Psychological morbidity is the main predictor of quality of life among caregivers of individuals in first-episode psychosis: data from a year-long longitudinal study in Brazil.

OBJECTIVE: To investigate quality of life (QoL) and QoL predictors among caregivers of individuals in first-episode psychosis (FEP). METHODS: This longitudinal study investigated predictors of QoL in caregivers of 80 individuals in FEP over a 1-year follow-up period, measured using a single component extracted from the 36-item Short-Form Health Survey (SF-36). RESULTS: Mediation analysis demonstrated that, at 1 year, high scores in the Self-Report Questionnaire (SRQ-20) were associated with high scores on the negative sub-scale of the Experience of Caregiving Inventory (ECI), which was also associated with low scores in the Essential Quality of Life (Essential QoL) component extracted from the SEF-36. Clinically, the resulting association indicates that depression and anxiety symptoms in caregivers at baseline are predictors of their 1-year quality of life, based on self-assessment of the caregiving experience. CONCLUSION: Supporting an individual in FEP can have a negative impact on QoL. Maintaining caregivers' mental health and subjective evaluation of the caregiving experience must be primary goals of FEP services. Complementary studies of FEP caregivers' QoL can support the design of personalized interventions in the near future.

Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder.

OBJECTIVES: To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms. METHODS: Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ). RESULTS: Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8 ± 68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6 ± 23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia. CONCLUSIONS: This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.

Depressive episodes in stable schizophrenia: critical evaluation of the DSM-IV and ICD-10 diagnostic criteria.

Depressive episodes are a common and potentially severe occurrence in schizophrenia but are poorly recognised by psychiatrists. Coherent diagnostic criteria are necessary to improve diagnosis and treatment of these conditions. To evaluate the usefulness of the ICD-10 category of post-schizophrenic depression (PSD) and the DSM-IV category of postpsychotic depressive disorder of schizophrenia (PDDS), 80 clinically stable schizophrenic outpatients were evaluated with two independent measures of depression, a dimensional measure and a categorical measure. One rater applied the DSM-IV criteria for major depressive episodes (MDE), and the other applied the Calgary Depression Scale for Schizophrenia, the Positive and Negative Syndrome Scale, and the Extrapyramidal Symptoms Rating Scale. Thirteen patients (16.3%) met criteria for MDE. All of them met the DSM-IV PDDS research criteria, but only two patients matched the ICD-10 PSD criteria, which require that the episode occurred in the 12 months after the last psychotic episode. There was no significant difference in the incidence of depressive episodes within 12 months after an acute psychotic episode and outside this time period. The data suggest that depressive episodes in schizophrenia are not restricted to the first year following the psychotic episode. Useful criteria for depressive episodes in schizophrenia should avoid a temporal relation with the psychotic episode.

Psychological morbidity is the main predictor of quality of life among caregivers of individuals in first-episode psychosis: data from a year-long longitudinal study in Brazil

Objective: To investigate quality of life (QoL) and QoL predictors among caregivers of individuals in first-episode psychosis (FEP). Methods: This longitudinal study investigated predictors of QoL in caregivers of 80 individuals in FEP over a 1-year follow-up period, measured using a single component extracted from the 36-item Short-Form Health Survey (SF-36). Results: Mediation analysis demonstrated that, at 1 year, high scores in the Self-Report Questionnaire (SRQ-20) were associated with high scores on the negative sub-scale of the Experience of Caregiving Inventory (ECI), which was also associated with low scores in the Essential Quality of Life (Essential QoL) component extracted from the SEF-36. Clinically, the resulting association indicates that depression and anxiety symptoms in caregivers at baseline are predictors of their 1-year quality of life, based on self-assessment of the caregiving experience. Conclusion: Supporting an individual in FEP can have a negative impact on QoL. Maintaining caregivers' mental health and subjective evaluation of the caregiving experience must be primary goals of FEP services. Complementary studies of FEP caregivers' QoL can support the design of personalized interventions in the near future.

Experience of recovery from a first-episode psychosis.

AIM: To understand the subjective factors involved in the recovery process following a first-episode psychosis. METHOD: Sixteen individuals from a First Episode Program in São Paulo, Brazil were evaluated by a semistructured interview designed to elicit an in-depth narrative of participants' subjective experience of recovery after a first-episode psychosis. Eligibility was established by using the Structured Clinical Interview for DSM-IV Axis I Disorders. The interviews were recorded, the transcripts were coded and themes were grouped together to form conceptual categories. RESULTS: The participants described the recovery course as a slow and gradual process. Improvement was perceived as based on a decrease or absence of psychotic symptoms, changes in social relationships, renewed autonomy and independence, and restoration of self-reliance and trust in others. CONCLUSIONS: Recovering after a first-episode psychosis can be considered a complex process correlated with treatment, social support, and individual experiences and characteristics. These are important areas to be addressed in first psychotic psychosis interventions, and gains can probably only be obtained in specialized first-episode psychosis programmes.

Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder

Objectives: To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms. Methods: Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ). Results: Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8±68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6±23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia. Conclusions: This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients

Foi realizado estudo de corte transversal para estudar fatores associados às expectativas familiares com familiares ambulatoriais esquizofrênicos pela Classificaçäo Internacional de Doenças, 9ª ediçäo e que tivessem mais de 4 anos de duraçäo da doença foram incluídos no estudo. A expectativa familiar foi medida pela diferença dos escores da Escala de Ajustamento Katz (R2 e R3), que säo baseados nas expectativas dos familiares e no nível atual de desempenho das atividades socialmente esperadas (Escore de Discrepância). O ajustamento social foi medido através da Escala de Avaliaçäo Global (GAS) do DSM-III-R. As avaliaçöes dos desfechos clínicos foram realizadas independentemente, e a amostra foi constituída por 44 pacientes (25 homens e 19 mulheres). A média do Escore de Discrepância foi duas vezes maior para os homens do que para as mulheres (p<0,02), e houve uma associaçäo inversa entre o escore de discrepância, quando idade atual e idade de início da doença, e número de admissöes psiquiátricas foram controladas através de uma técnica de análise de regressäo múltipla. Houve interaçäo entre sexo e ajustamento social, uma relaçäo inversa entre ajustamento social e escore de discrepância mais pronunciada nos homens. Estes achados säo discutidos diante das associaçöes potenciais entre atmosfera familiar, gênero e ajustamento social dos pacientes esquizofrênicos e a necessidade de haver mais pesquisas nesta área, p. ex., descriçöes etnográficas das interaçöes entre pacientes e familiares no ambiente doméstico, particularmente, nos países menos desenvolvidos