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PURPOSE: To generate a theory of the psychosocial processes influencing weight management among persons newly prescribed atypical antipsychotic medications. RESEARCH QUESTIONS: 1. What influences weight management in persons with first-episode psychosis who are newly prescribed atypical antipsychotic medications? 2. How is weight management facilitated in persons with first-episode psychosis who are newly prescribed atypical antipsychotic medications? 3. What psychosocial processes impede weight management in persons with first-episode psychosis who are newly prescribed atypical antipsychotic medications? METHODS: A qualitative, grounded theory research design was used to guide the study. Semi-structured interviews were the method of data collection and analysis was performed using constant comparison. SAMPLE & SETTING: A sample of 10 participants with first-episode psychosis prescribed atypical antipsychotics for at least eight weeks and six participants with a diagnosis of chronic schizophrenia who have been taking atypical antipsychotic medication for at least three years were obtained from an Outpatient Psychiatric program using theoretical sampling. FINDINGS: Contextual factors influencing weight management were: accessibility to resources, unstructured lifestyle, and others’ perception of their weight. Conditions influencing weight management were: rapid weight gain, insatiable hunger, and a lack of motivation boosters. Participants’ early responses to actions influencing weight gain management included discontinuing medications, choosing lower calorie foods, using walking in daily activities as exercise, accepting weight gain, and trying to manage weight but giving up. The consequences revealed from data analysis were contemplating weight management and not trying, as the barriers to weight management substantially exceeded the facilitators and many procrastinated in taking on any weight management strategies. CONCLUSION: The theoretical framework developed in this study can assist with the understanding and management of weight gain among this unique population. / Thesis (Master, Nursing) -- Queen's University, 2010-09-06 00:12:11.781

BACKGROUND: Soft neurological signs (SNS) are subtle, nonspecific neurological abnormalities that are present in first episode psychosis (FEP) patients. SNS are associated with clinical variables such as poor long term psychosocial functioning, executive functioning, and positive and negative symptomology. However, few studies have evaluated treatment responsiveness with respect to SNS. OBJECTIVE: To investigate whether SNS show: 1.) baseline and longitudinal differences between both diagnostic groups (schizophrenia (FEP-SZ), non-schizophrenia FEP-NSZ, and healthy controls (HC)) and treatment outcome (week 26 and year 1); 2.) relationships to clinical measures; 3.) predictive characteristics of treatment response. METHODS: SNS scores (Neurological Evaluation Scale) were obtained for 312 FEP (236 FEP-SZ and 76 FEP-NSZ subjects and 169 HC subjects and for subjects classified as treatment responsive and non-responsive at week 26 (N=105, N=105) and year 1 (N=101, N=97), respectively. Diagnostic group and treatment responsiveness group comparisons were assessed with ANCOVA and logistic regression models and both were co-varied for age, sex, race, and handedness. Baseline and longitudinal SNS relationships to clinical variables were determined using Spearman correlations and repeated measures correlations, and both were corrected by False Discovery Rate. Linear mixed effects model was utilized to analyze the data longitudinally. RESULTS: Baseline cognitive perceptual SNS measures had the greatest effect size differences, were predictive of group membership, and differentiated the two proband groups with FEP-SZ having worse SNS scores. Baseline cognitive perceptual SNS did not significantly predict treatment response at week 26 or year 1, but changes in cognitive perceptual at week 26 was predictive of treatment responsiveness at week 26 and year 1. Longitudinally, SNS scores drop in both FEP groups and treatment groups. The FEP-SZ group showed greater longitudinal within subject correlations than FEP-NSZ. SNS scores were only differentiated between year 1 outcome groups at week 8. There were greater longitudinal within subject correlations for the responsive group. CONCLUSION: Our findings indicate that there are baseline group differences and that changes in cognitive perceptual SNS scores at week 26 are predictive of treatment responsiveness at week 26 and year 1. / 2019-07-03T00:00:00Z

No / Background: Cognitive deficits are a core symptom of schizophrenia, severely debilitating and untreated by current medication. However, to date there is limited research focusing on the precise nature of the cognitive disturbances at first episode in ethnic populations. Improved understanding of this will allow improved approaches to therapy. The aim of this study was to investigate cognitive function with a first episode of psychosis South Asian patients. Methods: Twenty South Asian first episode psychosis patients and 15 healthy South Asian matched controls were recruited. All were second generation South Asian people living in the UK. Subjects who took part in the study completed the Positive and Negative Syndrome Scale (patient group), the Wechsler Test of Adult Reading and a battery of neuropsychological assessments to assess specific domains of cognition of relevance to Measurement and Treatment Research to Improve Cognition in Schizophrenia using the Cambridge Neuropsychological Test Automated Battery (CANTAB) (all groups). Results: Results show that first episode patients performed significantly worse than controls across all cognitive domains tested using CANTAB. Significant impairments were found in tests of visual and spatial memory, executive function, working memory, spatial planning and attention. Importantly, a number of cognitive performance indices (visual memory, spatial memory, executive function) were positively correlated with the severity of negative symptoms. Conclusion: We demonstrate that first episode South Asian patients display significant and specific cognitive deficits with evidence to support an association between negative symptoms and certain cognitive domains at first episode in this patient population.

Thesis (PhD (Psychiatry))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Contemporary research has confirmed the presence of cognitive deficits as a core feature of schizophrenia that has a definite and adverse impact on functional outcome. Cognitive functioning can be improved by psychopharmacological intervention, with evidence supporting the superiority of second generation antipsychotics over their first generation predecessors. Despite evidence that cognitive impairment contributes to medication non-adherence and that depot antipsychotics are able to enhance treatment compliance whilst decreasing relapse rates, depot preparations remain less frequently prescribed than their oral counterparts, especially in patients with first episode psychosis (FEP). The aims of this study were primarily to investigate cognitive deficits in patients with FEP, and to then describe the response of these impairments to treatment with a very low dose flupenthixol decanoate. This was a prospective, non-randomized, single arm, open-label, longitudinal study of 58 participants with FEP treated according to a fixed protocol over a period of 12 months. There was a wash-out phase of up to seven days during which all psychotropic medications were discontinued. There was an initial treatment period of one week with oral flupenthixol 1mg/day, after which flupenthixol decanoate was initiated at 10mg intramuscular depot injection every fortnight. Dose increases, in cases of poor or inadequate response, were allowed at 6-weekly intervals and in increments of 10mg per injection, up to a maximum of 30mg per fortnight. The principal findings of the study were as follows: The majority of participants were markedly ill, with significant cognitive impairment at baseline. There was a discrepancy between subjectively reported, and objectively measured, cognitive impairment. The majority of the participants responded to, and achieved remission, on a very low dose of flupenthixol decanoate (22.48 ± 0.47mg/month). The majority of symptomatic and cognitive improvement occurred between baseline and three months, with response leveling out at six months. Social cognition did not improve significantly over time, whereas functional outcome and quality of life did improve with treatment. Flupenthixol decanoate was well tolerated and side-effects were of a mild and transient nature. This study reconfirms that the majority of individuals with FEP experience significant cognitive impairment at baseline. It also suggests that these impairments can be successfully treated with a very low dose of flupenthixol decanoate. The use of depot flupenthixol decanoate ensures sustained treatment delivery, thereby decreasing the risk for relapse. This holds the promise of improved long-term functional outcome for those suffering with psychotic illness. / AFRIKAANSE OPSOMMING: Onlangse navorsing het kognitiewe inkorting identifiseer as een van die kern simptoomkomplekse van skisofrenie, met toenemende bewyse vir die duidelike en ongunstige impak hiervan op funksionele uitkoms. Kognitiewe funksionering kan deur psigofarmakologiese ingrepe verbeter word. Onlangse literatuur toon dat die tweede generasie antipsigotika relatief meer effektief is as hulle eerste generasie voorgangers. Ondanks bewyse vir die negatiewe impak van kognitiewe inkorting op behandelingsinskiklikheid, én data wat daarop wys dat die gebruik van langwerkende intramuskulere (depot) antipsigotika inskiklikheid verbeter en periodes van simptoom-terugval voorkom, word dié preparate steeds minder gereeld as hulle orale eweknieë voorgeskryf, veral by pasiënte met 'n eerste episode psigose (FEP). Die doel van hierdie studie was om kognitiewe probleme by pasiënte met FEP te beskryf, en ook om die respons hiervan op behandeling met 'n baie lae dosis flupentiksol dekanoaat, te ondersoek. Die studie was 'n prospektiewe, nie-ewekansige, enkel middel, oop studie van 58 deelnemers met FEP, wat oor „n tydperk van 12 maande volgens 'n spesifieke protokol behandel is. Daar was 'n uitwas periode van 7 dae, waartydens alle psigotrope medikasie gestaak is. Hierna is behandeling met orale flupentiksol 1mg/dag begin vir een week, waarna flupentiksol dekanoaat geinisieer is teen 10mg intramuskulêr elke 2de week. Dosisverhogings, in geval van onvoldoende respons, was toelaatbaar met 6-weeklikse tussenposes, in inkremente van 10mg per inspuiting, tot 'n maksimum van 30mg elke 2de week. Die vernaamste bevindinge van die studie was soos volg: Die meerderheid van die deelnemers was ernstig siek, met beduidende kognitiewe inkorting tydens basislyn evaluasie. Daar was 'n verskil tussen subjektief-gerapporteerde en objektief-meetbare kognitiewe inkorting. Die meerderheid van die deelnemers het goed reageer op behandeling en het ook remissie op 'n baie lae dosis flupentiksol dekanoaat (22.48 ± 0.47mg/maand), bereik. Die meerderheid van simptomatiese en kognitiewe verbetering het plaasgevind binne die eerste 3 maande, met afplatting in die tempo en hoeveelheid van verbetering vanaf 6 maande. Sosiale kognisie het nie beduidend gedurende die studieperiode verbeter nie. Funksionele uitkoms en lewenskwailiteit van deelnemers het ook met behandeling verbeter. Flupentiksol dekanoaat is goed verdra en die newe-effekte, indien dit teenwoordig was, was van ligte graad en verbygaande aard. Hierdie studie herbevestig dat individue met FEP beduidende kognitiewe inkorting by basislyn ervaar, maar dat hierdie inkortings effektief met 'n baie lae dosis van flupentiksol dekanoaat behandel kan word. Die gebruik van depot flupentiksol is 'n suksesvolle manier om volgehoue behandeling te verseker en sodoende die risiko vir terugvalle te verminder. Dit verstewig dus die hoop op beter langtermyn funksionering vir persone met psigotiese siektes.

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

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.

BACKGROUND: Idiopathic psychotic disorders, which include schizophrenia, schizoaffective and bipolar disorder with psychosis, are debilitating disorders affecting about 3% of the world’s population. Neurodevelopmental and neurodegenerative hypotheses have been proposed in psychosis, but the literature is mixed in regards to whether psychosis pathogenesis involves one or both of these processes. Since the visual system matures early in development, studying visual pathway abnormalities stratified by disease onset may further inform our understanding of psychosis pathogenesis. OBJECTIVE: The objective of this thesis is to determine whether disease onset, independent of illness duration, has a differential effect on visual cortical abnormalities in psychosis. We examined visual cortical measures for thickness, surface area, and volume using a pseudo-longitudinal study design of first episode psychosis-schizophrenia (FEP-SZ), FEP-non-schizophrenia (FEP-NSZ), early onset psychosis (EOP, <15 years of age), adult onset psychosis (OP, >15 and <30 years of age), and late onset psychosis (LOP, >30 years of age) groups. Relationships between visual cortical metrics and clinical or functional outcomes were performed. METHODS: The FEP sample (n= 102) included healthy controls (n= 44), FEP-SZ (n= 36), and FEP-NSZ (n= 22). The chronic psychosis data included healthy controls (n= 311) and psychosis probands (n=510). Psychosis probands was stratified by disease onset: EOP (n=213), OP (n=257), and LOP (n=40). Propensity matching was performed to match healthy controls (HC) according to age, sex and race. Linear regression models were performed comparing the means of visual cortical measures between groups. Partial Spearman correlations controlling for confounding factors were performed between visual cortical regions and clinical data. For FEP, clinical outcomes were assessed using Clinical Global Impression scale (CGI), Scale of Positive Symptoms (SAPS), and Scale of Negative Symptoms (SANS). For onset groups, clinical and functional outcomes were assessed using Positive and Negative Syndrome Scale (PANSS), Montgomery–Åsberg Depression Rating Scale (MADRS), Brief Assessment of Cognition (BACS), Wecshler Memory Scale (WMS) spatial span, anti-saccade error rates, dot expectancy pattern test, emotion recognition test, and Birchwood Social Functioning Scale (SFS). Multiple comparisons were performed using the Benjamini-Hochberg procedure. RESULTS: FEP-SZ was associated with smaller V1 and V2 areas, higher MT area and lower MT thickness compared to HCs. Lower MT thickness was associated with worse negative symptoms. Compared to HC, patients with chronic psychosis had lower V1, V2, and MT areas, as well as smaller MT thickness. V1 and V2 area and MT thickness were lower in the EOP group in comparison to matched HC. OP and LOP had a thinner MT region compared to matched HC. Of particular note, it was observed that EOP had greater area differences as compared to thickness reductions in the LOP group. Increased hallucinations and delusions were associated with a thinner MT region in the EOP group. CONCLUSION: When stratified by disease onset, FEP, EOP, OP, and LOP appear to have different pathogenic mechanisms and the severity of visual cortex neuroanatomical abnormalities are dependent on when the disease onset occurs. EOP occurs earlier in neurodevelopment resulting in greater severity in symptom and visual cortical measures as compared to OP. On the contrary, LOP appears to have a neurodegenerative mechanism which is evidenced by accelerated visual cortical thinning. / 2022-06-01T00:00:00Z

Indiana University-Purdue University Indianapolis (IUPUI) / Aim: Early psychosis has been identified as period during which rapid identification and treatment can lead to significant improvement in clinical and functional outcomes. Despite increased research, no studies have examined early psychosis in Veteran populations. It is unknown whether Veterans differ from non-Veterans at this stage of the disorder, and if the treatments offered to non-Veterans are appropriate to implement in Veteran Affairs Medical Centers. Given differences that appear between Veterans and non-Veterans in chronic psychosis, additional work is necessary to determine the best way to approach specialized treatment for Veterans experiencing early psychosis. Methods: The current study is a secondary analysis of assessment batteries collected at a community-based early intervention program and at a local Veteran Affairs Medical Center. Assessment results were compared for Veterans’ and non-Veterans’ background characteristics, symptoms, and neurocognitive deficits. Results: Significant differences were found between the two samples on age of illness onset, marital status, education level, positive symptoms of psychosis, and neurocognitive functioning. Logistic regression analyses identified age of onset as a potential underlying factor. Conclusions: While some aspects of illness presentation appear similar between Veterans and non-Veterans, there are important differences between these populations. Pre-existing treatment interventions, such as Social Skills Training, cognitive remediation approaches and cognitive behavior therapy for psychosis may be appropriate to implement with Veterans. Others– such as family based interventions or supported employment services – may need to be tailored to maximize the benefit for Veterans.

In the last decade, many first-episode psychosis programs have been developed in the United States and elsewhere. First-episode psychosis typically affects adolescents and young adults. These programs, therefore, emphasize early intervention to alter long-term consequences and address specific needs of the affected population. Open Dialogue, which has shown promise in Finnish studies, is one such program that is gaining popularity outside of Finland. The program emphasizes active involvement of family and collaborative decision making. The three studies in this dissertation elucidate how Open Dialogue can contribute to current treatment options and describe considerations in adaptation and implementation of Open Dialogue in the United States. The Promoting Action on Research Implementation in Health Services (PARiHS) framework describing the role of evidence, context, and facilitation in successful implementation provides the theoretical basis for these studies. Study One is a systematic scoping review of the literature describing first-episode psychosis programs. Study Two is a qualitative study of stakeholder experiences in a pilot study of the Open Dialogue model in the United States. It examines perceived usefulness, contextual support, and factors facilitating participation. Study Three examines organizational characteristics that supported implementation at the agency where the program was piloted in the United States. The scoping review of first-episode psychosis programs indicates a need for further research regarding their long-term benefits, optimal duration and intensity, and critical components. Family intervention appears to be beneficial, suggesting that the Open Dialogue approach to family support might be a valuable addition warranting further investigation. Stakeholders involved in the Open Dialogue pilot identified several unique and beneficial features of the approach, focusing particularly on the value of family involvement, transparency, respectfulness, and collaborative nature of the approach. The compatibility of the Open Dialogue model with agency values, strong leadership support and vision, alongside organizational capacity to deliver the services emerge as critical factors in successful implementation of the model in the pilot study. As per the PARiHS framework, contextual factors, particularly funding of this model of services in the United States healthcare environment are key determinants to address for the future implementation of Open Dialogue in the United States. / 2019-12-31T00:00:00Z