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First-episode Psychosis (first-episode + psychosis)
Selected AbstractsFirst-episode psychosis: A literature reviewINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2008Simone I. Reed ABSTRACT:, This paper reports on a literature review of the impacts of first-episode psychosis on both the patient and their family and carers. The discussion focuses on the effects on the patient experiencing psychotic symptoms for the first time, including disruption to their environment, social connectedness, and future plans. Patients experiencing these symptoms can experience fear, distress, and isolation. Many of these patients are also at greater risk to themselves and others. The family and carers witnessing this psychosis may experience fear, guilt, and often carry the emotional and physical burden of care. Early intervention and treatment are crucial to potentially achieving better clinical outcomes, and to alleviating the psychological impact on patients and their families. The nurse's role in the treatment of the patient experiencing first-episode psychosis is to facilitate early intervention through recognition of symptoms and ongoing assessment, work to reduce a patient's risks, manage treatments, and work with the patient to reduce the risk of relapse. [source] Involuntary movements and their correlates in first-episode psychosesACTA NEUROPSYCHIATRICA, Issue 5 2010Pallav Pareek No abstract is available for this article. [source] Early identification of non-remission in first-episode psychosis in a two-year outcome studyACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010E. Simonsen Simonsen E, Friis S, Opjordsmoen S, Mortensen EL, Haahr U, Melle I, Joa I, Johannessen JO, Larsen TK, Røssberg JI, Rund BR, Vaglum P, McGlashan TH. Early identification of non-remission in first-episode psychosis in a two-year outcome study. Objective:, To identify predictors of non-remission in first-episode, non-affective psychosis. Method:, During 4 years, we recruited 301 patients consecutively. Information about first remission at 3 months was available for 299 and at 2 years for 293 cases. Symptomatic and social outcomes were assessed at 3 months, 1 and 2 years. Results:, One hundred and twenty-nine patients (43%) remained psychotic at 3 months and 48 patients (16.4%) remained psychotic over 2 years. When we compared premorbid and baseline data for the three groups, the non-remitted (n = 48), remitted for <6 months (n = 38) and for more than 6 months (n = 207), duration of untreated psychosis (DUP) was the only variable that significantly differentiated the groups (median DUP: 25.5, 14.4 and 6.0 weeks, respectively). Three months univariate predictors of non-remission were being single, longer DUP, core schizophrenia, and less excitative and more negative symptoms at baseline. Two-year predictors were younger age, being single and male, deteriorating premorbid social functioning, longer DUP and core schizophrenia. In multivariate analyses DUP, negative and excitative symptoms predicted non-remission at 3 months, but only DUP predicted at 2 years. Conclusion:, Long DUP predicted both 3 month and 2-year non-remission rates in first-episode psychosis. [source] A 2-year follow-up of involuntary admission's influence upon adherence and outcome in first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010S. Opjordsmoen Opjordsmoen S, Friis S, Melle I, Haahr U, Johannessen JO, Larsen TK, Røssberg JI, Rund BR, Simonsen E, Vaglum P, McGlashan TH. A 2-year follow-up of involuntary admission's influence upon adherence and outcome in first-episode psychosis. Objective:, To see, if voluntary admission for treatment in first-episode psychosis results in better adherence to treatment and more favourable outcome than involuntary admission. Method:, We compared consecutively first-admitted, hospitalised patients from a voluntary (n = 91) with an involuntary (n = 126) group as to psychopathology and functioning using Positive and Negative Syndrome Scale and Global Assessment of Functioning Scales at baseline, after 3 months and at 2 year follow-up. Moreover, duration of supportive psychotherapy, medication and number of hospitalisations during the 2 years were measured. Results:, More women than men were admitted involuntarily. Voluntary patients had less psychopathology and better functioning than involuntary patients at baseline. No significant difference as to duration of psychotherapy and medication between groups was found. No significant difference was found as to psychopathology and functioning between voluntarily and involuntarily admitted patients at follow-up. Conclusion:, Legal admission status per se did not seem to influence treatment adherence and outcome. [source] Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) groupACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010A. Bechdolf Bechdolf A, Thompson A, Nelson B, Cotton S, Simmons MB, Amminger GP, Leicester S, Francey SM, McNab C, Krstev H, Sidis A, McGorry PD, Yung AR. Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group. Objective:, We aimed to replicate a recent finding of high prevalence of trauma history in patients at ,ultra-high risk' (UHR) of psychotic disorder and to investigate whether trauma predicts conversion to psychosis in this population. Method:, A consecutive sample of UHR patients was assessed. History of trauma was accessed with the General Trauma Questionnaire. Cox regression models were used to explore relationship between conversion to psychosis and trauma. Results:, Of 92 UHR patients nearly 70% had experienced a traumatic event and 21.7% developed psychosis during follow-up (mean 615 days). Patients who had experienced a sexual trauma (36%) were significantly more likely to convert to first-episode psychosis (OR 2.96) after controlling for meeting multiple UHR intake groups. Conclusion:, UHR patients have a high prevalence of history of trauma. Previous sexual trauma may be a predictor of onset of psychotic disorder in this population. [source] Incidence and diagnostic diversity in first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010R. Reay Reay R, Mitford E, McCabe K, Paxton R, Turkington D. Incidence and diagnostic diversity in first-episode psychosis. Objective:, To investigate the incidence and range of diagnostic groups in patients with first-episode psychosis (FEP) in a defined geographical area. Method:, An observational database was set up on all patients aged 16 years and over presenting with FEP living in a county in Northern England between 1998 and 2005. Results:, The incidence of all FEP was 30.95/100 000. The largest diagnostic groups were psychotic depression (19%) and acute and transient psychotic disorder (19%). Fifty-four per cent of patients were aged 36 years and over. Patients with schizophrenia spectrum disorder only accounted for 55% of cases. Conclusion:, This clinical database revealed marked diversity in age and diagnostic groups in FEP with implications for services and guidelines. These common presentations of psychoses are grossly under researched, and no treatment guidelines currently exist for them. [source] A multi-site Canadian perspective: examining the functional outcome from first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009N. M. Menezes 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. [source] Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection programACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009I. Joa Objective:, Psychotic disorders often start in adolescence. We aim to investigate premorbid and baseline differences characterizing patients with an onset of psychosis in adolescence versus adulthood. Method:, We compare first-episode, DSM-IV non-affective psychosis with onset before (n = 43) and after (n = 189) 18 years on duration of untreated psychosis (DUP), level of symptoms, suicidal behaviour, and other baseline clinical and demographic characteristics. Results:, Adolescent onset patients had poorer premorbid functioning, a longer DUP, higher suicidality, and more depressive symptoms. They also had better cognition, fewer psychotic symptoms, and were more likely to be treated on an out-patient basis. Conclusion:, Adolescents with first-episode psychosis may have a slower and more silent, i.e. insidious onset, and are at risk of experiencing longer treatment delays than adults. They fit the description of what used to be labeled process (versus reactive) schizophrenia. [source] Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sampleACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009C. Morgan Objective: We sought to investigate the prevalence and social correlates of psychotic-like experiences in a general population sample of Black and White British subjects. Method: Data were collected from randomly selected community control subjects, recruited as part of the ÆSOP study, a three-centre population based study of first-episode psychosis. Results: The proportion of subjects reporting one or more psychotic-like experience was 19% (n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic-like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. Conclusion: The higher prevalence of psychotic-like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course. [source] Clinical and serotonergic predictors of non-affective acute remitting psychosis in patients with a first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2009B. Arranz Objective:, The study aimed to establish clinical predictors of non-affective acute remitting psychosis (NARP) and assess whether these patients showed a distinct serotonergic profile. Method:, First-episode never treated psychotic patients diagnosed of paranoid schizophrenia (n = 35; 21 men and 14 women) or NARP (n = 28; 15 men and 13 women) were included. Results:, NARP patients showed significantly lower negative symptomatology, better premorbid adjustment, shorter duration of untreated psychosis, more depressive symptomatology and a lower number of 5-HT2A receptors than the paranoid schizophrenia patients. In the logistic regression, the four variables associated with the presence of NARP were: low number of 5-HT2A receptors; good premorbid adjustment; low score in the item ,hallucinatory behaviour' and reduced duration of untreated psychosis. Conclusion:, Our findings support the view that NARP is a highly distinctive condition different from either affective psychosis or other non-affective psychosis such as schizophrenia, and highlight the need for its validation. [source] Prevalence and correlates of comorbidity 8 years after a first psychotic episodeACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2007S. Farrelly Objective:, While rates and correlates of comorbidity have been investigated in the early course of psychosis, little is known about comorbidity in the medium-to-longer term or its relationship with outcome. Method:, A total of 182 first-episode psychosis (FEP) patients who met DSM-IV criteria for a current psychotic disorder 8 years after index presentation were grouped according to concurrent comorbidity [no concurrent axis I disorder; concurrent substance use disorder (SUD); other concurrent axis I disorder; concurrent SUD and other axis I disorder]. Outcomes were compared between groups controlling for relevant covariates. Results:, As much as 39% met criteria for one or more concurrent axis 1 diagnoses. Comorbidity was associated with greater severity of general psychopathology, but not with measures of functioning, treatment or negative symptoms. Conclusion:, Specific combinations of comorbid disorders may influence patterns of psychotic symptomatology. Routine examination of axis I disorders is warranted in the ongoing management of psychosis. [source] Reducing the duration of untreated first-episode psychosis , effects on baseline social functioning and quality of lifeACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2005I. Melle Objective:, Long duration of untreated psychosis (DUP) is associated with poorer outcome. The TIPS study demonstrated that DUP can be reduced through early detection (ED). As quality of life (QoL) is associated with DUP it is expected that reduction of DUP leads to better QoL. Method:, Consecutive first-episode patients with a DSM-IV diagnosis of non-organic, non-affective psychosis were included, 281 patients gave informed consent and 263 completed a full evaluation of QoL. Results:, There were no differences in subjective QoL between ED and No-ED groups attributable to reduction in DUP. There were significant bivariate differences in frequency of family and social contacts in favor of the ED group, but multivariate analyses indicated that these differences were based on differences in sample characteristics. Conclusion:, Deterioration in QoL may precede overt symptom formation. Focus on functional loss in ED educational campaigns may identify risk subjects earlier in the course of the disorder. [source] Assessing prolonged recovery in first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 2002L. Wong The Early Psychosis Prevention and Intervention Centre (EPPIC) is a comprehensive, specialized treatment service for individuals residing in the western metropolitan region of Melbourne who are experiencing their first psychotic episode. A subprogramme of EPPIC, the Treatment Resistance Early Assessment Team (TREAT), has been developing a framework for the management of individuals experiencing ,prolonged recovery' in early psychosis. TREAT is a consultation team that provides technical assistance to clinicians within EPPIC, comprising senior clinicians with expertise in the biopsychosocial treatment of early psychosis and persisting positive and negative symptoms. A system has recently been set up within the TREAT framework to routinely assess clinical and functional outcomes of these clients using standardized instruments. Case managers are trained to conduct assessments at multiple timepoints over the duration of their clients' treatment at EPPIC. A summary will be presented on the current sample (n=15) and examples of clinician and client feedback reports will be illustrated. Discussion is also provided on the development of training, procedures and materials to enhance integration of clinician and client outcome measures into routine clinical practice. [source] Effectiveness and tolerability of risperidone in Asian patients with first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 2002S. Verma Objectives, To evaluate the effectiveness and tolerability of risperidone in Asian patients with first-episode psychosis and to examine correlates of response in a naturalistic study. Method, Patients with first-episode psychosis were evaluated at baseline and weekly for 6 weeks with the Positive and Negative Scale for Schizophrenia (PANSS), Simpson,Angus Rating Scale (SARS), Barnes Akathisia Rating Scale (BARS), Rating Scale for Side-effects (RSSE), and the Abnormal Involuntary Movement Scale (AIMS). Results, 42 patients with a mean age of 24.85 ± 9.68 years and mean duration of untreated illness of 11.91 ± 22.04 months were recruited. The mean dose of risperidone was 1.82 ± 0.77 mg. The mean reduction in PANSS score was from 67.97 ± 20.02 at baseline to 42.53 ± 14.08 at week 6 (P < 0.005). The incidence of extrapyramidal symptoms was 9.5% and akathisia was 7.1%. 45.2% of patients showed more than or equal 40% reduction in the PANSS score (responders). When responders were compared to nonresponders, the responders had a significantly higher total and positive PANSS score at baseline. Conclusion, Risperidone is an effective and safe antipsychotic in first-episode psychosis. [source] Stigma and treatment delay in first-episode psychosis: a grounded theory studyEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2010Lauren Franz Abstract Aim: A longer duration of untreated psychosis (DUP) is associated with greater morbidity in the early course of schizophrenia. This formative, hypothesis-generating study explored the effects of stigma, as perceived by family members, on DUP. Methods: Qualitative interviews were conducted with 12 African American family members directly involved in treatment initiation for a relative with first-episode psychosis. Data analysis relied on a grounded theory approach. A testable model informed by constructs of Link's modified labelling theory was developed. Results: Four main themes were identified, including: (i) society's beliefs about mental illnesses; (ii) families' beliefs about mental illnesses; (iii) fear of the label of a mental illness; and (iv) a raised threshold for the initiation of treatment. A grounded theory model was developed as a schematic representation of the themes and subthemes uncovered in the family members' narratives. Conclusions: The findings suggest that due to fear of the official label of a mental illness, certain coping mechanisms may be adopted by families, which may result in a raised threshold for treatment initiation, and ultimately treatment delay. If the relationships within the grounded theory model are confirmed by further qualitative and quantitative research, public educational programs could be developed with the aim of reducing this threshold, ultimately decreasing DUP. [source] Early intervention with second-generation antipsychotics in first-episode psychosis: results of an 8-week naturalistic studyEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2010Richard C. Josiassen Abstract Objective: The objective was to compare short-term effectiveness of aripiprazole with three other second-generation antipsychotics (SGAs) in the treatment of first-episode psychosis. Method: In a naturalistic, ,single-blind' design, 60 subjects experiencing their first psychotic episode were treated for 8 weeks with aripiprazole (n = 19), risperidone (n = 16), olanzapine (n = 14) or quetiapine (n = 11). Medication and dosing decisions were made by treating psychiatrists, constrained to once-a-day dosing, low initial doses and no clozapine. Weekly ratings were obtained using the Positive and Negative Syndrome Scale (PANSS), Simpson-Angus Rating Scale and Barnes Akathasia Rating Scale. Weight and vital signs were also collected weekly. Results: The group presented with severe psychotic symptoms (mean baseline PANSS total score of 105.2), which were reduced rapidly (P < 0.0005). The between-group and group by time interaction terms were non-significant. Similar reductions were seen across all PANSS sub-scales. At Week 1 the mean PANSS Activation Scale score was reduced more with olanzapine than in the other groups (P < 0.002). Few instances of extrapyramidal symptoms occurred; all were sporadic and did not require treatment. Group body weight increased by 7.3% over the study. Vital signs remained unchanged. Conclusions: Early intervention with low doses of four SGAs led to rapid symptom reduction in first-episode psychotic patients with severe psychopathology. Although no clear medication advantages were observed in the short term, longer duration studies with larger samples will be required for determining efficacy, rates of compliance, relapse prevention and diminished incidence of extrapyramidal signs and symptoms. [source] Improving detection of first-episode psychosis by mental health-care services using a self-report questionnaireEARLY INTERVENTION IN PSYCHIATRY, Issue 4 2009Nynke Boonstra Abstract Objective: To examine the utility of the Community Assessment of Psychic Experiences (CAPE)-42, a self-report questionnaire, to improve detection of first-episode psychosis in new referrals to mental health services. Method: At first contact with mental health-care services patients were asked to complete the CAPE-42 and were then routinely diagnosed by a clinician. Standard diagnoses were obtained by means of the mini-Schedule for Clinical Assessment in Neuropsychiatry. Results: Of the 246 included patients, 26 (10.6%) were diagnosed with psychosis according to the mini-Schedule for Clinical Assessment in Neuropsychiatry. Only 10 of them were recognized by clinical routine, and 16 psychotic patients were not properly identified. Using an optimal cut-off of 50 on the frequency or distress dimension of the positive subscale of the CAPE-42 detected 14 of these misdiagnosed patients. The sensitivity of the CAPE-42 at this cut-off point was 77.5 and the specificity 70.5. Conclusion: Systematic screening of patients using a self-report questionnaire for psychotic symptoms improves routine detection of psychotic patients when they first come into contact with mental health services. [source] Stability of medication in early psychosis: a comparison between second-generation and low-dose first-generation antipsychoticsEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2009Stein Opjordsmoen Abstract Aim: This naturalistic study aims to compare discontinuation rates for low-dose first-generation versus second-generation antipsychotics in first-episode psychotic patients. Methods: The prescription of antipsychotic medication in 301 consecutively admitted patients with first-episode psychosis from four catchment areas is described. For the first year of inclusion a first-generation antipsychotic in low dose was recommended as the first medication. From the second year a second-generation antipsychotic was recommended as first choice. Switching was allowed when any drug was judged to be ineffective or to have serious side-effects. Switching during the first 2 years after inclusion is described. Results: Switching from a low-dose first-generation antipsychotic was more frequent than from a second-generation antipsychotic (90.7 vs. 58.4%). Lack of therapeutic effect and side-effects were the more frequently recorded reasons for changing in the first-generation group. Akathisia, parkinsonism, dyskinesias, dystonia and dysphoria were more often reported in patients on first-generation drugs. Weight gain and sedation were more often reported in patients on second-generation drugs. Conclusion: The findings suggest a better adherence to and tolerability for second-generation antipsychotics than for low-dose first-generation antipsychotics in first-episode psychosis. [source] The First-Episode Psychosis Outcome Study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patientsEARLY INTERVENTION IN PSYCHIATRY, Issue 2 2007Philippe Conus Abstract Aims:, Studies conducted in first-episode psychosis (FEP) samples avoid many biases. However, very few studies are based on epidemiological cohorts treated in specialized FEP services. The aim of this file audit study was to examine premorbid and baseline characteristics of a large epidemiological sample of FEP. Methods:, File audit study of all patients admitted to the Early Psychosis Prevention and Intervention Centre between 1998 and 2000 using a specialized questionnaire. Results:, There were 661 patient files included in the study. Premorbid evaluation revealed high rates of substance use disorder (74.1%), history of psychiatric disorder (47.5%), past traumatic events (82.7%) suicide attempts (14.3%) and family history of psychiatric illness (55.6%). Baseline characteristics revealed high intensity of illness (mean CGI 5.5), high prevalence of lack of insight (62%) and high rate of comorbidity (70%). Conclusion:, High rates of traumatic events or episodes of mental illness before treatment for FEP must be considered when designing treatment approaches because a too narrow focus on positive psychotic symptoms will inevitably lead to incomplete treatment. Additionally, early intervention programmes need sufficient range of resources to address the multiple challenges presented by FEP patients such as high severity of illness, comorbidities and functional impairment. Finally, observation of an important degree of functional impairment despite short duration of untreated psychosis suggests that while early detection of FEP is a necessary step in early intervention, it may not be sufficient to improve functional recovery in psychosis and that efforts aimed at identifying people during the prodromal phase of psychotic disorders should be pursued. [source] Superior temporal lobe dysfunction and frontotemporal dysconnectivity in subjects at risk of psychosis and in first-episode psychosisHUMAN BRAIN MAPPING, Issue 12 2009Nicolas A. Crossley Abstract Background: Superior temporal lobe dysfunction is a robust finding in functional neuroimaging studies of schizophrenia and is thought to be related to a disruption of fronto-temporal functional connectivity. However, the stage of the disorder at which these functional alterations occur is unclear. We addressed this issue by using functional MRI (fMRI) to study subjects in the prodromal and first episode phases of schizophrenia. Methods: Subjects with an at risk mental state (ARMS) for psychosis, a first psychotic episode (FEP), and controls were studied using fMRI while performing a working memory task. Activation in the superior temporal gyrus (STG) was assessed using statistical parametric mapping, and its relationship to frontal activation was examined using dynamic causal modeling. Results: The STG was differentially engaged across the three groups. There was deactivation of this region during the task in controls, whereas subjects with FEP showed activation and the response in subjects with ARMS was intermediately relative to the two other groups. There were corresponding differences in the effective connectivity between the STG and the middle frontal gyrus across the three groups, with a negative coupling between these areas in controls, a positive coupling in the FEP group, and an intermediate value in the ARMS group. Conclusions: A failure to deactivate the superior temporal lobe during tasks that engage prefrontal cortex is evident at the onset of schizophrenia and may reflect a disruption of fronto-temporal connectivity. Qualitatively similar alterations are evident in people with prodromal symptoms of the disorder. Hum Brain Mapp, 2009. © 2009 Wiley-Liss, Inc. [source] Efficacy of amisulpride in treating primary negative symptoms in first-episode psychosis: a pilot studyHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2006Brendan P. Murphy Abstract Objective Negative symptoms are debilitating and associated with poor role functioning and reduced quality of life. There is a paucity of research on antipsychotic efficacy against the primary negative symptoms, particularly in first-episode psychosis (FEP). We undertook a prospective, open-label pilot trial to investigate the use of amisulpride in the treatment of young people with FEP characterised by primary negative symptoms. Method Twelve male and two female first-episode patients with primary negative symptoms (aged 16,26) were commenced on low-dose amisulpride (mean 250,mg/day) and followed-up over a 6-month period. Primary outcome measures were the Scale for the Assessment of Negative Symptoms (SANS), the Quality of Life Survey (QLS) and their respective subscales. Results For the 12 completers there was a statistically significant improvement in SANS summary score (p,=,0.036), Affective Flattening subscale global score (p,=,0.046), QLS total score (p,=,0.021), QLS subscales of Instrumental Role (p,=,0.018) and Intra-psychic Foundations (p,=,0.009) from baseline to week 24. Conclusions Amisulpride appears to be associated with less severe negative symptoms and improved quality of life. Generalisabilty of the findings is limited by the small sample size and open-label design of our study, however the positive findings suggest that further controlled trials are warranted. Copyright © 2006 John Wiley & Sons, Ltd. [source] First-episode psychosis: A literature reviewINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2008Simone I. Reed ABSTRACT:, This paper reports on a literature review of the impacts of first-episode psychosis on both the patient and their family and carers. The discussion focuses on the effects on the patient experiencing psychotic symptoms for the first time, including disruption to their environment, social connectedness, and future plans. Patients experiencing these symptoms can experience fear, distress, and isolation. Many of these patients are also at greater risk to themselves and others. The family and carers witnessing this psychosis may experience fear, guilt, and often carry the emotional and physical burden of care. Early intervention and treatment are crucial to potentially achieving better clinical outcomes, and to alleviating the psychological impact on patients and their families. The nurse's role in the treatment of the patient experiencing first-episode psychosis is to facilitate early intervention through recognition of symptoms and ongoing assessment, work to reduce a patient's risks, manage treatments, and work with the patient to reduce the risk of relapse. [source] Personality disorders in first-episode psychosis,PERSONALITY AND MENTAL HEALTH, Issue 4 2008Erik Simonsen The aim of the study was to determine the prevalence of personality disorders in the early course of first-episode psychosis and their likely presence in the premorbid period. Fifty-five patients were enrolled at baseline and premorbid function was evaluated by the Premorbid Adjustment Scale. Thirty-three of these of the patients were assessed at two-year follow-up for comorbid personality disorders by the Structured Clinical Interview for DSM-IV Personality Disorders and by the self-report instrument Millon Clinical Multiaxial Inventory-II. Half of the patients met the criteria of two or more personality disorders, while one-third of the patients did not fulfil the criteria for any personality disorder. The schizoid and the avoidant were the most frequent personality disorders and both were associated with social withdrawal during childhood and adolescence. The limitation of the study is the small sample, the retrospective assessment and a 40% attrition rate. The strengths are that it is a clinical epidemiological sample of first-episode psychotic patients and that different but complimentary measures of the personality disorders were used. Copyright © 2008 John Wiley & Sons, Ltd. [source] | |||||||||||||