
Research view
Title: | Phenomenology and diagnostic outcome of first-episode psychosis |
Author: | Maha M. Eltayebani, Mamdouh M. Elgamal, Osama Gado and Tarek Shoukry |
Abstract: |
Background and objectives
The establishment of criteria for the definition of first-episode psychosis is complex.
The literature on this topic is controversial in terms of the limits of duration of symptoms
and the inclusion of prodromal symptoms, together with symptoms of the acute phase.
Defining first-episode psychosis and determining the diagnostic outcome in the short
term for early recognition and intervention might contribute significantly toward
reducing later morbidity and chance of recovery. The aim of the current study is to
examine the clinical presentation both at baseline and at short-term follow-up (2 years)
with determination of the diagnostic outcome on the basis of systemic and structured
instruments and frequent follow-up.
Methods
Ninety drug-naı¨ve patients were recruited consecutively from among inpatients
after the exclusion of patients with first-contact psychosis who had neurological
or central nervous system problems, chronic medical conditions, a history of
or current substance abuse or dependence and mental subnormality.
Assessment at baseline and after 2 years by structured DSM-IV interviews
(SCID), PANSS, HDRS, YMRS, and WAIS as well as WMS-III. Demographics
and clinical characteristics were obtained, and a consensus diagnosis was
made on the basis of structured instruments, medical records, collateral information,
and face-to-face interviews.
Results
Patients with first-episode psychosis were divided into three diagnostic outcome
groups: schizophrenia spectrum (n = 49; 54.4%), bipolar psychosis (n = 21; 23.3%),
and depressive psychosis (n = 20; 22.2%). Patients in the schizophrenia spectrum
were predominantly men, single, and students with no educational differentiation and
with no familial risk compared with patients with other two diagnoses. Younger age,
early age of onset, long duration of untreated psychosis and short duration of
untreated illness, and low rate of hospitalization, but with longer duration of stability
and higher sensitivity for extrapyramidal side effects were reported more in the
schizophrenia spectrum group than the affective spectrum group. Cognitive functions
were better in bipolar and depressive psychosis both at baseline and at the short-term
assessment (2 years later) compared with schizophrenia spectrum patients, who
showed more improvement after 2 years of assessment on attention and executive
function than effective ones. Higher severity of depression was recorded on
depressive psychosis in both steps of assessment than that in patients with bipolar
schizophrenia. The mean YMRS scores were higher in patients with bipolar
psychoses, followed by schizophrenia patients than the depressive group. PANSS fivefactor
analysis showed that negative symptoms and cognitive disorganization were the
highly significant differentiating aspect of the schizophrenia spectrum group than the
affective spectrum patients.
Conclusion and recommendations
Overlap of symptoms and clinical presentation in patients of first-episode psychosis
both at baseline and for short-term outcome is quite common. Interacting longitudinal
and cross-sectional assessment may help to clarify this complexity of presentation at
first-episode psychosis. Focus on the differentiation of primary and secondary symptoms
in researches as well as biological findings is important to clarify this heterogeneity.
Keywords:
affective spectrum, first-episode psychosis, phenomenological symptom presentation,
schizophrenia spectrum
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Journal: | Egyptian Journal of Psychiatry 2013, 34:115–127 |
Text: | |
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