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Prolonged recovery in first-episode psychosis

Published online by Cambridge University Press:  06 August 2018

Jane Edwards ,
Dana Maude ,
Patrick D. McGorry ,
Susan M. Harrigan  and
John T. Cocks
Jane Edwards*
Affiliation:
Centre for Young People's Mental Health, University of Melbourne, Parkville, Australia
Dana Maude
Affiliation:
Centre for Young People's Mental Health, University of Melbourne, Parkville, Australia
Patrick D. McGorry
Affiliation:
Centre for Young People's Mental Health, University of Melbourne, Parkville, Australia
Susan M. Harrigan
Affiliation:
Centre for Young People's Mental Health, University of Melbourne, Parkville, Australia
John T. Cocks
Affiliation:
Centre for Young People's Mental Health, University of Melbourne, Parkville, Australia
*
Correspondence: J. Edwards, Assistant Director (Clinical), EPPIC, Centre for Young People's Mental Health, University of Melbourne, 35 Poplar Road, Parkville, Australia, 3052
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Abstract

Background Early identification and specialised treatment of individuals with enduring positive symptoms may assist in alleviating symptoms and has the potential to change the course of illness.

Method Prevalence and descriptive data on enduring positive symptoms in two first-episode samples are outlined. Attempts to incorporate the focus of early intervention for persisting psychosis into routine clinical care of individuals with first-episode psychosis are described.

Results Of the 227 individuals with first-episode psychosis who were assessed using the Brief Psychiatric Rating Scale at 3/6 months and 12 months following initial stabilisation (from a total sample of 347), 6.6% experienced enduring positive symptoms at all three time points. When the analysis was restricted to schizophrenia, schizophreniform and schizoaffective disorders (n=158) the percentage increased to 8.9%. These patients had significantly longer mean duration of untreated psychosis prior to initiation of treatment and, at 12-month follow-up, significantly higher depression and poorer psychosocial functioning.

Conclusions The association of untreated psychosis with treatment resistance supports the argument for early intervention as soon as possible following the onset of psychotic symptoms.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 172 , Issue S33: Verging on reality , June 1998 , pp. 107 - 116
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

Albiston, D. J., Francey, S. M. & Harrigan, S. M. (1998) Group programme for recovery from early psychosis. British Journal of Psychiatry, 172 (suppl. 33), 117–121.Google Scholar
Andreasen, N. C. (1982) Negative symptoms of schizophrenia. Archives of General Psychiatry 39, 782–789.CrossRefGoogle Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R), Washington, DC: APA.Google Scholar
Beck, A. T., Ward, D. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Bentall, R. P., Haddock, G. & Slade, P. D. (1994) Cognitive behaviour therapy for persistent auditory hallucinations: from theory to therapy. Behavior Therapy 25, 51–66.CrossRefGoogle Scholar
Cannon-Spoor, H. E., Potkin, S. G. & Wyatt, R. J. (1982) Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia bulletin, 8, 470–484.Google Scholar
Carpenter, W.T., Heinrichs, D.W. & Wagman, A. M. I. (1988) Deficit and nondeficit forms of schizophrenia: the concept. American Journal of Psychiatry, 145, 578–583.Google Scholar
Chadwick, P. D. J. & Lowe, C. F. (1990) Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology, 58, 225–232.Google Scholar
Curtis, J., Roy, R. & Beevor, A. (1995) Health of the Nation Outcome Scales (HoNOS). In Measurement for Mental Health: Contributions for the College Research Unit (ed Wing, J. K.). London: Royal College of Psychiatrists.Google Scholar
Drury, V., Birchwood, M., Cochrane, R., et al (1996) Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. British Journal of Psychiatry, 169, 593–601.Google Scholar
Early Psychosis Prevention and Intervention Centre (1997a) Working with Families in Early Psychosis. Melbourne: Department of Human Services.Google Scholar
Early Psychosis Prevention and Intervention Centre (1997b) Psychoeducation in Early Psychosis. Melbourne: Department of Human Services (Victoria).Google Scholar
Edwards, J., Francey, S. M., McGorry, P. D., et al (1994) Early psychosis prevention and intervention: evolution of a comprehensive community-based specialised service. Behaviour Change, II, 223–233.Google Scholar
Edwards, J., McGorry, P. D., Waddell, F., et al (1997) Enduring negative or deficit symptoms in first-episode psychosis: comparison of 3 methods using follow-up data. Schizophrenia Research, 24, 14.CrossRefGoogle Scholar
Edwards, J., Cocks, J. & Bott, J. (1998) Preventive case management in first episode psychosis. In Recognition and Management of Early Psychosis: A Preventive Approach (eds D McGorry, P. & Jackson, H. J.). New York: Cambridge University Press.Google Scholar
Edwards, J. & McGorry, P. D. (1998) Early intervention in psychotic disorders: a critical step in the prevention of psychological morbidity. In Handbook of Cognitive–Behavioural Therapy with Severely III patients (eds Perris, C. & McGorry, P. D.). Chichester: Wiley.Google Scholar
Garety, P. A., Kuipers, L., Fowler, D., et al (1994) Cognitive behavioural therapy for drug resistant psychosis. British Journal of Medical Psychology 67, 259–271.Google Scholar
Haddock, G., Morrison, A. P., Hopkins, R., et al (1998) Individual cognitive–behavioural interventions in early psychosis. British Journal of Psychiatry, 172 (suppl. 33), 101–106.Google Scholar
Haddock, G., Sellwood, W., Tarrier, N., et al (1994) Developments in cognitive–behaviour therapy for persistent psychotic symptoms. Behaviour Change, II, 200–212.Google Scholar
Heinrichs, D.W., Hanlon, T. E. & Carpenter, W.T. Jr (1984) The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10, 388–398.CrossRefGoogle ScholarPubMed
Hogarty, G. E., Kornblith, S. J., Greenwald, D., et al (1995) Personal therapy: a disorder relevant psychotherapy for schizophrenia. Schizophrenia Bulletin, 21, 379–393.CrossRefGoogle ScholarPubMed
Jackson, H. J., McGorry, P. D., Edwards, J., et al (1996) Cognitively orientated psychotherapy for early psychosis (COPE). In Early Intervention and Prevention in Mental Health (eds Cotton, P. & Jackson, H.J.). Melbourne: Academic Press.Google Scholar
Jackson, H. J., McGorry, P. D., Edwards, J., et al (1998) Cognitively-orientated psychotherapy for early psychosis (COPE). British Journal of Psychiatry, 172 (suppl. 33), 93–100.Google Scholar
Kane, J. M. (1989). The current status of neuroleptics. Journal of Clinical Psychiatry, 50, 322–328.Google Scholar
Kane, J. M. & Marder, S. P. (1993) Psychopharmacologic treatment of schizophrenia. Schizophrenia Bulletin, 19, 287–302.Google Scholar
Kerwin, R. W. (1996) An essay on the use of new antipsychotics. Psychiatric Bulletin, 20, 23–29.Google Scholar
Kingdon, D. G. & Turkington, D. (1994) Cognitive–Behavioural Therapy of Schizophrenia. New York: Guilford Press.Google Scholar
Larsen, T. K., McGlashan, T. H. & Moe, L. C. (1996) First-episode schizophrenia: I. Early course parameters. Schizophrenia Bulletin, 22, 241–256.Google Scholar
Lieberman, J., Jody, D., Geisler, S., et al (1993) Time course and biological correlates of treatment response in first-episode schizophrenia. Archives of General Psychiatry 50, 369–376.Google Scholar
Lieberman, J., Koreen, A. R., Chakos, M., et al (1996) Factors influencing treatment response and outcome of first-episode schizophrenia. Journal of Clinical Psychiatry, 57, 5–9.Google Scholar
Loebel, A. D., Lieberman, J. A., Alvir, J. M. J., et al (1992) Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry, 149, 1183–1188.Google Scholar
Mayerhoff, D. I., Loebel, A. D., Jose, M. J., et al (1994) The deficit state in first-episode schizophrenia. American Journal of Psychiatry, 151, 1417–1422.Google Scholar
Meltzer, H.Y. (1995) Clozapine: is another view valid? American Journal of Psychiatry, 152, 821–823.Google ScholarPubMed
McGlashan, T. H. (1988) A selective review of recent North American long-term follow up studies of schizophrenia. Schizophrenia Bulletin, 14, 512–542.Google Scholar
McGlashan, T. H. (ed.) (1996) Early detection and intervention in schizophrenia. Schizophrenia Bulletin, 22, 197–352.Google Scholar
McGorry, P. D., Goodwin, R. J. & Stuart, G. W. (1988) The development, use and reliability of the Brief Psychiatric Rating Scale (nursing modification): an assessment procedure for the nursing team in clinical and research settings. Comprehensive Psychiatry, 29, 575–587.Google Scholar
McGorry, P. D., Copolov, D. L. & Singh, B. S. (1990a) The Royal Park Multidiagnostic Instrument for Psychosis: Part I. Rationale and review. Schizophrenia Bulletin, 16, 501–515.Google Scholar
McGorry, P. D., Singh, B. S., Copolov, D. L., et al (1990b) The Royal Park Multidiagnostic Instrument for Psychosis: Part II. Development, reliability, and validity. Schizophrenia bulletin, 16, 517–536.CrossRefGoogle Scholar
McGorry, P. D., Edwards, J., Mihalopoulos, C., et al (1996) Early Psychosis Prevention and Intervention Centre: An evolving system for early detection and intervention. Schizophrenia Bulletin, 22, 305–326.Google Scholar
Mueser, K.T., Douglas, M. S., Bellack, A. S., et al (1991) Assessment of enduring deficit and negative symptom subtypes in schizophrenia. Schizophrenia Bulletin, 17, 565–581.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.Google Scholar
Peralta, V. & Cuesta, M. J. (1994) Subjective experiences in schizophrenia: a critical review. Comprehensive Psychiatry, 35, 198–204.Google Scholar
Power, P., Elkins, K., Adlard, S., et al (1998) Analysis of the initial treatment phase in first-episode psychosis. British Journal of Psychiatry, 172 (suppl. 33), 71–76.Google Scholar
Roberts, G. (1991) Delusional belief systems and meaning in life: a preferred reality? British Journal of Psychiatry, 159 (suppl. 14), 19–28.Google Scholar
Szymanski, S. R., Cannon, T. D., Gallacher, F., et al (1996) Course of treatment response in first-episode and chronic schizophrenia. American Journal of Psychiatry, 153, 519–525.Google ScholarPubMed
Tohen, M., Stoll, A. L., Strakowski, S. M., et al (1992) The McLean First-Episode Psychosis Project: Six month recovery and recurrence outcome. Schizophrenia Bulletin, 18, 273–282.Google Scholar
Wyatt, R. J. (1991) Neuroleptics and the natural course of schizophrenia. Schizophrenia Bulletin, 17, 325–351.Google Scholar
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