Examining disorganization in patients with first episode psychosis: Findings from a 1‐year follow‐up of the ‘Parma early psychosis’ program

Abstract

Aim: Disorganization has been considered as a clinical domain close to the core of psychosis. However, it has received poor attention, especially at the illness onset. Moreover, most of the studies examining disorganized symptoms have been conducted in patients with chronic psychosis and research in the early stages of illness is still relatively scarce. Thus, the aims of this study were (a) to longitudinally monitor the stability of disorganization in patients with first episode psychosis (FEP) across a 1-year follow-up period, and (b) to investigate any relevant association of disorganized symptoms with functioning, psychopathology and the specific treatment components of an 'early intervention in psychosis' (EIP) program along the 1 year of follow-up.Methods: At baseline, 312 FEP participants (aged 12-35 years) completed the positive and negative syndrome scale (PANSS) and the global assessment of functioning (GAF). Spearman's correlations and multiple linear regression analysis were used.Results: At baseline, disorganization showed significant associations with all PANSS subscores, and a relevant negative correlation with GAF score. Across the follow-up, FEP individuals showed a significant improvement in disorganization severity. This decrease was specifically related to both baseline antipsychotic dosage and the number of individual cognitive-behavioural therapy sessions offered across the 1-year follow-up period.Conclusions: Disorganization is clinically relevant in FEP patients, already ate the enrollment in an EIP program. However, it tends to improve over time together with the delivery of specialized, person-tailored FEP interventions within a specific EIP protocol.

Correlations between Negative Symptoms and Cognitive Deficits in Individuals at First Psychotic Episode or at High Risk of Psychosis: A Systematic Review

“…As found in the FEP population, and also in HR subjects, NS severity seemed not to correlate with ViLM impairment [124,128,130], but the quality of evidence was poor for most studies [128,130]. Finally, our literature search retrieved few, inconsistent, and potentially biased data on the relationship between NS with VF [125,127,129], EF [31,129,130], and SC [126,127,131].…”

“…Among the studies on first-episode psychosis, nine were categorized as being of good methodological quality [104][105][106][107][108][109][110][111][112][113], six studies as being of an average methodological quality [78,[114][115][116][117][118], and five as being of poor methodological quality [68,[119][120][121][122]. In relation to studies on the clinical high-risk population, only one study was categorized as being of good methodological quality [123], while three studies were categorized as being of average methodological quality [31,124,125], and seven studies as being of poor methodological quality [126][127][128][129][130][131][132].…”

“…The 11 studies focusing on HR populations applied the following criteria to define the risk of psychosis: six studies applied the Structured Interview for Psychosis-Risk Syndromes (SIPS) criteria [124,[126][127][128]130,132], two studies applied The Comprehensive Assessment of At-Risk Mental States (CAARMS) criteria [123,131], one study used both the Structured Interview for Psychosis-Risk Syndromes (SIPS) and the CAARMS to enroll subjects [125], one study applied the Basel Screening Instrument for Psychosis (BSIP) [129], and one applied the following operational criteria, (a) Brief Limited Psychotic Symptoms (BLIPS), (b) attenuated psychotic symptoms assessed by using the Brief Psychiatric Rating Scale-Expanded, and (c) family risk with reduced function, which was defined as having both a first-degree family member with a psychotic disorder or schizotypal personality disorder and functional impairment defined as a decrease of at least 30 points on the Global Assessment of Functioning scale [31].…”

“…Seven out of eleven studies carried out in HR subjects used rating scales specifically developed for this population [125][126][127][128][130][131][132], while three studies used the SANS [31,123,129] (Table 3). Most studies used the SIPS, which includes social anhedonia, avolition, the expression of emotion, the experience of emotions and self, ideational richness, and also occupational functioning; the last two aspects are not conceptualized as negative symptoms, and the latter one clearly overlaps with the role of functioning.…”

“…-Poor: [127,131] Range of correlation coefficients, number of studies reporting significant correlations/total number of studies investigating the relationship, and assessed methodological quality for each study reporting a significant correlation between NS total score and cognitive impairment in HR subjects.…”