The role of symptoms and insight in mediating cognition and functional outcome in first episode psychosis. Early Intervention in Psychiatry.

Abstract

Achieving functional recovery for patients with psychosis is still a challenge in clinical practice. A better understanding of the mechanism that leads to better functional outcome is crucial, especially in the early stage of psychosis. This study investigated how cognition, symptoms, insight affect functional outcome in a first episode psychosis cohort. One hundred and sixty patients, aged 15 to 64, were recruited from the Early Assessment Service for Young People with Psychosis, a territory-wide, 3-year early intervention service in Hong Kong from July 1, 2014, to June 30, 2016. The social functioning was measured by the Role Functioning Scale. Structural equation modelling (SEM) was used to examine the direct and indirect relationships between functional outcome and other latent constructs, which include cognition, symptoms (negative and general symptoms as measured by the Positive and Negative Syndrome Scale), insight (Scale to Assess Unawareness of Mental Disorder), and pre-morbid measures (education and duration of untreated psychosis). We identified symptoms and insight as mediators between cognition and functional outcome. There was a direct relationship between cognition and functional outcome, which became insignificant when insight and symptoms were added into the model. Symptoms and insight were significantly associated with cognition and was predictive of functional outcome. Interventions for improving functional outcome should also target on cognition, symptoms and insight of the patient after first episode psychosis.