Pre-empting social damage through early detection: Long-term negative symptom and vocational function levels

Presentation First Author: 
Wenche ten Velden Hegelstad

Background: Poor vocational outcome remains a challenge in first episode psychosis (FEP): Only 13-43% of patients have any employment. In the Scandinavian TIPS study, early detection and negative symptoms predicted long-term recovery, of which full time paid employment was part. Little is known about associations over time between negative symptoms, early detection, and employment. Objective: To test the hypothesis that early detection improves vocational outcome through sustained lower levels of negative symptoms, thus improving patients ability to function. Methods: We compared rates of employment and symptoms over ten years in 281 patients from a usual and an early detection area. Patients were followed up at one (N=251), two (N=235), five (N=188) and 10 years (N=174). Data were analysed using generalized estimating equation modelling, accounting for interrelatedness of repeated measures and estimating values for missing data. Results: Early detection, gender, education and negative symptoms predicted vocational outcome over ten years. There was significant interaction between negative symptoms and early detection; the impact of sustained negative symptoms was higher in the early detection area. Employment rates were significantly higher in the early detection area at ten years. Conclusions: Results indicate that early detection may improve vocational outcome through sustaining lower levels of negative symptoms, thereby increasing the chances of improved functional outcome. However, high negative symptom levels that prevail in spite of early detection may have a very strong detrimental effect. Hence, early assertive psychosocial interventions in addition to early detection may be necessary to improve function in these patients.

Conference Name: 
Presentation Date: 
January, 2015
Additional Authors: 
Kolbjørn S Brønnick - Inge Joa - Jan Olav Johannessen - Johannes Langeveld - Tor Ketil Larsen - Ingrid Melle - Bjørn Rishovd Rund - Stein Opjordsmoen - Erik Simonsen - Thomas McGlashan - Svein Friis
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