Predictors of Symptom Severity and Functioning in First Episode Psychosis

  • Anvar SadathEmail author
  • D. Muralidhar
  • Shivarama Varambally
  • B. N. Gangadhar
Original Article


There is dearth of studies on the role of critical socio-demographic and clinical variables on psychopathology and functional outcome in persons with first episode psychosis (FEP), especially from lower and middle income countries. Therefore, we studied the predictors of psychiatric symptom severity and socio-occupational dysfunction among persons with non-affective FEP in India. Using multiple linear regression models, we examined the role of gender, previous admission, psychiatric co-morbidity, duration of psychosis, and duration of untreated psychosis (DUP) on psychiatric symptom severity and socio-occupational dysfunction among 71 persons with non-affective FEP. The participants were recruited from a tertiary mental health center in South India. The Brief psychiatric Rating Scale (BPRS) and Social Occupational Functioning Scale (SOFS) were used measure symptom severity and socio-occupational dysfunction respectively. Gender (male), presence of co-morbid psychiatric illness, higher duration of psychosis, and longer DUP significantly increased psychiatric symptoms and socio-occupational dysfunction. The independent variables predicted 40% variance on psychiatric symptoms and 37% variance on socio-occupational dysfunction. Both regression models were significant at p < 0.001 level. The study is helpful to understand the common predictors of symptoms and functioning in FEP. However, future studies need to examine the role of other critical mediating variables on psychopathology and functions to evolve a comprehensive pathway model.


First episode psychosis Non-affective psychosis Psychiatric symptoms Socio-occupational dysfunction 


  1. 1.
    Addington J, van Mastrigt S, Addington D. Patterns of premorbid functioning in first-episode psychosis: initial presentation. Schizophr Res. 2003;62(1):23–30.PubMedGoogle Scholar
  2. 2.
    Gómez-de-Regil L, Kwapil TR, Blanqué JM, Vainer E, Montoro M, Barrantes-Vidal N. Predictors of outcome in the early course of first-episode psychosis. Eur J Psychiatry. 2010;24(2):87–97.Google Scholar
  3. 3.
    Remschmidt H, Theisen F. Early-Onset Schizophrenia1. Neuropsychobiology. 2012;66(1):63–9.PubMedGoogle Scholar
  4. 4.
    Malla A, Payne J. First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull. 2005;31(3):650–71.PubMedGoogle Scholar
  5. 5.
    Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry. 2005;62(9):975–83.PubMedGoogle Scholar
  6. 6.
    Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. NPJ Schizophr. 2015;1:14005.Google Scholar
  7. 7.
    Haas G, Garratt L, Sweeney J. Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. J Psychiatr Res. 1998;32(3–4):151–9.PubMedGoogle Scholar
  8. 8.
    Shrivastava A, Shah N, Johnston M, Stitt L, Thakar M, Chinnasamy G. Effects of duration of untreated psychosis on long-term outcome of people hospitalized with first episode schizophrenia. Indian J Psychiatry. 2010;52(2):164–7.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Iyer SN, Mangala R, Thara R, Malla AK. Preliminary findings from a study of first-episode psychosis in Montreal, Canada and Chennai, India: comparison of outcomes. Schizophr Res. 2010;121(1–3):227–33.PubMedGoogle Scholar
  10. 10.
    Sadath A, Muralidhar D, Varambally S, Gangadhar B, Jose JP. Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis. Asian J Psychiatr. 2017;25:163–8.PubMedGoogle Scholar
  11. 11.
    Sadath A, Muralidhar D, Varambally S, Jose JP, Gangadhar BN. Caregiving and help seeking in first episode psychosis: a qualitative study. J Psychosoc Rehabil Ment Health. 2014;1(2):47–53.Google Scholar
  12. 12.
    Saravanan B, Jacob K, Johnson S, Prince M, Bhugra D, David AS. Outcome of first-episode schizophrenia in India: longitudinal study of effect of insight and psychopathology. Br J Psychiatry. 2010;196(6):454–9.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Iyer SN, Loohuis H, Pawliuk N, Joober R, Malla AK. Concerns reported by family members of individuals with first-episode psychosis. Early Interv Psychiatry. 2011;5(2):163–7.PubMedGoogle Scholar
  14. 14.
    Chand P, Thirthalli J, Murthy P. Substance use disorders among treatment naïve first-episode psychosis patients. Compr Psychiatry. 2014;55(1):165–9.PubMedGoogle Scholar
  15. 15.
    Jilani AQ, Saha R, Dalal PK, Kallivayalil RA, Tiwari A, Kar SK. The impact of awareness of psychotic disorder on pathways to psychiatric care for first episode psychosis in India. Int J Cult Ment Health. 2017:1–16.Google Scholar
  16. 16.
    Bambole V, Shah N, Sonavane S, Johnston M, Shrivastava A. Study of negatives symptoms in first episode schizophrenia. Open J Psychiatry. 2013;3(03):323.Google Scholar
  17. 17.
    Sadath A, Muralidhar D, Varambally S, Gangadhar BN. Does group intervention have benefits on expressed emotion and social support in carers of persons with first episode psychosis? Soc Work Ment Health. 2017;15(5):524–37.Google Scholar
  18. 18.
    Sadath A, Muralidhar D, Varambally S, Justin J, Gangadhar BN. Effectiveness of Group Intervention for Caregivers of Persons with First Episode Psychosis. Eur Psychiatry 2015;30:856.Google Scholar
  19. 19.
    WHO. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. 1992.Google Scholar
  20. 20.
    Breitborde NJ, Srihari VH, Woods SW. Review of the operational definition for first-episode psychosis. Early Interv Psychiatry. 2009;3(4):259–65.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Craig TK, Garety P, Power P, Rahaman N, Colbert S, Fornells-Ambrojo M, et al. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ. 2004;329(7474):1067.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Castro-Fornieles J, Parellada M, Gonzalez-Pinto A, Moreno D, Graell M, Baeza I, et al. The child and adolescent first-episode psychosis study (CAFEPS): design and baseline results. Schizophr Res. 2007;91(1):226–37.PubMedGoogle Scholar
  23. 23.
    Sadath A, Muralidhar D, Varambally S, Jose JP, Gangadhar BN. Family intervention in first-episode psychosis. SAGE Open. 2015;5(4):2158244015613108.Google Scholar
  24. 24.
    Coentre R, Levy P, Figueira ML. Early intervention in psychosis: first-episode psychosis and critical period. Acta Med Port. 2011;24(1):117–26.PubMedGoogle Scholar
  25. 25.
    Strakowski SM, Tohen M, Stoll AL, Faedda GL, Mayer PV, Kolbrener ML, et al. Comorbidity in psychosis at first hospitalization. Am J Psychiatry. 1993;150:752.PubMedGoogle Scholar
  26. 26.
    Saraswat N, Rao K, Subbakrishna D, Gangadhar B. The Social Occupational Functioning Scale (SOFS): a brief measure of functional status in persons with schizophrenia. Schizophr Res. 2006;81(2):301–9.PubMedGoogle Scholar
  27. 27.
    Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962;10(3):799–812.Google Scholar
  28. 28.
    Malhotra S, Shah R. Women and mental health in India: an overview. Indian J Psychiatry. 2015;57(Suppl 2):S205–11.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Das M, Angeli F, Krumeich AJ, van Schayck OC. The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India. Int J Equity Health. 2018;17(1):24.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Hindin MJ. Women’s power and anthropometric status in Zimbabwe. Soc Sci Med. 2000;51(10):1517–28.PubMedGoogle Scholar
  31. 31.
    Doan RM, Bisharat L. Female autonomy and child nutritional status: the extended-family residential unit in Amman, Jordan. Soc Sci Med. 1990;31(7):783–9.PubMedGoogle Scholar
  32. 32.
    Borooah VK. Gender bias among children in India in their diet and immunisation against disease. Soc Sci Med. 2004;58(9):1719–31.PubMedGoogle Scholar
  33. 33.
    Al-Krenawi A, Graham JR. Gender and biomedical/traditional mental health utilization among the Bedouin-Arabs of the Negev. Cult Med Psychiatry. 1999;23(2):219–43.PubMedGoogle Scholar
  34. 34.
    Vlassoff C. Gender inequalities in health in the third world: uncharted ground. Soc Sci Med. 1994;39(9):1249–59.PubMedGoogle Scholar
  35. 35.
    Thirthalli J, Channaveerachari NK, Subbakrishna DK, Cottler LB, Varghese M, Gangadhar BN. Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India. Indian J Psychiatry. 2011;53(4):319–23.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Qin H, Zhang J, Wang Z, Min H, Yan C, Chen F, et al. Duration of untreated psychosis and clinical outcomes of first-episode schizophrenia: a 4-year follow-up study. Shanghai Arch Psychiatry. 2014;26(1):42–8.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Sim K, Swapna V, Mythily S, Mahendran R, Kua EH, McGorry P, et al. Psychiatric comorbidity in first episode psychosis: the Early Psychosis Intervention Program (EPIP) experience. Acta Psychiatr Scand. 2004;109(1):23–9.PubMedGoogle Scholar
  38. 38.
    Heitz U, Cherbuin J, Menghini-Müller S, Egloff L, Ittig S, Beck K, et al. Comorbidities in patients with an at-risk mental state and first episode psychosis. Eur Psychiatry. 2017;41(Supplement):S198.Google Scholar
  39. 39.
    Strakowski SM, Keck PE Jr, McElroy SL, Lonczak HS, West SA. Chronology of comorbid and principal syndromes in first-episode psychosis. Compr Psychiatry. 1995;36(2):106–12.PubMedGoogle Scholar
  40. 40.
    Berge D, Mane A, Salgado P, Cortizo R, Garnier C, Gomez L, et al. Predictors of relapse and functioning in first-episode psychosis: a two-year follow-up study. Psychiatric. 2016;67(2):227–33.Google Scholar
  41. 41.
    Sadath A, Kumar S, Mathew S. Sociodemographic Predictors of Psychiatric Disability in India. J Psychosoc Rehabil Ment Health. 2017;4(1):29–33.Google Scholar
  42. 42.
    Rabinowitz J, De Smedt G, Harvey PD, Davidson M. Relationship between premorbid functioning and symptom severity as assessed at first episode of psychosis. Am J Psychiatry. 2002;159(12):2021–6.PubMedGoogle Scholar
  43. 43.
    Thorup A, Petersen L, Jeppesen P, Ohlenschlæger J, Christensen T, Krarup G, et al. Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. J Nerv Ment Dis. 2007;195(5):396–405.PubMedGoogle Scholar
  44. 44.
    Gonzalez-Rodriguez A, Studerus E, Spitz A, Bugra H, Aston J, Borgwardt S, et al. Gender differences in the psychopathology of emerging psychosis. Israel J Psychiatry Relat Sci. 2014;51(2):85–92.Google Scholar
  45. 45.
    Barajas A, Banos I, Ochoa S, Usall J, Villalta V, Dolz M, et al. Age of onset of a first psychotic episode: are there any clinical differences between men and women? Psiquiatria Biologica. 2007;14(4):136–41.Google Scholar
  46. 46.
    Häfner H, Riecher A, Maurer K, Fätkenheuer B, Löffler W, Munk-Jørgensen P, et al. Sex differences in schizophrenic diseases. Fortschr Neurol Psychiatr. 1991;59(9):343–60.PubMedGoogle Scholar
  47. 47.
    Häfner H, Maurer K, Löffler W, An der Heiden W, Munk-Jørgensen P, Hambrecht M, et al. The ABC Schizophrenia Study: a preliminary overview of the results. Soc Psychiatry Psychiatr Epidemiol. 1998;33(8):380–6.PubMedGoogle Scholar
  48. 48.
    Hagen K, Solem S, Larsen TK, Joa I, Kvale G, Hansen B. Obsessive Compulsive Disorder (OCD) in Patients with First Episode Psychosis (FEP): a Prospective Study. Clin Neuropsychiatry. 2014;11(6):164–69.Google Scholar
  49. 49.
    Sim K, Mahendran R, Chong SA. Health-related quality of life and psychiatric comorbidity in first episode psychosis. Compr Psychiatry. 2005;46(4):278–83.PubMedGoogle Scholar
  50. 50.
    Chang WC, Hui CL, Tang JY, Wong GH, Chan SK, Lee EH, et al. Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study. Psychol Med. 2013;43(9):1883–93.PubMedGoogle Scholar
  51. 51.
    Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–804.PubMedGoogle Scholar
  52. 52.
    Barnes TR, Leeson VC, Mutsatsa SH, Watt HC, Hutton SB, Joyce EM. Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia. Br J Psychiatry. 2008;193(3):203–9.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer (India) Private Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Anvar Sadath
    • 1
    Email author
  • D. Muralidhar
    • 2
  • Shivarama Varambally
    • 3
  • B. N. Gangadhar
    • 3
  1. 1.Department of PsychiatryGovernment Medical CollegeKollamIndia
  2. 2.Department of Psychiatric Social WorkNational Institute of Mental Health and Neuro-SciencesBangaloreIndia
  3. 3.Department of PsychiatryNational Institute of Mental Health and Neuro-SciencesBangaloreIndia

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