Introduction: Quality of Life (QoL) is an important outcome measure for people with a first episode psychosis (FEP). Despite high numbers of patients being admitted to psychiatric hospitals following an FEP, the impact of hospital admission on outcome measures such as QoL is under-investigated. This study aimed to systematically review evidence of the impact of hospital admission on QoL in patients with an FEP. Methods: A systematic review was conducted in line with the PRISMA Guidelines. PsychINFO, Medline, CINAHL and EMBASE were searched from 2000 to 2022, examining the impact of QoL for people with an FEP following a hospital admission. Quantitative, qualitative and mixed methods studies were included in the search. Study quality was assessed using the Mixed Methods Assessment Tool. Data was analysed using narrative synthesis. Results: Seven hundred and eight two abstracts were found. Fifty-three full texts were reviewed. Data was extracted for eight articles. Across the eight studies, four discrete QoL measures were employed. Results showed that QoL scores were consistent over time, with little statistical change from baseline to follow-up. Across studies, participants reported low average QoL scores. Across studies, information on the treatment components and duration of hospital admission were scarce. Conclusion: There is a relative paucity of studies that have examined QoL in relation to hospital admission. QoL scores remained consistent over time, suggesting that QoL is relatively well preserved at the first episode. Further research is needed on the impact of inpatient-based interventions in FEP.

Background: Early intervention in Psychosis (EIP) services are vital in reducing long-term impact of first-episode psychosis (FEP). However, women with FEP encounter unique biological, social and systemic challenges that may delay diagnosis, hinder access to cares and affect treatment engagement. Aims: This study explores clinicians’ perspectives on the sex-specific needs of women with FEP, focusing on hormonal influences, caregiving responsibilities stigma and systemic barriers to care within EIP services. Method: A qualitative design was employed, utilising semi-structured interviews with 20 clinicians from EIP and adult mental health services in Dublin, Ireland. Reflective Thematic Analysis was used to identify key themes, with an inductive constructivist approach underpinning the analysis. Results: Five key themes emerged: (1) Sex differences in presentation, with women showing later onset, higher emotional distress, and lower rates of substance-induced psychosis; (2) Hormonal interactions, highlighting the impact of menstruation, pregnancy, and menopause on symptomatology and treatment response; (3) Shame and adjustment, with internalised stigma, delayed help-seeking, and disruption of social roles (4) Barriers to care, including caregiving responsibilities and inflexible service models. Clinicians emphasised the need for integrated, sex-sensitive, and trauma-informed care, as well as improved collaboration between psychiatry, gynaecology, and endocrinology and; (5) Recommendations for improving care. Conclusions: Women with FEP face multifaceted barriers to accessing and engaging with EIP services. Implementing clinician recommendations namely, flexible and integrated care, trauma-informed and sex-sensitive approaches, and robust cross-disciplinary collaboration is vital for improving outcomes. Future research should incorporate service user perspectives to further refine inclusive and effective EIP pathways for women.

Aims: Research on family functioning in psychosis has typically focused on specific family-related factors and their impact on symptomatology, finding strong associations between high expressed emotion and poor outcomes, especially in those with long-term illness. The objective of this review is to examine the impact of a broad range of family-related factors and their relationship with clinical, social, occupational, and relational outcomes in first-episode psychosis (FEP). Method: A systematic search of databases PsycInfo, Pubmed, Embase and CINHAL between 1990 and August 2023 was completed. In total, 1408 articles were screened, and study quality was assessed using the JBI Critical Appraisal Checklists for Analytical Cross-Sectional Studies and Cohort Studies. A narrative synthesis approach was used to analyse the data. Results: Of the 1408 identified articles, 80 full-text articles were screened. Fifteen studies were included for data extraction. The objectives and scope of the selected studies varied considerably. Studies consisted of cross-sectional and prospective cohort designs. Participants consisted of FEP patients and family members, with the patient age range varying from 15.9 to 30.8 (MD=24.5). Significant associations were identified between family factors (high EE, family environment and carer burden) and symptom and social outcomes. Discussion: While findings emphasised the significant impact of family factors on symptomatic and social outcomes, the literature had significant limitations due to the absence of underlying theoretical models and understanding of the dynamics of distress in families within FEP. Future research should seek to develop a model accounting for such processes.

Background: Trauma plays an important role in the development and maintenance of psychosis. However, it is still under-examined in daily clinical practice. The current study investigated the rates of recording of trauma-exposure in the clinical histories of a first-episode psychosis (FEP) cohort attending an early intervention psychosis service. Methods: This study used a retrospective chart review methodology in a six-year epidemiologically complete (FEP) first-episode psychosis cohort attending an early intervention psychosis service. The Trauma and Life Events Checklist was used to define the rate and types of trauma exposure reported in clinical histories. The relationships were examined between recorded trauma-exposure and positive and negative symptoms, depression, and duration of untreated psychosis at first assessment. Results: A high rate of recorded trauma exposure was found, indicating that clinicians are recording trauma-exposure in daily practice through clinical histories. Childhood trauma exposure was recorded in 47.4% of the sample. No significant relationships between the recorded trauma-exposure and symptom measures were found. A significant relationship was found between interpersonal stressors and positive symptoms, and work-related stress and negative symptoms, highlighting the important of proximal stressful life events. Discussion: Even though clinicians were not assessing trauma systematically using standardised instruments, this study found that clinicians were recording trauma-exposure in daily practice. The high rates of trauma-exposure highlighted the need for trauma to be systematically diagnosed, assessed and treated in planning services for people with psychosis. This study found no significant relationship between recorded trauma-exposure and symptomology.

Objectives: This current study investigated a model of trauma and social pathways of psychosis in people with Unusual Sensory Experiences (USEs) in the general population. Design: The study used a cross-sectional, quantitative design, using an online survey methodology with a self-selecting sample of people reporting multi-modal unusual sensory experiences. Methods: Participants (n=149) completed a survey examining trauma exposure, dissociative experiences, attachment, social rank and 6 separate USEs. The trauma social pathways model of psychosis was tested using hierarchical linear regression models and Structured Equation Modelling (SEM). Results: Hierarchical regression analyses found that all USEs were predicted by trauma-exposure, anxious attachment, and dissociation. Social comparison and compartmentalisation only predicted one mode of hallucinations and overall neither were a strong component of the model. SEM analysis indicated that overall the model was well fitted. The SEM analysis emphasised a dual route to auditory hallucinations via disrupted attachment or trauma-exposure, mutually mediated by dissociation. Conclusion: The findings of this study underscore the importance of addressing dissociation and attachment in understanding the development of multi-modal USEs and in guiding the formulation and intervention of clinical presentations of psychosis. Additionally, fostering attachment security at a service level could improve engagement with mental health services and promote safeness through consistent, sensitive care.