Early predictors for late hospitalizations up to 14 years after first episode psychosis.

PURPOSE: New hospitalizations after first episode psychosis (FEP) may be viewed as an indicator of instability in a psychotic disorder. In the current study we wanted to analyse long term risk for psychosis hospitalizations after FEP. We also wanted to analyse predictors for late hospitalizations, with focus on early antipsychotic medication. METHODS: First episode psychosis cases were recruited to the Swedish Parachute project in 1996-1997. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion. Longitudinal data from population registers on psychiatric hospitalizations up to 14 years after inclusion were analysed. One hundred and sixty-one cases were included of the original 175 in the project. Associations with possible early predictive factors from the original project data were analysed with COX regression. RESULTS: A majority of the cases (67%) had hospitalizations in the first year after inclusion in the study. The cohort then diverged into a group (46%) with new hospitalizations for psychosis after the first year, most of them multiple times, and another group (54%) without new hospitalizations for psychosis, many without any late antipsychotic medication. Forty-two percentage of the cases had antipsychotic medication by month 12, and it was significantly associated with later psychosis hospitalizations (HR = 2.5, p value < 0.001). CONCLUSIONS: The study demonstrates that a large part of FEP cases have a good outcome as measured by absence of new hospitalizations for psychosis, and that many cases may terminate antipsychotic medication within a year of FEP onset without later relapses needing hospitalizations.

Early recovery and employment outcome 13 years after first episode psychosis.

175 cases of first episode psychosis were recruited to the Parachute project in 1996-97. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion. Outcome-data for year 13 after inclusion, were retrieved from Swedish population registries on 161 of the original cases. During the first year after inclusion the cohort improved in the scores of the Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Function (GAF) to median levels that later remained rather stable. By month 12 the median GAF score was 65. 68% of the cases were in remission from psychotic symptoms as assessed with BPRS. 38% of the cases in remission and 60% not in remission had prescriptions of antipsychotic medication by month 12. By year 13 after inclusion, 42% were in employment and 55% had any dispensation of antipsychotic medication. 70% of the cases with employment had no dispensations of antipsychotic medication. In conclusion, Many first episode psychosis cases that were offered extensive psychosocial support and cautious use of antipsychotic medication had good early recovery and good late employment outcome.

Psychometric evaluation of the Danish and Swedish Satisfaction with Life Scale in first episode psychosis patients.

PURPOSE: To psychometrically evaluate the Satisfaction with Life Scale in two cohorts of first-episode psychosis patients in the Danish National Schizophrenia Project and in the Swedish Parachute Project. METHOD: Four properties of the Satisfaction with Life Scale were examined in the Danish cohort (explorative investigation) and then confirmed in the Swedish cohort: (1) the factor structure; (2) correlations between subscales; (3) internal consistencies of subscales; and (4) main tendencies (arithmetic means) and variations (standard deviations) of subscales. The relations between the Satisfaction with Life Scale and various life conditions were investigated in the Swedish cohort. RESULTS: For both samples, the analysis indicated that the obtained four-dimensional 11-item scale had satisfactory properties. Moderately high scores were obtained in the four subscales: "living," "social relationships," "self and present life" and "work." They correlated positively with each other, the internal consistencies of the subscales were acceptable and the means for the subscales indicated no apparent floor or ceiling effects. The four dimensions obtained seem relevant and presented good face validity. The dimensions were confirmed in the Swedish sample. CONCLUSION: The Satisfaction with Life Scale shows satisfactory psychometric properties and seems valid and useful among first-episode psychosis patients.

Association between financial strain, social network and five-year recovery from first episode psychosis.

Despite much effort to positively affect long-term outcome in psychosis and schizophrenia many patients are still facing a poor outcome with persistent psychotic symptoms and decline in social functioning. The aim of this study was to examine the relationship between financial strain and social network and five-year outcome of first episode psychosis (FEP). FEP patients were divided into recovered (n = 52) and non-recovered (n = 19). Each person was matched according to age and gender with four persons (n = 284) from a longitudinal population-based study. All persons had answered an extensive questionnaire including social network, quantitative and qualitative, financial strain and mental health. Linear regression analysis showed that both financial strain and social network were associated, and had a unique contribution, to outcome. The results indicate that FEP patients might benefit from interventions that reduce financial strain thus facilitating daily life and cultural and social activities.

Diagnostic stability over 3 years in a total group of first-episode psychosis patients.

First-episode psychosis (FEP) patients are often given diagnoses that later have to be changed. The aim of this study was to measure the diagnostic stability in a total group of FEP patients; 146 FEP patients were followed longitudinally and prospectively. Their revised baseline diagnoses were compared with their 3-year follow-up diagnoses. The schizophrenic spectrum disorders showed a high diagnostic stability as a group, but there was a great flow of patients between the different schizophrenic spectrum diagnoses. Also schizophrenia was a stable diagnosis. The affective psychosis group was homogenous without interaction of other psychosis groups. The other psychosis diagnoses, both regarded as a group and individually, turned out to be quite heterogeneous, with low stability values and a split course, often ending up in the schizophrenic spectrum. Fifty one per cent did not fulfil the criteria for DSM-IV axis 1 psychosis diagnosis at follow-up. In conclusion, our findings suggest that in the early phase of psychosis. Only three different diagnostic categories would be sufficient; "schizophrenic spectrum type", "affective psychosis," and for the rest "psychotic disorder NOS."

Gender differences in the prediction of 5-year outcome in first episode psychosis.

OBJECTIVE: To examine gender differences in prediction of long-term outcome in first episode psychosis (FEP). METHOD: Eighty-one male and 72 female FEP patients were compared regarding the sensitivity and specificity of the Predictive Rating Scale (PRS). The contributions of pre-admission clinical and socio-demographic characteristics to a poor 5-year outcome were analysed for males and females separately. Gender differences in the relations between predictors and outcome were examined using the equality of correlation comparing correlation coefficients. RESULTS: The sensitivity of the PRS was significantly better for males than for females. The following items: 'the highest Global Assessment of Functioning (GAF) the year before first admission < or =70' and 'GAF at first admission < or =30' explained most of the variance of a poor 5-year outcome for males, whereas for females the corresponding items were 'the highest educational level is compulsory school', 'living with parents' and 'contact with friends < or =2-3 times/month'. When the PRS was adapted assigning a weight of two to the item 'the highest educational level is compulsory school' for females, the sensitivity increased. CONCLUSION: This study revealed that the predictors for poor outcome differ between male and female patients with FEP.

Outpatient vs. comprehensive first-episode psychosis services, a 5-year follow-up of Soteria Nacka.

Three years experience of an outpatient unit for first-episode psychosis showed that most of the patients at some point became hospitalized in a psychiatric ward with discontinuity in care as a consequence. Adding "need-adapted" inpatient care in the form of a small and calm crisis home guaranteed continuity in approach and treatment, as the same caregivers staffed the inpatient and outpatient parts of Soteria. Information on early signs of psychosis was given to other units of the psychiatric clinic and to general practitioners. As the organization was considerably changed from that point of time, the patients could be divided into two separate groups. The aim of the present study was to follow the patients in the two groups for 5 years, comparing the outcome. The results showed that easily accessible need-adapted treatment with integrated overnight care might be advantageous for first-episode psychotic patients. The duration of untreated psychosis was shorter and the outcome better.

Predicting 5-year outcome in first-episode psychosis: construction of a prognostic rating scale.

OBJECTIVE: The aim of this study was to construct a rating scale to predict long-term outcome on the basis of clinical and sociodemographic characteristics in patients with symptoms of psychosis who seek psychiatric help for the first time. METHOD: Patients (N = 153) experiencing their first episode of psychosis (DSM-IV schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic episode, delusional disorder, affective psychosis with mood-incongruent delusions, or psychotic disorder not otherwise specified or being actively psychotic) were consecutively recruited from 17 psychiatric clinics in Sweden from January 1996 through December 1997 (24 months). Baseline characteristics were assessed with an extensive battery of psychiatric rating scales; duration of untreated psychosis, premorbid characteristics, and cognitive functioning were also assessed. The relationship between baseline characteristics and the 5-year outcome was analyzed using a stepwise logistic regression model. RESULTS: In the logistic regression analysis, 5 variables were found to have unique contributions in the prediction of outcome. In order of magnitude of the odds ratios, these variables were Global Assessment of Functioning (GAF) score during the year before first admission, education level, actual GAF score at first admission, gender, and social network. The sensitivity, i.e., correctly identified cases (poor outcome), was 0.84, and the specificity, i.e., the correctly identified non-cases (good outcome), was 0.77. CONCLUSION: To initiate adequate interventions, it is crucial to identify patients experiencing their first episode of psychosis who are likely to have an unfavorable long-term outcome. The predictive rating scale described here is a feasible tool for early detection of these patients.

Psychosocial correlates with depressive symptoms six years after a first episode of psychosis as compared with findings from a general population sample.

BACKGROUND: Depression is frequently occurring during and after psychosis. The aim of this study was to analyze if the psychosocial characteristics associated with depression/depressive symptoms in the late phase of a first episode psychosis (FEP) population were different compared to persons from the general population. METHODS: A questionnaire was sent out to all individuals six years after their FEP and to a general population sample. Depressive symptoms were recorded using a self-rating scale, the Major Depression Inventory. RESULTS: Formerly FEP persons had a higher representation of depressive symptoms/depression, unemployment, financial problems and insufficient social network. Depressive symptoms/depression were found to be associated with psychosocial problems. An age and gender effect was found in the general population, but not in the FEP sample. When the psychosocial characteristics were taken into account there were no association between having had FEP and depressive symptoms. CONCLUSIONS: The association between having been a FEP patient and depressive symptoms/depression disappeared when negative social aspects were taken into account.