الفهرس 
Introduction
The diagnostic systemsOnly 14 pages are availabe for public view
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Abstract
The experience of psychosis is difficult and distressing, to both patients and care givers, difficulties arise from not only the experience of psychotic symptoms, but also the associated emotional and cognitive dysfunction which significantly affect the quality of life.
The population of first episode psychosis patients, had been the interest of researches for long years, and allowed them to study psychotic disorders relatively free of confounders, such as chronicity of illness, long term hospitalization and treatment and has given much hope that the outcome of illness can be improved significantly by applying early interventions.
Understanding these clinical aspects would pave the way to an earlier recognition of the disorder and a more accurate diagnosis, the earlier the recognition and intervention in psychotic disorders the more there will be opportunity to implement measures to prevent impairments and complications that are related to chronicity.
The study aims to assess the following:
1. Assessing clinical characteristics of FEP patients ,independent of the confounding effect of illness chronicity, long term treatment and long term hospitalization.
2. Assessing phenomenology among different diagnostic subgroups of patients presenting with FEP.
3. Examining the diagnostic outcome. Effect of the duration of untreated psychosis on symptom severity and cognition. Diagnostic stability and predictors of a second episode after short term follow up (1 year).
4. Testing cognitive functioning in patients with FEP subgroups (and comparing them to control.
5. Assessing personality traits and disorders among patients experiencing a first psychotic episode.
Subjects and methods:
The present descriptive-prospective study was carried out at the Psychiatry unit of the department of Neurology and Psychiatry, Assiut University Hospitals, Egypt, which is the largest and most leading educational and therapeutic institution in Upper Egypt, serving patients from Assiut and the surrounding governorates.
The initial sample evaluated at baseline constituted of 108 patients, and 50 healthy controls. Patients were divided as groups of schizophrenia spectrum disorder, bipolar disorder with psychotic features, depressive disorders with psychotic features.
Seventy two patients showed at follow up at 12 months and were evaluated for clinical outcomes ,diagnostic stability and cognitive functions
Tools used:
A) Initial Clinical Assessment:
-Initial sheet applied to all patients on the first interview and another Follow up sheet completed on further follow up visit.
-Arabic version of Mini International Neuropsychiatric Interview Plus (MINI Plus) (Ghanem et al., 2000).
-The Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1987).
-Global assessment of function scale (GAF) (American Psychiatric Association, 2000).
B)Assessment of cognitive function:
- Arabic version of Wechsler Adult Intelligence Scale -Revised ( Melika L. 1996).
- Arabic version of Memory Assessment Scale (Arabic version): Translated by :El Telawy H. and Hadhoud E. Author: (Williams, 1990).
-Brief Visuo Spatial Memory Test -Revised (BVMT-R) Author:(Benedict, 1997).
-P300 audio evoked potential .
C)Assessment of personality:
-Arabic translation of Structured clinical interview for DSM-IV axis II (SCID- II) (First et al., 1997) translated by: (Hatata et al., 2004).
-Arabic version of Structured Interview for the Five Factor Model of personality (SIFFM) (Trull & Widiger, 1997)( Albehary et al., 2005).
The main results obtained from this study were:
1-Socidemographis and clinical characteristics:
The diagnostic outcome during the first year, out of the 108 patients with first episode psychosis, 47 (43.5%) patients were diagnosed with schizophrenia spectrum psychosis,41 (38%) with bipolar psychosis and 20 patients with depressive psychosis (18.5%).
The mean age for SSD patient was (27.49±10.7) years, for bipolar psychosis (24.68±7.3) years and for depressive psychosis was (25.50±6.7) years, there was no significant difference between patients groups as regard to age of onset.
Males constituted 53% of patients sample and females 47%.
Mean age of male patients was 27.35± 10.63 years ,80.70 % of them were single, 63.15% living in rural areas, 47.35% were either illiterate / read and write or had basic education, and 51% were non skilled workers.
Mean age of female patients was 24.61 ± 6.36 years, 51% of them were married , 54.90 % lived in rural areas, 56.86 % had basic education, 90.20% were housewives, and 9.80% were students .
Bipolar disorder is the most frequent diagnosis among males (42.10%) and females (33.35%).
Depressive psychosis and brief psychotic disorder are higher in frequency in females (27.4%, 25.5%) than males (10.5%, 17.5%) respectively.
Schizophrenia and schizophreniform disorders are more frequently diagnosed in males (12.3%, 10.5%), than females (1.95%, 7.85%) respectively.
As regard to mode of onset , significant number of bipolar disorder with psychotic features patients ( 82.92%) had acute onset of symptoms and significant number of depressive disorders with psychotic features patients had insidious onset of symptoms (90%) ( P<0.000).
It was found that 85.20% of total patients sought help from a traditional healer before their first hospital admission. It was found that 100% of MDD patients ,87.24% of SSD patients and 75.60% of BP patients sought help from a traditional healer before their first hospital admission.
Twenty five cases out of the 72 cases who completed the follow up at 1 year, shifted their diagnoses, the most shifting diagnoses were psychotic disorder not otherwise specified (100%) and schizoaffective disorder (100%), schizophreniform disorder (85.7%), brief psychotic disorder (61%), major depressive disorder with psychotic features (14.2%), less diagnostic shift was found in bipolar disorder with psychotic features (4.5%). The more stable diagnoses were Schizophrenia (100%) stability.
The mean duration of untreated psychosis (DUP) for schizophrenia spectrum patients was 62.45±72.33 days, while the mean duration of untreated psychosis for bipolar disorders with psychotic features was 21.34 ± 19.12 days, the mean duration of untreated psychosis for major depressive disorder with psychotic features was 69.00± 45.81 days
The DUP was significantly higher ( P< 0.000) for depressive psychosis, than the other two groups, SSD and bipolar psychosis .
It was found that 61.11% of SSD patients had two episode by the end of the first year, 59.10% of bipolar patients had one episode by the end of first year, while 64.29% of depressive patients had two episodes by the end of one year.
As regard the number of patients rehospitalized in the first year , most of patients in all diagnostic groups were rehospitalized once, the percentage was 69.44% for SSD patients, 63.64% for bipolar patients and 85.71% for depressive patients.
Comparison of mean scores of positive and negative syndrome scale (PANSS) among first episode patients groups showed the following:
As regard to positive subscale, BP had a significantly higher positive mean scores in comparison to both SSD and MDD, SSD had a significantly higher positive mean scores in comparison to MDD.
As regard to negative subscale ,SSD had a significantly higher negative mean scores in comparison to BP and MDD ,there was no significant difference between BP and MDD.
2- Personality assessment:
All first episode diagnostic groups had significantly higher scores as regard to neuroticism in comparison to controls, with no significant difference in between groups.
All first episode diagnostic groups had significantly lower scores in comparison to controls as regard to extraversion, openness to experience, conscientiousness, with no significant difference in between the diagnostic groups.
As regard to agreeableness, MDD with psychotic features patients have significantly higher scores than both SSD and BP with psychotic features patients and insignificantly different scores from control group.
It was found that 18( 16.7%) patients had fulfilled the criteria for a personality disorder, 51(47.2% ) patients had significant subthreshold personality disorder criteria .The avoidant and the schizoid were the most frequent threshold personality disorders ( 44.45 %, 22.25 % respectively) , followed by borderline and histrionic personality disorder ( 11.10 %), less frequently was the OCPD, paranoid personality disorders.
As regard to the significant subthreshold personality disorder criteria , the highest percentage was the avoidant (29.41%) followed by schizoid (15.70 %), followed by the borderline (13.72%),OCPD, paranoid, antisocial, and less frequently are narcissistic, histrionic, schizotypal personality disorder criteria.
3-Assesment of cognitive functions:
First episode psychosis patients had significantly lower scores on the studied variables of WAIS-R, MAS and BVMT-R, schizophrenia and bipolar psychosis had significantly lower scores in comparison to depressive psychosis.
There was insignificant change in cognitive functions assessed after one year, reflecting a stability in cognitive function early in the course of illness despite treatment.
There was a significant negative correlation between DUP and delayed and total recall scores for total patients after 1 year, and insignificant correlation between cognitive functions mean scores for total patients and the duration of untreated psychosis at first presentation and after 1 year.
As regard to assessment of cognitive functions using P300 audio evoked potential:
All patients diagnostic groups ,have significantly lower P300 amplitude than controls .Also all of them have longer P300 wave latencies than controls.
Among patient diagnostic groups: SSD patients have significantly lower P300 amplitude than BP patients and MDD patients. Also they have longer P300 latencies than BP and MDD patients.
BP patients have significantly lower P300 amplitude than MDD patients .