Deirdre Jackson

Depression and quality of life in first-episode psychosis

AIM Quality 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. METHODS We 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. RESULTS There 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. CONCLUSIONS These 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.

Suicidality prior to presentation in first-episode psychosis

Introduction: Suicide and attempted suicide contribute significantly to the increased mortality and morbidity associated with psychotic illness. The period of highest risk is reportedly in the early years of illness. While the literature concentrates on completed suicide in chronic psychosis, less is understood about attempted suicide in first‐episode psychosis (FEP).

Caregiver psychoeducation for first-episode psychosis

INTRODUCTION International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes. METHODS Caregivers of people with first-episode psychosis completed a 23-item adapted version of the self-report Family Questionnaire (KQ) and a 17-item adapted version of the self-report Drug Attitudes Inventory (DAI) before and after the six-week DETECT Information and Support Course (DISC). Using a Generalised Linear Repeated Measures Model, we analyzed the differences in proportions of correct answers before and after the programme. RESULTS Over a 24-month study period, 31 caregivers (13 higher socioeconomic; 13 lower socioeconomic; five unspecified socioeconomic; 19 female; 12 male) participated in the DISC programme and completed inventories before and after the course. Knowledge of psychosis and specific knowledge of medication treatment improved among caregivers overall (p<.01; effect sizes 0.78 and 0.94 respectively). There were no significant gender or socioeconomic differences in any improvement. DISCUSSION This study confirms that caregiver psychoeducation specifically for first-episode psychosis directly improves knowledge of the illness overall and, in particular, knowledge of medication. Gender is not a factor in this, while the lack of any socioeconomic differences dispels the myth that patients in lower socioeconomic groups are disadvantaged because their caregivers know less.

Early intervention service for psychosis: views from primary care.

Aim: Although General Practitioners (GPs) have a pivotal role in early detection and treatment of psychosis, there is sparse information on their views of early intervention (EI) services and how information related to EI should be delivered.

Are symptoms associated with increased levels of perceived stress in first-episode psychosis?

Several studies report on the presence of external stress and life events prior to the onset and exacerbation of psychotic illness. However, the relationship between the subjective appraisal of stress at first presentation with psychosis is less well understood. This paper reports on the relationship between the individual perception of stress and symptomatology in individuals with first-episode psychosis at presentation to community mental health services. We assessed 123 individuals using standardized measures of symptoms, quality of life, perceived stress, global functioning, and duration of untreated psychosis. At first presentation, people with more depressive symptoms and reduced overall functioning were more likely to report increased levels of perceived stress. In addition, people with less positive symptoms of psychosis were experiencing higher levels of subjective stress. In terms of stress vulnerability models, it is important to consider how functioning and symptoms can influence individual appraisal of stress. Acknowledging this interaction can provide opportunities for nursing interventions directed at enhancing adaptive coping and provide benchmarks for assessing the effectiveness of nursing interventions provided in the acute phase of psychosis. Further research should focus on the interaction between symptoms and individually-appraised stress over time.

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.

First rank symptoms in first episode psychosis and their relationship to the duration of untreated illness.

Most studies of First Rank Symptoms (FRS) are based on cross-sectional inpatient samples of people with schizophrenia at various stages of illness. We sought to examine the prevalence of FRS in a representative sample of first episode psychosis patients and compare those with and without FRS clinically and in terms of duration of untreated illness. Information was gathered from 158 consecutive cases of first episode psychosis presenting in a defined geographical region through semi-structured interview tools. Of this sample, 40.5% of cases received a diagnosis of schizophrenia. The prevalence of FRS among the entire group was 52.5%. After controlling for multiple testing, no FRS contributed significantly to predicting a diagnosis of schizophrenia. There was no significant relationship between the duration of untreated illness and FRS.