Predictors of good functional outcome in patients presenting with first-episode psychosis

Abstract

OBJECTIVE: Whether psychosis patients can return to a productive level of functioning in the community has received well-deserved research attention. Previous studies found that the functional outcomes were improved in patients with early intervention (EI) services when compared to standard care. This report aimed to determine the predictors of good functioning in first-episode psychosis patients. METHODS: The analysis was based on the data obtained from a randomised single-blind controlled trial aimed to compare extended 1-year EI service (EI group, n = 82) comprising continuing phase-specific case management with step-down standard care (SC group, n = 78) in 160 Chinese patients who had received 2-year intensive EI service for first episode psychosis in Hong Kong. Patients were assessed through face-to-face interview at study entry and 12 months of follow-up. The functional outcome was assessed by Social and Occupational Functioning Assessment Scale (SOFAS) and Role Functioning Scale (RFS). All patients were classified into either good or poor functional outcome group. Good functioning was defined as scored of >60 in SOFAS, >4 in RFS self-care and immediate social network, and >5 in work productivity and extended social network. RESULTS: Comparing with the poor functioning group, being a female; being employed at baseline, better insight, less severe positive, negative and depressed symptoms, and shorter duration of untreated psychosis were found to be associated with good functioning. Logistic regression analysis demonstrated that female (p = 0.037), extra year of EI service (p = 0.002), better insight (p = 0.024), and better baseline functioning (p = 0.000) independently predicted functioning in patients. CONCLUSION: Results from this study confirmed the significance of the extended year of EI service in improving the functional outcome of psychosis patients. Gender, baseline insight, and baseline functioning are also found to be predictors of the good functional outcome.