Sandra Northcott

Social support and three-year symptom and admission outcomes for first episode psychosis

This paper presents the first published findings examining the relationship of social support to three-year symptom outcome and hospitalizations for a group of first episode patients with psychotic disorders. Social support was measured using items from the provider version of the Wisconsin Quality of Life Scale as assessed at the time of initiation of treatment for 113 patients. Outcome was assessed by level of positive and negative symptoms at three-year follow-up and number of psychiatric admissions during those three years. Higher levels of social support were found to correlate with lower levels of positive symptoms and few hospitalizations at follow-up. The relationship of social support to follow-up symptoms and hospitalization was independent of other potential predictors such as gender, age, premorbid adjustment and duration of untreated illness.

Symptom and functional outcomes for a 5 year early intervention program for psychoses

There continues to be controversy concerning the long term benefits of specialized early intervention programs (SEI) for psychotic disorders. Recent reports of five year outcomes for SEI programs indicate that benefits of early intervention programs at two year follow-up have disappeared at five years. The Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario offers continuity of care for five years, with a lower intensity level of specialized intervention after the initial two years. In this paper we examine whether the outcomes observed at two years were maintained at five year follow-up. In addition, it was possible to compare PEPP outcomes with those of the OPUS project at two and five years. Results indicate that improvement of symptoms between entry into PEPP and two year follow-up were maintained at five years. In addition, there was further improvement in global functioning between two and five year follow-up. Comparison of PEPP outcomes at two and five year follow-up to those of OPUS suggest that longer term continuity of care within SEI is associated with continuing benefits at least with respect to level of positive symptoms and functioning.

Grey matter and social functioning correlates of glutamatergic metabolite loss in schizophrenia

BACKGROUND Thalamic glutamine loss and grey matter reduction suggest neurodegeneration in first-episode schizophrenia, but the duration is unknown. AIMS To observe glutamine and glutamate levels, grey matter volumes and social functioning in patients with schizophrenia followed to 80 months after diagnosis. METHOD Grey matter volumes and proton magnetic resonance spectroscopy metabolites in left anterior cingulate and left thalamus were measured in 17 patients with schizophrenia before medication and 10 and 80 months after diagnosis. Social functioning was assessed with the Life Skills Profile Rating Scale (LSPRS) at 80 months. RESULTS The sum of thalamic glutamate and glutamine levels decreased over 80 months, and correlated inversely with the LSPRS. Thalamic glutamine and grey matter loss were significantly correlated in frontal, parietal, temporal and limbic regions. CONCLUSIONS Brain metabolite loss is correlated with deteriorated social functioning and grey matter losses in schizophrenia, consistent with neurodegeneration.

Does treatment delay predict occupational functioning in first-episode psychosis?

Although duration of untreated psychosis (DUP) predicts treatment outcome as assessed by symptoms in first-episode psychosis, there is much less evidence concerning its relation to social functioning. We present the results of a prospective study of 163 first-episode psychosis patients examining occupational activity at three years, after initiation of treatment. Both shorter DUP and higher social support were significantly associated with more full time occupational activity at follow-up. The findings suggest the importance of reducing treatment delay and increasing social support in order to improve occupational outcomes for those with first-episode psychosis.

The role of treatment delay in predicting 5-year outcomes in an early intervention program

BACKGROUND Past research on the relationship between treatment delay and outcomes for first-episode psychosis has primarily focused on the role of duration of untreated psychosis (DUP) in predicting symptomatic outcomes up to 2 years. In the current study we examine the influence of both DUP and duration of untreated illness (DUI) on symptoms and functioning at 5 years follow-up while controlling for other early characteristics. METHOD A total of 132 patients with first-episode psychosis and treated in an early intervention program were prospectively followed up for 5 years. Outcomes assessed included positive and negative symptoms, overall functioning, weeks on disability pension and weeks of full-time competitive employment. RESULTS While DUP showed a significant correlation with level of positive symptoms at follow-up, this was not independent of pre-morbid social adjustment. DUI emerged as a more robust independent predictor of negative symptoms, social and occupational functioning and use of a disability pension. CONCLUSIONS Delay between onset of non-specific symptoms and treatment may be a more important influence on long-term functioning for first-episode patients than DUP. This suggests the possible value of treating such signs and symptoms as early as possible regardless of the effectiveness of such interventions in reducing likelihood or severity of psychotic symptoms.

Persistent psychoses in first episode patients.

This study was carried out to identify characteristics of patients with schizophrenia spectrum disorder who continue to have persistent psychoses (15%) for 2 years after initiation of treatment by comparing them to those who maintained full recovery of positive symptoms (42%) up to 2 years. Compared to those in recovery, significantly more patients with persistent psychoses were single, male, had a higher prevalence of drug abuse and abnormal EEG findings at presentation for treatment. Duration of untreated psychoses or untreated illness did not discriminate between the groups.

Social support and functional outcomes in an early intervention program

OBJECTIVE To examine social support at initiation of treatment of psychosis and after one year of treatment as predictors of functioning at five year follow-up. METHODS Early social support was assessed for 132 patients. Follow-up assessments included number of weeks of full-time occupation, number of weeks on a disability pension and global assessment of functioning. RESULTS One year ratings of social support better predicted occupational activity at follow-up than initial social support. Social support predicted functional outcomes independently of other early characteristics. CONCLUSIONS Findings support the importance of interventions to improve the level of support of individuals with psychotic disorders.

EEG abnormalities and 3-year outcome in first episode psychosis.

Objective:  This study assesses the relationship of EEG to several aspects of 3 year symptomatic and functional outcome in first episode psychosis.

The significance of family history in first-episode schizophrenia spectrum disorder.

There have been inconsistent findings regarding the significance of family history of schizophrenia spectrum disorders in relation to presentation and course of illness. There has been little research relevant to this issue from first-episode patients. We examined the differences in premorbid adjustment, symptoms, and intellectual functioning between 28 first-episode schizophrenia spectrum patients with a history of such illness in first degree relatives and 28 matched patients without such a family history. The results indicate that whereas the 2 groups did not differ in presenting symptoms, those with a positive family history showed poorer intellectual functioning and less reduction in symptoms at 2 and 3 year follow-up and greater likelihood of abnormal electroencephalogram findings. The findings provide evidence that presence of a positive family history in first-episode patients is associated with a more pernicious form of illness.

EEG abnormalities and two year outcome in first episode psychosis

Objective:  This study examines the relationship of EEG to 2 year symptomatic outcome, duration of illness and untreated psychosis and gender.