Stressful Life Events in Onset of First Episode of Acute and Transient Psychotic Disorder

Cognitive dysfunctions are one of the main domains of symptom clusters in schizophrenia that are strongly related to poor prognosis and psychosocial impairment. We conducted a study to investigate the level of cognitive functions in patients with first episode psychosis (FEP) and effect of psychosocial factors related to psychosis and cognitive dysfunctions in this population. We included 60 FEP patients and 60 healthy control subjects. Cognitive functions of the study population were evaluated by using neuropsychological test battery including Stroop, Rey Verbal Learning and Memory, Digit Span, Trail Making, Digit Symbols, Controlled Word Association etc. Psychosocial risk factors were assessed using Childhood Trauma Questionnaire, Social Environment Measurement Tool, Life Events Scale, Tobacco Alcohol Use Scale and Substance/Marijuana Use Scale. Cognitive functions were significantly impaired in FEP patients compared to normal controls. Patients had poor performance in verbal memory, attention, processing speed, working memory and executive functions that is similar to the previous literature findings. Stressful life events in the last year and familial liability of schizophrenia and psychosis in 1st degree relatives were strong predictors to develop psychosis in patients with FEP. Both factors also seemed to be related to cognitive dysfunctions. In this study, patients with stressful life events in the last year were likely to have memory and executive dysfunctions. It has been shown that psychosocial risk factors had played an important role in developing psychosis. However, these factors also may negatively affect cognitive functions that may make the patient predispose to develop psychosis in FEP patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Stressful Life Events In First Episode Psychosis

Journal of Psychiatrists Association of Nepal ◽

10.3126/jpan.v10i1.40346 ◽

2021 ◽

Vol 10 (1) ◽

pp. 38-42

Author(s):

B.D. Karki ◽

D. Joshi ◽

A.P. Adhikari

Keyword(s):

Life Events ◽

Perceived Stress ◽

Stressful Life Events ◽

First Episode Psychosis ◽

Stressful Life ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Episode Psychosis

Introduction: First episode psychosis refers to the first time someone experiences psychotic symptoms or a psychotic episode. There are evidences related to the role of major life events and childhood trauma in the development of first episode psychosis. There are few studies regarding the environmental exposure to stressful life events and how these events might influence the onset of a psychotic disorder, and role of perceived stress. This study aimed to identify the relationship between stressful life events and first episode psychosis in Nepalese context. Material And Method: It was a hospital based cross-sectional, descriptive study. A total of 50 cases of first episode psychosis were included and the diagnosis was made according to ICD 10- Diagnostic Criteria for Research and verified by two consultant psychiatrists. Semi Structured Performa was designed to collect the information about the socio demographic data and perceived stress was assessed with Presumptive Stressful Life Events Scale (PSLES). Results: There were 62% female and 38% male patients with first episode psychosis with mean age 26.32 years. Majority of the participants were from rural areas (94%), married (58%), educated up to primary level (38%) and housewife (40%). 60.7% of ATPD had stressful life events (P =0. 000)which was higher than the stressful life events in patient with Schizophrenia (P =0. 005). There was a positive correlation between stressful life events and gender, setting, socioeconomic status and Diagnosis (P <0.05). Conclusion: Results show the relevance of presence of stressful life events as a potent source of perceived stress in first episode psychosis sample. Therefore this study highlights the importance of psychosocial intervention in this vulnerable group for management of illness and might be an important strategy for prevention.

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Visual working memory deterioration preceding relapse in psychosis

Psychological Medicine ◽

10.1017/s0033291716000751 ◽

2016 ◽

Vol 46 (11) ◽

pp. 2435-2444 ◽

Cited By ~ 8

Author(s):

C. L. M. Hui ◽

Y. K. Li ◽

A. W. Y. Li ◽

E. H. M. Lee ◽

W. C. Chang ◽

...

Keyword(s):

Working Memory ◽

Visual Working Memory ◽

Life Events ◽

Stressful Life Events ◽

First Episode Psychosis ◽

Stressful Life ◽

First Episode ◽

Medication Discontinuation ◽

Episode Psychosis ◽

Memory Deterioration

BackgroundRelapse is distressingly common after the first episode of psychosis, yet it is poorly understood and difficult to predict. Investigating changes in cognitive function preceding relapse may provide new insights into the underlying mechanism of relapse in psychosis. We hypothesized that relapse in fully remitted first-episode psychosis patients was preceded by working memory deterioration.MethodVisual memory and verbal working memory were monitored prospectively in a 1-year randomized controlled trial of remitted first-episode psychosis patients assigned to medication continuation (quetiapine 400 mg/day) or discontinuation (placebo). Relapse (recurrence of positive symptoms of psychosis), visual (Visual Patterns Test) and verbal (Letter–Number span test) working memory and stressful life events were assessed monthly.ResultsRemitted first-episode patients (n = 102) participated in the study. Relapsers (n = 53) and non-relapsers (n = 49) had similar baseline demographic and clinical profiles. Logistic regression analyses indicated relapse was associated with visual working memory deterioration 2 months before relapse [odds ratio (OR) 3.07, 95% confidence interval (CI) 1.19–7.92, P = 0.02], more stressful life events 1 month before relapse (OR 2.11, 95% CI 1.20–3.72, P = 0.01) and medication discontinuation (OR 5.52, 95% CI 2.08–14.62, P = 0.001).ConclusionsVisual working memory deterioration beginning 2 months before relapse in remitted first-episode psychosis patients (not baseline predictor) may reflect early brain dysfunction that heralds a psychotic relapse. The deterioration was found to be unrelated to a worsening of psychotic symptoms preceding relapse. Testable predictors offer insight into the brain processes underlying relapse in psychosis.

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