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Substance misuse is a common comorbid problem in people presenting with
first-episode psychosis and is associated with a poor short-term
The aim of this study is to examine differences in baseline
characteristics and 1-year outcome between individuals with first-episode
psychosis who have never misused substances, those who stop misusing
substances after initial presentation and those who persistently misuse
substances over the 1-year assessment period.
Patients were recruited to the Northern Ireland First Episode Psychosis
Study (n = 272). Clinical assessments were performed at baseline and at 1
year (n = 194) and data were collected from the case notes.
Individuals with persistent substance misuse had more severe depression,
more positive symptoms, poorer functional outcome and greater rates of
relapse at 1 year than those who stopped and those who had never misused
substances. There were no differences in outcome between people who had
never misused substances and those who stopped misusing after
These results support assertive intervention targeted at comorbid
substance misuse in individuals with first-episode psychosis.
Researching psychotic disorders in unison rather than as separate
diagnostic groups is widely advocated, but the viability of such an
approach requires careful consideration from a neurocognitive
To describe cognition in people with bipolar disorder and schizophrenia
and to examine how known causes of variability in individual's
performance contribute to any observed diagnostic differences.
Neurocognitive functioning in people with bipolar disorder
(n = 32), schizophrenia (n = 46) and
healthy controls (n = 67) was compared using analysis of
covariance on data from the Northern Ireland First Episode Psychosis
The bipolar disorder and schizophrenia groups were most impaired on tests
of memory, executive functioning and language. The bipolar group
performed significantly better on tests of response inhibition, verbal
fluency and callosal functioning. Between-group differences could be
explained by the greater proclivity of individuals with schizophrenia to
experience global cognitive impairment and negative symptoms.
Particular impairments are common to people with psychosis and may prove
useful as endophenotypic markers. Considering the degree of individuals'
global cognitive impairment is critical when attempting to understand
patterns of selective impairment both within and between these diagnostic
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