Characteristics, course and outcome in first-episode psychosis : a cross-cultural comparison of Finnish and Spanish patient groups

Abstract

Skitsofreniaryhmän psykoosien syitä ei edelleenkään tunneta täysin ja myös käsitykset tarvittavasta hoidosta vaihtelevat. Eri maiden kulttuuriset erot näyttäisivät liittyvän sekä sairauden esiintyvyyteen että ennusteeseen. Outi Kalla vertailee väitöskirjassaan suomalaisia ja espanjalaisia ensi kertaa psykoosiin sairastuneita potilaita ja tarkastelee heidän psykososiaalisia ominaisuuksiaan, sairaudenkulkuaan ja ennustettaan. Kalla selvitti, millaisia potilaita tutkimusyksiköissä hoidettiin ensimmäistä kertaa skitsofreniaryhmän psykoosin vuoksi ja erosivatko potilasryhmät psyykkis-sosiaalisilta ominaisuuksiltaan hoitoon tullessa. Hän tarkasteli myös, miten potilaiden hoito ja vointi etenivät vuoden kuluessa hoitoon tulosta sekä mitkä tekijät vaikuttivat seurantahetkellä vallitsevaan psyykkiseen tilaan ja toimintatasoon.

This study focused on the early course and 12-month outcome of patients from Finland and Spain with first-episode psychosis. First, the thesis examined cognitive deficits at admission for treatment. Second, personality characteristics and functioning at admission were explored. Third, the duration of untreated psychosis (DUP) and its association with early course characteristics were examined. Finally, the 12-month outcome and factors associated with it were investigated. The Finnish data consisted of four patient groups gathered from three hospitals: Kupittaa (two groups), Keroputaa and Kangasvuori. The Spanish data were collected from the University General Hospital of Gregorio Marañón. Forty-one Finnish and 32 Spanish patients participated in Studies I and II. Forty-nine Finnish and 37 Spanish patients participated in Studies III and IV of whom 68 (79%) were followed up for 12 months. The methods used were the Rorschach (CS), the BPRS, the GAS, the Grip on Life and a standardised semi-structured questionnaire. The patient groups showed less severe cognitive deficits than expected, and these were more often related to inaccurate perception than to thought disorder. They showed signs of maladaptive personality functioning, e.g. poor social skills, lack of interest in interpersonal relationships, poor emotional control and distress. The Finnish patients showed more excessive self-focusing while the Spanish ones showed more deficits in the areas of self-perception and interpersonal relations. The mean DUP was 4 months for the Finnish patients and 10 months for the Spanish ones. Long DUP was associated with poor earlier functioning and insidious onset. In the Finnish group long DUP was more strongly associated with a weak social network and maladaptive family relations, while in the Spanish group it was associated with a higher level of positive symptoms at admission. At 12 months, one fourth of the patients experienced psychotic symptoms. About 60 % of patients showed good global functioning and a maintained Grip on Life. The most important predictors of poor outcome were poor earlier functioning and weal social network in both patient groups. Among the Finnish patients, competence in peer relations and among the Spanish ones, family-related factors seemed to weigh heavily in the recovery from psychosis. Overall, although the Finnish and Spanish patients differed in certain aspects, received different treatment, and lived in a different sociocultural environment, they shared many similarities in illness manifestation, course and outcome. However, the prognostic importance of the role played by the patient’s social network and family seemed to be mediated by the sociocultural environment.