The course of negative symptoms over the first five years of treatment: Data from an early intervention program for psychosis

Norman, Ross; Manchanda, Rahul; Harricharan, Raj; Northcott, Sandra

doi:10.1016/j.schres.2015.09.010

Cited by 20 publications

(18 citation statements)

References 61 publications

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“…Contrary to some [22,42,43], but not all [7], of those few studies examining clinical correlates of amotivation in FEP, we failed to demonstrate significant association between DUP and amotivation. The comparatively briefer DUP (median DUP: 13 weeks) of our cohort might obscure the potential impacts of prolonged untreated psychosis on the development of motivational impairment.…”

Section: Discussioncontrasting

confidence: 99%

“…Prior literature has consistently indicated that negative symptoms represent a multi-dimensional construct comprising two distinct sub-domains, namely motivational impairment (i.e., amotivation) and diminished expression (DE) [4]. Among these two sub-domains, amotivation has been found to be more prevalent and persistent over time than DE [5–7]. Recent studies have further demonstrated that amotivation is a major predictor of concurrent and longitudinal functional outcome in chronic schizophrenia [8–13] and first-episode psychosis (FEP) [14–16], above and beyond the contributions of cognitive deficits, DE and other symptom dimensions [6,9,16].…”

Section: Introductionmentioning

confidence: 99%

“…Given that amotivation is a key component of negative symptoms and a chief determinant of functional disability [21], it thus represents a critical therapeutic target for preventing development of persistent negative symptoms and promoting early functional recovery. Nonetheless, despite its significant clinical implications in early intervention (EI) for psychosis, very few studies have been conducted to prospectively examine predictors of amotivaiton in FEP [7,22,23].…”

Section: Introductionmentioning

confidence: 99%

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Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

et al. 2017

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BackgroundAmotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI).MethodsOne hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments.ResultsAmotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation.ConclusionOur findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

et al. 2017

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“…The LF group was also characterized by higher levels of negative symptoms, with Avolition being an independent predictor of functional outcome. Negative symptoms have traditionally been associated with schizophrenia spectrum disorders (Norman et al, 2015). However, a growing body of evidence suggests that they are expressed in association with LF across different psychiatric diagnoses (Minichino et al, 2016a).…”

Section: Discussionmentioning

confidence: 99%

Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system

Minichino

Francesconi

Carrión

et al. 2017

Schizophrenia Research

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A critical research goal is to identify modifiable risk factors leading to functional disabilities in young psychiatric patients. The authors developed a multidimensional trans-diagnostic predictive model of functional outcome in patients with the recent-onset of a psychiatric illness. Baseline clinical, psychosis-risk status, cognitive, neurological-soft-signs measures, and dopamine-related-gene polymorphisms (DRD1-rs4532, COMT-rs165599, and DRD4-rs1800955) were collected in 138 young non-psychotic outpatients. 116 individuals underwent follow-up (mean=2.2years, SD=0.9) examination. A binary logistic model was used to predict low-functioning status at follow-up as defined by a score lower than 65 in the social occupational functioning assessment scale. A total of 54% of patients experiences low functioning at follow-up. Attention, Avolition, and Motor-Coordination subscale were significant predictors of low-functioning with an accuracy of 79.7%. A non-significant trend was found for a dopamine-related-gene polymorphism (DRD1-rs4532). The model was independent of psychotic-risk status, DSM-diagnosis, and psychotic conversion. A trans-diagnostic approach taking into account specific neurocognitive, clinical, and neurological information has the potential to identify those individuals with low-functioning independent of DSM diagnosis or the level of psychosis-risk. Specific early interventions targeting modifiable risk factors and emphasize functional recovery in young psychiatric samples, independent of DSM-diagnosis and psychosis-risk, are essential.

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“…Few authors have specifically explored the impact of illness duration on sexspecific findings, and SHIP data provide this opportunity. We chose five years postfirst-episode as a cut-off point for our examination into duration of illness, as previous research has suggested that early intervention (during the first five years after a first episode) is effective in reducing symptom severity and improving prognosis in many domains, especially in terms of motivation and positive symptoms (Agius, 2009;Agius et al, 2010;Agius et al, 2009;Amminger et al, 2011;Bird et al, 2010;Birnbaum et al, 2015;Cabral and Chaves, 2010;Chen et al, 2011;Coentre et al, 2011;Cotton et al, 2011;Gleeson et al, 2009;Henry et al, 2010;Liu et al, 2010;Marshall and Rathbone, 2011;Norman et al, 2015;Norman et al, 2012;Porter, 2012;Restek-Petrovic et al, 2012;Shrivastava et al, 2012;Srihari et al, 2012;Theodore et al, 2012), and these findings continue to be replicated and debated (Carrión et al, 2017;Castle and Singh, 2015;Chong et al, 2016;Conrad et al, 2014;Ehmann et al, 2014;Galletly et al, 2016;Hahn et al, 2016;Howes et al, 2016;Hughes et al, 2014;Joyce et al, 2016;Lambert et al, 2016;Laurens et al, 2015;Lower et al, 2015;Marshall et al, 2015;…”

Section: Introductionmentioning

confidence: 99%

Men and women with psychosis and the impact of illness-duration on sex-differences: The second Australian national survey of psychosis

Hanlon

Campbell

Single

et al. 2017

Psychiatry Research

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We aimed to examine and compare sex-differences in people receiving treatment for psychotic illnesses in community settings, based on long or short duration of illness; expecting association between longer illness-duration and worse outcomes in women and men. Clinical, demographic and service-use data from the Survey of High Impact Psychosis were analysed by sex and duration of illness (≤5 years; ≥6 years), using independent t-tests, chi-square tests, one-way ANOVA, and Cramer's V. Of the 1825 participants, 47% had schizophrenia, 17.5% bipolar and 16.1% schizo-affective disorders. More women than men had undertaken post-school education, maintained relationships, and been living in their own homes. Women with a shorter-illness-duration showed social functioning equivalent to non-ill women in the general population. Men tended to have an early illness onset, show premorbid dysfunction, be single, show severe disability, and to use illicit substances. Men with a longer-illness-duration were very socially disadvantaged and isolated, often experiencing homelessness and substance use. Men with a short-illness-duration were most likely to be in paid employment, but two-thirds earned less than $AUD500 per fortnight. Men with longer-illness-duration showed most disability, socially and globally. Interventions should be guided by diagnosis, but also by a person's sex and duration of illness.

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The course of negative symptoms over the first five years of treatment: Data from an early intervention program for psychosis

Cited by 20 publications

References 61 publications

Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system

Men and women with psychosis and the impact of illness-duration on sex-differences: The second Australian national survey of psychosis

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