Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment

Abstract

Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.

Dimensional structure of first episode psychosis

“…Consistent with Cocchi et al () and Subramaniam et al (), a two‐step cluster analysis was subsequently performed on the factors resulting from the EFA. The extracted cluster was then compared on the main socio‐demographic and clinical features with ANOVAs for continuous variables and χ 2 for categorical ones.…”

“…Other research adopted a categorical approach or recruited chronic or institutionalized patients (Kendler, Karkowski, & Walsh, 1998). Some other studies (Cocchi et al, 2014) included clinical features other than symptoms, such as recovery and chronicity that are predicted by diagnostic criteria, thus enhancing a circular definition of disorder. Finally, in other research (Subramaniam et al, 2016) psychopathological evaluation was not comprehensive with a major focus on socio-demographic characteristics.…”

Needs of individuals recovering from a first episode of mental illness: A scoping review

“…In other areas of health care, it has been suggested that the predictive value of needs could be calculated to more efficiently evaluate and address them (Maguire et al 2013, p. 462). Regardless of whether such a systematic approach is used, results of this review reiterate the importance of acknowledging that individuals who experience a first episode of mental illness are not a homogenous population (Cocchi et al 2014) and may not experience the same course of needs. When addressing the second research question, it is evident that the assessment tools that have been used to evaluate the needs of individuals recovering from a first episode of mental illness are inadequately equipped to accomplish this task holistically.…”

“…Regardless of whether such a systematic approach is used, results of this review reiterate the importance of acknowledging that individuals who experience a first episode of mental illness are not a homogenous population (Cocchi et al . ) and may not experience the same course of needs.…”

Characterizing the inpatient care of young adults experiencing early psychosis: A medical record review

“…Delusions, hallucinations, disorganized thought and speech patterns and grossly disorganized or catatonic behaviour are domains of symptoms that define psychotic disorders (APA, 2013). Psychotic experiences tend to be unique among individuals as each person may present with different symptoms (Cocchi et al, 2013). Duration of episodes is also variable and symptoms may be periodic or persistent until treatment is received.…”