Abstract
The aims of this study were to examine the prevalence and pattern of lifetime Diagnostic and Structural Manual of Mental Disorders (fourth version) major depressive episodes, and the relationship between patient characteristics and current severity of depressive symptoms in first episode psychosis patients (FEPP). A total of 122 FEPP from the ongoing longitudinal thematically organized psychosis research study were included at first treatment. A total of 58 patients (48%) had experienced one or more major depressive episodes; 21 (17%) before onset of psychosis and 37 (30%) during or after onset of psychosis. Poor premorbid childhood adjustment, substance abuse, and excitative symptoms at start of treatment were statistically significant associated with higher current severity of depressive symptoms. Alcohol use was significantly associated with current severity of depression in men, while excitative symptoms were associated in women. Thus depressive symptoms are frequent among FEPP, with indications of gender specific differences in patient characteristics that might imply different approaches to treatment.
Highlights
In the second paper we examined whether premorbid adjustment was associated with the afflicted individuals’ self-esteem and whether lowered self-esteem may contribute to the development of delusions and hallucinations in first episode psychosis (FEP)
In paper II we aimed to investigate to what extent premorbid adjustment is related to selfesteem in first episode psychosis, to what extent self -esteem is related to the level of hallucinations and we explored to what extent self-esteem is related to the level of delusions in general and persecutory delusions in particular
Self-esteem was significantly associated with the four submeasures of Premorbid Adjustment Scale (PAS), hallucinations, persecutory delusions and depression
Summary
Concerning the first possible pathway, that social anxiety disorder may evolve as part of a premorbid developmental disorder, Birchwood and coworkers did not find any differences in premorbid peer-relations in a group of first episode patients with social anxiety disorder compared to first episode patients without social anxiety disorder (Birchwood et al, 2006). This is in contrast to the Edinburgh High-Risk Study that found early “situational anxiety” to be one of the best predictors of conversion to psychosis (Johnstone et al, 2005;Owens et al, 2005). If social anxiety disorder in patients with psychosis represents a pre-morbid disorder with interpersonal difficulties we would expect that patients with severe social anxiety symptoms would show poorer premorbid functioning, reduced social adjustment, when compared to patients without social anxiety disorder
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