Dissertations / Theses on the topic 'Fist Episode of Psychosis'
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1
Upthegrove, Rachel. "Depression in first episode psychosis." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/1650/.
Abstract:
There has been renewed interest into affective symptoms and psychological approaches to schizophrenia and other psychosis, yet no in-depth investigation as to the course, consequences or indeed psychological causes of depression in a phase specific manner in the important first episode. Our understanding of risk and aetiological processes in psychotic illness will only advance once we accurately identify the “end phenotype” of psychotic illness. This series of studies investigates the course of depression in first episode psychosis, its significance in terms of suicidal thinking, and relation to both diagnosis and other symptom domains. Depression in the acute and post psychotic phases is explored, through the importance of the awareness and appraisal of positive symptoms, and diagnosis itself. Significant findings include a pervasive nature of depression throughout the course of first episode psychosis, the predictive nature of prodromal depression and the high prevalence of suicidal acts. Appeasement and engagement with voices, subordination to persecutors and the (ineffective) use of safety behaviours drive a position of entrapment, demoralization and a lack of control. In addition negative illness appraisals are stable and may vary between cultural groups. Implications are explored, in terms of clinical practice, aetiological pathways, potential treatments and intervention strategies
2
Billings, J. "Making sense of first episode psychosis." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1446413/.
Abstract:
This paper addresses whether the concept of illness perceptions, which has been developed in the arena of chronic physical illness, can be applied to an acute mental illness such as first episode psychosis. Literature related to first episode psychosis and illness perceptions is reviewed and the potential benefits and problems of using the illness perceptions framework when trying to understand how people make sense of a first episode of psychosis are discussed. Finally, areas warranting exploration in further research are highlighted.
3
Butjosa, Molines Anna. "Stressful life events and first-episode psychosis." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/461706.
Abstract:
Nowadays, advances in affective and social neuroscience have shown how the exposure to environmental factors has an impact on the structure and functioning of the brain being thus, active agents in the formation of an individual’s level of vulnerability. There is an increasing interest in the influence of stress on many diseases including a first-episode psychosis (FEP).
From the stress-vulnerability model (Zubin & Spring, 1977) to the current models of neural diathesis-stress (Pruessner et al., 2017), schizophrenia is conceptualised as an episodic disorder in which there is vulnerability and stress due to biological and/or environmental factors. This suggests that patients are likely predisposed to manifesting psychotic episodes induced by the impact of precipitating factors, such as stressful life events (SLEs). In FEP, the role of stressors, specifically SLEs, as predisposing factors or adjuvants to the onset of the disease is relevant. These events are circumstances that occur in the lives of people with an identifiable beginning and end which have the potential to alter their current mental or physical status. However, there are very few studies on SLEs in patients with schizophrenia - and even fewer in patients with FEP-, thereby emphasising the need for such studies. SLEs can be treated as prodromal events, which together with other events, contribute to the appearance of later psychotic symptomatology. Indeed, it is likely that the diversity of environmental factors associated with schizophrenia may be linked to an equal number of different underlying mechanisms. Several studies have evaluated the role of SLEs, but most of the studies include these events as trauma, what makes their research and evaluation more difficult and complicated.
This thesis was aimed at achieving adequate and effective early intervention in psychotic disorders since: i) in general, few studies have specifically evaluated SLEs; ii) no studies have analysed the age of onset of FEP in relation to SLEs; iii) no studies have been found about gender differences, family history and psychotic symptomatology in relation to SLEs; and iv) no instruments are available to assess SLEs along the life cycle.
The main objective of this thesis was to evaluate the relationship between SLEs and the development of FEP. This objective was developed under three specific objectives: 1) to systematically review the literature available on SLEs and FEP, 2) to evaluate the impact of SLEs and the influence of sociodemographic and clinical variables on the appearance of FEP, and 3) to validate an instrument to measure SLEs in FEP and in a healthy population.
The data obtained in this thesis provide more in depth knowledge regarding SLEs and their evaluation and detection as well as the relationship of these events with clinical variables and symptoms in a sample of patients with FEP and healthy controls. The objective of identifying
SLEs across the stress-vulnerability model psychosis phenotype continuum may provide insights into the aetiology of this disorder and may lead to the development of strategies for its prevention and treatment.
We provide further corroboration that rather than being a correlate of frank psychosis, the variability of SLEs may play an important role in FEP populations and this is of great relevance to the practice of professionals dedicated to detecting, caring for, and treating people with this disease. The work presented in this thesis is framed within the stress-vulnerability model and the clinical staging model, which considers the phenotypic continuum reflecting a shared interactive set of diathesis, psychosocial and sociocultural factors.
Currently, few studies have evaluated SLEs in these sample types and there is a need to obtain more in depth information on the influence of SLEs in these populations in which genetics and stress play a relevant role.Actualment, els avenços en la neurociència afectiva i social han demostrat com l’exposició als factors ambientals influeix en l’estructura i la funció del cervell, essent agents actius en la formació del nivell de vulnerabilitat de l’individu. A més, hi ha un interès creixent en la influència de l’estrès en moltes malalties, incloent un primer episodi psicòtic (PEP). Des del model de vulnerabilitat-estrès (Zubin i Spring, 1977) fins als models actuals de diàtesi- estrès neural (Pruessner et al., 2017), l’esquizofrènia es conceptualitza com un trastorn episòdic en què hi ha vulnerabilitat i estrès a causa de factors biològics i/o ambientals. Això suggereix que probablement els pacients estiguin predisposats a manifestar episodis psicòtics induïts per l’impacte dels factors precipitants, com els esdeveniments vitals estressants (EVEs). En el PEP, és rellevant el paper dels estressors, específicament EVEs, com a factors predisponents o adjuvants a l’aparició de la malaltia. Aquesta tesi tenia com a objectiu aconseguir una intervenció primerenca adequada i efectiva en trastorns psicòtics ja que: i) en general, pocs estudis han avaluat específicament els EVEs; ii) cap estudi ha analitzat l’edat d’aparició de PEP en relació amb els EVEs; iii) no hi ha estudis sobre diferències de gènere, historia familiar i simptomatologia psicòtica en relació amb els EVEs; i per últim, iv) no hi ha instruments disponibles per avaluar els EVEs durant el cicle vital. L’objectiu principal d’aquesta tesi va ser avaluar la relació entre els EVEs i el desenvolupament del PEP. Aquest objectiu es va desenvolupar en tres objectius específics: 1) revisar de forma sistemàtica la literatura disponible dels EVEs i PEP, 2) avaluar l’impacte dels EVEs i la influència de les variables sociodemogràfiques i clíniques sobre l’aparició de PEP, i 3) validar un instrument per mesurar els EVEs en pacients amb PEP i en població sana. Les dades obtingudes en aquesta tesi proporcionen un coneixement més profund sobre els EVEs i la seva avaluació i detecció, així com la relació d’aquests esdeveniments amb variables i símptomes clínics en una mostra de pacients amb PEP i controls sans.
4
Goodby, Emmeline. "Future-directed thinking in first episode psychosis." Thesis, Royal Holloway, University of London, 2014. http://digirep.rhul.ac.uk/items/ad1f1379-cc0a-ce62-ccf1-220f68ec8fc3/1/.
Abstract:
Psychosis encompasses a constellation of symptoms that have far-reaching social, physical and functional consequences for sufferers. One of the key clinical concerns in the management of psychotic illnesses is the risk of suicide, which is greatest in the early stages of psychosis. Hopelessness is consistently associated with risk for suicide but as a concept it is not well defined and is not specific enough to be of use in prediction of suicide. Future-directed thinking, particularly regarding positive future events, constitutes an aspect of hopelessness that is closely associated with risk for suicide. This study employed the Future Thinking Task to investigate whether future-directed thinking in first episode psychosis is significantly different from that of matched controls in performance or content, and to clarify the nature of its association with suicide risk in this patient group. In addition, the association of future-directed thinking with the negative symptoms of psychosis was investigated. The results showed that individuals with psychosis were impaired in future-directed thinking globally, particularly with respect to the coming year. Specific deficits were shown in the domains of relations with other people and personal development and understanding. Associations were shown between future-directed thinking and suicide, and reduced positive future-directed thinking was shown to be strongly associated with increased severity of negative symptoms. The results suggest avenues for novel interventions to improve hopelessness, suicide risk and the severity of negative symptoms in psychotic illness, and thereby improve functional outcomes.
5
Ajnakina, Olesya. "First episode psychosis : looking backwards and forwards." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/first-episode-psychosis(be65b62b-4c1a-496b-b7bf-3ada607e761d).html.
Abstract:
Introduction: Psychotic disorders are known for their wide variability in clinical and social outcomes beginning from illness onset and throughout their course. Our current lack of understanding of the origins for this heterogeneity is further compounded by dearth in knowledge on how patients come to the attention of mental health services and methodological incongruity across different studies. Employing samples of first episode psychosis (FEP) patients, the aims of this thesis were to: 1) look back on the pathways to care patients used to enter mental health services and the use of prodromal services in South London; and 2) examine trajectories of the psychotic disorders and potential predictors of their longitudinal outcomes. Methods: Two large samples of patients with FEP (i.e., GAP and EU-GEI) were utilised in this thesis. For the study 1, information on pathways to care undertaken prior to coming to generic services for FEP was extracted from the Biomedical Research Centre (BRC) Case Register Interactive Search (CRIS) system. For studies 2, 3 and 4, using electronic clinical records, extensive information in three domains-clinical, social and service uses-was collated over 4-5 years after contact with mental health services. Results: Only a small fraction of individuals (4.1%) who present with FEP to the main secondary mental health provider have previously been in contact with prodromal services and made a subsequent transition to psychotic disorder; 77% this sub-group of patients entered their pathway to care via referral from General Practice or other health professional. In contrast, 45% of FEP group without prior contact with the prodromal services made first contact with mental health services via emergency services and 18% of this group were referred by the criminal justice system. Further, combining the baseline schizophrenia diagnosis with five symptom dimensions (i.e., positive, negative, excited, disorganised/concrete and depressed dimensions) generated the best model fit for predicting time to first remission. During the 5-year follow up after first contact with mental health services, a higher proportion of Black African and Black Caribbean ethnicity had compulsory re-admissions and instances of police involvement during an admission to a psychiatric unit compared with White British ethnic group. Patients of Black African and Black Caribbean ethnicity did not differ from White British ethnic group in overall functional disability and illness severity, or frequency of remission or recovery during the follow up period. However, patients of Black ethnicity become increasing socially excluded as their illness progress. In a sample of first-episode schizophrenia spectrum patients, 35% of the sample met the criteria for treatment resistance (TR) at the end of the first 5 years of follow up. Of these TR patients, 70% of these were treatment resistant from illness onset. Those who subsequently developed TR were more likely to have an early illness onset (<20 years) compared to those with non-TR. The relationship between an early age of onset (<20 years) and TR was specific to patients of Black ethnicity and patients of male gender. Conclusions: Very few of those who come to FEP services come after being seen for an at-risk-mental state by prodromal services suggesting that the scope for reducing or delaying onset of psychosis by this means may still be limited. My results indicate that supplementing the baseline categorical schizophrenia diagnosis with ratings on five symptom dimensions improves the prediction of delayed treatment response as measured by time to first remission. Further, the longitudinal trajectory of psychosis in patients of Black ethnicity did not show greater clinical or functional deterioration than white patients. However, their course remains characterised by more compulsion, and longer periods of admission. Finally, I showed that for the majority of the TR group, lack of response to antipsychotic treatment is present from illness onset, necessitating a consideration for an earlier use of clozapine.
6
Meek, Ian Tod. "Satisfaction with antipsychotic medication in first episode psychosis." Thesis, University of East Anglia, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.577566.
Abstract:
Background: Antipsychotic medication is given in first episode psychosis in a prophylactic sense and also as a treatment. Young people experiencing their first episode of psychosis are generally the most responsive to pharmacological treatment. They are also the most susceptible to adverse events. Avoiding adverse events when individuals first start treatment is particularly important as the person's initial clinical experience may colour their attitude to medication thereafter. What it is like to take antipsychotic medication from the perspective of young people experiencing their first episode of psychosis has received relatively little attention, yet non-adherence in this population is reported to be as high as 50%. Objective: The aim of this study was to determine the experience of taking antipsychotic medication from the perspective of young people experiencing their first episode of psychosis. Methods: A purposive sample of young people with first episode psychosis responded to open-ended questions regarding their experience of taking antipsychotic medication. A thematic analysis was undertaken. Results: Twenty young people reported their experiences of taking antipsychotic medication. Eight themes were identified: [1] it does what is says on the tin; [2] impact on mood; [3] the drugs don't work; [4] side effects; [5] acceptability of medication; [6] weighing up the costs and benefits; [7] impact on activities of daily living; [8] there has to be something else. Conclusion: Young people with psychosis reported a mix of both positive and negative views about antipsychotic medication. Sedation was the most frequently reported and troublesome side effect. Hopes that with the advent of atypical antipsychotics adherence would improve with a less severe side effect profile have clearly not come to fruition. It is important to pay attention to young people's uncensored accounts of what it is really like to take antipsychotic medication. Key words: first episode psychosis, antipsychotic agents, patient satisfaction, qualitative research, patient experience, adherence, adverse events
7
O'Donoghue, Emma. "Psychological flexibility in a first episode psychosis sample." Thesis, University of London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.542325.
8
Raune, David John. "Psychosocial stress and the first episode of psychosis." Thesis, King's College London (University of London), 2002. https://kclpure.kcl.ac.uk/portal/en/theses/psychosocial-stress-and-the-first-episode-of-psychosis(7e57bcb0-2b09-488e-bd0a-5cf4e7f630d7).html.
9
Kolliakou, Anna. "Patterns of cannabis use in first-episode psychosis." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/patterns-of-cannabis-use-in-firstepisode-psychosis(9d70beb1-9b58-4143-9bc6-87065b64866b).html.
Abstract:
There is ample evidence that patients with psychosis are more likely to use illicit substances than the general population, with cannabis being the most popular. Research has also shown that cannabis use is associated with poor prognostic outcomes in patients with an established psychotic disorder. It is important to understand the reasons patients with psychosis endorse for their cannabis use and findings so far point towards an ‘alleviation of dysphoria’ model rather than the ‘self-medication’ hypothesis. It is not known how the level of motivation to change cannabis use can affect patients’ actual use. Lack of validated readiness to change questionnaires for use with psychotic populations makes it essential to develop and validate such measures. The aim of this thesis was to evaluate the reasons for cannabis use and its effects on psychotic outcomes in a patient cohort with first-episode psychosis. The association between cannabis use and other illicit drug use was also investigated. Readiness to change was evaluated as a predictor of cannabis use outcomes using two questionnaires. The main finding was that cannabis use was not associated with psychotic outcomes but was related to other illicit drug use. With regards to reasons, patients chose enhancement and social motives as most important for their cannabis use providing support for the ‘alleviation of dysphoria’ model. Preliminary analysis showed no clear pattern of association between readiness to change and cannabis use outcome. Utility of two readiness to change measures for use with patients with psychosis was not validated. These findings add to the small evidence base that cannabis use is not associated with prognostic outcomes in psychosis. No evidence for the self medication hypothesis was observed. Readiness to change was not associated with cannabis use outcomes signifying the need for using validated measures to assess motivation in psychotic populations.
10
Baggott, Eleanor. "Recovery from first-episode psychosis and the role for services beyond first-episode detection." Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/36710/.
Abstract:
Contemporary views of psychosis are more positive about outcomes and the potential for people with psychosis to have experiences of recovery. People who experience psychosis often use NHS services to help them manage their difficulties and specialist psychosis services, like Early Intervention (EI) are now common. However, it is not just secondary mental health services that are important in helping to manage people with psychosis. The first paper explores the role for primary care in managing this client group and systematically reviews the UK literature from 1997 on empirically tested methods of improving the primary care management of this group. The evidence in support of specific methods targeting service users, primary care staff and service organisation remain inconclusive and further research and development of initiatives is needed. This paper critically evaluates the methodological limitations of the research and considers the implications for practice and future research. The second paper reports on an empirical investigation into the experiences of recovery in people who have experienced their first-episode of psychosis. Eight participants were recruited from a UK Early Intervention Service and interviewed using a semi-structured method. Interpretive Phenomenological Analysis was used and seven themes related to recovery emerged from the service users’ accounts. The themes are discussed in relation to the clinical implications for EI services and the methodological limitations and future research directions are considered. The third paper reflects on the experiences of conducting empirical research whilst working clinically within the same service. The impact on the research-practitioner, service user-participant and wider service implications are discussed.
11
Achim, Amélie M. "Functional brain imaging of episodic memory in schizophrenia and first episode of psychosis." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=111847.
Abstract:
Memory is one of the cognitive functions that is most affected in schizophrenia and memory dysfunctions have a major impact on the functioning and quality of life of these patients. Functional brain imaging can help us identify the brain structures that are affected during the performance of a memory task. Identifying these regions can help us identify the specific cognitive processes that are affected in schizophrenia. To this end, I performed a meta-analysis of published functional brain imaging studies of episodic memory in schizophrenia. This meta-analysis showed that the prefrontal cortex and the medial temporal lobes are the brain regions that are most consistently reported as being affected in schizophrenia during the performance of a memory task. Most studies however used a low-level baseline condition that did not target a specific cognitive process. In addition, they included patients with a long-term history of schizophrenia, leaving open the possibility that factors linked to illness chronicity could have influenced the pattern of results. Based on the insights gleaned from the meta-analysis, I performed a functional magnetic resonance imaging study of episodic memory encoding in patients with a first episode of a schizophrenia spectrum psychosis (FEP) and healthy subjects. Three processes known to be involved in memory encoding were targeted, namely associative processing, semantic associative novelty and encoding success. In healthy subjects, both associative processing and semantic associative novelty were associated with increased activation in the medial temporal lobes, with no interaction between these two variables. In people with FEP, encoding success and associative processing revealed intact patterns of prefrontal and medial temporal lobe activation. In contrast, semantic associative novelty was associated with a marked reduction in medial temporal activation. The identification of selectively intact and deficient processes involved in memory encoding has potential clinical relevance for the development of more focused cognitive remediation strategies.
12
Brunet, Katerine. "PTSD following recovery from a first episode of psychosis." Thesis, University of Birmingham, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.434704.
13
Coulter, Carlton. "First-episode psychosis and the moral exculpation of parents." Thesis, University of East London, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532930.
Abstract:
In recent years a significant investment has been made in order to set up Early Intervention in Psychosis teams across England. These teams are responsible for delivering mental health services to people said to be experiencing first-episode psychosis, including the provision of 'psycho-education' for parents. The present study involved conducting eight interviews with such parents using a broad range of questions on the subject of first-episode psychosis. The study adopted a discursive psychology perspective towards the subject matter, with the analysis focusing on the rhetorical and interactional aspects of the discourse, through the use of specific discourse analysis and conversation analysis techniques respectively. The results of the analysis suggested that participants oriented to a common cultural understanding that parents can be responsible for causing, preventing, and intervening in the course of, such things as first-episode psychosis. In orienting to notions of parental causality, participants were seen to invoke lay versions of the type of causal explanations of schizophrenia that have been outlined in the psychological literature over the last century. Yet, the participants were also seen to work up the expert status of the interviewer, to defer to professional knowledge, and to claim to know nothing of such matters. This aspect of the analysis was taken as evidence of the success of the 'psy' project in establishing the superiority of professional knowledge over lay accounts. The analysis also demonstrated how participants attempted to work up their moral credentials as parents. This was understood as demonstrating that the parents did not orient to first-episode psychosis as a biological phenomenon, but rather as a moral assessment of their children's non-conforming behaviour, for which they, as parents, were morally culpable. The results of the study were used to make recommendations regarding how EIP teams should approach the task of working with parents.
14
Anderson, Richard J. "The epidemiology of first - episode psychosis in Northern Ireland." Thesis, Queen's University Belfast, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.534699.
15
Kapasi, Masuma. "Cognitive function in first-episode psychosis : Infulences and outcomes." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.520952.
16
Tong, Chun-yat, and 湯俊逸. "Suicide ideation and first episode psychosis in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/192975.
Abstract:
Patients with psychosis comprise a high-risk group in terms of suicide behaviors especially in the early phases. Suicide ideation on the other hand acts as the starting point along the chain of suicide. However less is known about suicide ideation among patients at their first-episode psychosis (FEP).
Present study investigated contributing factors in suicidal ideation among FEP patients in Hong Kong. FEP outpatients (N=20) and normal controls (N=20) were invited to complete a set of self-assessment questionnaires. These questionnaires measured a wide range of potential risk factors including hopelessness, impulsiveness, reasons for living, insight, drug-attitude and treatment satisfaction.
Results showed that patients have a higher occurrence-rate of suicide ideation (45%) compared to patients without ideation. Ideators were significantly more hopeless, impulsive, more aware of their illness and having fewer survival & coping beliefs.
Taken together, current study extended the stress-diathesis model in explaining suicidal behaviors among psychotic patients. We also demonstrated that insight in patients plays a role in interacting with suicide ideation. Further, since hopelessness appeared to be the strongest associative factor among all, this study has implications on prevention work focusing on hope maintenance.published_or_final_version
Psychological Medicine
Master
Master of Psychological Medicine
17
Smith, Lindsay Murray. "Ethnic differences in caregiving processes in first-episode psychosis." Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/ethnic-differences-in-caregiving-processes-in-firstepisode-psychosis(66f70fff-a099-4316-8d60-bda81da9bdb1).html.
Abstract:
Background:Few studies have investigated the impact of caregiving on a national scale, or ethnic differences in caregiving processes. This is despite growing numbers of informal carers and demographic change in the UK. Individuals identifying as black African, black Caribbean, black British and black ‘other’ (BA_BAC) by UK Census ethnicity criteria (2001) are currently over-represented within psychiatric services in urban settings and are known to perceive statutory support to be inappropriate for their needs. Aim:Initially, to examine the mental and physical health consequences of caregiving in general. Secondly, the aim was to compare ethnic differences in the processes identified within cognitive models of caregiving in psychosis. The third aim was to assess the validity of a new measure of service users’ perceptions of the quality of caregiving relationships. Method:Primary outcome measures obtained from the Adult Psychiatric Morbidity Survey (APMS) 2007 were used to examine the physical and mental health impact of caregiving roles compared to no caregiving in a representative sample of households in England. In the second study, BA_BAC carers and carers who identified as white British or white ‘other’ (WB) were recruited through Early Intervention in psychosis services in London. The Camberwell Family Interview was used to assess Expressed Emotion and computerised self-report measurements were obtained of distress, appraisals of caregiving, explanatory models of illness and coping. Within and between groups comparisons were conducted cross-sectionally based on self-identified ethnicity. In the third study, a systematic review was conducted to identify items to measure perceived Expressed Emotion. An aggregated scale was completed by first-episode psychosis service-users who agreed to accompany their carers in participating in the studies, along with a clinical interview assessing symptoms. Results:25% (N=1883) of the APMS 2007 sample identified themselves as carers in study 1. They had poorer mental health, and higher psychiatric symptom scores than non-caregivers. A significant dose effect was found, with an observable decline in mental health above 10 hours per week. A twofold increase in psychiatric symptom scores in the clinical range was recorded in those providing care for more than 20 hours per week. In adjusted analyses, there was no excess of physical disorders in carers. In the first-episode psychosis sample (study 2), over one third of all carers (N=78) exceeded clinical thresholds of depressive symptoms. Sixty-five percent reported sleep problems and poor sleep was found to mediate the relationship between negative appraisals of caregiving and distress (p<.0001). BA_BAC carers (N=41) were less likely to report intrusive, overprotective behaviours in caregiving and they maintained higher levels of warmth in discussing their relative. Significant group differences were recorded in carers’ beliefs about the causes of illness and their coping strategies. In study 3, a measure of service-user perceived Expressed Emotion showed moderate to good reliability and validity, taking into account illness severity. Better performance was observed for the measure with BA_BAC service-user participants (N=12/44). Conclusions:Even at low levels of caregiving, (10 hours a week) there is observable impact on the mental health of carers. This is found from the initial stages of caring for someone with a mental health condition. Distress frequently reaches clinical thresholds, particularly for individuals providing the most care, and those trying to cope with complex needs. Strategies aimed at maintaining carers’ mental health must consider this adverse and often progressive impact. Ethnic group differences in responses to caregiving may affect reported well being in carers and their interactions with service users. This is relevant to the development of culturally-informed Family Interventions in psychosis and interventions aimed specifically at carers. Measurement instruments targeting service-user perceptions of caregiving relationships may have clinical applications, particularly for ethnically diverse groups.
18
Miller, Jason Michael. "Hope in primary caregivers' experience of first episode psychosis." Thesis, University of Leeds, 2010. http://etheses.whiterose.ac.uk/1086/.
Abstract:
Introduction: Primary caregivers provide essential care and support to people with psychosis and are often key players within recovery. The recovery model and an expanding research literature suggest that the concept of hope is an important factor in adaptively coping with psychosis and also serves a critical role within recovery. The present study sought to explore how hope featured within the experiences of six primary caregivers of young people with first episode psychosis within the context of two UK early intervention services. Method: Interpretive Phenomenological Analysis was adopted as the methodological framework with which to approach the research and analyse the data. Primary caregivers were interviewed about their experiences of supporting and caring for a young person with first episode psychosis. Results: Five major themes were identified as characterising the experiences of participants. Caregivers experienced a maelstrom of distressing change and loss following the young person’s psychosis and struggled to make sense of what was happening. A range of experiences were also described during the young person’s recovery and receiving help from services. Hope was described as an important factor in sustaining and motivating caregivers through the demands of care giving and in their efforts to support the young person towards recovery. Discussion: Having experienced a range of distressing and often traumatising experiences, the findings of the present study suggest that caregivers have a range of parallel support and recovery needs. In particular, the findings highlight the need for caregivers and their families to jointly making sense of the young person’s psychosis from a very early stage. The findings also indicate that service providers should seek to nurture the hopes of carers and a range of possible interventions are suggested. The experiences described by caregivers within the present study may also have implications for understanding the development of expressed emotion within the context of first episode psychosis.
19
Clarke, Rachel. "Possible selves in first episode psychosis : a mixed methods study." Thesis, University of East Anglia, 2016. https://ueaeprints.uea.ac.uk/60861/.
Abstract:
This study involved the application of possible selves theory to first episode psychosis (FEP) with the aims of understanding more about negative symptoms, functional outcomes and sense of self in FEP. A mixed-methods, explanatory sequential design was utilised. In the initial quantitative phase, a pre-existing data set of 80 participants allowed exploration of relationships between negative symptoms, functioning and possible selves. The qualitative phase, involving eight new participants, was then used to expand on specific findings from the quantitative phase, particularly how descriptions of possible selves might change as a result of experiencing FEP. Contrary to predications, relationships between elements of possible selves and negative symptoms were not found. Being optimistic about achieving possible selves was positively related to functional outcomes suggesting that positive self-beliefs may be important in functional recovery from FEP. Overall, findings also suggest that experiencing FEP does not necessarily have a negative impact on sense of self, potentially aided by hopeful, understanding and dependable social support. After experiencing FEP future fears about relapsing become more salient. These findings are discussed in relation to previous literature. This is followed by consideration of the theoretical and clinical implications of the findings along with suggestions for future research.
20
Taylor, Hannah E. F. "Parents and young people in transition after first episode psychosis." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3721/.
Abstract:
A first episode of psychosis (FEP) is a significant life event for both a young person and their parent. This life event highlights a period of transition which is negotiated within the young person-parent relationship. The way in which the dyad reacts to and copes with the experience is important throughout the episode of FEP. Aims: This study aimed at describing how young people and their parents understand their experiences of FEP, and analysing how their relationships influenced recovery, and how psychosis and recovery affected the relationship itself. Method: A sample of ten participants, five young people who experienced psychosis and five parents were recruited. Data were collected using individual grounded theory interviews. Narratives were analysed using Grounded Theory. Results: A theory of recovery in the context of a parent-young person relationship was developed encompassing five core categories which were constructed through common pathways in which stories of recovery were told. These included formative experiences, independence, safe haven, secure base and parental distress. These categories were reflected across and within the relationships of parents and young people. Conclusions: This study provides an understanding of the process of recovery from the context of a parent and young person relationship. Therefore, offers a basis to explore further both relational and systemic factors important in the recovery from psychosis.
21
Hui, Lai-ming Christy, and 許麗明. "Predictors of relapse in first-episode schizophrenia and related psychosis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B41634081.
22
Glossop, H. "Young people's beliefs about help-seeking for first episode psychosis." Thesis, Canterbury Christ Church University, 2012. http://create.canterbury.ac.uk/11213/.
Abstract:
The importance of early intervention for positive outcomes following a first episode of psychosis (FEP) is recognised, however, there are still delays in young people seeking help. The aim of this qualitative study was to explore beliefs about help-seeking in young people who have recently experienced a FEP. Twelve participants were interviewed and transcripts were analysed using grounded theory. Five categories of beliefs were identified which contributed to the development of a preliminary model of beliefs about a need for help-seeking. Young people’s beliefs about their experiences as normal or abnormal, and about the process and outcome of help-seeking, influenced beliefs about needing help. Existing beliefs about mental health problems, and beliefs about the impact of experiences on the self were important to the meaning young people ascribed to beliefs about help-seeking. Social networks were important in the development of these beliefs. The study identified beliefs which promoted and inhibited young people’s help-seeking beliefs for FEP. Self-stigma was present prior to help-seeking. Implications for clinical interventions include education to promote help-seeking for distress and not abnormality, and to dispel myths about the help-seeking process and outcome. Further research is needed to determine which beliefs are most important to young people’s help-seeking for FEP.
23
Morland, T. "The predictive factors of subjective recovery in first-episode psychosis." Thesis, University College London (University of London), 2007. http://discovery.ucl.ac.uk/1444858/.
Abstract:
Conceptualisations of recovery from psychosis have evolved over time, from medically defined models of symptom reduction, to more recent definitions of subjective recovery. First-episode psychosis (FEP) individuals present as a group who are in the early stages of adjustment to the experience of a psychotic illness. Due to the typically early age of onset, they are also in the process of adjusting to major life and role changes. This paper addresses how recovery from FEP has been conceptualised and measured in the literature, and focuses on the validity of applying such measures and concepts specifically to an FEP group.;Key terms: First episode psychosis, subjective recovery, recovery and early intervention in psychosis.
24
Gee, Brioney. "Negative symptoms in first-episode psychosis : a mixed methods investigation." Thesis, University of East Anglia, 2016. https://ueaeprints.uea.ac.uk/64222/.
Abstract:
Negative symptoms – reductions in expression, motivation, pleasure and sociability – are observed across the spectrum of functional psychoses. They have been identified as a significant predictor of poor outcomes following first-episode psychosis and are a treatment priority for individuals with lived-experience of psychosis. However, the mechanisms underlying negative symptoms remain poorly understood. This thesis aims to contribute to our understanding of negative symptoms in the early phase of psychosis using a mixed methods approach. Participants in the EDEN study (n = 1006) were followed up for 12 months following acceptance into UK Early Intervention in Psychosis services. Negative symptom severity data were modelled using latent class growth analysis, allowing latent classes comprising individuals with similar patterns of change in negative symptoms severity over time to be identified. Predictors of latent class membership were ascertained and the relationship between negative symptom trajectories and concurrent social recovery explored. Subsequently, transcripts of qualitative interviews conducted with a subsample (n = 24) of the cohort were analysed thematically. Comparisons were made between the accounts of members of the identified latent classes. Experiences and personal understandings of negative symptoms, psychosis, treatment and recovery were explored, providing insights into potential mechanisms underlying negative symptoms and their relationship with social recovery. The quantitative and qualitative findings were integrated and interpreted in relation to existing research and theory. Together they informed the development of a conceptual model of negative symptoms and their relationship with poor social recovery following first-episode psychosis. The model suggests that active psychological processes may be important to negative symptoms and their contribution to poor social recovery. It is proposed that offering tailored psychosocial interventions at the earliest stage of disorder – after the onset of nonspecific negative symptoms but before the emergence of attenuated positive symptoms – may be warranted to improve outcomes following psychosis onset.
25
Hui, Lai-ming Christy. "Predictors of relapse in first-episode schizophrenia and related psychosis." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B41634081.
26
Barkl, Sophie June. "Facial Emotion Identification in Early-Onset and First-Episode Psychosis." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15507.
Abstract:
Psychotic conditions are a major public health concern as service expenditure costs are high, rates of unemployment are elevated, and risk of homelessness is increased. Improvements in the treatment of acute symptoms have resulted in many patients living in the community, which requires the ability to negotiate the social world. Social cognition refers to the set of skills involved in the perception, interpretation and effective use of social information. A fundamental building block of social cognition is the ability to quickly and accurately identify facial expressions of emotion (facial emotion identification: FEI). FEI has been found impaired and stable across time in people suffering from schizophrenia and first-episode psychosis (FEP), as well as in people at ultra-high risk of converting to psychosis and family members of people with psychosis. Taken together, this suggests that the ability to accurately identify facial expressions of emotions may be a trait marker of illness, rather than a consequence of illness. If so, a clearer understanding of the nature of these deficits at the early stages of illness would have implications for our theoretical understanding of the development and maintenance of psychotic illnesses. Furthermore, FEI deficits show cross-sectional and prospective ties with the ability of people with established schizophrenia to function in everyday life. The identification of factors that contribute to social disability in schizophrenia, especially those amenable to change, is a core aim of research. Therefore, an examination of the links between FEI and functioning in early-onset and first-episode psychosis would have implications for the provision of remediation programs aimed at ameliorating functional decline at the early stages of illness. This thesis contains a series of empirical manuscripts that have been published or are to be submitted for publication. This series of manuscripts is preceded by a general introduction to psychosis, schizophrenia, social cognition and FEI (Chapter 1) and a systematic review and meta-analysis of the literature assessing FEIdeficits in EOP and FEP (Chapter 2). This review found that, similar to patients with chronic schizophrenia, patients at the early stages of illness have difficulties accurately identifying facial expressions of emotion. Chapter 3 is an empirical study that aims to address several shortcomings identified in the extant literature. Patients with early-onset psychosis (n= 34, mean age = 14.11, 53% female) and healthy controls (n= 42, mean age 13.80, 51% female) completed a task of FEI that measured accuracy, error pattern and response time. Relative to controls, patients (i) had lower accuracy for identifying facial expressions of emotions, especially fear, anger and disgust, (ii) were more likely to misattribute other emotional expressions as fear or disgust, and (iii) were slower at accurately identifying all facial expressions. FEI accuracy was not significantly correlated with clinical symptoms of psychosis or current functioning. Chapter 4 follows eight of these children and adolescents (mean age = 17.53, 50% female) over time (2 to 4 years) to assess the longitudinal stability of facial emotion identification deficits in early psychosis, with a concurrent consideration of clinical course and functional outcome. Results indicated that, overall, FEI deficits remain stable over time in EOP, despite improvements in real-world functioning and fluctuations in clinical state. Chapter 5 compares FEI in patients with FEP with two different types of psychosis, affective psychoses (FEAP: n= 15, mean age = 19.53, 40% female) and schizophrenia spectrum psychoses (FESz: n= 69, mean age = 20.70, 38% female) to healthy controls (HC: n= 159, mean age = 19.97, 34% female). This is important, as little is known about differential deficits in FEI in specific types of psychosis, especially in patients experiencing their first episode of illness. Patients with FESz displayed more severe and pervasive deficits compared to FEAP. The results of this study suggest a differential impairment in FEI severity and pattern contingent on the type of psychosis. In the final empirical paper (Chapter 6) findings obtained on 6-month follow-up of patients (n= 29, mean age = 20.30, 38% female) with FEP are reported. FEI deficits were found to remain stable over time, with the exception of improvement in the accurate identification of sadness. Significant relationships between impaired baseline emotion identification task performance and poorer longitudinal functional outcomes, in the context of weak associations between baseline clinical symptoms of psychosis and longitudinal functional outcomes, suggests FEI deficits may contribute to social disability in psychotic disorders. In summary, the results of the studies contained in this thesis suggest that (i) FEI deficits are present in EOP and FEP, (ii) these deficits are stable and endure over time, and (iii) are related to long term functioning in FEP. These findings further our theoretical understanding of psychotic disorders by supporting the hypothesis that FEI deficits represent a candidate neurocognitive marker and endophenotype of schizophrenia spectrum disease. These findings underscore the need for detailed investigation of FEI impairment in EOP and FEP and provide support for the provision of social cognitive remediation programs to people at the early stages of illness in the hope of ameliorating long term functional decline.
27
Leirer, Daniel Jonathan. "Integrated approaches to the risk prediction of first-episode psychosis." Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/integrated-approaches-to-the-risk-prediction-of-firstepisode-psychosis(62bde120-14b3-4584-ac9e-6ed86443d5b7).html.
Abstract:
Psychosis is a complex condition that features in many psychiatric disorders, and significantly affects the quality of life for both patients and family members. As part of the Genetics and Psychosis (GAP) study, this thesis presents one of the largest blood gene expression datasets on first-episode psychosis patients to date. This work aimed to characterise the blood-based biological perturbations in psychosis and to investigate the predictive ability of gene expression data. Firstly changes in expression, between healthy controls and first-episode psychosis patients was explored, to identify genes associated with psychosis. I identified hundreds of differentially expressed genes and found associations to pathways involved in transcription, oxidative stress and viral replication. Secondly, network approaches were used to construct modules of genes based on co-expression. I identified modules correlated to the severity of positive symptoms, and enrich-ment for pathways associated with the stress response and multiple brain regions. Thirdly regularised generalised linear models with bootstrapping were used to generate predictions based on combinations of gene expression, genetic and demographic data. The highest performance was found for models incorporating gene expression data, with minimal improvement using additional data. Prediction accuracy for identifying psychosis samples was found to increase with severity of positive symptoms in schizophrenia samples, but not in other psychoses. Finally, machine learning methods were used on public schizophrenia gene expression data to build a variety of predictive models. These models were tested on the Genetics and Psychosis (GAP) gene expression data. The results show increased predictive performance on samples with a schizophrenia diagnosis, compared to other types of psychosis. Overall the thesis presents work analysing a novel gene expression dataset. The results suggest that blood gene expression signatures are more predictive for positive symptoms in schizophrenia than for other psychoses. This work also highlights expression differences in innate immune pathways and the stress response.
28
Harris, Samantha. "Exploring young people's constructions of a first episode of psychosis." Thesis, University of East London, 2016. http://roar.uel.ac.uk/5410/.
Abstract:
Background: Mental health services have been demonstrated to play a key role in shaping how people make sense of their experiences of psychosis. Past research has highlighted the dominance of the biomedical model within services, however, first-person accounts suggest this is not always meaningful or helpful for recovery. Early Intervention in Psychosis (EIP) services aim to provide a more holistic, non-stigmatising approach for young people experiencing a First Episode of Psychosis (FEP). However, there is very limited research exploring how these services might impact upon how young people construct their experiences. This study aimed to explore the culturally available narratives drawn upon by young people accessing EIP services and the consequences of these for service utilisation and subjectivity. Method: Semi-structured interviews were carried out with five young people (aged 18-35) who were accessing an EIP service for a FEP. A Narrative Analysis (NA) approach facilitated exploration of how young people constructed their experiences of a FEP and how they narrated this had changed since accessing the EIP service. Results: The participant’s narratives emphasised the idiosyncratic ways they constructed their FEP, drawing on a range of culturally available discourses. While accessing the EIP service appeared to facilitate the exploration of a range of casual theories, often drawing on a biopsychosocial model, their narratives also highlighted the implicit power of the biomedical approach in shaping their sense of self and the future. Conclusions: The findings support previous literature that highlights the importance of meaning-making for young people experiencing a FEP. The discourses available within EIP services appear to play a key role in shaping young people’s constructions and this study highlights the value of privileging multiple perspectives when supporting people to make sense of their experiences of psychosis.
29
Barajas, Vélez Ana. "Premorbid and prodromal functioning as predictors at onset of psychosis: a first-episode study." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/377764.
Abstract:
Las fases tempranas de una enfermedad representan un período importante, tanto desde el punto de vista de la investigación como en relación al resultado de la enfermedad y su pronóstico. En relación con los trastornos el espectro psicótico, se ha observado que la heterogeneidad comienza temprano, mucho antes de la aparición de la psicosis. En este sentido, es posible que factores que influyen en las fases premórbida y prodrómica puedan ser entendidos como factores de riesgo moduladores de la expresión de los síntomas psicóticos. Entonces, ampliar nuestro conocimiento sobre la caracterización del período previo a la aparición de los síntomas psicóticos francos podría contribuir a descubrir pistas sobre la etiología, evolución y pronóstico de los trastornos del espectro psicótico.
Desde la hipótesis del continnum, el desarrollo de la psicosis franca ya está diferencialmente programado desde las fases previas al inicio de la enfermedad. Sin embargo, una de las dificultades encontradas en la literatura científica está relacionada con la caracterización y evaluación del período premórbido y prodrómico. Este trabajo de investigación, presentado como un compendio de publicaciones, se centra en la caracterización de las fases tempranas de la psicosis, particularmente en relación con los factores premórbidos y prodrómicos asociados con el inicio de la psicosis. Además, la presente tesis tiene implicaciones preventivas claras. Se busca ampliar nuestro conocimiento sobre cómo los pacientes con un primer episodio de psicosis (PEP) expresan la enfermedad en sus primeras etapas, así como cuáles son los factores premórbidos y prodrómicos asociados con un mal resultado en el inicio de la psicosis.
Los objetivos específicos de esta tesis son los siguientes: a) Examinar las propiedades psicométricas de la Escala de Adaptación Premórbida - versión española (PAS-S); b) Estudiar la estructura dimensional de la PAS-S así como los factores asociados con el funcionamiento clínico, social y cognitivo; c) Evaluar la capacidad predictiva de los síntomas prodrómicos en el desarrollo de un PEP; d) Describir las diferencias de género en psicosis desde un enfoque dimensional; e) Analizar las diferencias clínicas en relación al inicio de la psicosis.
Los principales resultados de esta tesis se resumen como sigue: a) PAS-S muestra propiedades psicométricas apropiadas con respecto a los indicadores de validez y fiabilidad en los pacientes que sufren un trastorno psicótico; b) el ajuste premórbido (PA) se explica mejor a través de tres factores, dividiendo el factor social clásico en dos componentes, el dominio PA social y el dominio PA socio-sexual. Cada dominio muestra un patrón diferencial de deterioro y correlatos específicos; c) hay una amplia heterogeneidad sintomática en la fase prodrómica próxima a la transición a la psicosis, existiendo dimensiones prodrómicas con diferentes capacidades para predecir las dimensiones psicopatológicas en el inicio de la psicosis; d) las diferencias entre hombres y mujeres en la expresión de la psicosis se extienden a través de un continuo, desde las formas premórbidas y subclínicas de la enfermedad hasta el inicio de la psicosis, con mejor pronóstico en las mujeres que en los hombres; e) la edad de inicio del PEP es una variable relevante en el estudio de la expresión clínica de la psicosis.
En conclusión, esta tesis muestra que el nivel apropiado de análisis en el estudio del desarrollo de la psicosis no se encuentra en el inicio del episodio psicótico, sino más bien en las fases tempranas de la psicosis (período premórbido y prodrómico). A lo largo de estas fases pueden ocurrir varios factores de riesgo, que pueden contribuir a la expresión diferencial en el desarrollo de la psicosis en función de la combinación de estos factores. Hay factores no modificables (como la historia familiar y el género) y otros que podrían ser alterados en caso de poder intervenir (como el funcionamiento social deteriorado y los síntomas subclínicos). Todos ellos deben ser considerados en el establecimiento de nuevos modelos de detección de pacientes con riesgo de psicosis. Esto podría alentar el progreso hacia el conocimiento de nuevas estrategias para la detección precoz e intervenciones psicosociales adaptadas a las necesidades de los pacientesThe early phases of an illness represent an important period, both from a research viewpoint and also in relation to the outcome of the illness and its prognosis. In relation to the psychotic spectrum disorders, it has been observed that the heterogeneity begins early, long before the onset of psychosis. In this sense, it is possible that factors influencing the premorbid and prodromal phases might be understood as risk factors modulating the expression of psychotic symptoms. Then, broadening our knowledge regarding the characterisation of the period prior to the onset of overt psychotic symptoms might contribute to uncovering clues to etiology, course and prognosis of psychotic spectrum disorders. From the continuum hypothesis, the development of full-blown psychosis is already differentially programmed from the previous phases at the onset of illness. However, one of the difficulties found in the scientific literature is related to the characterization and evaluation of the premorbid and prodromal period. This work research, presented as a compendium of publications, is focused on the characterization of early phases of psychosis, particularly in relation to premorbid and prodromal factors associated with onset of psychosis. In addition, the present thesis has clear preventive implications. It seeks to broaden our knowledge about how patients with a first-episode psychosis (FEP) express the disease in its earlier stages as well as what premorbid and prodromal factors are associated with a poor outcome at the onset of psychosis. The specific aims of this thesis are the following: a) To examine the psychometric properties of the Premorbid Adjustment Scale - Spanish version (PAS-S); b) To study the dimensional structure of PAS-S as associated factors with clinical, social and cognitive outcome; c) To assess the predictive capacity of the prodromal symptoms to the development of an FEP; d) To describe gender differences in psychosis from a dimensional approach; e) To analyze clinical differences according to the onset of psychosis. The key findings of this thesis are summarized as follows: a) PAS-S shows appropriate psychometric properties regarding indicators of validity and reliability in patients experiencing a psychotic disorder; b) premorbid adjustment (PA) is best explained by three factors, splitting the classic social factor into two components, Social PA and Socio-sexual PA domains. Each domain shows a differential pattern of deterioration and specific correlates; c) there is an extensive symptomatic heterogeneity in the proximal prodromal phase of transition to psychosis, with prodromal dimensions having different capacities for predicting psychopathological dimensions at the onset of psychosis; d) the differences between men and women in the expression of psychosis extend across a continuum, from the premorbid and subclinical forms of illness to the debut of psychosis, with better prognosis in women than in men; e) the age at onset of FEP is a relevant variable in the study of clinical expression of psychosis. In conclusion, this thesis shows that the appropriate level of analysis in the study of psychosis development is not found in the onset of psychotic episode but rather in earlier phases of psychosis (premorbid and prodromal periods). Throughout these phases several risk factors may occur, which can contribute to differential expression in the development of psychosis depending on which combination of these factors is given. There are unmodifiable factors (such as family history and gender) and others that may be altered if it is possible to intervene (such as impaired social functioning and sub-clinical symptoms). All of these should be considered in establishing new models of detection of patients at risk of psychosis. This could encourage progress towards knowledge of new strategies for early detection and psychosocial interventions adapted to the needs of patients.
30
Christoforidis, Gina. "First episode psychosis: an IPA exploration of the experiences of partners." Thesis, University of Surrey, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.576117.
Abstract:
There exists a wealth of research which suggests that for family members, caring for an individual with psychosis can be a distressing experience. However, despite the growing body of literature surrounding First Episode Psychosis (FEP) and caregivers, the experiences of partners have somehow been neglected. This study aimed to bridge this gap in the literature by exploring partners' experiences of being with an individual who has recently developed psychosis, investigating the impact on the individual and the relationship from a transitions perspective. Six partners of individuals within one of two allocated Early Intervention Services took part. Semi- structured interviews and Interpretative Phenomenological Analysis (IPA, Smith et al. 2009) were used to collect and analyse data respectively. Three super-ordinate themes were developed from the data: The Self versus the Psychosis, Living in the Relationship with the Psychosis and Looking to the Outside for Support. Participants described how their sense of self had been affected since the arrival of psychosis in their lives, illustrating how they entered into a battle with the psychosis, adapting both behaviourally and psychologically whilst trying to take control of the situation. Participants also described how they renegotiated their lives in light of a third presence, the psychosis, in their relationship. Complexities surrounding seeking external support were also described by participants. These results are considered in light of existing literature and clinical implications. Overall, the findings support the development of relationship-specific family intervention initiatives within FEP, including the needs of partners
31
Tso, F., and 曹斐. "Longitudinal neurocognitive functions in First-episode psychosis: 24-month follow-up." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31227909.
32
Revell, Emily. "Combined cognitive remediation and social cognition training in first episode psychosis." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/combined-cognitive-remediation-and-social-cognition-training-in-first-episode-psychosis(a309c184-9478-4763-b2a2-2547463e08da).html.
Abstract:
Introduction: Impaired neurocognition, especially social cognition, predicts disability in schizophrenia. Early intervention to target impairment is theoretically attractive as a means to minimise chronic disability. Many trials confirm that Cognitive Remediation (CR) produces meaningful, durable improvements in cognition and functioning but few interventions remediate social cognition or focus on the early stages of schizophrenia. Methods: A systematic review and meta-analysis of 11 randomised controlled trials (RCTs) of CR in first episode psychosis (FEP) was completed. A randomised controlled pilot trial was then conducted to investigate a combined CR and social cognition training (CR+SCT) intervention in FEP compared to CR alone, assessing cognition, functioning and symptoms at baseline and follow-up. Qualitative feedback was also obtained in a nested feasibility and acceptability study to assess engagement, intervention suitability and attrition. Results: In the systematic review and meta-analysis, random effects models revealed a non-significant effect of CR on global cognition in FEP. However, there was a significant effect on functioning and symptoms, which was larger in trials with adjunctive psychiatric rehabilitation and small group interventions. In the pilot trial, the CR+SCT group had significantly better social functioning scores post-treatment, especially on the interpersonal relationships scale, however there was no significant effect on social cognition. CR+SCT also improved visual learning and set-shifting. There was no specific effect on symptoms. The nested feasibility and acceptability study found CR and CR+SCT to be acceptable and feasible for early intervention in psychosis service users, with high engagement rates and high user-reported satisfaction. Users perceived improvements in neurocognition and reported using strategies learnt during CR in daily life. Conclusions: Meta-analysis suggests that CR is beneficial in FEP. Evidence from the pilot trial shows that a CR intervention enhanced with SCT can improve functioning more than CR alone and that such an intervention is feasible and acceptable. A larger RCT is required to explore the full benefits of a CR+SCT intervention compared to CR and treatment as usual.
33
Berry, Christopher. "Subjective experiences of psychosis : investigating the psychological impact of first-episode psychosis using Interpretative Phenomenological Analysis (IPA)." Thesis, University of Oxford, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.419375.
34
S, Mok L. "Social anxiety and low grade symptoms in patients following first episode psychosis." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B3138576X.
35
Mattsson, Maria. "First episode psychosis and outcome : findings from a Swedish multi-centre study /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-338-2/.
36
Mok, L. S., and 莫麗莎. "Social anxiety and low grade symptoms in patients following first episode psychosis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B3138576X.
37
Penny, Elizabeth. "How is first episode psychosis and early intervention understood by Pakistani families?" Thesis, University of Leicester, 2005. http://hdl.handle.net/2381/31218.
Abstract:
Section A: Literature Review : How are Mental Health Problems and Mental Health Services Understood in British Asian Communities? The review outlines literature relating to Asian communities in Britain and their beliefs about and experience of mental illness, particularly psychosis. It particularly examines the experience of Asian service users and carers. The review highlights cultural differences in the understanding and treatment of mental illness. It also suggests specific difficulties these communities have in accessing services. Section B: Research Report: How Is First Episode Psychosis And Early Intervention Understood By Pakistani Families? Aims: The report aims firstly to better understand the beliefs held by Pakistani carers towards their family member's psychotic illness. Secondly, it explores Pakistani carers attitudes towards an Early Intervention for Psychosis Service, accessed by their family member. Methods: Eleven participants (Pakistani in origin) whose close family member was accessing the Early Intervention Service are interviewed. Interpretative Phenomenological Analysis is used to qualitatively analysis transcripts. Result: Three superordinate themes are evident: "Story of the Illness" "A Social Illness" and "Treatment and Change". These describe the impact that their family member's illness has on participants' lives, and their complex understandings of causes and treatment. Conclusions: The study expands our understanding of participants' complex and multi-layered understanding of psychosis, its causes and treatment, as well as their experience of services. Implications and suggestions for further research are discussed. Section C: Critical Appraisal: The critical appraisal is a reflection on the process of doing the research, based on a research diary. It includes a critique of the methodology selected and development of the research from design to write up. Areas of difficulty are highlighted, including recruitment, confidentiality and the use of interpreters. The influence of the researcher on the work is considered.
38
Press, Claire. "Developing culturally adapted cognitive remediation for South Asian first episode psychosis sufferers." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/developing-culturally-adapted-cognitive-remediation-for-south-asian-first-episode-psychosis-sufferers(9dd2210e-3587-4acc-986b-5f2121467ff5).html.
Abstract:
Introduction: An increased incidence of schizophrenia among migrant and ethnic minority groups has been established. Ethnic minorities have poorer access to and outcomes from evidence based psychosocial interventions compared to the majority population. The overall aims of this thesis was to explore culturally adapted psychosocial interventions for migrant and ethnic minority schizophrenia sufferers, and use the results of these investigations to develop culturally adapted cognitive remediation (CR) to meet the needs of South Asian first episode sufferers. Methods: A systematic review and meta-analysis of previous randomised controlled trials (RCTs) investigated the quality, methods and effectiveness of culturally adapted psychosocial interventions for schizophrenia. Interviews, analysed using framework analysis, explored the acceptability, and perceived accessibility, of CR to the target population. CR for first episode psychosis was then adapted to target South Asian sufferers' needs and participants' satisfaction and engagement measured in a feasibility study. Results: The systematic review identified 17 RCTs of culturally adapted psychosocial interventions for schizophrenia. Meta-analysis of culturally adapted Family Intervention (caFI) compared to Treatment As Usual (TAU) showed no reduction in relapse risk. There were non-significant reductions in risk and number of hospitalisations during the intervention and significant shortening of total time in hospital. Meta-analysis of culturally adapted Social Skills Training (caSST), compared to TAU showed improvements in medication and symptom management but no effects when compared to a time-matched psychosocial intervention. Results must be interpreted with caution due to the small number of trials included and limitations in their analyses. Cultural adaptations made to the interventions were similar across trials. This allowed for the development of a measure systematically recording the methods used in culturally adapting interventions. Scale items included: language, therapeutic alliance, teaching style, manual content, family, treatment goals, explanatory models of illness, help seeking behaviour, delivery, stigma, societal context and cultural tenets. Emergent themes from qualitative interviews with ten South Asian first episode schizophrenia sufferers included: help seeking for psychosis, sociocultural influences on help seeking, experience of cognitive deficits, and recommended cultural adaptations to CR. CR was well received by all respondents. Level of acculturation and the influence of family and illness beliefs were associated with distinct pathways to care. A feasibility study of culturally adapted cognitive remediation (caCR) for first episode South Asian psychosis patients resulted in high levels of service user satisfaction, therapeutic alliance and participant retention rates. The majority (87.5%) reported cognitive benefits and a boost in self-esteem. Conclusions: The scale of cultural adaptations for psychosocial interventions for schizophrenia will provide a framework for those developing culturally adapted interventions for migrant or ethnic minority communities and a means to record the degree and type of adaptation. CaCR was acceptable to first episode South Asian psychosis sufferers. A larger trial is required to investigate this intervention's efficacy in terms of cognitive and global functioning.
39
Wong, Wun-tsang, and 黃韻錚. "A qualitative study on the admission experience of patients with first-episode psychosis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206557.
Abstract:
Background: For early psychosis patients, the first few years were critical period for determining long-term illness outcome. The first experience of admission had significant bearing on the perception of subsequent psychiatric treatment received. From this perspective, it was important to be aware of how patients suffered and how they coped in order to regain their sense of self of insight and treatment adherence and trust with nurses’ rapport and their therapeutic relationship. In this regard, a qualitative study was done with an aim to (i) explore the admission experiences and beliefs participants held upon admission and after discharged within two months. (ii) any influences on their perceptions of experience during and after admission which might impact on therapeutic relationship and treatment attitude
Method: Eight ICD-10 first-episode psychosis (FEP) patients aged between 18 and 55 years who admitted to psychiatric inpatient unit for the management of their FEP were recruited. Two face-to-face in-depth interviews were conducted for each participant. First interview was conducted within 2 weeks of admission, while second interview was conducted during psychiatric outpatient follow-up appointment within two months after discharged from hospital. All interviews were audiotaped and transcribed. Thematic analysis was employed to derive common themes regarding patients’ experience and perception on psychiatric hospitalization for their FEP.
Results: Thematic analysis revealed six main themes regarding patients’ subjective experience and perception on the illness and hospitalization. These were uncontrollable sense of self, supportive relationship with family members, unpleasant admission procedure, and feeling out of control during hospitalization, perceived benefits of admission, and perceived adverse impacts of admission.
Conclusion: Our findings indicated that ideas about what constitute admission perception needed to take into account of patient’s views and experience in order to emphasize therapeutic optimism rather than pessimism, and to inform treatment contexts and the views of nursing staff.published_or_final_version
Psychological Medicine
Master
Master of Psychological Medicine
40
Breitborde, Nicholas JK, Emily K. Bell, David Dawley, Cindy Woolverton, Alan Ceaser, Allison C. Waters, Spencer C. Dawson, et al. "The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service." BioMed Central Ltd, 2015. http://hdl.handle.net/10150/610297.
Abstract:
BACKGROUND: There is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER). METHODS: Sixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation. RESULTS: Over the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system. CONCLUSIONS: The results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011
41
Windell, Deborah L. "Treatment and recovery in first-episode psychosis : a qualitative analysis of client experiences." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=100177.
Abstract:
Background: There is currently very little research on recovery from the perspective ofindividuals with recent-onset of psychotic disorders. Forming a better understanding ofthesubjective meaning ofrecovery and recovery experiences during this early phase ofrecovery caninform effective and meaningful service design and practices.Method: Thirty individuals recovering from psychosis and receiving specialized earlyinterventiontreatment were interviewed regarding the meaning and experience of recovery frompsychosis during the early phase (2-5 years) ofthe illness course.Results: Recovery was described as a multidimensional experience that included aspects of"illness recovery," "psychological recovery," and "social recovery." Seven common earlyrecovery experiences were identified. Individual variations in the magnitude ofdescribeddisruption of self and social functioning, duration ofthe illness-acceptance process and theprocess treatment negotiation greatly influenced the experience ofrecovery.Conclusion: Differences in illness acceptance and social recovery trajectories have importantimplications for understanding individual responses to the experience ofpsychosis, its diagnosisand treatment. These differences emphasize the importance of assisting individuals with theconstruction of meaning and the reengagement in social roles following the initial illnessexperience.Contexte: Il y a actuellement peu de recherche sur la rétablissement du point de vue d'individusaprès un premier épisode de psychose. La formation d'une meilleure compréhension de senssubjectif des expériences de rétablissement pendant cette première phase de rétablissement peutinformer le design efficace et expressif des services et des pratiques.Méthode: Trente individus se rétablissement de la psychose et recevant un traitement depremière intervention spécialisé ont été interviewés à propos du sens et de l'expérience derétablissement de la psychose pendant la première phase (2-5 ans) du cours de maladie.Résultats: La rétablissement a été décrite comme une expérience multidimensionnelle qui ainclus des aspects de "la rétablissement de maladie," "la rétablissement psychologique," et "larétablissement sociale." Identifiées ont été sept premières expériences de rétablissementcommunes. Les variations individuelles dans l'étendue de perturbation décrite de soi et defonctionnement social, la durée du processus d'acceptation de maladie et de la négociation duprocessus de traitement ont beaucoup influencé l'expérience de rétablissement.Conclusions : Les différences dans les trajectoires d'acceptation de maladie et de rétablissementsociale ont des implications importantes pour comprendre les réponses individuelles àl'expérience de psychose, sa diagnose et traitement. Ces différences accentuent l'importanced'assister les individus avec la construction de sens et avec le réengagement dans les rôlessociaux après l'expérience de maladie initiale.
42
Hovington, Cindy. "Understanding persistent negative symptoms in first episode psychosis: Implementing neurocognitive and neuroanatomical approaches." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121181.
Abstract:
Background. Negative symptoms (alogia, blunted affect, amotivation, reduced social drive) are a core feature of psychotic disorders. In comparison to positive symptoms, negative symptoms do not respond well to treatment, thus becoming persistent in a large percentage of psychosis patients. Persistent negative symptoms (PNS) remain an unmet therapeutic need, in part, due to our lack of understanding of the cognitive and neural correlates of these symptoms. Furthermore, most studies ill investigate PNS in patients with enduring schizophrenia, which introduces confounding factors. Hence, there is a need for a better understanding of these symptoms in patients with a first episode of psychosis (FEP).Purpose. Our overall aim was to define and characterize the cognitive and neural correlates of persistent negative symptoms identified in patients with first episode psychosis. Methods. All FEP patients were treated at the Prevention and Early Intervention Program for Psychosis (PEPP) at the Douglas Mental Health University Institute in Montreal. First, the heuristic value of various PNS definitions applied in the literature was explored. The relationship between PNS definitions and functional outcome was also explored. The most clinically relevant PNS definition was then applied to subsequent studies. Secondly, memory ability was examined in three memory domains including verbal, visual and working memory. Memory was compared at baseline in FEP patients with PNS and without PNS. In addition, the trajectory of memory ability was assessed at a 12-month follow-up. Lastly, white matter microstructure was investigated in FEP patients identified as having PNS. A region of interest analysis was applied to assess fronto-temporo-limbic white matter tracts. Fractional anisotropy was measured in each tract and compared between PNS patients, non-PNS and healthy controls. Results. Persistent negative symptoms were defined as having a score of 3 or greater in at least 1 global subscales of the Scale for the Assessment of Negative Symptoms. In addition, FEP patients were required to have minimal positive, depressive, and extrapyramidal symptoms. Patients whose negative symptoms at the above-mentioned level of severity persisted beyond month 3 of their first year of treatment in the PEPP program met the criteria for PNS. Applying this definition allowed us to determine the prevalence of PNS in FEP, which was found to be 27%. Further, patients with PNS had poorer functioning at month 12 than those without PNS. All FEP patients were administered neuropsychological tests with focus being placed on memory ability in those affected with PNS. Results suggested that in comparison to patients without PNS and healthy controls, patients affected by PNS had poorer verbal memory ability. In addition, follow up memory scores indicated that memory impairments in PNS were stable through the first year. Lastly, fractional anisotropy was shown to be lower in both patient groups compared to healthy controls. While the non-PNS demonstrated significantly lower FA values in the uncinate fasciculus compared to healthy controls, lower fornix FA was found in the PNS group compared to healthy controls. Conclusions and significance.Our studies highlight a 27% prevalence of PNS in first episode psychosis, supporting previous assumptions of a greater prevalence of PNS in comparison to deficit syndrome (with a prevalence estimated at 15%). Patients with PNS present with: poorer functional outcome, greater verbal memory deficits and impaired white matter integrity in the limbic system. Thus, applying the PNS definition in future studies may help further elucidate the impact of negative symptoms in FEP, by providing a more homogenous subgroup of patients who are more severely impaired than patients without PNS.Contexte. Les symptômes négatifs (réduction de langage parlé, émoussement de l'affect, amotivation, retrait social) sont au cœur des troubles psychotiques. Contrairement aux symptômes positifs, les symptômes négatifs sont peu influencés par le traitement pharmacologique. Les symptômes négatifs persistants (SNP) sont encore peu ciblés par des nouveaux traitements, en partie, dû à notre connaissance limitée des corrélats neuronaux et cognitifs de ces symptômes. Il est pertinent de mieux comprendre les symptômes négatifs en début d'évolution chez les patients présentant un premier épisode psychotique. Objectif. L'objectif global de notre étude est de définir et caractériser les corrélats neuronaux et cognitifs des symptômes négatifs persistants identifiés chez les patients présentant un premier épisode psychotique. Méthode. Les patients présentant un premier épisode psychotique ont été traités au Programme d'évaluation, d'intervention et de prévention des psychoses, (PEPP) à l'institut universitaire de santé mentale Douglas à Montréal. La valeur heuristique de plusieurs définitions des SNP employée dans la littérature a été investiguée. La relation entre les définitions des SNP et l'évolution fonctionnelle a également été explorée. La définition la plus cliniquement pertinente a été appliquée aux études subséquentes. Ensuite, la capacité de la mémoire a été examiné pour son lien possible avec les symptômes négatifs. Spécifiquement la performance mnésiques des patients avec ou sans SNP a été comparée au niveau de base. De plus, la trajectoire de la capacité de la mémoire a été évaluée après 12 mois de suivi. Finalement, la microstructure de la matière blanche des patients avec SNP a été examinée. Une approche par régions d'intérêt a été préconisée afin d'évaluer les faisceaux fronto-temporo-limbiques de la matière blanche. Résultats. Un score de 3 ou plus sur au moins une des sous-échelles globales de l'échelle d'évaluation des symptômes négatifs (SANS) représentait un des critères pour définir les symptômes négatifs persistants. De plus, les patients devaient avoir peu de symptômes positifs, dépressifs ou extrapyramidaux. Finalement, les patients dont les symptômes négatifs persistaient au-delà de 3 mois dans leur première année de traitement dans le programme, répondaient aux critères de sélection pour les SNP. En appliquant cette définition nous avons observé une prévalence des SNP de 27% chez les patients. De plus, les patients avec SNP avaient un fonctionnement plus faible après 12 mois de suivi. Les tests neuropsychologiques administrés à tous les patients ont mis l'accent sur la capacité de la mémoire. Les résultats suggèrent que les patients avec SNP, par rapport aux patients sans SNP et les sujets sains, avaient une capacité de mémoire verbale plus faible. De plus, le suivi des scores de mémoire ont indiqué que les troubles de la mémoire associés aux SNP étaient stables pendant la première année. Enfin, l'AF s'est avérée plus faible dans les deux groupes de patients (avec et sans SNP), comparée aux sujets sains. De plus, les patients sans SNP ont obtenu des valeurs de AF significativement plus faibles dans le faisceau unciné que les contrôles sains, alors que les patients avec SNP ont en plus obtenus des valeurs de FA plus faibles dans le fornix.Conclusions. Nos études démontrent une prévalence des SNP de 27% chez les patients présentant un premier épisode psychotique, ce qui confirme des recherches antérieures. Les patients atteints des SNP sont caractérisés par un fonctionnement plus faible, une capacité de mémoire verbale plus faible et des valeurs de AF plus faibles dans les régions limbiques. Ainsi, l'application de la définition des SNP dans de futures études pourrait aider à élucider d'avantage l'impact des symptômes négatifs lors du premier épisode psychotique, en identifiant de façon précoce, un groupe plus homogène de patients qui présentent une issue clinique et fonctionnelle moins favorable.
43
Thorrington, Selina. "Implicit and explicit self-stigma, psychological flexibility and outcomes in first episode psychosis." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12336/.
Abstract:
Section A reviews the literature from two areas: it looks first at empirical studies exploring self-stigma in psychosis and secondly at psychological flexibility in psychosis. In doing so, the review aims to consider the question as to whether the psychological flexibility model, as presented by Acceptance and Commitment Therapy, can help us to understand how and why self-stigma can have a detrimental impact on some individuals experiencing symptoms of psychosis. Section B reports on a quantitative study of self-stigma, psychological flexibility, psychological well-being and quality of life in a First Episode Psychosis population. Research suggests that individuals experiencing psychosis may self-stigmatise, whereby negative beliefs and stereotypes about mental health difficulties are internalised. This in turn has been found to impact negatively on a number of areas. The psychological flexibility model presented by Acceptance and Commitment Therapy may help us to understand this. This study aimed to explore self-stigma using both an explicit and implicit measure of self-stigma to see how these were related to psychological flexibility, quality of life and well-being. Twenty-six participants experiencing first episode psychosis were recruited. They completed self-report questionnaires pertaining to quality of life, psychological well-being, psychological flexibility and explicit self-stigma. In addition, they completed a computer based reaction-time task designed to measure implicit self-stigma. Significant relationships were found between explicit self-stigma and well-being, and between psychological flexibility, explicit self-stigma, quality of life and well-being. Explicit self-stigma was found to statistically mediate the relationship between flexibility and well-being. Implicit self-stigma was not related to any investigated variable. The findings suggest psychological inflexibility may lead to greater self-stigma, which in turn decreases psychological well-being. This implied that interventions geared towards increasing flexibility may not only improve well-being, but may also help address issues of self-stigma.
44
Hodgekins, Joanne. "Investigating the psychological typology of social recovery in individuals with first episode psychosis." Thesis, University of East Anglia, 2012. https://ueaeprints.uea.ac.uk/42396/.
Abstract:
Background Social disability has long been linked with psychosis. However, at what stage disability occurs, whether it exists for all individuals, and factors predicting outcome are still under debate. Assessing social functioning in first episode psychosis (FEP) presents a methodological challenge as many existing tools were developed for chronic schizophrenia and are confounded with psychotic symptoms. Aims This study explored the prevalence and typology of social disability in FEP. Different trajectories of social recovery were examined as well as predictors of outcome. Method A sample of 878 individuals with FEP were assessed upon entry into Early Intervention for Psychosis (EIP) services and followed up over 12 months. Social disability was assessed using weekly hours engaged in structured activity on the Time Use Survey (TUS). Recovery profiles were examined using two approaches: transition between clinical and non-clinical cut-off scores on the TUS, and Latent Class Growth Analysis. Baseline predictors of outcome were examined using ordinal and multinomial regression. Results At baseline, over 80% of participants scored below the non-clinical cut-off of 45 hours per week in structured activity. Male gender and poor premorbid adjustment in adolescence predicted baseline levels of social disability. Over 50% of participants remained socially disabled following 12 months of EIP service provision. Social recovery over the 12 month study period was predicted by baseline time use, gender, Typology of Social Recovery from FEP J. Hodgekins iii ethnicity, age of onset of psychosis, duration of untreated psychosis, negative symptoms, and premorbid adjustment in adolescence. Conclusion Social disability is prevalent in FEP, although a significant minority do not experience any social disability and make a full social recovery. Where social disability is present upon entry into EIP services it can remain stable over time. Social disability may occur in adolescence, even before the onset of psychotic symptoms. The clinical and theoretical implications of the findings are discussed.
45
Edge, Rachael Sarah. "Journeys into recovery : family narratives of first episode psychosis and behavioural family therapy." Thesis, Staffordshire University, 2015. http://eprints.staffs.ac.uk/2239/.
Abstract:
This thesis explores the journeys undertaken by families when someone experiences a first episode of psychosis (FEP), and the family seeks help and receives treatment. A review of the literature on families' experiences of help-seeking for FEP provides a focus on the beginning of this time. The literature is synthesised to reveal a journey through the early help-seeking experience, and the extent to which experiences are shared between carers and individuals with FEP is explored. The empirical research paper provides insight into families' experiences further along on their journey; presenting a qualitative study on family narratives of FEP and Behavioural Family Therapy (BFT). Families completing BFT were interviewed, and narrative analysis was used to identify their shared narratives and the subplots within these. A broad narrative of the journey from illness to recovery is presented, with subplots within each broad phase of the journey considered. The extent to which narratives can provide evidence of effectiveness in BFT is explored, as well as consideration of how such narratives may aid recovery. The role of parental power in maintaining family narratives is considered, and further research and clinical implications are discussed. The reflective review paper presents a reflective background and critique of the literature review and empirical research study, as well as an extended discussion of some points within these. The author's journey through the creation of this thesis is presented, within the wider context of clinical psychology research. Decisions made during creation of the thesis are elucidated, and the limitations and value of the thesis are considered. This reflective journey begins with the author's own epistemological position, and consideration of how this influenced the thesis, and ends with consideration of personal learning points gained during completion of the thesis.
46
Maidment, Megan. "Social recovery following first-episode psychosis : the role of negative symptoms and motivation." Thesis, University of East Anglia, 2014. https://ueaeprints.uea.ac.uk/50723/.
Abstract:
Background Impairment in social functioning following psychosis is associated with negative symptoms, particularly reduced motivation (Foussias & Remington, 2010). Cognitive models of negative symptoms propose that expectancy appraisals are involved in the expression and maintenance of negative symptoms (Rector, Beck, & Stolar, 2005; Staring & Van der Gaag, 2010). Theories of motivation (e.g. expectancy-value theory; Eccles and Wigfield 2002) describe how self-efficacy beliefs, appraisals of task value, and self-schema may influence behaviour, but minimal research has applied these models to the understanding of negative symptoms and functional outcomes in first-episode psychosis. This was the aim of the current study. Method A cross-sectional, correlational study was conducted to explore relationships between negative symptoms and appraisals of self-efficacy, task value and self-schema in a clinical sample of individuals with first-episode psychosis. Fifty-one participants completed measures examining psychotic symptoms, functioning, and appraisals. Results Relationships between negative symptoms and appraisals of self-efficacy, task value and self-schema were found, however these relationships were not significant when controlling for depression and anxiety symptoms. Contrary to expectations, there was no difference in the strength of relationships between self-efficacy, subjective task value and self-schema and the negative symptoms associated with motivation compared with other negative symptoms. Self-efficacy and self-schema were not significantly correlated with social functioning, but negative symptoms significantly mediated the relationship between subjective task value and social functioning. Discussion Although some hypotheses were partially supported, depressive symptoms accounted for the most variance in negative symptoms in this sample. The findings support a psychological approach for treatment to assist functional recovery of individuals with first-episode psychosis. This study addresses some methodological limitations of previous research, though was itself limited by small sample size. Theoretical implications for the applicability of cognitive models of negative symptoms and theories of motivation in first-episode psychosis are also discussed.
47
Merritt, Kate Sky. "Glutamate dysfunction in first episode psychosis and relationship with the response to treatment." Thesis, King's College London (University of London), 2016. https://kclpure.kcl.ac.uk/portal/en/theses/glutamate-dysfunction-in-first-episode-psychosis-and-relationship-with-the-response-to-treatment(082da8ec-6d0b-49d6-87fa-e03939e92ac8).html.
Abstract:
Abnormal glutamatergic neurotransmission is strongly implicated in the pathophysiology of schizophrenia. The main technique available for assessing central glutamate function in man in vivo is proton magnetic resonance spectroscopy (1H-MRS), which can be used to measure glutamate, its metabolite glutamine, or their combination (Glx). Although around sixty 1H-MRS studies in schizophrenia have been published, the findings have been inconsistent, and the extent to which these vary with the brain region examined, the stage of the disorder, the severity of symptoms and the effects of treatment is unclear. Nevertheless, data from recent cross-sectional studies suggest that glutamate concentrations may relate to the degree to which patients respond to antipsychotic medication. However, it is not yet known whether glutamate is predictive of the future therapeutic response, or whether glutamate concentrations change as a consequence of treatment. This issue can be addressed through the longitudinal assessment of glutamate concentrations in patients with psychosis before and after antipsychotic treatment. A meta-analysis of the entire literature to date indicates that schizophrenia is associated with elevated 1H-MRS glutamate metabolites in the medial temporal cortex, basal ganglia, and thalamus, and that these findings vary with the stage of the disorder. The relationship between 1H-MRS glutamate metabolites and symptom severity was examined in a large dataset of individual patient data, pooled from multiple research samples. However this did not identify robust associations between glutamate measures and symptom scores, consistent with the findings from a systematic review of studies that had examined this issue. To investigate whether glutamatergic differences between antipsychotic responders and non-responders are predictive or consequential to the therapeutic response, a longitudinal (10 month) 1H-MRS study in FEP was conducted. This revealed that Glx levels in the thalamus declined with antipsychotic treatment in patients who responded well, but did not change in patients with a poor response after both 5 weeks and 10 months. Parallel work involving repeated 1H-MRS scanning of healthy volunteers indicated that these findings were not attributable to non-specific time effects. Overall, the results from this thesis suggest that alterations in glutamatergic function are evident in a number of brain regions in schizophrenia, and that these differ between patients who do and do not respond to treatment with antipsychotic medication. These findings have implications for our understanding of the pathophysiology of the disorder, the stratification of patients, and the development of novel treatments.
48
Jackson, D. "Understanding treatment delay in first episode psychosis : the parents' experience of help seeking." Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1445666/.
Abstract:
This thesis is presented in three parts. Part One is a literature review, in which the empirical literature that investigated the relationship between a range of psychosocial variables and 'duration of untreated psychosis' (DUP) is reviewed. Part Two presents the empirical paper, describing the main qualitative study for this thesis. The study explored the experiences, perceptions and beliefs of the parents of 14 young people who had recently experienced a first episode of psychosis and who delayed seeking help from mental health services. Part Three represents a critical appraisal of the study undertaken, which provides background to the study, reflections on the process and an extended discussion of the clinical implications of the research.
49
Scoriels, Linda. "Metabolic, cognitive and emotional endophenotypes in first episode psychosis : characterisation and a potential treatment." Thesis, University of Cambridge, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.609222.
50
Lee, Lai-fan, and 李麗芬. "Neurocognitive and psychopathology correlates of subjective quality of life in first episode remitted psychosis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/192979.
Abstract:
Subjective quality of life (QOL) has been measured as one of the important clinical outcomes of schizophrenia. Many studies on examining the relationship between subjective QOL and symptomatology as well as neurocognitive functions were reported. Consistent data have suggested that the severity of depressive symptoms contributed to poor subjective QOL of schizophrenia. However, reports on the relationship of subjective QOL with negative symptoms, neurocognitive functions, and duration of untreated psychosis were largely inconsistent.
The current study on the examination of subjective QOL in schizophrenia, is to emphasize the importance of inner experiences of schizophrenia but do not treat them as Freedman (1974) called “average schizophrenic”, in order to find out a more effective intervention for improving subjective QOL of schizophrenia. The purpose of the present cross-sectional study was to replicate these previous studies on investigating factors related to subjective QOL of schizophrenia including, positive symptoms, negative symptoms, neurocognitive functions, as well as duration of untreated psychosis. Besides, as most previous studies focused on chronic schizophrenia, this study involved first episode remitted psychosis patients, and to test whether it was the same phenomenon between chronic schizophrenia and first episode remitted psychosis on subjective QOL. The study result can contribute to propose suitable treatment for improving QOL of persons with schizophrenia.
In this study, 140 subjects with first episode remitted schizophrenia were examined. Significant associations between subjective QOL and psychopathology, neurocognitive functions were found; modest correlation of duration of untreated psychosis was also reported. Also, subjective QOL was associated with self-perception on the illness outlook in the first episode population.published_or_final_version
Psychological Medicine
Master
Master of Psychological Medicine