Skip to main content

Advertisement

Log in

Predictors of Symptom Severity and Functioning in First Episode Psychosis

  • Original Article
  • Published:
Journal of Psychosocial Rehabilitation and Mental Health Aims and scope Submit manuscript

Abstract

There is dearth of studies on the role of critical socio-demographic and clinical variables on psychopathology and functional outcome in persons with first episode psychosis (FEP), especially from lower and middle income countries. Therefore, we studied the predictors of psychiatric symptom severity and socio-occupational dysfunction among persons with non-affective FEP in India. Using multiple linear regression models, we examined the role of gender, previous admission, psychiatric co-morbidity, duration of psychosis, and duration of untreated psychosis (DUP) on psychiatric symptom severity and socio-occupational dysfunction among 71 persons with non-affective FEP. The participants were recruited from a tertiary mental health center in South India. The Brief psychiatric Rating Scale (BPRS) and Social Occupational Functioning Scale (SOFS) were used measure symptom severity and socio-occupational dysfunction respectively. Gender (male), presence of co-morbid psychiatric illness, higher duration of psychosis, and longer DUP significantly increased psychiatric symptoms and socio-occupational dysfunction. The independent variables predicted 40% variance on psychiatric symptoms and 37% variance on socio-occupational dysfunction. Both regression models were significant at p < 0.001 level. The study is helpful to understand the common predictors of symptoms and functioning in FEP. However, future studies need to examine the role of other critical mediating variables on psychopathology and functions to evolve a comprehensive pathway model.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Addington J, van Mastrigt S, Addington D. Patterns of premorbid functioning in first-episode psychosis: initial presentation. Schizophr Res. 2003;62(1):23–30.

    Article  PubMed  Google Scholar 

  2. Gómez-de-Regil L, Kwapil TR, Blanqué JM, Vainer E, Montoro M, Barrantes-Vidal N. Predictors of outcome in the early course of first-episode psychosis. Eur J Psychiatry. 2010;24(2):87–97.

    Article  Google Scholar 

  3. Remschmidt H, Theisen F. Early-Onset Schizophrenia1. Neuropsychobiology. 2012;66(1):63–9.

    Article  PubMed  Google Scholar 

  4. Malla A, Payne J. First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull. 2005;31(3):650–71.

    Article  PubMed  Google Scholar 

  5. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry. 2005;62(9):975–83.

    Article  PubMed  Google Scholar 

  6. Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. NPJ Schizophr. 2015;1:14005.

  7. Haas G, Garratt L, Sweeney J. Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. J Psychiatr Res. 1998;32(3–4):151–9.

    Article  PubMed  Google Scholar 

  8. Shrivastava A, Shah N, Johnston M, Stitt L, Thakar M, Chinnasamy G. Effects of duration of untreated psychosis on long-term outcome of people hospitalized with first episode schizophrenia. Indian J Psychiatry. 2010;52(2):164–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Iyer SN, Mangala R, Thara R, Malla AK. Preliminary findings from a study of first-episode psychosis in Montreal, Canada and Chennai, India: comparison of outcomes. Schizophr Res. 2010;121(1–3):227–33.

    Article  PubMed  Google Scholar 

  10. Sadath A, Muralidhar D, Varambally S, Gangadhar B, Jose JP. Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis. Asian J Psychiatr. 2017;25:163–8.

    Article  PubMed  Google Scholar 

  11. Sadath A, Muralidhar D, Varambally S, Jose JP, Gangadhar BN. Caregiving and help seeking in first episode psychosis: a qualitative study. J Psychosoc Rehabil Ment Health. 2014;1(2):47–53.

    Article  Google Scholar 

  12. Saravanan B, Jacob K, Johnson S, Prince M, Bhugra D, David AS. Outcome of first-episode schizophrenia in India: longitudinal study of effect of insight and psychopathology. Br J Psychiatry. 2010;196(6):454–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Iyer SN, Loohuis H, Pawliuk N, Joober R, Malla AK. Concerns reported by family members of individuals with first-episode psychosis. Early Interv Psychiatry. 2011;5(2):163–7.

    Article  PubMed  Google Scholar 

  14. Chand P, Thirthalli J, Murthy P. Substance use disorders among treatment naïve first-episode psychosis patients. Compr Psychiatry. 2014;55(1):165–9.

    Article  PubMed  Google Scholar 

  15. Jilani AQ, Saha R, Dalal PK, Kallivayalil RA, Tiwari A, Kar SK. The impact of awareness of psychotic disorder on pathways to psychiatric care for first episode psychosis in India. Int J Cult Ment Health. 2017:1–16.

  16. Bambole V, Shah N, Sonavane S, Johnston M, Shrivastava A. Study of negatives symptoms in first episode schizophrenia. Open J Psychiatry. 2013;3(03):323.

    Article  Google Scholar 

  17. Sadath A, Muralidhar D, Varambally S, Gangadhar BN. Does group intervention have benefits on expressed emotion and social support in carers of persons with first episode psychosis? Soc Work Ment Health. 2017;15(5):524–37.

    Article  Google Scholar 

  18. Sadath A, Muralidhar D, Varambally S, Justin J, Gangadhar BN. Effectiveness of Group Intervention for Caregivers of Persons with First Episode Psychosis. Eur Psychiatry 2015;30:856.

    Article  Google Scholar 

  19. WHO. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. 1992.

  20. Breitborde NJ, Srihari VH, Woods SW. Review of the operational definition for first-episode psychosis. Early Interv Psychiatry. 2009;3(4):259–65.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Craig TK, Garety P, Power P, Rahaman N, Colbert S, Fornells-Ambrojo M, et al. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ. 2004;329(7474):1067.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Castro-Fornieles J, Parellada M, Gonzalez-Pinto A, Moreno D, Graell M, Baeza I, et al. The child and adolescent first-episode psychosis study (CAFEPS): design and baseline results. Schizophr Res. 2007;91(1):226–37.

    Article  PubMed  Google Scholar 

  23. Sadath A, Muralidhar D, Varambally S, Jose JP, Gangadhar BN. Family intervention in first-episode psychosis. SAGE Open. 2015;5(4):2158244015613108.

    Article  Google Scholar 

  24. Coentre R, Levy P, Figueira ML. Early intervention in psychosis: first-episode psychosis and critical period. Acta Med Port. 2011;24(1):117–26.

    PubMed  Google Scholar 

  25. Strakowski SM, Tohen M, Stoll AL, Faedda GL, Mayer PV, Kolbrener ML, et al. Comorbidity in psychosis at first hospitalization. Am J Psychiatry. 1993;150:752.

    Article  PubMed  Google Scholar 

  26. Saraswat N, Rao K, Subbakrishna D, Gangadhar B. The Social Occupational Functioning Scale (SOFS): a brief measure of functional status in persons with schizophrenia. Schizophr Res. 2006;81(2):301–9.

    Article  PubMed  Google Scholar 

  27. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962;10(3):799–812.

    Article  Google Scholar 

  28. Malhotra S, Shah R. Women and mental health in India: an overview. Indian J Psychiatry. 2015;57(Suppl 2):S205–11.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Das M, Angeli F, Krumeich AJ, van Schayck OC. The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India. Int J Equity Health. 2018;17(1):24.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hindin MJ. Women’s power and anthropometric status in Zimbabwe. Soc Sci Med. 2000;51(10):1517–28.

    Article  PubMed  Google Scholar 

  31. Doan RM, Bisharat L. Female autonomy and child nutritional status: the extended-family residential unit in Amman, Jordan. Soc Sci Med. 1990;31(7):783–9.

    Article  PubMed  Google Scholar 

  32. Borooah VK. Gender bias among children in India in their diet and immunisation against disease. Soc Sci Med. 2004;58(9):1719–31.

    Article  PubMed  Google Scholar 

  33. Al-Krenawi A, Graham JR. Gender and biomedical/traditional mental health utilization among the Bedouin-Arabs of the Negev. Cult Med Psychiatry. 1999;23(2):219–43.

    Article  PubMed  Google Scholar 

  34. Vlassoff C. Gender inequalities in health in the third world: uncharted ground. Soc Sci Med. 1994;39(9):1249–59.

    Article  PubMed  Google Scholar 

  35. Thirthalli J, Channaveerachari NK, Subbakrishna DK, Cottler LB, Varghese M, Gangadhar BN. Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India. Indian J Psychiatry. 2011;53(4):319–23.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Qin H, Zhang J, Wang Z, Min H, Yan C, Chen F, et al. Duration of untreated psychosis and clinical outcomes of first-episode schizophrenia: a 4-year follow-up study. Shanghai Arch Psychiatry. 2014;26(1):42–8.

    PubMed  PubMed Central  Google Scholar 

  37. Sim K, Swapna V, Mythily S, Mahendran R, Kua EH, McGorry P, et al. Psychiatric comorbidity in first episode psychosis: the Early Psychosis Intervention Program (EPIP) experience. Acta Psychiatr Scand. 2004;109(1):23–9.

    Article  PubMed  Google Scholar 

  38. Heitz U, Cherbuin J, Menghini-Müller S, Egloff L, Ittig S, Beck K, et al. Comorbidities in patients with an at-risk mental state and first episode psychosis. Eur Psychiatry. 2017;41(Supplement):S198.

    Article  Google Scholar 

  39. Strakowski SM, Keck PE Jr, McElroy SL, Lonczak HS, West SA. Chronology of comorbid and principal syndromes in first-episode psychosis. Compr Psychiatry. 1995;36(2):106–12.

    Article  PubMed  Google Scholar 

  40. Berge D, Mane A, Salgado P, Cortizo R, Garnier C, Gomez L, et al. Predictors of relapse and functioning in first-episode psychosis: a two-year follow-up study. Psychiatric. 2016;67(2):227–33.

    Google Scholar 

  41. Sadath A, Kumar S, Mathew S. Sociodemographic Predictors of Psychiatric Disability in India. J Psychosoc Rehabil Ment Health. 2017;4(1):29–33.

    Article  Google Scholar 

  42. Rabinowitz J, De Smedt G, Harvey PD, Davidson M. Relationship between premorbid functioning and symptom severity as assessed at first episode of psychosis. Am J Psychiatry. 2002;159(12):2021–6.

    Article  PubMed  Google Scholar 

  43. Thorup A, Petersen L, Jeppesen P, Ohlenschlæger J, Christensen T, Krarup G, et al. Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. J Nerv Ment Dis. 2007;195(5):396–405.

    PubMed  Google Scholar 

  44. Gonzalez-Rodriguez A, Studerus E, Spitz A, Bugra H, Aston J, Borgwardt S, et al. Gender differences in the psychopathology of emerging psychosis. Israel J Psychiatry Relat Sci. 2014;51(2):85–92.

    Google Scholar 

  45. Barajas A, Banos I, Ochoa S, Usall J, Villalta V, Dolz M, et al. Age of onset of a first psychotic episode: are there any clinical differences between men and women? Psiquiatria Biologica. 2007;14(4):136–41.

    Article  Google Scholar 

  46. Häfner H, Riecher A, Maurer K, Fätkenheuer B, Löffler W, Munk-Jørgensen P, et al. Sex differences in schizophrenic diseases. Fortschr Neurol Psychiatr. 1991;59(9):343–60.

    Article  PubMed  Google Scholar 

  47. Häfner H, Maurer K, Löffler W, An der Heiden W, Munk-Jørgensen P, Hambrecht M, et al. The ABC Schizophrenia Study: a preliminary overview of the results. Soc Psychiatry Psychiatr Epidemiol. 1998;33(8):380–6.

    Article  PubMed  Google Scholar 

  48. Hagen K, Solem S, Larsen TK, Joa I, Kvale G, Hansen B. Obsessive Compulsive Disorder (OCD) in Patients with First Episode Psychosis (FEP): a Prospective Study. Clin Neuropsychiatry. 2014;11(6):164–69.

    Google Scholar 

  49. Sim K, Mahendran R, Chong SA. Health-related quality of life and psychiatric comorbidity in first episode psychosis. Compr Psychiatry. 2005;46(4):278–83.

    Article  PubMed  Google Scholar 

  50. Chang WC, Hui CL, Tang JY, Wong GH, Chan SK, Lee EH, et al. Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study. Psychol Med. 2013;43(9):1883–93.

    Article  PubMed  Google Scholar 

  51. Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–804.

    Article  PubMed  Google Scholar 

  52. Barnes TR, Leeson VC, Mutsatsa SH, Watt HC, Hutton SB, Joyce EM. Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia. Br J Psychiatry. 2008;193(3):203–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anvar Sadath.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadath, A., Muralidhar, D., Varambally, S. et al. Predictors of Symptom Severity and Functioning in First Episode Psychosis. J. Psychosoc. Rehabil. Ment. Health 5, 111–118 (2018). https://doi.org/10.1007/s40737-018-0115-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40737-018-0115-3

Keywords

Navigation