Epidemiological factors associated with treated incidence of first-episode non-affective psychosis in Cantabria: insights from the Clinical Programme on Early Phases of Psychosis

Aim: The aim of the study was to analyse the treated incidence of schizophrenia in Cantabria (Northern Spain) and the sociodemographic risk factors associated with the illness onset. Methods: Data were obtained from patients included in the Cantabria's Clinical Programme on First‐Episode Psychosis (schizophrenia spectrum DSM‐IV diagnosis) from 2001 to 2005, from the Cantabria first‐episode schizophrenia study (carried out between 1988 and 1989) and from the 2001 Spanish census. Results: Annual incidence was 1.38 per 10 000 inhabitants in the risk‐ageperiod. Identified risk factors were male gender (relative risk (RR): 1.61), age 15–25 years (RR: 3.48), unemployment (RR: 2.82), single status (RR: 5.88), low educational level (RR: 4.38), urban environment (RR: 1.62) and cannabis consumption (odds ratio: 12.83). The incidence in females was significantly lower than the one obtained 15 years ago. Conclusions: The reported factors suggest that underlying biological and social factors modulate the risk of psychosis. This balance operates differently in males and females.     

Duration of untreated psychosis and outcome in first-episode psychosis. Perspective from a developing country

OBJECTIVE: To investigate the association between duration of untreated psychosis (DUP) and treatment outcome in a sample of subjects from a developing country. METHOD: Forty-eight subjects with a first episode of psychosis were evaluated prior to treatment and at 3-month intervals over a period of 24 months. We first examined correlations between DUP and symptom improvement as measured on the Positive and Negative Symptom Scale (PANSS), and then performed multivariate analysis to determine the validity of DUP as a predictor of outcome. RESULTS: DUP was significantly correlated with improvement in PANSS total and negative subscale scores as well as the PANSS depression factor at 21 and 24 months. Multivariate analysis found DUP to be the only significant predictor of improvement in negative symptoms at 24 months. CONCLUSION: DUP was a significant predictor of outcome in a cohort form a developing country. This study provides support for early detection and intervention strategies.     

A multi‐site Canadian perspective: examining the functional outcome from first‐episode psychosis

Objective: To examine factors contributing to variance in functional outcome in first‐episode psychosis (FEP) following 1 year of treatment. Method: Naturalistic 1‐year follow‐up of a FEP cohort (n = 200), from programs in four university centers in Ontario, Canada. Functional recovery was defined by ‘Social and Occupational Functioning Assessment Scale’ (SOFAS) score>60. Regression analysis examined the contribution of independent variables to variance in functional outcome. Results: Twelve‐month outcome measures were available for 76.5% of the original cohort. Of these, 70% reported being in school/work and in satisfactory relationships. The functional recovery rate was 51%, compared to 74% attaining symptomatic remission. The greatest contributors to variance in outcome were ongoing symptoms at 6 months and substance abuse comorbidity. Conclusion: After 1 year of treatment, FEP patients show high rates of symptomatic remission and relatively lower rates of functional recovery. Symptoms and substance abuse contribute to variance in outcome.     

Initial medical work-up of first-episode psychosis: a conceptual review

Aim: To help clinicians carry out a comprehensive, medical diagnostic assessment in first‐episode patients who are suspected of developing schizophrenia. Methods: Conceptual review of the published work with emphasis on the diagnostic goals of excluding medical causes of psychosis and establishing a medical baseline. Results: There is no agreed‐upon standard for the initial medical work‐up of first‐episode cases. Excluding secondary causes of schizophrenia requires consideration of likelihood of disease; laboratory test performance; and relevance of positive test results. Conclusions: We propose a medical work‐up for first‐episode psychosis that combines: (i) broad screening; (ii) exclusion of specific diseases informed by treatability and epidemiology; and (iii) medical baseline measures.     

Early detection and intervention in first-episode schizophrenia: a critical review

OBJECTIVE: To review the literature on early intervention in psychosis and to evaluate relevant studies. Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention). RESULTS: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow-up data showing a positive effect on prognosis have been presented. CONCLUSION: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic.     

Neuropsychological functions predict 1- and 3-year outcome in first-episode psychosis

OBJECTIVE: To examine neuropsychological performance as a possible predictor of course and outcome in first-episode psychotic (FEP) patients. METHOD: A group of consecutive FEP patients (n = 120) tested with Wechsler Adult Intelligence Scales-Revised (WAIS-R) at baseline was compared with a healthy group (n = 30) matched for age, education and gender. Relationship between WAIS-R and both Brief Psychiatric Rating Scale and Global Assessment of Function (GAF) ratings were studied at baseline and at 1- and 3-year follow-ups. RESULTS: The performance of FEP patients was significantly lower (P < 0.001) than that of healthy comparison subjects on all WAIS-R subtests except for Information and Comprehension. The WAIS-R scores of patients with schizophrenia syndromes (DSM-IV) were lower than those of patients with non-schizophrenia syndromes on Block Design. Low WAIS-R Full-Scale IQ scores in FEP patients predicted the presence of negative symptoms at 1-year follow-up and of low GAF ratings at 3-year follow-up. CONCLUSION: Neurocognitive performance at admission appears to predict various aspects of functional outcome in FEP.