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Vulnerability to psychosocial disability in psychosis

  • S. L. Griffiths (a1), S. J. Wood (a1) (a2) (a3) and M. Birchwood (a4)

Abstract

Psychosocial disability affects a number of individuals with psychosis and often begins years before the formal onset of disorder. This suggests that for many, their psychosocial disability is enduring, and targeted interventions are therefore needed earlier in their developmental trajectories to ensure that psychosocial disability does not become entrenched. Poor psychosocial functioning also affects individuals with a range of different emerging mental health problems, putting these young people at risk of long-term social marginalisation and economic disadvantage; all of which are known risk factors for the development of psychosis. Identification of the markers of poor psychosocial functioning will help to inform effective treatments. This editorial will discern the early trajectories and markers of poor psychosocial outcome in psychosis, and highlight which individuals are most at risk of having a poor outcome. This editorial will also discuss whether early interventions are currently being targeted appropriately and will propose how intervention and preventative strategies can be implemented, to restore psychosocial trajectories in a way that enables young people to maximise their life chances.

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Corresponding author

Author for correspondence: Sian Lowri Griffiths, E-mail: s.l.griffiths@bham.ac.uk

References

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Addington, J and Addington, D (1993) Premorbid functioning, cognitive functioning, symptoms and outcome in schizophrenia. Journal of Psychiatry & Neuroscience 18, 1823.
Addington, J, Saeedi, H and Addington, D (2005) The course of cognitive functioning in first episode psychosis: changes over time and impact on outcome. Schizophrenia Research 78, 3543.
Addington, J, Saeedi, H and Addington, D (2006) Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. The British Journal of Psychiatry 189, 373378.
Addington, J, Liu, L, Buchy, L, Cadenhead, K, Cannon, T, Cornblatt, B, Perkins, D, Seidman, L, Tsuang, TM, Walker, EF, Woods, S, Bearden, C, Mathalon, D and McGlashan, T (2015) North American prodrome Longitudinal Study (NAPLS 2): the prodromal symptoms. Journal of Nervous and Mental Disease 203, 328335.
Adolphs, R (2009) The social brain: neural basis of social knowledge. Annual Review Psychology 60, 693716.
Agerbo, E, Byrne, M, Eaton, WW and Mortensen, PB (2004) Marital and labor market status in the long run in schizophrenia. Archives of General Psychiatry 61, 2833.
Allott, K, Liu, P, Proffitt, T-M and Killackey, E (2011) Cognition at illness onset as a predictor of later functional outcome in early psychosis: a systematic review and methodological critique. Schizophrenia Research 125, 221235.
Alvarez-Jimenez, M, Priede, A, Hetrick, SE, Bendall, S, Killackey, E, Parker, AG, McGorry, PD and Gleeson, GF (2012) Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophrenia Research 139, 116128.
Anda, RF, Felitti, VJ, Bremner, JD, Walker, JD, Whitfield, C, Perry, BD, Dube, SR and Giles, WH (2006) The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience 256, 174186.
Ayesa-Arriola, R, Manuel Rodríguez-Sánchez, J, Pérez-Iglesias, R, González-Blanch, C, Pardo-García, G, Tabares-Seisdedos, R, Vazquez-Barquero, JL and Crespo-Facorro, B (2013) The relevance of cognitive, clinical and premorbid variables in predicting functional outcome for individuals with first-episode psychosis: a 3 year longitudinal study. Psychiatry Research 209, 302308.
Barker, V, Gumley, A, Schwannauer, M and Lawrie, SM (2015) An integrated biopsychosocial model of childhood maltreatment and psychosis. The British Journal of Psychiatry 206, 177180.
Bartholomeusz, C and Allott, K (2012) Neurocognitive and social cognitive approaches for improving functional outcome in early psychosis: theoretical considerations and current state of evidence. Schizophrenia Research and Outcome 2012, 115.
Bartholomeusz, CF, Killackey, E, Thompson, A and Wood, SJ (2011) Interventions targeting social and vocational dysfunction in individuals with a schizophrenia spectrum disorder. In Ritsner, MS (ed., ), Handbook of Schizophrenia Spectrum Disorders. Vol. III. Dordrecht: Springer, pp. 173207.
Birchwood, M and MacMillan, J (1993) Early intervention in schizophrenia. Australian and New Zealand Journal of Psychiatry 27, 374378.
Birchwood, M, Todd, P and Jackson, C (1998) Early intervention in psychosis: the critical-period hypothesis. British Journal of Psychiatry Supplement 172, 5359.
Blakemore, S (2008) Development of the social brain during adolescence. The Quarterly Journal of Experimental Psychopathology 61, 4049.
Bond, GR, Drake, RE and Luciano, A (2014) Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiology and Psychiatric Sciences 24, 112.
Bremner, JD (2003) Long-term effects of childhood abuse on brain and neurobiology. Child and Adolescent Psychiatric Clinics of North America 12, 271–29.
Chung, YS, Kang, D, Shin, NY, Yoo, SY and Kwon, JS (2008) Deficits of Theory of Mind in individuals at ultra-high risk for Schizophrenia. Schizophrenia Research 99, 111118.
Cornblatt, BA, Auther, AM, Niendam, T, Smith, CW, Zinberg, J, Bearden, CE and Cannon, TD (2007) Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin 33, 688702.
Cornblatt, BA, Carrion, RE, Addington, J, Seidmen, L, Walker, EF, Cannon, TD, Cadenhead, KS, McGlashan, TH, Perkins, DO, Tsuang, MT, Wood, SW, Heinssen, R and Lencz, T (2012) Risk factors for psychosis: impaired social and role functioning. Schizophrenia Bulletin 38, 12471257.
Correll, CU, Galling, B, Pawar, A, Krivko, A, Bonetto, C, Ruggeri, M, Craig, TJ, Nordentofy, M, Srihari, VH, Guloksuz, S, Hui, CLM, Chen, EYH, Valencia, M, Juarez, F, Robinson, DG, Schooler, NR, Brunette, MF, Mueser, KT, Rosenheck, RA, Marcy, P, Addington, J, Estroff, SE, Robinson, J, Penn, D, Severe, JB and Kane, JM (2018) Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry 75, 555565.
Cotter, J, Drake, RJ, Bucci, S, Firth, J, Edge, D and Yung, AR (2014) What drives poor functioning in the at-risk mental state? A systematic review. Schizophrenia Research 159, 267277.
Couture, SM, Penn, DL and Roberts, DL (2006) The functional significance of social cognition in schizophrenia: a review. Schizophrenia Bulletin 32, 4463.
Eurofound (2012) NEETs – Young People not in Employment, Education or Training: Characteristics, Costs and Policy Responses in Europe. Luxembourg: Publications Office of the European Union.
Fenton, SW and McGlashan, T (1994) Antecedents, symptom progression, and long-term outcome of the deficit syndrome in schizophrenia. The American Journal of Psychiatry 151, 351356.
Fett, A-K, Viechtbauer, W, Dominguez, M, Penn, DL, van Os, J and Krabbendam, L (2011) The relationship between neurocognition and social cognition with functional outcomes in psychosis. Neuroscience and Behavioural Reviews 35, 573588.
Fowler, D, Hodgekins, J, Painter, M, Reilly, T, Crane, C, Macmillan, I, Mugford, M, Croudace, T and Jones, PB (2009) Cognitive behaviour therapy for improving social recovery in psychosis: a report from the ISREP MRC Trial Platform study (Improving Social Recovery in Early Psychosis). Psychological Medicine 39, 16271636.
Fowler, D, Hodgekins, J, French, P, Marshall, M, Freemantle, N, McCrone, P, Everard, L, Lavis, A, Jones, PB, Amos, T, Singh, S, Sharma, V and Birchwood, M (2017) Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial. The Lancet Psychiatry 5, 4150.
Fusar-Poli, P, Byrne, M, Valmaggia, L, Day, F, Tabraham, P, Johns, L and McGuire, P (2010) Social dysfunction predicts two years clinical outcome in people at ultra-high risk for psychosis. Journal of Psychiatric Research 44, 294301.
Gladwell, D, Popli, G and Tsuchiya, A (2015) Estimating the impact of health on NEET status. Sheffield Economics Research Paper Series. Available at https://www.sheffield.ac.uk/economics/research/serps/articles/2015_016 (Accessed 20 May 2018).
Green, MF, Kern, RS, Braff, DL and Mintz, J (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophrenia Bulletin 26, 119136.
Hafner, H and an der Heiden, W (1999) The course of schizophrenia in the light of modern follow-up studies: the ABC and WHO studies. European Archives of Psychiatry and Clinical Neuroscience 249, 1426.
Heinz, A, Deserno, L and Reininghau, U (2013) Urbanicity, social adversity and psychosis. World Psychiatry 12, 187197.
Heinze, K, Lin, A, Nelson, B, Reniers, RLEP, Upthegrove, R, Clarke, L, Roche, A, Lowrie, A and Wood, SJ (2018). The impact of psychotic experiences in the early stages of mental health problems in young people. BMC Psychiatry 18, 214.
Hodgekins, J, Birchwood, M, Christopher, R, Marshall, M, Coker, S, Everard, L, Lester, H, Jones, P, Amos, T, Singh, S, Sharma, V, Freemantle, N and Fowler, D (2015 a) Investigating trajectories of social recovery in individuals with first episode psychosis: a latent class growth analysis. The British Journal of Psychiatry 207, 536543.
Hodgekins, J, French, P, Birchwood, M, Mugford, M, Christopher, R, Marshall, M, Everard, L, Lester, H, Jones, P, Amos, T, Singh, S, Sharma, V, Morrison, T and Fowler, D (2015 b) Comparing time use in individuals at different stages of psychosis and a non-clinical comparison group. Schizophrenia Research 161, 188193.
Iorfino, F, Hermens, DF, Cross, SPM, Zmicerevska, N, Nichles, A, Badcock, CA, Groot, J, Scott, EM and Hickie, IB (2018) Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study. British Medical Journal Open 8, 3.
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollbergh, W, de Graaf, R and van Os, J (2003) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandanavica 109, 3845.
Jeppesen, P, Petersen, L, Thorup, A, Abel, AB, Øhlenschlæger, J, Christensen, , Karup, G, Jorgensen, P and Nordentoft, M (2008) The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis. Psychological Medicine 38, 11571166.
Kirkbride, JB, Errazuriz, A, Croudace, TJ, Morgan, C, Jackson, D, Boydell, J, Murray, R and Jones, PB (2012) Incidence of schizophrenia and other psychoses in England, 1950-2009: a systematic review and meta-analyses. Plos One 7, 3.
Kirkpatrick, B, Buchanan, RW, Ross, DE and Carpenter, WT Jr (2001) A separate disease within the syndrome of schizophrenia. Archive of General Psychiatry 58, 165171.
Lee, TY, Hong, SB, Shin, NY and Kwon, JS (2015) Social cognitive functioning in prodromal psychosis: a meta-analysis. Schizophrenia Research 164, 2834.
Lin, A, Wood, SJ, Nelson, B, Brewer, WJ, Spiliotacopoulos, D, Bruxner, A, Broussard, C, Pantelis, C and Yung, AR (2011) Neurocognitive predictors of functional outcome two to 13 years after identification as ultra-high risk for psychosis. Schizophrenia Research 132, 17.
Lin, CH, Huang, CL, Chang, YC, Chen, PW, Lin, CY, Tsai, GE and Lane, HY (2013 a) Clinical symptoms, mainly negative symptoms, mediate the influence of neurocognition and social cognition on functional outcome of schizophrenia. Schizophrenia research 146, 231237.
Lin, A, Wood, SJ and Yung, AR (2013 b) Measuring psychosocial outcome is good. Current Opinion in Psychiatry 26, 138143.
Lucas, S, Redobaldo-Hodge, M, Shores, A, Brennan, J and Harris, A (2008) Predictors of outcome three years after diagnosis of first episode psychosis. Psychiatry Research 161, 1118.
Malla, A and Payne, J (2005) First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin 31, 650671.
Mangalore, R and Knapp, M (2007) Cost of schizophrenia in England. The Journal of Mental Health Policy and Economics 10, 2341.
Maras, PM and Baram, TZ (2012) Sculpting the hippocampus from within: stress, spines, and CRH. Trends Neuroscience 35, 315324.
McCabe, KL, Maloney, EA, Stain, HJ, Loughland, CM and Carr, VJ (2012) Relationship between childhood adversity and clinical and cognitive features in schizophrenia. Journal of Psychiatric Research 46, 600607.
McGlashan, T and Hoffman, R (2000) Schizophrenia as a disorder of developmentally reduced synaptic connectivity. Archives of General Psychiatry 57, 637648.
McGorry, PD, Killackey, E and Yung, A (2008) Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 7, 148156.
National Institute for Health and Clinical Excellence (2014) Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia. London: National Institute for Health and Clinical Excellence.
Pantelis, C and Bartholomeusz, CF (2014) Social neuroscience in psychiatry: pathways to discovering neurobiological risk and resilience. World Psychiatry 13, 146147.
Piskulic, D, Addington, J, Cadenhead, K, Cannon, TA, Cornblatt, B, Heinssen, R, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW and McGlashan, TH (2012) Negative symptoms in individuals at clinical high risk of psychosis. Psychiatry Research 196, 220224.
Powell, A (2018) NEET: Young People Not in Education, Employment or Training. House of Commons Library: Briefing Paper.
Rammou, A, Fisher, HL, Johnson, S, Major, B, Rahaman, N, Chamberlain-Kent, N and Stone, JM (2017) Negative symptoms in first-episode psychosis: clinical correlates and 1-year follow-up outcomes in London Early Intervention Services. Early Intervention in Psychiatry, 110.
Rodwell, L, Romaniuk, H, Nilsen, WB, Carlin, JB, Lee, KJ and Patton, GC (2018) Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training. Psychological Medicine 48, 861871.
Santesteban-Echarri, O, Paino, M, Rice, S, González-Blanch, C, McGorry, PD, Gleeson, J and Alvarez-Jimenez, M (2017) Predictors of functional recovery in first-episode psychosis: a systematic review and meta-analysis of longitudinal studies. Clinical Psychology Review 58, 5975.
Stain, HJ, Brønnick, K, Hegelstad, WTV, Joa, I, Johannessen, JO, Langeveld, J, Mawn, L and Larsen, TK (2013) Impact of interpersonal trauma on the social functioning of adults with first-episode psychosis. Schizophrenia Bulletin 40, 14911498.
Stouten, LH, Veling, W, Laan, W, van der Helm, M and van der Gaag, M (2014) Psychotic symptoms, cognition and affect as predictors of psychosocial problems and functional change in first-episode psychosis. Schizophrenia Research 158, 113119.
Strauss, JS, Carpenter, WT Jr (1977) Prediction of outcome in schizophrenia: III. Five-year outcome and its predictors. Archives of General Psychiatry 34, 159163.
The Organisation for Economic Co-operation and Development (OECd) (2015). OECD Employment Outlook 2015. Paris: OECD Publishing.
Tandberg, M, Ueland, T, Andreassen, OA, Sundet, K and Melle, I (2012) Factors associated with occupational and academic status in patients with first-episode psychosis with a particular focus on neurocognition. Social Psychiatry and Psychiatric Epidemiology 47, 17631773.
Thompson, A, Papas, A, Bartholomeusz, C, Allott, K, Amminger, GP, Nelson, B, Wood, S and Yung, A (2012) Social cognition in clinical “at risk” for psychosis and first episode psychosis populations. Schizophrenia Research 141, 204209.
United Nations Convention on the Rights of Persons with Disabilities (2006). Available at http://www.un.org/disabilities/documents/convention/convention_accessible_pdf.pdf (Accessed 20 June 2018).
van Os, J, Kenis, G and Rutten, BPF (2010) The environment and schizophrenia. Nature 468, 203212.
Velthorst, E, Nieman, DH, Linszen, D, Becker, H, de Haan, L, Dingemans, PM, Birchwood, M, Patterson, P, Salokangas, RK, Heinimaa, M, Heinz, A, Juckel, G, Reventlow, HGV, French, P, Stevens, H, Schultze-Lutter, F, Klosterkotter, J and Ruhrmann, S (2010) Disability in people clinically at high risk of psychosis. British Journal of Psychiatry 197, 278284.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J and Bentall, R (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient, control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.

Keywords

Vulnerability to psychosocial disability in psychosis

  • S. L. Griffiths (a1), S. J. Wood (a1) (a2) (a3) and M. Birchwood (a4)

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