Outcome In First-episode Psychosis Research Articles

Reducing the duration of untreated psychosis: roles of mental health teams

Better outcomes in first-episode psychosis (FEP) have been associated with lesser duration of untreated psychosis (DUP), making reduction of DUP a key target of early intervention in psychosis (EIP) services. Here, the authors examine the case records within an EIP to find out which psychiatric service had started the antipsychotic if a patient was being prescribed one, and discuss the contribution of teams other than EIP in reducing DUP.

Substance abuse in first episode psychosis: Baseline characteristics and clinical outcome

IntroductionThere are high rates of substance use disorders (SUD) amongst first episode psychosis (FEP). SUD have been linked to better premorbid adjustment, more severe positive and negative symptoms at presentation and poorer symptomatic and functional outcome [1]. Moreover, shorter duration of untreated psychosis (DUP) has been described as an important predictor of outcome in FEP [2].AimsWith this study, we want to know which baseline characteristics and clinical outcomes differ between FEP patients with and without substance use.MethodsOne hundred and seventy-five FEP were consecutively admitted to Hospital del Mar since January 2008 to September 2014 and entered the FEP programme of the institution. The included evaluation was socio-demographic and clinical data at baseline and 1 year follow-up. We studied differences in age, gender, DUP, GAF scores at baseline and 1 year follow-up and PANSS subscale scores at base and 1 year follow-up between substance users and non-users.ResultsCannabis: we found that users were significative younger (P < 0.01), had a higher proportion of males (P < 0.01) and a significative shorter DUP in users (P = 0.008).Alcohol: we found that users were significative younger (P < 0.009), had a higher proportion of males (P < 0.003) and a significative lower PANNS negative scores at baseline (P = 0.01) and 1 year follow-up (P = 0.03).ConclusionsIn our sample of first episode psychosis, cannabis and alcohol use is linked with a younger age and a high proportion of males. Moreover, it seems that cannabis use could be associated with a shorter DUP.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Childhood adversities: Social support, premorbid functioning and social outcome in first-episode psychosis and a matched case-control group.

The establishment of childhood adversities as risk factors for non-affective psychosis has derived a need to consider alternative interpretations of several psychosis-related factors. This paper sought to examine premorbid adjustment trajectories and social outcome factors in relation to childhood adversities. Perceived support has been found to decrease the risk of post-traumatic stress disorder, and we wished to compare perceived support in people with first-episode psychosis to non-clinical control persons and explore its relation to childhood adversities. Every individual presenting with a non-affective first-episode psychosis (F20-29, except F21) in Region Zealand over a 2-year period was approached for participation and the 101 consenting participants were matched to 101 people with no psychiatric disorders. Comprehensive demographic data were collected. Assessment instruments included the Premorbid Assessment Scale, the Global Assessment of Functioning scale and the Childhood Trauma Questionnaire. The latter represented the childhood adversities in addition to parental separation and institutionalization. There were no associations between number of childhood adversities and different social or academic premorbid trajectories. Those with more adversities had lower global functioning the year prior to treatment start and reported lower rates of perceived support during childhood along with less current face-to-face contact with family members. Lack of peer support remained a significant predictor of psychosis when adversities were adjusted for; peer support diminished the risk of psychosis caused by childhood adversities by 10%. Childhood adversities may not predict specific premorbid trajectories, but have an effect on global functioning when the psychosis has begun. Perceived support, especially from peers, may be important in the development of psychosis, and those with more adversities may represent a vulnerable subgroup who need more assistance to increase and maintain supportive networks.

Association between rostral prefrontal cortical activity and functional outcome in first-episode psychosis: a longitudinal functional near-infrared spectroscopy study

BackgroundFew biomarkers can be used easily and noninvasively to measure clinical condition and future outcome in patients with first-episode psychosis (FEP). To develop such biomarker using multichannel functional near-infrared spectroscopy (fNIRS), cortical function in the prefrontal cortex was longitudinally measured during a verbal fluency task. MethodsSixty-nine fNIRS measurements and 77 clinical assessments were obtained from 31 patients with FEP at baseline, 6-month, and 12-month follow-ups. Sixty measurements were obtained from 30 healthy controls matched for age, sex, and premorbid IQ. We initially tested signal changes for 12months, and then investigated the relationship between fNIRS signals and clinical assessments. ResultsSignal changes from baseline to 12-month follow-up were not evident in any group. Patients with FEP had significant positive correlation coefficients between 6-month fNIRS signals and the 12-month Global Assessment of Functioning (GAF) score in the left middle frontal gyrus (FDR-corrected p=.0016–.0052, r=.65–.59). fNIRS signals at the 12-month follow-up were associated with 12-month GAF score in the bilateral superior and middle frontal gyri (FDR-corrected p=.00085–.018, r=.72–.55), and with the difference between baseline and 12-month GAF scores in the right superior frontal gyrus (FDR-corrected p=.000067–.00012, r=.80–.78). These associations were significant even after controlling for demographic variables. No association between baseline fNIRS signals and later GAF scores was found. DiscussionfNIRS measurement can potentially be used as a biomarker to aid sequential assessment of neuro-clinical conditions through the early stage of psychosis.

Associations between the schizophrenia susceptibility gene ZNF804A and clinical outcomes in psychosis.

We sought to test the hypothesis that the rs1344706 A allele will be associated with worse clinical outcome in first-episode psychosis. A data linkage was set up between a large systematic study of first-episode psychosis and an electronic health-record case register at the South London and Maudsley NHS Foundation Trust—a large provider of secondary mental-health care. A sample of 291 patients, who presented with a first psychotic episode (ICD10 diagnoses F20–29 or F30–33) and in whom the rs1344706 genotype had been assayed, were followed to examine the duration of mental-health in-patient care during the 2 years following first service contact, as a primary outcome. Secondary outcome measures were whether or not an in-patient episode occurred and the number of in-patient episodes during this period. A strong association was found between the number of rs1344706 A alleles and the cumulative duration of mental-health in-patient stay over the 2 years since initial presentation. In the 84.2% who experienced an in-patient episode during this period, the mean duration of admission was an additional 38 days for each A allele increment. Therefore, in addition to its potential role as a risk factor for psychosis, the ZNF804A rs1344706 A allele is associated with worse clinical outcome.

Exposure to Political Violence in Northern Ireland and Outcome of First Episode Psychosis.

The impact of political violence on individuals presenting with an episode of first episode psychosis has not been examined. Individuals were assessed for exposure to political violence in Northern Ireland (the "Troubles") by asking for a response to 2 questions: one asked about the impact of violence "on your area"; the second about the impact of violence "on you or your family's life." The participants were separated into 2 groups (highandlowimpact) for each question. Symptom profiles and rates of substance misuse were compared across the groups at baseline and at 3-year follow up. Of the 178 individuals included in the study 66 (37.1%) reported ahighimpact of the "Troubles" on their life and 81 (45.5%) ahighimpact of the "Troubles" on their area. There were no significant differences in symptom profile or rates of substance misuse betweenhighandlowgroups at presentation. At 3-year follow-uphighimpact of the "Troubles" on life was associated with higher Positive and Negative Symptom Scale (PANSS) Total (P= .01), PANSS-Positive (P< .05), and PANSS-General (P< .01) scores and lower global assessment of functioning disability (P< .05) scores, after adjusting for confounding factors. Impact of the "Troubles" on area was not associated with differences in symptom outcomes. This finding adds to the evidence that outcomes in psychosis are significantly impacted by environmental factors and suggests that greater attention should be paid to therapeutic strategies designed to address the impact of trauma.

Family Intervention in First-Episode Psychosis

Family interventions have produced benefits on clinical and family outcomes in long standing psychosis. However, little is known about the efficacy of such interventions in the early stages of psychosis. This article reviews published research over the last two decades on family intervention in first-episode psychosis. Electronic databases, such as PubMed, PsycINFO, and ScienceDirect, have been systematically searched. In addition, an exhaustive Internet search was also carried out using Google and Google Scholar to identify the potential studies that evaluated family interventions in first-episode psychosis. We have identified seven reports of five randomized controlled trials (RCTs) and five non-randomized and uncontrolled studies of family intervention. Our review on 12 reports of family intervention studies has shown mixed effects on outcomes in first-episode psychosis. Most of the reports showed no added benefits or very short-term benefits on primary clinical or family outcome variables. There is a dearth of family intervention studies in first-episode psychosis. More RCTs are needed to reach reliable conclusions.

The relationship between cognition, job complexity, and employment duration in first-episode psychosis.

To investigate the relationship between cognition and employment duration in first-episode psychosis (FEP), and establish if a "fit" between cognition and job complexity is associated with longer employment duration. This study involved secondary data analysis of a subsample of FEP individuals (n = 65) who participated in a randomized controlled trial comparing Individual Placement and Support plus treatment as usual (TAU), versus TAU alone, over 6 months. A cognitive battery was administered at baseline and employment duration (hours) and job complexity in the longest held job over 6 months were measured. Factor analysis with promax rotation of the cognitive battery revealed 4 cognitive domains: (a) attention and processing speed; (b) verbal learning and memory; (c) verbal comprehension and fluency; and (d) visual organization and memory (VO&M). The final hierarchical regression model found that VO&M and job complexity independently predicted employment duration in longest held job; however, the "fit" (or interaction) between VO&M and job complexity was not significant. These findings suggest that VO&M and job complexity are important predictors of employment duration, but it is not necessary to ensure VO&M ability matches job complexity. However, there are limited comparative studies in this area, and other aspects of the person-organization fit perspective may still be useful to optimize vocational outcomes in FEP.

Exploring cognitive heterogeneity in first-episode psychosis: What cluster analysis can reveal

Variable outcomes in first-episode psychosis (FEP) are partly attributable to heterogeneity in cognitive functioning. To aid identification of those likely to have poorer or better outcomes, we examined whether purported cognitive profiles identified through use of cluster analysis in chronic schizophrenia were evident in FEP. We also aimed to assess whether there was a relationship between cognitive profile and factors independent of the solution, providing external validation that the cognitive profiles represented distinct subgroups. Ward's method hierarchical cluster analysis, verified by a k-means cluster solution, was performed using data obtained from a cognitive test battery administered to 128 participants aged 15–25 years. Four cognitive profiles were identified. A continuity element was evident; participants in cluster four were more cognitively impaired compared to participants in cluster three, who appeared more cognitively intact. Clusters one and two were distinguishable across measures of attention and working memory and visual recognition memory, most likely reflecting sample specific patterns of deficit. Participants in cluster four had significantly lower premorbid and current IQ and higher negative symptoms compared to participants in cluster three. The distinct levels and patterns of cognition found in chronic schizophrenia cohorts are also evident across diagnostic categories in FEP.

Work life after psychosis: A detailed examination.

Conducting research on the work outcomes of first episode psychosis (FEP) samples may extend our understanding of the factors associated with the work outcome of people with schizophrenia and other psychotic illnesses. To conduct a detailed study of the work outcome of an FEP sample. Members of a FEP cohort, who had completed a 12-year clinical outcome assessment, were invited to participate in an adjunctive work outcome study. Engagement in paid and non-paid work was first established and the relationship with potentially influential baseline characteristics investigated. Subsequently the influence of work outcome to participants' level of quality of life, mental health, recovery, and social inclusion were examined. Among the 38 participants the mean percentage of time spent in work was 62% of which 50% was in paid work and 12% was in non-paid work. Being employed at inception was the only independent predictor of the duration of the follow-up period spent in work. Relationships between work outcome and all measures of wellbeing were found. The paid and non-paid work attained by people affected by a psychotic illness played an important role in the extent of their wellbeing, recovery, and social inclusion.

MK-801 and amphetamine result in dissociable profiles of cognitive impairment in a rodent paired associates learning task with relevance for schizophrenia.

Paired associates learning (PAL) has been suggested to be predictive of functional outcomes in first episode psychosis and of conversion from mild cognitive impairment to Alzheimer's disease. An automated touch screen-based rodent PAL (rPAL) task has been developed and is sensitive to manipulations of the dopaminergic and glutamatergic system. Accordingly, rPAL when used with pharmacological models of schizophrenia, like NMDA receptor blockade with MK-801 or dopaminergic stimulation with amphetamine, may have utility as a translational model of cognitive impairment in schizophrenia. The purpose of this study was to determine if amphetamine- and MK-801-induced impairment represent distinct models of cognitive impairment by testing their sensitivity to common antipsychotics and determine the relative contributions of D1 versus D2 receptors on performance of PAL. Rats were trained in rPAL and were then treated with MK-801, amphetamine, risperidone, haloperidol, quinpirole, SK-82958, or SCH-23390 alone and in combination. While both amphetamine and MK-801 caused clear impairments in accuracy, MK-801 induced a profound "perseverative" type behavior that was more pronounced when compared to amphetamine. Moreover, amphetamine-induced impairments, but not the effects of MK-801, could be reversed by antipsychotics as well as the D1 receptor antagonist SCH-23390, suggesting a role for both the D1 and D2 receptor in the amphetamine impairment model. These data suggest that amphetamine and MK-801 represent dissociable models of impairment in PAL, dependent on different underlying neurobiology. The ability to distinguish dopaminergic versus glutamatergic effects on performance in rPAL makes it a unique and useful tool in the modeling of cognitive impairments in schizophrenia.

Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis.

BackgroundAlthough depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use.Methods64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome.ResultsSubclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001) and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009).ConclusionsSubclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.

P.3.d.024 Antipsychotic treatment and outcome in first-episode psychosis: a 2-year longitudinal, multicenter, pragmatic study

The presence of solid bitumen strongly affects hydrocarbon storage and expulsion from a source rock as it might either cause blockage of pore throats leading to lower effective gas permeability, or contribute to hydrocarbon storage and provide migration pathways when a continuous network of hydrocarbon-wet organic matter (OM) pores is formed. Furthermore, organic matter transformation reactions are suggested to influence mineral diagenesis as well. In an attempt to characterize different solid bitumen types and transformation stages over a broad maturity interval (0.5–2.7%Ro) and for varying primary kerogen compositions, we reviewed optical and scanning electron microscopy (SEM) data of 35 solid bitumen-rich shale samples with a Cambrian to Triassic age. We were able to identify in-situ pre-oil solid bitumen, as well as remobilized post-oil solid bitumen at various maturity stages from the early oil window onwards. Solid bitumen is the main host for SEM-visible organic matter porosity; onset of porosity development in solid bitumen differs considerably between predominantly oil-prone (e.g., alginites, amorphous OM from algal and bacterial precursors) and gas-prone (vitrinite-rich) kerogen compositions. Furthermore, solid bitumen (pyrobitumen) in rocks with a terrestrially dominated OM composition seems to be considerably less mobile within the source rock compared to pre- and post-oil solid bitumen in oil-prone rocks, and less reactive in terms of porosity generation. In most samples, several solid bitumen populations with varying fluorescence properties and bitumen reflectance were observed, complicating the use of these petrographic maturity indicators. The apparently different solid bitumen populations often form continuous networks at the SEM-scale. Microstructural features such as irregularly distributed sponge-like porosity or detrital and authigenic mineral inclusions in the sub-micrometer scale were found to have a great influence on texture and reflectance under reflected light microscopy. The formation of authigenic minerals (quartz, various carbonate phases with different Ca/Mg/Fe proportions, magnetite in Cambrian samples) was observed frequently in post-oil solid bitumen of oil-prone rocks, indicating a close genetic relationship between transformation products formed during hydrocarbon generation (e.g., acetate, carbon dioxide and methane) and the dissolution and precipitation of minerals during diagenesis. In some cases, stylolite-like features in the sub-micrometer scale were found, showing that processes well-known from reservoir characterization at core-scale also play a role at the micrometer-scale. Furthermore, the observed strong interaction between organic matter transformation and mineral authigenesis indicates a substantial aqueous component even in pores filled apparently exclusively with solid bitumen.

Predictors of schizophrenia spectrum disorders in early-onset first episodes of psychosis: a support vector machine model.

Identifying early-onset schizophrenia spectrum disorders (SSD) at a very early stage remains challenging. To assess the diagnostic predictive value of multiple types of data at the emergence of early-onset first-episode psychosis (FEP), various support vector machine (SVM) classifiers were developed. The data were from a 2-year, prospective, longitudinal study of 81 patients (age 9-17 years) with early-onset FEP and a stable diagnosis during follow-up and 42 age- and sex-matched healthy controls (HC). The input was different combinations of baseline clinical, neuropsychological, magnetic resonance imaging brain volumetric and biochemical data, and the output was the diagnosis at follow-up (SSD vs. non-SSD, SSD vs. HC, and non-SSD vs. HC). Enhanced recursive feature elimination was performed for the SSD vs. non-SSD classifier to select and rank the input variables with the highest predictive value for a diagnostic outcome of SSD. After validation with a test set and considering all baseline variables together, the SSD vs. non-SSD, SSD vs. HC and non-SSD vs. HC classifiers achieved an accuracy of 0.81, 0.99 and 0.99, respectively. Regarding the SSD vs. non-SSD classifier, a combination of baseline clinical variables (severity of negative, disorganized symptoms and hallucinations or poor insight) and neuropsychological variables (impaired attention, motor coordination, and global cognition) showed the highest predictive value for a diagnostic outcome of SSD. Neuroimaging and biochemical variables at baseline did not add to the predictive value. Thus, comprehensive clinical/cognitive assessment remains the most reliable approach for differential diagnosis during early-onset FEP. SVMs may constitute promising multivariate tools in the search for predictors of diagnostic outcome in FEP.

Electroencephalographic abnormalities and 5-year outcome in first-episode psychosis.

To examine the relation of electroencephalographic abnormalities to 5-year outcomes in first-episode psychosis (FEP). Patients (n = 103) had their baseline electroencephalogram (EEG) classified by modified Mayo Clinic criteria. Symptoms and psychosocial functioning were rated after 5 years of treatment. Dysrhythmic EEG was associated with persistence in positive and negative symptoms of psychoses and poorer psychosocial functioning at 5-year follow-up, independently of other characteristics, such as duration of untreated illness or premorbid adjustment. A higher percentage of people with comorbid substance use disorder had normal EEG. Abnormal baseline EEG in FEP is associated with poorer 5-year symptomatic and functional outcome.

Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis

Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis

Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis—Reply

Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis—Reply

Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis

Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis

Duration of Untreated Psychosis and Associated Factors in First Episode Psychosis in Mzuzu in Northern Malawi

Objective: Early intervention is said to improve outcome in first episode psychosis, yet studies in developed countries have persistently found that many individuals with first episode psychosis delay significantly, before they access mental health services. Whether these findings apply to Malawi is not known. This study, therefore, aims to assess the average Duration of Untreated Psychosis (DUP), defined as the interval from first psychotic symptoms to first effective treatment, and assess factors that are associated with DUP in Mzuzu, Malawi. Methodology: The study was conducted in a catchment area with a population of 1,022,417. A total of 140 patients were recruited and assessed using Structured Clinical Interview for DSM-IV-TR (SCID), schedule for the assessment of positive and negative symptoms, Beiser Scale, and Global Assessment of Functioning (GAF) Scale. The data were analysed using Statistical Package for Social Sciences (SPSS). DUP was assessed using Beiser Scale, and in-depth interview from carers. Pearson Chi-square was used to analyse factors associated with DUP. Results: The mean DUP was 51.70 months. Low level of education, unemployment, diagnosis of schizophrenia, low GAF and negative symptoms were associated with a longer DUP. Most patients were assisted by family members in accessing services, and traditional healers were most commonly the first resource used. Those who first consulted traditional healers had a longer DUP than those who first consulted a health care service. Conclusion: The findings indicate that individuals with schizophrenia in Mzuzu have long Dup this could be due to difficulties in accessing health services and that several factors are associated with this delay.

What needs to follow early intervention? Predictors of relapse and functional recovery following first‐episode psychosis

As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis (FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning. An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service (EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning. Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive 'Not in Education Employment or Training' status at end-point include being in a minority ethnic group, substance misuse and number of relapses. Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery.