Life In First-episode Psychosis Research Articles

Autistic features and executive functions in first episode psychosis: Associations with functionality and quality of life.

The present study aimed at investigating the relationships between autistic features and cognitive deficits, functionality and quality of life in first episode psychosis (FEP) patients. Sixty FEP patients [mean age (SD)=32.53 (10.74), n=23 female, n=37 male] were enrolled in this cross-sectional study. Data was collected using a sociodemographic and clinical data form, the Positive and Negative Syndrome Scale (PANSS), the PANSS Autism Severity Score (PAUSS), the Personal and Social Performance Scale (PSP), the Frontal Assessment Battery (FAB), and the World Health Organization Quality of Life Scale Short Form in Turkish Version (WHOQOL-BREF TR). Autistic symptom severity was found to be higher in males than females, and higher in patients with a family history of psychotic disorder. An inverse relationship was found between the duration of education and the severity of autistic symptoms. While there was an inverse relationship between autistic symptom severity and executive functions and functionality, no significant correlation was found with quality of life. Negative symptom severity was a predictor of executive functions and functionality. No significant difference was observed between autistic and psychotic domains which were related to executive functions. Our study is the first to examine the relationship between autistic/psychotic symptoms and executive functions and functionality in patients with FEP. The results show that autistic symptoms are associated with worse social and personal functioning and worse executive functions in patients with FEP. Longitudinal follow-up studies with larger samples are required to determine the direction of the relations.

Quality of life in first episode psychosis: a cluster analytic approach.

Quality of life is increasingly recognised as an important outcome for young people with first episode psychosis (FEP). The first aim was to determine whether distinct homogenous subgroups of young people with FEP could be delineated based on profiles on quality of life domains (Physical Health, Psychological, Social relationships and Environmental). The second aim was to examine the discriminant validity of these subgroups with respect to demographic, functioning and clinical features of FEP. Quality of life, demographic characteristics, clinical characteristics, cognition and functioning were assessed in 145 people with FEP. Cluster analysis using Ward's methods and Squared Euclidean Distance with a k-means verification were employed to identify subgroups with homogenous quality of life profiles. The clusters were externally validated using multinomial logistic regressions. Three distinct quality of life profiles were identified: one with good quality of life across all domains (30%), one with poor quality of life particularly in Psychological and Social relationships domains (28%), and one 'intermediate' group with comparatively low Psychological quality of life (42%). Depression, semantic verbal fluency, social inclusion and social/occupational functioning showed associations with group membership. Our results suggest the potential of maintaining relatively good quality of life despite the experience of FEP. Future research on interventions to improve quality of life may consider the potential of addressing depression, social inclusion and social/occupational functioning.

Cognitive function, social functioning and quality of life in first-episode psychosis: a 1-year longitudinal study

Introduction: Nonunion due to a critical-sized bone defect is a complicated problem. The healing process must fulfill three mandatory elements of osteogenesis, osteoinduction, and osteoconduction. One ideal source to provide an abundant number of osteogenic cells is from the process of the culture of bone marrow stem cells which demands the availability of processing facility. Unfortunately, this sophisticated option is not always feasible in every hospital in low-income to middle-income countries. We tried to fulfill the requirement of osteogenic cells by using simple and cost-effective bone marrow aspirate. We presented two cases of critical-sized diaphyseal bone defect treated with the combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma (PRP).Presentation of cases: The defect sizes were five and six centimeters in humerus and tibia respectively. We applied a combination of bone marrow aspirate, cancellous bone allograft, and PRP to promote bone healing in the defect sites. Both patients have achieved the good clinical and radiological outcome.Discussion: Critical-sized bone defects require the application of tissue engineering. Aspirated bone marrow can be used as a more affordable option to provide the element of osteogenic cells in bone healing. Combined with cancellous bone allograft and PRP, they fulfill the required ingredients to promote bone regeneration.Conclusion: Bone defects remain one of the most challenging conditions to treat in orthopedic. There are many options to treat the defect but the fundamental prerequisites of cells, scaffolds and growth factors for healing have developed into the concept of tissue engineering: osteogenesis, osteoinduction, and osteoconduction.

A meta-analysis of factors associated with quality of life in first episode psychosis

ObjectiveImproving quality of life for people with first episode psychosis is an important aspect of recovery. Our objective was to review the associative factors on quality of life in first episode psychosis. A meta-analysis was conducted on the associations between quality of life, symptom severity, and duration of untreated psychosis. MethodFifty-one articles were identified (published through 08/29/2016) that provided data on the relationship between quality of life and at least one other outcome measure of interest in first episode psychosis. Of those studies, 21 were included in a meta-analysis (n = 3992) of the relationship between quality of life, severity of psychosis, and duration of untreated psychosis. ResultsMeta-analysis identified significant negative correlations between quality of life and severity of symptoms (total symptom scores: r = −0.32, p < 0.001) and quality of life and duration of untreated psychosis (r = −0.21, p < 0.001). Heinrich's quality of life scale emerged as being more sensitive to the presence of psychotic symptoms than other measures of quality of life. ConclusionsAssociations were found between certain disease specific variables and quality of life in first episode psychosis, highlighting the relationship between symptom presentation and quality of life and the need for early intervention. Proper assessment of quality of life is important to promote improved quality of life in patients with first episode psychosis. Future research is needed to examine the interacting effects of symptom presentation, duration of untreated psychosis, and other variables, such as neurocognition, on quality of life.

Subjective quality of life in first-episode psychosis. A ten year follow-up study

Subjective quality of life (S-QoL) is an important outcome measure in first episode psychosis (FEP). The aims of this study were to describe S-QoL-development the first 10-years in FEP patients and to identify predictors of this development. MethodsA representative sample of 272 patients with a first episode psychotic disorder was included from 1997 through 2000. At 10year follow-up 186 patients participated. QoL was measured by the Lehman's Quality of Life Interview. Linear mixed model analyses were performed to investigate longitudinal effects of baseline psychiatric symptoms and socio-economic variables and the effects of changes in the same variables on S-QoL-development. ResultsS-QoL improved significantly over the follow-up period. More contact with family and a better financial situation at baseline had a positive and longstanding effect on S-QoL-development, but changes in these variables were not associated with S-QoL-development. Higher depressive symptoms and less daily activities at baseline both had a negative independent effect, but a positive interaction effect with time on S-QoL-development indicating that the independent negative effect diminished over time. In the change analysis, increased daily activities and a decrease in depressive symptoms were associated with a positive S-QoL-development. ConclusionsTreatment of depressive symptoms and measures aimed at increasing daily activities seem important to improve S-QoL in patients with psychosis. More contact with family and a better financial situation at baseline have a long-standing effect on S-QoL-development in FEP patients.

Comparison of generic and disease-specific measures of quality of life in first-episode psychosis

BackgroundQuality of life (QOL) is now recognised as an important measure of outcome that could potentially influence clinical decision-making for those with a first-episode psychosis (FEP). A number of QOL instruments are available however; many differ in their conceptual orientation which may have serious implications for the outcome of QOL studies, interpretation of findings and clinical utility. We aimed to compare two commonly used tools representing both generic and disease-specific constructs to examine whether both tools appraise the same underlying QOL traits and also whether disease-specific tools retain their psychometric properties when used in FEP groups. MethodsWe assessed 159 consecutive individuals presenting with FEP in a defined catchment area with two commonly used QOL tools and examined the findings using the multi-trait multi-method matrix. ResultsSimilarly named domains of QOL between both tools (Psychological Wellbeing, Physical Health, Social Relations) showed good convergent validity using confirmatory factor analysis. However, discriminant validity was not established given that domains loading onto their indicated latent factors were more strongly correlated with their non-corresponding latent factors. ConclusionsA major consideration in undertaking the present study was to assess the extent to which the outcome of QOL studies in FEP were valid and that systematic error did not provide another plausible explanation for findings. Establishing convergent validity demonstrates that either tool could be used satisfactorily to measure the QOL construct identified however; we did not establish discriminant validity. Doing so would have demonstrated that QOL domains are substantively different in that they contain some unique piece of information determining clinical utility. These findings are important for our understanding of multi-dimensional models of QOL.

Depression and quality of life in first-episode psychosis

AimQuality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL. MethodsWe assessed 208 individuals with first-episode non-affective psychosis using measures of diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), symptoms (Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning), insight (Birchwood Scale), duration of untreated psychosis (Beiser Scale), and QOL World Health Organisation Quality of Life Instrument (WHOQOL-Bref). We used multiple regression to determine the contribution of depressive symptoms to QOL domains while controlling for socio-demographic and other clinical characteristics. ResultsThere were complete data for 146 individuals with FEP. Quality-of-life domains were consistently predicted by depressive symptoms including depressive mood and hopelessness rather than biological symptoms of depression with those experiencing more depressive symptoms reporting worse QOL. Those who were treated as in-patients reported improved QOL, and hospitalization was an independent predictor of most QOL domains. In-patients displayed greater levels of positive symptoms with those involuntarily detained displaying greater levels of bizarre behavior, thought disorder, and delusions. ConclusionsThese findings suggest that QOL is heavily influenced by depressive symptoms at initial presentation; however, as QOL domains are also influenced by admission status with in-patients being more symptomatic in terms of positive symptoms, subjective QOL assessment may be compromised during the acute phase of illness by both positive and depressive symptom severity.

Cognitive function, social functioning and quality of life in first-episode psychosis: A 1-year longitudinal study

Objective. The majority of patients with schizophrenia have cognitive deficits early in the disease. We evaluated the relationship between cognitive function, social functioning and quality of life in patients with first-episode psychosis. Methods. This was a longitudinal study in 15 patients aged 18–30 years who had recently experienced a first psychotic episode and were treated with the atypical antipsychotic aripiprazole, cognitive-behavioural therapy, psycho-educational sessions, family supportive sessions and social interventions. Patients were evaluated at baseline and after 1 year. Cognitive assessment included attention, memory, language skills and problem solving. Social functioning, quality of life, and psychopathological evaluation were performed with validated tools. Results. At baseline, patients had a severe impairment of social functioning and a low quality of life, while a specific pattern of cognitive functions was not identified. After 1-year, we observed a significant improvement in social functioning and quality of life, without a significant decrease in cognitive function. Conclusion. Contrary to previous findings, we found that social functioning and quality of life are related, but independent of cognitive impairment. The use of antipsychotic agents that do not interefere with cognitive function plus psychological assistance is a valuable treatment approach in patients with first-episode schizophrenia.

146 – Can we rely on subjective measurement of quality of life in first episode psychosis?

In spare part distribution, contracts characterized by different unit prices, lead times, minimum order quantities are usually offered to different types of customers. In this context, one of the main problems is the decision on the allocation of the on–hand inventory to the different customers in order to minimize the total back–order cost. In this paper, we propose two allocation policies that use a dynamic critical level to reserve on-hand inventory for high priority customers. The first policy sets the critical level according to a target service level for high priority demand, while the other sets the critical level according to the back-order costs for the different classes of customers. The effectiveness of the two policies with respect to no rationing or stock piling polices is shown using the data of a European spare part company. Moreover, the relationship between the two policies is evaluated from a managerial perspective.

Premorbid adjustment, symptom development and quality of life in first episode psychosis: a systematic review and critical reappraisal

To systematically review the relationship of premorbid adjustment to symptomatology in first episode psychosis (FEP), taking into account the influence of duration of untreated psychosis (DUP). Electronic databases were searched to identify relevant studies. A variety of approaches to the reporting of premorbid adjustment were identified. There was no significant association between premorbid adjustment and DUP, supporting the proposition that they are independent constructs. The effect of premorbid adjustment upon positive symptomatology was negligible. Premorbid adjustment had a modest effect upon negative symptoms and quality of life, increasing over duration of follow-up. Premorbid adjustment remains a valid construct in the study of FEP. Both premorbid adjustment and DUP confer independent effects on aspects of symptomatology in FEP. Results for premorbid adjustment are similar to previous findings in more chronic samples. The potential for conceptualizing premorbid functioning by developmental, academic/social and typological approaches is currently underexploited.

What Influences Purpose in Life in First-Episode Psychosis?

Although purpose in life (PIL) is significant to psychological wellbeing, there is little published research on PIL among those with a mental illness. This prospective study of first-episode psychosis (n = 54) included assessment of symptomatology, PIL and duration of untreated psychosis. The results showed that the baseline PIL scores of those with first-episode psychosis were lower than those of other populations. This was worsened by a long duration of untreated psychosis and was linked to depression. The study concludes that psychosis results in many losses for the individual, including PIL. Meaningful occupation can address this lost sense of purpose and the occupational difficulties associated with psychosis.

Measuring quality of life in first-episode psychosis

Quality of life (QoL) measures are increasingly recognized as necessary parts of outcome assessments in psychosis. The present paper is a comprehensive study of patients with first-episode psychosis where QoL is measured by the commonly used Lehman Quality of Life Interview (L-QoLI). The aim is to examine if the L-QoLI maintain its original structure when used in a group of patients with first-episode psychosis, and to investigate what determines global subjective QoL with a specific emphasis on premorbid adjustment, duration of untreated psychosis (DUP) and clinical symptoms. The study indicates that the psychometric properties of the L-QoLI do not change significantly when used in first-episode samples. The patients report subjective and objective QoL in the fair to good range, with only a moderate association between the objective and subjective measures. Poor global satisfaction is predicted by being single, abusing drugs, being depressed, having a diagnosis of psychotic affective disorder, having poor premorbid social adjustment and DUP over 10 weeks. The study supports the notion that patients with first-episode psychosis construct QoL in the same way as other groups, and that longer durations of compromised function at this stage produces poor satisfaction with life rather than a downward readjustment of expectations.

Relative Contributions of Psychiatric Symptoms and Neuropsychological Functioning to Quality of Life in First-Episode Psychosis

To report on the relationship between quality of life (QOL), psychiatric symptoms and neuropsychological functioning in a sample of young people who have experienced a first episode of psychosis 2-3 years following initial presentation. Fifty-one participants aged 15-27 years old completed the short form of the World Health Organization Quality of Life scale (WHOQOL-Bref), a self-report instrument assessing physical, psychological, social and environmental aspects of QOL. A comprehensive neuropsychological battery was administered. Measures of psychiatric symptoms including depression (as assessed by the Calgary Depression Scale), positive, negative and general psychopathology (as assessed by the Positive and Negative Syndrome Scale) were obtained. Multiple regression analyses were used to evaluate the ability of neuropsychological measures and psychiatric symptoms to predict QOL. When neuropsychological variables were considered on their own, cognitive flexibility, verbal fluency, verbal ability and sustained attention explained up to 28% of the variance in the four domains of QOL. However, in the presence of psychiatric symptoms, neuropsychological variables were no longer significant predictors for physical and psychological QOL; depression, general psychopathology and negative symptoms together explained up to 43% of the variance in QOL, with neuropsychological variables remaining significant for social and environmental QOL. In young people with their first episode of psychosis, QOL is more strongly related to levels of psychopathology, particularly depression, than neuropsychological deficits. This finding replicates previous studies in chronic schizophrenia that have suggested QOL is more strongly related to levels of psychopathology than the presence of neuropsychological deficits.

Relative contributions of psychiatric symptoms and neuropsychological functioning to quality of life in first-episode psychosis

Relative contributions of psychiatric symptoms and neuropsychological functioning to quality of life in first-episode psychosis