Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis

Malla, Ashok; Norman, Ross; Manchanda, Rahul; Townsend, Laurel

doi:10.1017/s0033291702006050

Cited by 143 publications

(127 citation statements)

References 32 publications

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“…22 Patients typically have severe cognitive impairments and poor outcomes precluding them from living in the community. In contrast, cognition did not predict changes in ADLs among patients with FEP, 23 who are relatively less impaired and better functioning than institutionalized patients, or among community-dwelling patients. 24 In these populations, other factors, such as physical health, are probably more likely to play a role in determining self-care abilities.…”

Section: Self-carementioning

confidence: 60%

Cognition, Function, and Disability in Patients with Schizophrenia: A Review of Longitudinal Studies

2014

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This paper aims to review longitudinal studies assessing the impact of cognition on function in patients with schizophrenia. PubMed and Scholars Portal were searched using search terms related to schizophrenia, cognition, function, and longitudinal studies. Some functional abilities have been studied more than others. Some studies suggest that the impact of cognition on function depends on the severity of baseline cognitive deficits. Other studies suggest that the impact of cognition on function depend on what phase of the illness the patient is in or what stage in that particular function the patient is involved in. Finally, few studies assessed interactions between cognition and other aspects of schizophrenia in predicting function, such as functional capacity, insight, motivation, and negative symptoms. More longitudinal and comprehensive studies are needed. A focus on community living is of high public significance as patients with schizophrenia continue to grow old. Future studies should also focus on the longitudinal interactions between cognition and other dimensions of schizophrenia as well as on the biological factors that underlie these interactions. W W W Cognition, fonction et incapacité chez des patients souffrant de schizophrénie : une revue des études longitudinalesCet article vise à examiner les études longitudinales évaluant l'effet de la cognition sur la fonction des patients souffrant de schizophrénie. Des recherches ont été effectuées dans PubMed et Scholars Portal à l'aide de mots clés liés à la schizophrénie, la cognition, la fonction, et les études longitudinales. Certaines capacités fonctionnelles ont été étudiées plus que d'autres. Des études suggèrent que l'effet de la cognition sur la fonction dépend de la gravité des déficits cognitifs au départ. D'autres études font valoir que l'effet de la cognition sur la fonction dépend de la phase de la maladie ou du stade de cette fonction où se situe le patient. Enfin, peu d'études ont évalué les interactions entre cognition et autres aspects de la schizophrénie pour prédire la fonction, comme la capacité fonctionnelle, l'intuition, la motivation, et les symptômes négatifs. Il faut plus d'études longitudinales et exhaustives. Mettre l'accent sur la vie dans la communauté est d'une grande importance publique car les patients souffrant de schizophrénie continuent de vieillir. Les futures études devraient aussi se pencher sur les interactions longitudinales entre la cognition et d'autres dimensions de la schizophrénie, ainsi que sur les facteurs biologiques qui sous-tendent ces interactions.S chizophrenia affects more than 24 million adults, worldwide, and about a quarter of a million in Canada.

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Section: Self-carementioning

confidence: 60%

Cognition, Function, and Disability in Patients with Schizophrenia: A Review of Longitudinal Studies

2014

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“…[1][2][3] Poor adherence is also associated with an increased risk of relapse, 4,5 a higher rate of hospital readmissions, 6 a higher level of residual symptoms, 5 a poorer quality of life, 6 and lower overall functioning. 7 Social support has also been linked to outcome in schizophrenia and related disorders, either directly 8 or through the impact of family-related interventions on symptoms, 9 relapse, 10 social functioning, 9 as well as the number and length of hospitalizations. [11][12][13] Further, numerous studies reveal the positive impact of social support and the quality of social networks on remission status, 14 improvement of symptoms, rates of hospitalization, 15 and the degree of adaptive functioning.…”

Section: Limitationsmentioning

confidence: 99%

The Influence of Perceived Social Support on Medication Adherence in First-Episode Psychosis

et al. 2013

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Objective: Our study examines the unique influence of social and family support on adherence to medication in a sample of patients treated for first-episode psychosis (FEP).Method: Social and family support using the Multidimensional Scale of Perceived Social Support and medication adherence (consensus of subjective and objective data) were evaluated on a monthly basis during a 6-month period in a sample of 82 FEP patients. The relation between social support and adherence was evaluated using correlational and linear regression analyses, controlling for other relevant variables. A longitudinal analysis using hierarchical linear models was conducted to model change in adherence over time. Results:Monthly correlations between social support and adherence were significant at 4 of 7 time points during a 6-month period. There was a modest correlation between the percentage of months of good adherence and the average level of family support across the study period. The linear regression failed to demonstrate a significant relation between baseline social support and overall adherence during the entire study period. Change in social support over time was inversely associated with change in adherence. Conclusions:Our study emphasizes the concurrent influence of social (mostly family) support on adherence but this effect does not persist over time. Changes in the degree of social support may have a complex effect on changes in adherence. W W W

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“…5,[8][9][10] Poor adherence has also been associated with an increased risk and rate of relapse, 11,12 increased number of voluntary and involuntary admissions, 13 greater levels of residual positive symptoms, 12 and poor quality of life, 12 social relations, and activities of daily living. 14 Outcome in the early phase of illness may be associated with longer-term global outcome in schizophrenia. 15 Hence, potentially malleable predictors, such as adherence to medication during treatment of FEP, may have important implications for the course of illness.…”

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confidence: 99%

Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis

et al. 2009

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Objective: To examine the hypothesis that poorer social and family support, identifiable at the onset of treatment, is associated with nonadherence in the first 6 months of treatment of patients with first-episode psychosis (FEP), independent of other patient-related factors.Method: Consecutive patients (n = 100) admitted to a specialized early intervention service for FEP who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for either a schizophrenia spectrum disorder or an affective psychosis were evaluated monthly for 6 months regarding their adherence to medications. Using sociodemographic and illness-related factors, including social and family support, as independent variables and adherence as the dependent variable, univariate analyses were followed by logistic regression.Results: Fifty-six patients (54.9%) were adherent (76% to 100% of doses taken) and 46 (45.1%) nonadherent (less than 76% of doses taken). Nonadherent patients were less likely to have received a good level of social support (c 2 = 5.89, df = 1, P = 0.02), as rated by their respective case manager, and more likely to be single (Fisher exact test, P = 0.019) and to have refused medication at the first offer of treatment (c 2 = 19.70, df = 1, P = 0.001). Using logistic regression, both the level of social support (OR = 3.552, P = 0.03) and early medication acceptance (OR = 11.092, P < 0.001) were significant as predictors of adherence. Conclusion Clinical Implications· Social and family support may be an important determinant of adherence to medication very early in the course of treatment of FEP. · Refusal to be treated at the first offer of treatment remains the most likely reason for nonadherence to medication, at least in the first 6 months of treatment of FEP. · Interventions may need to be designed to influence adherence to medication very early in the course of treatment. Limitations· The measure of social and family support used may have been too brief and not able to tap into different aspects of support from family and others in the social environment. · The absence of influence of insight on adherence to medication might have resulted from using the one item from the Positive and Negative Symptom Scale for assessing insight and not using a more detailed measure of insight. · The relatively high level of nonadherence may be a reflection of a very conservative measure of adherence to medication (taking greater than 75% of doses of medication prescribed).

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Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis

Abstract: In addition to pre-morbid adjustment potentially malleable variables such as level of residual (but not acute) symptoms, adherence to medication and cognitive deficits are likely to influence outcome on aspects of community functioning in individuals treated for first episode of psychosis.

Cited by 143 publications

References 32 publications

Cognition, Function, and Disability in Patients with Schizophrenia: A Review of Longitudinal Studies

Cognition, Function, and Disability in Patients with Schizophrenia: A Review of Longitudinal Studies

The Influence of Perceived Social Support on Medication Adherence in First-Episode Psychosis

Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis

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