First episode psychosis (FEP) usually affects the adolescents and young adults, presenting with positive symptoms, negative and cognitive symptoms (O’Donoghue et al., 2015; Baldwin et al., 2005; Austin et al., 2015; Kenney et al., 2015). Along with these symptoms, these individuals also show difficulties in managing social and daily activities (Sullivan et al., 2013, 2014). Even though early identification and treatment with antipsychotic medication leads to the improvement in positive, negative and cognitive symptoms, improvement in the daily activities and social functioning are not readily evident (Schooler et al., 2005; Keefe et al., 2004; Malla et al., 2002; Robinson et al., 2004). Individuals with first episode psychosis have difficulties in initiating and sustaining activities and social contacts in the family and community level. Various biological, psychological and social factors could play a possible role for these social deficits in individuals with first episode psychosis (Healey et al., 2016; Malla and Payne, 2005; Stouten et al., 2015).
Various scales have been devised to assess the social functioning and disabilities in individuals with schizophrenia (Burns and Patrick, 2007). One of the scales that have been used is the life skills profile (LPS) scale. This scale was initially developed by Rosen et al., (1989) and measures the adaptation of individuals with schizophrenia in the community. It measures the various aspects in the social realm by its five subscales – self-care, non-turbulence, social contact, communication and responsibility (Rosen et al., 2001).
Many studies have used LSP to assess the community functioning in schizophrenia (Manickam and Chandran, 2005; Parker et al., 1991; Puig et al., 2013). Although LPS is not found to correlate with the cognitive symptoms, it predicts the community functioning in individuals with schizophrenia (Parker et al., 1991).
Individuals with first episode psychosis usually live with their family and their family members are the primary caregivers. When the FEP individuals face difficulties in managing their daily routine and engaging in meaningful community activities, this not only affect the individuals themselves but also the primary caregivers. This leads to physical, emotional and financial distress to the caregivers (Jansen et al., 2015; McCann et al., 2011; Patel et al., 2014). Hence, adequate assessment of social deficits at all stages of treatment and prompt management of the deficits in FEP is of utmost importance.
Few studies have explored the use of LPS in first episode psychosis to assess the social functioning (Aoyama et al., 2011; Malla et al., 2002; Poloni et al., 2013). Moreover, most of the studies done using LPS in schizophrenia were cross-sectional in design and have not evaluated the changes in LPS after treatment in a prospective design.
The aim of the current study was to assess the social functioning by using life skills profile scale in individuals with first episode psychosis at baseline and to compare the same after one-year follow-up.
MATERIALS AND METHODS
Participants
Subjects were recruited from the Schizophrenia Research Foundation (SCARF)-McGill First-Episode Psychosis Program, a specialized assessment, treatment and follow-up program for individuals with FEP in Chennai. Subjects were recruited into the study after a written informed consent. The study was approved by the institutional review board.
Inclusion criteria for the study group include age between 16-35 years of age, International Classification of Diseases, tenth edition (ICD-10) diagnosis of psychotic disorder and prior treatment with anti-psychotic medications for not longer than a month. Exclusion criteria include mental retardation, primary neurological or medical disorders and primary substance use disorder. Subjects with primary psychotic disorder with co-morbid substance use were included in the study group. After recruitment into the study, the subjects were followed up for the study period of one year.
Measurements
A structured performa was employed to record the socio-demographic data of the study subjects during the recruitment into the study. The subjects were administered the following scale: Positive and Negative Syndrome Scale (PANSS) to assess the psychopathology and Global assessment of Functioning (GAF) to assess the functioning in daily activities.
Life Skills Profile (LSP) scale was used to measure the daily and social functioning in the individuals with FEP. This scale is subdivided into five subscales measuring various domains such as self-care, non-turbulence, social contact, communication and responsibility. Individual and total scores can be measured. Assessments were done within one month of entry into the study group for the baseline data and were repeated at the end of one year.
Statistical analysis
Statistical analysis was performed using SPSS version 16. Groups were compared by student t-test. The statistical significance was set at p<0.05 using a two-tailed statistic.
RESULTS
The demographic variables of the participants are depicted in Table 1. The mean age of the subjects was 26.75.1. Nearly 70% of the participants were males. The initial diagnosis in one-third of the participants was schizophrenia while other diagnoses made were psychosis NOS and schizophreniform disorder.
The total LSP score showed statistically significant improvement at one-year follow-up when compared with baseline score (p = 0.004). the two subscales of LSP that has shown significant difference were non-turbulence and communication (Table 2).
DISCUSSION
The aim of the current study was to assess the daily and social functioning in individuals with FEP at baseline and after one year of treatment with antipsychotic medications and psychosocial support. The daily and social functioning was assessed by life skills profile scale which measures various relevant domains.
The results indicate that there is an overall improvement in the LSP scale at the end of one year when compared with baseline. Specifically, two domains, non-turbulence and communication has shown statistically significant improvement. But the other domains such as self-care, social contact and responsibility have not shown a significant change at the end of follow-up period indicating the partial improvement in the social domain in individuals with FEP.
The results of the current study is concurrent with other studies that have explored the daily living activities and social functioning in individuals with FEP (Górna et al., 2005; Grant et al., 2001; Jaracz et al., 2007). The results from these studies indicate that the deficits in the social and daily functioning in FEP is present from the onset of illness and persist even after treatment with antipsychotic medications, in the short-term follow up.
The neurobiological aspects underlying the social deficits in FEP is still not completely elucidated (Bertrand et al., 2007; Schmidt et al., 2011; Thompson et al., 2012; Williams et al., 2008). Various research directions have indicated that the social deficits could be an independent aspect of the disorder and specific interventions designed to address the social and daily functioning may be needed in FEP to have better outcome in long term (Bartholomeusz et al., 2013).
The major advantage of this study is the follow-up of the individuals with first episode psychosis for one year and reassessment of social functioning in prospective design. The major limitation of the study is the generalizability of the results could be limited as the study participants were recruited from the hospital rather than from the community. Moreover, other factors that could have a role in the social functioning such as cognitive deficits, expressed emotions and social stigma were not assessed in this study.
CONCLUSION
This study has shown that even tough certain aspects of social functioning improves with treatment in FEP, important domains like self-care, social contact and responsibility are not improved with the standard treatment. These factors could hinder the overall improvement in these individuals and in pursuing a meaningful role in the family, work place and society, at large. This underpins the need for further research in developing modules and interventions to address the social deficits in FEP.