

...

Keyword(s):

Cognitive Performance ◽

Verbal Memory ◽

Negative Symptoms ◽

Cognitive Reserve ◽

Clinical Symptoms ◽

First Episode ◽

Cognitive Domains ◽

The Impact ◽

The Relationship

Abstract Background Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome. Methods A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning. Results At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR. Conclusions Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.

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Sex Differences in Verbal Memory Predict Functioning Through Negative Symptoms in Early Psychosis

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa054 ◽

2020 ◽

Vol 46 (6) ◽

pp. 1587-1595 ◽

Cited By ~ 2

Author(s):

Gabriella Buck ◽

Katie M Lavigne ◽

Carolina Makowski ◽

Ridha Joober ◽

Ashok Malla ◽

...

Keyword(s):

Sex Differences ◽

Verbal Memory ◽

Visual Memory ◽

Parental Education ◽

Negative Symptoms ◽

Early Psychosis ◽

First Episode ◽

Severe Illness ◽

Cognitive Domains

Abstract Verbal memory (VM) is one of the most affected cognitive domains in first-episode psychosis (FEP) and is a robust predictor of functioning. Given that healthy females demonstrate superior VM relative to males and that female patients show less-severe illness courses than male patients, this study examined whether normative sex differences in VM extend to FEP and influence functioning. Four hundred and thirty-five patients (299 males, 136 females) with affective or nonaffective psychosis were recruited from a catchment-based specialized FEP intervention service and 138 nonclinical controls (96 males, 42 females) were recruited from the same community. One of the two neurocognitive batteries comprising six cognitive domains (VM, visual memory, working memory, attention, executive function, processing speed) were administered at baseline. In patients, positive and negative symptoms were evaluated at baseline and functioning was assessed at 1-year follow-up. Patients were more impaired than controls on all cognitive domains, but only VM showed sex differences (both patient and control males performed worse than females), and these results were consistent across batteries. In patients, better baseline VM in females was related to better functioning after 1 year, mediated through fewer baseline negative symptoms. Supplemental analyses revealed these results were not driven by affective psychosis nor by age and parental education. Thus, normative sex differences in VM are preserved in FEP and mediate functioning at 1-year follow-up via negative symptoms. This study highlights the importance of investigating sex effects for understanding VM deficits in early psychosis and suggests that sex may be a disease-modifying variable with important treatment implications.

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Cognitive reserve as a moderator of outcomes in five clusters of first episode psychosis patients: a 10-year follow-up study of the PAFIP cohort

Psychological Medicine ◽

10.1017/s0033291721003536 ◽

2021 ◽

pp. 1-15

Author(s):

Rosa Ayesa-Arriola ◽

Victor Ortiz-García de la Foz ◽

Nancy Murillo-García ◽

Javier Vázquez-Bourgon ◽

María Juncal-Ruiz ◽

...

Keyword(s):

Negative Symptoms ◽

Cognitive Reserve ◽

Protective Factor ◽

First Episode Psychosis ◽

First Episode ◽

Illness Onset ◽

Premorbid Adjustment ◽

Episode Psychosis ◽

Low Education

Abstract Background Cognitive reserve (CR) has been associated with the development and prognosis of psychosis. Different proxies have been used to estimate CR among individuals. A composite score of these proxies could elucidate the role of CR at illness onset on the variability of clinical and neurocognitive outcomes. Methods Premorbid intelligence quotient (IQ), years of education and premorbid adjustment were explored as proxies of CR in a large sample (N = 424) of first-episode psychosis (FEP) non-affective patients. Clusters of patients were identified and compared based on premorbid, clinical and neurocognitive variables at baseline. Additionally, the clusters were compared at 3-year (N = 362) and 10-year (N = 150) follow-ups. Results The FEP patients were grouped into five CR clusters: C1 (low premorbid IQ, low education and poor premorbid) 14%; C2 (low premorbid IQ, low education and good premorbid adjustment) 29%; C3 (normal premorbid IQ, low education and poor premorbid adjustment) 17%; C4 (normal premorbid IQ, medium education and good premorbid adjustment) 25%; and C5 (normal premorbid IQ, higher education and good premorbid adjustment) 15%. In general, positive and negative symptoms were more severe in the FEP patients with the lowest CR at baseline and follow-up assessments, while those with high CR presented and maintained higher levels of cognitive functioning. Conclusions CR could be considered a key factor at illness onset and a moderator of outcomes in FEP patients. A high CR could function as a protective factor against cognitive impairment and severe symptomatology. Clinical interventions focused on increasing CR and documenting long-term benefits are interesting and desirable.

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Neurodevelopmental markers in different psychopathological dimensions of first episode psychosis: The ESPIGAS Study

European Psychiatry ◽

10.1016/j.eurpsy.2008.04.003 ◽

2008 ◽

Vol 23 (8) ◽

pp. 533-540 ◽

Cited By ~ 17

Author(s):

Miguel Ruiz-Veguilla ◽

Jorge A. Cervilla ◽

Maria Luisa Barrigón ◽

Maite Ferrín ◽

Blanca Gutiérrez ◽

...

Keyword(s):

Negative Symptoms ◽

Principal Component ◽

Obstetric Complications ◽

First Episode ◽

Negative Group ◽

Affective Psychosis ◽

Neurological Soft Signs ◽

Premorbid Adjustment ◽

Episode Psychosis ◽

First Onset

AbstractObjectiveThe main aim of this study was to explore whether specific groups of patients with first episode non-affective psychosis could be identified on a psychopathological basis and, then, whether such identified groups could be validated by exploring their correlation with a variety of neurodevelopmental markers.MethodEighty-seven patients with a first episode of non-affective psychotic disorder were consecutively recruited. We assessed psychopathology and neurological soft signs using the PANSS and the Neurological Evaluation Scale, respectively. We collected information on obstetric complications, premorbid adjustment and family history.ResultsAll PANSS symptoms were analysed using principal component analysis and four factors were obtained (negative, disorganization, positive and paranoid). Subsequently, the four factors were subjected to a cluster analysis where three groups emerged: “paranoid” (n = 40), “low score” (n = 29) and “negative” (n = 18) subtype. After adjusting by sex and age, we found that the “negative group” had poorer social premorbid adjustment, worse verbal fluency and higher prevalence of both obstetric complications and neurological soft signs, when compared with the “low score” group. Similarly, the “negative group” showed significantly poorer social premorbid adjustment and higher number of neurological soft signs than the “paranoid group”.ConclusionsOur results support that, among non-affective first onset psychotic patients, those with predominant negative symptoms are more likely to correlate with higher presence of neurodevelopmental markers.

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Early Psychosis: Diagnosis and Treatment

Current Psychopharmacologye ◽

10.2174/2211556009999200723123322 ◽

2020 ◽

Vol 09 ◽

Author(s):

Nataly S. Beck ◽

Melanie L. Lean ◽

Kate V. Hardy ◽

Jacob S. Ballon

Keyword(s):

United States ◽

Early Identification ◽

Mental Health Problems ◽

The United States ◽

Early Psychosis ◽

Screening Tools ◽

Diagnosis And Treatment ◽

First Episode ◽

Psychotic Episode ◽

First Onset

Background: The typical age of onset for psychotic disorders is concurrent with the typical age of enrollment in higher education. College and graduate students often experience new academic and social demands that may leave them vulnerable to substance use and mental health problems, including the initial onset of a psychotic episode. Objective: To provide a current overview of the guidelines and literature for the diagnosis and treatment of first-onset psychosis with special consideration for the college and graduate student population in the United States. To highlight areas of need and provide recommendations for clinicians who work at educational institutions and their health services, along with general psychiatrists and psychologists who work with post-secondary education populations, to help close the treatment gap. Method: A review of interventions and best practice for the treatment of early psychosis in college students was conducted, informed by the authors’ current experience as clinicians with this population at a United States university. Results: Thorough psychiatric interviews and screening tools can help in the early identification of individuals at clinical high risk for and at first onset of psychosis. Coordinated specialty care services are the gold standard for early psychosis services, including psychotherapy (such as cognitive behavioral therapy and individual resiliency training), as well as support for a student to return to school or work. Individuals experiencing a first episode of psychosis in general respond better to lower doses of antipsychotics and may also experience more adverse effects. Conclusion: Return to a high level of functioning is possible in many cases of first onset of psychosis, and early identification and treatment is essential.

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