Skip to main content

Advertisement

SpringerLink
Log in

Predictors of functional status at service entry and discharge among young people with first episode psychosis

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients with poor functioning and the features influencing functional status over time may pave the way to better treatment.

Method

A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status).

Results

52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functioning and education, and were more likely to have self-reported histories of learning disability, forensic issues, traumatic experiences and substance use. At service entry, they had more severe symptoms and poorer global functioning. 37% of these patients maintained a poor functional status at discharge, and 18% of those with a good functional status at service entry experienced a decline.

Conclusions

Although psychosocial interventions might assist a young person with FEP with working towards functional goals, for some, the impact of factors such as ongoing substance use and forensic issues on functional status needs to be addressed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Schizophrenia was the reference category in the logistic regression. Those with schizoaffective disorders had significantly better outcomes than those with schizophrenia. The same result was found when comparing schizophrenia to bipolar disorder.

References

  1. Rinaldi M, Killackey E, Smith J, Shepherd G, Singh SP, Craig T (2010) First episode psychosis and employment: a review. Int Rev Psychiatry 22:148–162

    Article  PubMed  Google Scholar 

  2. Bond GR, Drake RE, Luciano A (2016) Employment and educational outcomes in early intervention programmes for early psy-chosis: a systematic review. Epidemiol Psychiatr Sci 24:446–457

    Article  Google Scholar 

  3. Killackey E, Jackson HJ, McGorry PD (2008) Vocational intervention in first episode psychosis: individual placement and support versus treatment as usual. Br J Psychiatry 193:114–120

    Article  PubMed  Google Scholar 

  4. Marwaha S, Johnson S (2004) Schizophrenia and employment. A review. Soc Psychiatry Psychiatr Epidemiol 39:337–349

    Article  PubMed  Google Scholar 

  5. Dewa CS, Trojanowski L, Cheng C, Loong D (2012) Examining the factors associated with paid employment of clients enrolled in first episode of psychosis programs. Schizophr Res Treatment 2012:739616. doi:10.1155/2012/739616

    Article  PubMed  PubMed Central  Google Scholar 

  6. Norman RMG, Malla AK, Manchanda R, Windell D, Harricharan R, Takhar J, Northcott S (2007) Does treatment delay predict occupational functioning in first episode psychosis. Schizophr Res 91:259–262

    Article  PubMed  Google Scholar 

  7. Goulding SM, Chien VH, Compton MT (2010) Prevalence and correlates of school drop-out prior to initial treatment of non-affective psychosis: further evidence suggesting a need for supported education. Schizophr Res 116:228–233

    Article  PubMed  Google Scholar 

  8. Tapfumaneyi A, Johnson S, Joyce J, Major B, Lawrence J, Mann F, Chisholm B, Ra-haman N, Wooley J HF (2015) Predictors of vocational activity over the first year in inner-city early intervention in psychosis services. Early Interv Psychiatry 9:447–458

    Article  PubMed  Google Scholar 

  9. Turner N, Browne S, Clarke M, Gervin M, Larkin C, Waddington JL, O’Callaghan E (2009) Employment status amongst those with psychosis at first presentation. Soc Psychiatry Psychiatr Epidemiol 44:863–869

    Article  PubMed  Google Scholar 

  10. Chang WC, Man Tang JY, Ming Hui CL, Wa Chan SK, Ming Lee EH, Hai Chen EY (2014) Clinical and cognitive predictors of vocational outcome in first-episode schizophrenia: a prospective 3 year follow-up study. Psychiatry Res 220:834–839

    Article  Google Scholar 

  11. Ramsay C, Stewart T, Compton MT (2012) Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a US sample. Soc Psychiatry Psychiatr Epidemiol 47:797–803

    Article  PubMed  Google Scholar 

  12. Dickerson FB, Stallings C, Origoni A, Boronow JJ, Sullens A, Yolken RH (2007) The association between cognitive functioning and occupational status in persons with a recent onset of psychosis. J Nerv Ment Dis 195:566–571

    Article  PubMed  Google Scholar 

  13. Tandberg M, Ueland T, Andreassen A, Sundet K, Melle I (2012) Factors associated with occupation and academic status in patients with first-episode psychosis with a particular focus on neurocognition. Soc Psychiatry Psychiatr Epidemiol 47:1763–1773

    Article  PubMed  Google Scholar 

  14. Malla AK, Norman RMG, Manchanda R, Ahmed MR, Scholten D, Harricharan R, Cortese L, Takhar J (2002) One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophr Res 54:231–242

    Article  PubMed  Google Scholar 

  15. Dudley R, Nicholson M, Stott P, G S (2014) Improving vocational outcomes of service users in an early intervention in psychosis service. Early Interv Psychiatry 8:98–102

    Article  PubMed  Google Scholar 

  16. Drake RE, Bond GR, Goldman HH, Hogan MF, Karakus M (2016) Individual Placement and Support services boost employment for people with serious mental illness, but funding is lacking. Health Aff 35:1098–1105

    Article  Google Scholar 

  17. Killackey E, Allott K, Cotton S, Jackson HJ, Scutella R, Tseng Y-P, Borland J, Proffitt TM, Hunt S, Kay-Lambkin F, Chinnery G, Baksheev G, Alvarez-Jimenez M, McGorry PD (2013) A randomized controlled trial of vocational intervention for young people with first-episode psychois: method. Early Interv Psychiatry 7:329–337

    Article  PubMed  Google Scholar 

  18. Schimmelmann BG, Conus P, Cotton SM, Kupferschmid S, McGorry PD, Lambert M (2012) Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis. Eur Psychiatry 27:463–469

    Article  CAS  PubMed  Google Scholar 

  19. Cotton SM, Luxmoore M, Woodhead G, Albiston DD, Gleeson JFM, McGor ry PD (2011) Group programmes in early intervention services. Early Interv Psychiatry 5:259–266

    Article  PubMed  Google Scholar 

  20. Conus P, Cotton SM, Schimmelmann BG, McGorry PD, Lambert M (2007) The First-Episode Psychosis Outcome Study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patients. Early Interv Psychiatry 1(1):191–200

    Article  Google Scholar 

  21. Tohen M, Hennen J, Zarate CM, Baldessarini RJ, Strakowski SM, Stoll AL, Faedda GL, Suppes T, Gebre-Medhin P, Cohen BM (2000) Two-year syndromal and functional recovery in 219 cases of first episode major affective disorder with psychotic features. Am J Psychiatry 157(2):220–228

    Article  CAS  PubMed  Google Scholar 

  22. McGorry PD, Copolov DL, Singh BS (1990) Royal park multidiagnostic instrument for psychosis: part II. Development, reliabillity and validity. Schizophr Bull 16(3):517–536

    Article  CAS  PubMed  Google Scholar 

  23. Conus P, Cotton SM, Schimmelmann BG, McGorry PD, Lambert M (2010) Pre-treatment and outcome correlates of sexual and physical trauma in an epidemiological cohort of first episode psychosis patients. Schizophr Bull 36:1105–1114

    Article  PubMed  Google Scholar 

  24. Conus P, Cotton SM, Schimmelmann BG, Berk M, Daglas R, McGorry PD, Lambert M (2010) Pretreatment and outcome correlates of past sexual and physical trauma in 118 bipolar I disorder patients with a first episode of psychotic mania. Bipolar Disord 12:244–252

    Article  PubMed  Google Scholar 

  25. Marion-Veyron R, Lambert M, Cotton SM, Schimmelmann BG, Gravier B, McGorry PD, Conus P (2015) History of offending behavior in first episode psychosis patients: a marker of specific clinical needs and a call for early detection strategies among young offenders. Schizophr Res 161:163–168

    Article  PubMed  Google Scholar 

  26. Guy W (1976) ECDEC Assesment manual for psychopharmacology, revised. National Institute of Mental Health, Rockville

    Google Scholar 

  27. Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W (1997) Modification of the clinical global impressions (CGI) scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res 73(3):159–171

    Article  CAS  PubMed  Google Scholar 

  28. Conus P, Lambert M, Cotton S, Bonsack C, McGorry PD, Schimmelmann BG (2010) Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort. Schizophr Res 118:256–263

    Article  PubMed  Google Scholar 

  29. Robinson DG, Woerner MG, Alvir JM, Bilder RM, Hinrichsen GA, Lieberman JA (2002) Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder. Schizophr Res 57:209–219

    Article  PubMed  Google Scholar 

  30. Malla AK, Norman R, Joober R (2005) First-episode psychosis, early intervention, and outcome: What have we learned. Can J Psychiatry 50(14):881–891

    PubMed  Google Scholar 

  31. Rabinowitz J, De Smedt G, Harvey PD, Davidson M (2002) Relationship between premorbid functioning and symptom severity as assessed at first episode of psychosis. Am J Psychiatry 159:2021–2026

    Article  PubMed  Google Scholar 

  32. Cannon TD, Bearden CE, Hollister JM, Rosso IM, Sanchez LE, Hadley T (2000) Childhood cognitive functioning in schizophrenia patients and their unaffected siblings: a prospective cohort study. Schizophr Bull 26:379–393

    Article  CAS  PubMed  Google Scholar 

  33. Brewer WJ, Francey SM, Wood SJ, Jackson HJ, Pantelis C, Phillips LJ, Yung AR, Anderson VA, McGorry PD (2005) Memory impairments identified in people at ultra-high risk for psychosis who later develop first-episode psychosis. Am J Psychiatry 162:71–78

    Article  PubMed  Google Scholar 

  34. Bilder RM, Reiter G, Bates J, Lencz T, Szesko P, Goldman RS, Robinson D, Lieberman JA, Kane JM (2006) Cognitive development in schizophrenia: follow-back from the first episode. J Clin Exp Neuropsychol 28:270–282

    Article  PubMed  Google Scholar 

  35. Rund BR, Melle I, Friis S, Johannesen JO, Larsen TK, Midboe LJ, Opjordsmoen S, Simonsen E, Vaglum P, McGlashan T (2007) The course of neurocognitive functioning in first-episode psychosis and its relation to premorbid adjustment, duration of untreated psychosis, and relapse. Schizophr Res 91:132–140

    Article  PubMed  Google Scholar 

  36. Large MM, Nielssen O (2011) Violence in first-episode psychosis: a systematic review and meta-analysis. Schizophr Res 125:209–220

    Article  PubMed  Google Scholar 

  37. Ramsay C, Flanagan P, Gantt S, Broussard B, Compton MT (2011) Clinical correlates of maltreatment and traumatic experiences in childhood and adolescence among predominantly African American, socially disadvantaged, hospitalized, first-episode psychosis patients. Psychiatry Res 188:343–349

    Article  PubMed  PubMed Central  Google Scholar 

  38. Compton MT, Furman AC, Kaslow NJ (2004) Preliminary evidence of an association between childhood abuse and cannabis dependence among African American first episode schizophrenia-spectrum disorder patients. Drug Alcohol Depend 76:311–316

    Article  PubMed  Google Scholar 

  39. Allott K, Cotton S, Chinnery G, Baksheev G, Massey J, Sun P, Collins Z, Barlow E, Broussard C, Wahid T, Proffit T, Jackson H, Killackey E (2013) The relative contribution of neurocognition and social cognition to 6-month vocational outcomes following individual placement and support in first episode psychosis. Schizophr Res 150:136–143

    Article  PubMed  Google Scholar 

  40. Garety PA, Craig TKJ, Dunn G, Fornells-Ambrojo M, Colbert S, Rahaman N, Read J, Power P (2006) Specialised care for early psychosis: symptoms, social functioning and patient statisfaction: randomised controlled trial. Br J Psychiatry 188:37–45

    Article  PubMed  Google Scholar 

  41. Menezes NM, Arenovich T, Zipursky RB (2006) A systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med 36:1349–1362

    Article  CAS  PubMed  Google Scholar 

  42. Killackey E, Jackson HJ, Gleeson J, Hickie I, McGorry PD (2006) Exciting career opportunity beckons! Early Intervention and vocational rehabilitation in first episode psychosis: employing cautious optimism. Aust NZ J Psychiatry 40:951–960

    Article  Google Scholar 

  43. Lehman AF, Goldberg R, Dixon L, McNary S, Postrado L, Hackman A, McDonnell K (2002) Improving employment outcomes for persons with severe mental illnesses. Arch Gen Psychiatry 59:165–172

    Article  PubMed  Google Scholar 

  44. Abdel-Baki A, Ouellet-Plamondon C, Salvat E, Grar K, Potvin S (2017) Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program. Psychiatry Res 247:113–119

    Article  PubMed  Google Scholar 

  45. Kerfoot KE, Rosenheck RA, Petrakis IL, Swartz S, Keefe RSE, McEvoy JP, Stroup TS (2011) Substance use and schizophrenia: adverse correlates in the CATIE study sample. Schizophr Res 132:177–182

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orygen, The National Centre of Excellence in Youth Health, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia

    S. M. Cotton, K. Filia, V. Rayner, D. L. Foley, A. Ratheesh, A. Watson, P. Rodger & P. D. McGorry

  2. Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia

    S. M. Cotton, K. Filia, V. Rayner, D. L. Foley, A. Ratheesh, A. Watson, P. Rodger & P. D. McGorry

  3. Department of Psychiatry and Psychotherapy, Psychosis Centre, Centre of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    M. Lambert

  4. University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland

    B. G. Schimmelmann

  5. School of Psychology, University of Queensland, Brisbane, Australia

    L. Hides

  6. Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Clinique de Cery, Université de Lausanne, 1008, Prilly, Switzerland

    P. Conus

Authors
  1. S. M. Cotton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Lambert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. G. Schimmelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Filia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. Rayner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Hides
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. L. Foley
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Ratheesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Rodger
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P. D. McGorry
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P. Conus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. M. Cotton.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cotton, S.M., Lambert, M., Schimmelmann, B.G. et al. Predictors of functional status at service entry and discharge among young people with first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 52, 575–585 (2017). https://doi.org/10.1007/s00127-017-1358-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-017-1358-0

Keywords

Search

Navigation