Karolinska Institutet
Browse

First episode psychosis and outcome : findings from a Swedish multi-centre study

Download (1.04 MB)
thesis
posted on 2024-09-02, 22:56 authored by Maria Mattsson

The Parachute Project was a Swedish multi-centre project that included 175 First Episode Psychosis patients who were followed over five years. The aim was to provide need adapted care with low medication and based on out-patient support in order to positively affect long-term outcome. One historical and one prospective treatment-as-usual group provided comparison follow-up data. The aim of this thesis is to describe outcome from various perspectives in FEP patients. Study I compared symptoms, functional outcome, care consumption and costs between the Parachute patients with a baseline schizophrenia syndrome and the comparison groups at three-year follow-up. Study II examined the relation of background variables to patients satisfaction with care (PSC) at 1-year follow up. Study III and IV explored the relation between background variables, baseline status gender and 5-year outcome. Study V examined the associations between perceived financial strain and qualitative and quantitative network to level of recovery after 5-years.

After three years the consumption of inpatient care had been significantly lower in the Parachute group than in the prospective comparison group. In spite of increased outpatient care in the Parachute patients group the total mean cost was about half of the cost in the Prospective comparison group. Symptoms and functional outcome were better compared to the Historical group but there were no differences compared to the Prospective group. At one year follow-up the Parachute Project patients showed a high satisfaction with the received care. Factors that were shown to be predictors of PSC were educational level , social network , duration of untreated psychosis (DUP) and Global Assessment of Functioning (GAF) the year prior to onset together with negative symptoms and lack of hope at admission. Twenty-nine percent of the variance in PSC was explained by these factors. At five year follow-up 85 patients (37 males, 48 females) showed a good outcome and 68 patients (44 males, 24 females) a poor outcome. The relative contribution of the baseline characteristics to the 5-year outcome was analyzed. The variables found to have unique contributions were: GAF the year before first admission ≤ 70 , highest educational level is compulsory school , GAF at first admission ≤30 , male gender and contact with friends ≤ 2-3 times/month . Furthermore, gender differences in the predictors were examined. GAF the year before first admission ≤ 70 and GAF at first admission ≤30 explained most of the variance of a poor 5-year outcome for males, whereas for females the corresponding items were highest educational level is compulsory school , living with parents and contact with friends ≤ 2-3 times/month . A predictive rating scale (PRS) was constructed from the results. After five years the Parachute Project patients answered a questionnaire from the PART study, a population-based study of mental ill health, which included questions about qualitative and quantitative network and experience of financial strain. The relation between these variables and outcome group (PART participants, recovered FEP patients and non-recovered FEP patients) was examined. The results showed that financial strain, quantitative social-network and qualitative social-network explained 16% of the variance in the outcome groups.

In summary, the results showed that it is possible to provide need-adapted care to persons suffering from psychosis, but further studies with a naturalistic design are needed to increase knowledge regarding what ingredients are effective and how various interventions interact. In addition it is important with early intervention to decrease the prodromal period and DUP. Outcome depended on various factors present before the first contact with psychiatry and those factors differ between the genders. Thus outcome measures have to be comprehensive and cover various aspect of a person s life. It is not enough to measure outcome, i.e. only with symptom levels or diagnosis. More factors have to be examined and taken into account, such as gender, age, quality of life, amount of medication, social adversity and financial strain, both in treatment choices as well as in outcome measures.

List of scientific papers

I. Cullberg J, Mattsson M, Levander S, Holmqvist R, Tomsmark L, Elingfors C, Wieselgren IM (2006). Treatment costs and clinical outcome for first episode schizophrenia patients: a 3-year follow-up of the Swedish "Parachute Project" and two comparison groups. Acta Psychiatr Scand. 114(4): 274-81
https://doi.org/10.1111/j.1600-0447.2006.00788.x

II. Mattsson M, Lawoko S, Cullberg J, Olsson U, Hansson L, Forsell Y (2005). Background factors as determinants of satisfaction with care among first-episode psychosis patients. Soc Psychiatry Psychiatr Epidemiol. 40(9): 749-54. Epub 2005 Sep 5
https://doi.org/10.1007/s00127-005-0945-7

III. Flyckt L, Mattsson M, Edman G, Carlsson R, Cullberg J (2006). Predicting 5-year outcome in first-episode psychosis: construction of a prognostic rating scale. J Clin Psychiatry. 67(6): 916-24
https://pubmed.ncbi.nlm.nih.gov/16848651

IV. Mattsson M, Flyckt L, Cullberg J, Edman G, Nyman H, Forsell Y (2007). Gender differences in the prediction of 5-year outcome in first episode psychosis. International Journal for Methods in Psychiatric Research. [Accepted]
https://doi.org/10.1002/mpr.228

V. Mattsson M, Topor A, Cullberg J, Forsell Y (2007). Association between financial strain, social network and five-year recovery from first episode psychosis. [Submitted]

History

Defence date

2007-11-30

Department

  • Department of Global Public Health

Publication year

2007

Thesis type

  • Doctoral thesis

ISBN

978-91-7357-338-2

Number of supporting papers

5

Language

  • eng

Original publication date

2007-11-09

Author name in thesis

Mattsson, Maria

Original department name

Department of Public Health Sciences

Place of publication

Stockholm

Usage metrics

    Theses

    Categories

    No categories selected

    Keywords

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC