Outcomes In Early Psychosis Research Articles

Social Recovery Therapy in improving activity and social outcomes in early psychosis: Current evidence and longer term outcomes

BackgroundSocial Recovery Therapy (SRT) is a cognitive behavioural therapy which targets young people with early psychosis who have complex problems associated with severe social disability. This paper provides a narrative overview of current evidence for SRT and reports new data on a 2year follow-up of participants recruited into the Improving Social Recovery in Early Psychosis (ISREP) trial. MethodIn the ISREP study 50 participants (86%) were followed up at 2years, 15months post treatment. The primary outcome was engagement in paid work, assessed using the Time Use Survey. Engagement in education and voluntary work were also assessed. In addition, the Positive and Negative Syndrome Scales (PANSS) and the Beck Hopelessness Scale (BHS) were administered. Results25% of individuals with non-affective psychosis in the treatment group had engaged in paid work at some point in the year following the end of therapy, compared with none of the control group. Data from the PANSS and BHS suggested no worsening of symptoms and an indication that gains in hope were maintained over the 15month period following the end of therapy. ConclusionSocial Recovery Therapy is a promising psychological intervention which may improve social recovery in individuals with early psychosis. The new data reported in this paper shows evidence of gains in engagement in paid employment outcomes that persisted 15months beyond the period of active intervention.

Longitudinal perspectives on the psychosis spectrum in 22q11.2 deletion syndrome.

The prevalence of psychotic disorders in individuals with 22q11.2 Deletion Syndrome (22q11DS) reaches 25-35% in young adulthood and may provide a neurogenetic model for clinical risk of psychotic disorders in the general population. This review focuses on prospective longitudinal studies in 22q11DS, which capture fluctuations in psychosis symptoms over time and may provide insights into potential demographic, clinical, cognitive, and neuroimaging predictors of psychosis-spectrum outcomes in the general population. Findings are compared and contrasted with those from idiopathic psychosis-spectrum populations. Onset of psychotic disorders in 22q11DS can occur over a wide range of ages, peaking in late adolescence. Symptoms may be gradually progressive or episodic in nature, highlighting the importance and challenge of risk and resilience prediction models. Converging results suggest that psychosis-spectrum outcomes in 22q11DS are predicted by lower baseline functioning, higher baseline psychosis-spectrum symptoms, presence of mood disturbance or anxiety, and lower baseline and subsequent decline in global measures of cognition. Predictors of transition to threshold psychotic disorders and ages of onset are similar in idiopathic clinical risk. They also share similarly global cognitive deficits, but not to the same extent as in 22q11DS. While neuroimaging studies in idiopathic clinical risk suggest loss of prefrontal gray matter, there is no consistent evidence yet emerging in the limited literature in 22q11DS. Interventional efforts in 22q11DS aimed at halting progression to psychosis or mitigating outcomes in early psychosis may be best implemented during the adolescent age range. Collaborative longitudinal efforts may help to address existing gaps in our understanding.

Identifying neurocognitive markers for outcome prediction of global functioning in individuals with first-episode and ultra-high-risk for psychosis.

There is an increasing need for identifying neurocognitive predictors of global functional outcome in early psychosis toward optimizing an early intervention strategy. We conducted a longitudinal observational study to investigate an association between neurocognitive assessments at baseline and global functional outcome at an average of 1-year follow up. Participants included ultra-high-risk for psychosis (UHR) individuals who had not converted to psychosis during the follow-up period (UHR-NP) and those with first-episode psychosis (FEP). We evaluated neurocognition at baseline using the Brief Assessment of Cognition in Schizophrenia Japanese version, including Verbal Memory, Working Memory, Motor Speed, Verbal Fluency, Attention/Processing Speed, and Executive Function. We also assessed global functional outcome using the modified Global Assessment of Functioning (mGAF) scale both at baseline and after the follow-up period. Thirty-four UHR-NP individuals (34/47, 72%) and 29 FEP individuals (29/36, 81%) completed assessment of neurocognitive function at baseline and functional outcome at follow up. In the UHR-NP group, Attention/Processing Speed was significantly associated with the mGAF score at follow up. In the FEP group, Executive Function was significantly associated with the average mGAF score during follow up. Attention/Processing Speed and Executive Function at baseline may predict global functional outcome of early psychosis. These neurocognitive tests are easy to incorporate in clinical settings and, if replicated in independent samples, may be included in routine clinical assessments for prediction of functional outcome in early psychosis.

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis.

Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.

Compensatory cognitive training for people with first-episode schizophrenia: Results from a pilot randomized controlled trial

Cognitive training or remediation now has multiple studies and meta-analyses supporting its efficacy in improving cognition and functioning in people with schizophrenia. However, relatively little is known about cognitive training outcomes in early psychosis. We conducted a pilot randomized controlled trial of Compensatory Cognitive Training (CCT) compared to Treatment as Usual (TAU) in 27 participants with first-episode psychosis who had received treatment for psychosis for less than six months. Assessments of cognition (MATRICS Consensus Cognitive Battery; MCCB) and functional capacity (UCSD Performance-Based Skills Assessment-Brief; UPSA-B) were administered at baseline and following the 12-week treatment. The CCT condition, compared to TAU, was associated with significant improvements on the MCCB composite score, as well as MCCB subtests measuring processing speed (Trail Making) and social cognition (Mayer–Salovey–Caruso Emotional Intelligence Test), with large effects on these three outcome measures. There were no significant CCT-associated effects on the UPSA-B or on positive, negative, or depressive symptoms. CCT treatment of cognitive impairments in first-episode schizophrenia is feasible and can result in large effect size improvements in global cognition, processing speed, and social cognition.

The Psychosis Recent Onset GRoningen Survey (PROGR-S): defining dimensions and improving outcomes in early psychosis.

Psychotic disorders are among the most complex medical conditions. Longitudinal cohort studies may offer further insight into determinants of functional outcome after a psychotic episode. This paper describes the Psychosis Recent Onset in GRoningen Survey (PROGR-S) that currently contains data on 1076 early-episode patients with psychosis, including symptoms, personality, cognition, life events and other outcome determinants. Our goal in this report is to give an overview of PROGR-S, as a point of reference for future publications on the effect of cognition, personality and psychosocial functioning on outcomes. PROGR-S contains an extensive, diagnostic battery including anamnesis, biography, socio-demographic characteristics, clinical status, drug use, neuropsychological assessment, personality questionnaires, and physical status tests. Extensive follow-up data is available on psychopathology, physical condition, medication use, and care consumption. Sample characteristics were determined and related to existing literature. PROGR-S (period 1997–2009, n = 718) included the majority of the expected referrals in the catchment area. The average age was 27 (SD = 8.6) and two-thirds were male. The average IQ was lower than that in the healthy control group. The majority had been diagnosed with a psychotic spectrum disorder. A substantial number of the patients had depressive symptoms (479/718, 78%) and current cannabis or alcohol use (465/718, 75%). The level of community functioning was moderate, i.e. most patients were not in a relationship and were unemployed. The PROGR-S database contains a valuable cohort to study a range of aspects related to symptomatic and functional outcomes of recent onset psychosis, which may play a role in the treatment of this complex and disabling disorder. Results reported here show interesting starting points for future research. Thus, we aim to investigate long-term outcomes on the basis of cognition, personality, negative symptoms and physical health. Ultimately, we hope that this paper will contribute improving the health of patients with psychotic disorders.

Clinical and cognitive predictors of vocational outcome in first-episode schizophrenia: A prospective 3 year follow-up study

Schizophrenia is associated with pronounced vocational impairment. Previous research has mostly focused on chronic patients and few studies were conducted to investigate predictors of work outcome in first-episode populations. The impact of cognitive dysfunction on employment outcome in early psychosis was under‐studied. In this study, we prospectively followed up 93 patients aged 18–55 years presented with first-episode schizophrenia-spectrum disorder for 3 years with an aim to identify early clinical and cognitive predictors of vocational outcome. Pre-morbid adjustment, baseline symptomatology and cognitive functions, and employment outcome were assessed. Result indicated that approximately half of the patients (53.8%) were engaged in full-time work at intake and at 3 years. Pre-morbid adjustment, baseline occupational status and Wisconsin Card Sorting Test (WCST) performance were found to predict vocational outcome. Analysis on a subgroup of patients who were unemployed at intake showed that subjects who remained unemployed over 3 years had poorer WCST performance and more severe positive symptoms at baseline than those having job attainment during follow-up. Our results thus confirmed predictive value of pre-morbid functioning and baseline occupational status on vocational outcome. In addition, our findings suggested that executive function might be a critical cognitive determinant of employment outcome in the early course of schizophrenia.

A double-blind randomized controlled trial of oxytocin nasal spray and social cognition training for young people with early psychosis.

Social-cognitive deficits contribute to poor functional outcomes in early psychosis; however, no effective pharmacological treatments exist for these problems. This study was the first to investigate the efficacy of an extended treatment of oxytocin nasal spray combined with social cognition training (SCT) to improve social cognition, clinical symptoms, and social functioning in early psychosis. In a double-blind, randomized, placebo-controlled, between-subjects trial, 52 individuals (aged 16-35 years) diagnosed with an early psychosis schizophrenia-spectrum illness were recruited. Participants received oxytocin (24 International Units) or placebo nasal spray twice-daily for 6 weeks, combined with group SCT (2 × 1 hour weekly sessions for 6 weeks). An additional dose of oxytocin was administered before each weekly session. Assessments were conducted at baseline, post-treatment, and at 3-month follow-up. Primary outcomes included the Reading the Mind in the Eyes Test, the Scale for the Assessment of Positive and Negative Symptoms, and the Social Functioning Scale. Secondary outcomes included self-report and behavioral assessments of social cognition, symptom severity, and social functioning. Results showed that on all primary and secondary outcomes, there was no benefit of oxytocin nasal spray treatment in comparison to placebo. Exploratory post hoc analysis suggested that increased use of nasal spray was, however, associated with reductions in negative symptoms in the oxytocin condition only. This study represents the first evaluation of oxytocin treatment for early psychosis. Although results suggest no benefit of oxytocin treatment, results also highlight an urgent need to consider nasal spray delivery and dose-related variables for future clinical trials.

Cannabis and stimulant disorders and readmission 2 years after first-episode psychosis

Few studies have examined the impact of stimulant use on outcome in early psychosis. Ceasing substance use may lead to positive outcomes in psychosis. To examine whether baseline cannabis or stimulant disorders and ongoing drug use predict readmission within 2 years of a first psychosis admission. Predictors of readmission were examined with Cox regression in 7269 people aged 15-29 years with a first psychosis admission. Baseline cannabis and stimulant disorders did not predict readmission. A stimulant disorder diagnosis prior to index psychosis admission predicted readmission, but a prior cannabis disorder diagnosis did not. Ongoing problem drug use predicted readmission. The lowest rate of readmission occurred in people whose baseline drug problems were discontinued. Prior admissions with stimulant disorder may be a negative prognostic sign in first-episode psychosis. Drug use diagnoses at baseline may be a good prognostic sign if they are identified and controlled.

Evaluation of a multi-element treatment center for early psychosis in the United States

A growing body of research has demonstrated the potential for comprehensive, phase-specific care to improve clinical and functional outcomes in early psychosis. However, there have been no evaluations of such treatment models in the United States (US). This study is a naturalistic, prospective 1-year follow-up of an early psychosis cohort treated in one of the first US-based multi-element treatment centers. Participants were 163 individuals treated at the Outreach and Support Intervention Services (OASIS) clinic, a multi-element treatment center for early psychosis. Data were collected as part of routine care at 6-month intervals. Primary outcomes included role functioning and involvement in work or school. Over the course of 1 year of treatment, individuals experienced significant improvements in positive and negative symptoms, role functioning, and global functioning. The proportion of individuals meeting symptom remission and functional remission criteria increased significantly from baseline to 1 year, as did the proportion of individuals attending school. There were also trend-level reductions in substance abuse. This study provides preliminary support for the efficacy of comprehensive early intervention services in the US.

Neurocognitive and social cognitive approaches for improving functional outcome in early psychosis: theoretical considerations and current state of evidence.

Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed.

Social outcome in early psychosis.

It has been demonstrated that patients experiencing their first-episode of psychosis have social functioning deficits that are equivalent to those seen in patients with a more chronic course of illness. The purpose of this study is to examine social functioning over the course of the first year after admission to an early psychosis programme. The social functioning of 177 first-episode subjects was assessed on admission and 1 year later and compared with that of 40 non-psychiatric controls. Assessment measures included the Quality of Life Scale (QLS). At the 1-year follow-up there was significant improvement in quality of life. However, even those first-episode patients experiencing a remission from positive symptoms had lower QLS scores than the non-psychiatric controls. These results are encouraging and supportive of early intervention. There is room for more improvement in the application and development of psychological interventions for these young patients.

Social outcome in early psychosis: A two year follow-up

Social outcome in early psychosis: A two year follow-up

Early detection and treatment delay: implications for outcome in early psychosis

The rapidly growing interest in early psychosis has three preventive foci. The prepsychotic phase is when most psychosocial impairment develops, but the specifics of treatment remain difficult to research and apply. Although the total duration of untreated illness may be more critical, the duration

Coping Style Predicts One Year Outcome in Early Psychosis

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Relationship between personality and course and outcome in early psychosis: A review of the literature

The literature relating to the relationship between personality factors and course and outcome for the schizophrenic disorders is reviewed utilizing the approach proposed by Klein, Wonderlich, and Shea (1993). Developed to explicate the relationship between personality and depression, this approach allows for consideration of the contribution of premorbid personality and also of changes in personality occurring secondary to the onset of the psychotic disorder. A model incorporating a developmental understanding of the impact on personality of the potentially traumatic experience of the onset of a schizophrenic disorder in late adolescence is presented. Directions for future research are outlined.

Eye tracking impairment in clinically identified patients with schizotypal personality disorder

Eye tracking accuracy, which has been found to be impaired in schizophrenic patients and their relatives, was assessed in 26 patients with schizotypal personality disorder, 17 control subjects with other non-schizophrenia-related personality disorders, 29 normal control subjects, and 44 schizophrenic patients. Both schizotypal and schizophrenic patients, but not control subjects with other personality disorders, demonstrated significantly more impaired tracking than the normal control subjects. These results suggest that patients with clinically defined schizotypal personality disorder may be biologically related to schizophrenic patients as part of a spectrum of schizophrenia-related disorders.

The role of social relationships in the recovery from psychotic disorders.

Little attention outside the therapeutic setting has been given to specifying the aspects of social relationships that might be helpful for patients recovering from psychotic episodes. The authors studied 20 patients who had been hospitalized for a psychotic episode for 1 year following discharge to examine the role their social relationships played during this period. The data show that 12 functions of social relationships were important and that there were two phases of social needs--convalescence and rebuilding--over the recovery period. The authors discuss the theoretical and clinical implications of these findings.