Areas, potentially reducing future opportunities and impacting on developing a sense of one’s self as an autonomous adult, (McGorry, 2000).
Recent research on first episode of psychosis emphasizes the importance of early interventions to initiate remissions and to prevent relapses (Wisdom et al., 2011). The emerging literature on first episode of psychosis highlights the high prevalence and adverse consequences of substance use, misuse or disorder. Approximately one-half of first-episode clients have a history of cannabis abuse or dependence and one-third have a current cannabis disorder. The proportions are similar for alcohol use disorders (Wisdom et al., 2011). Smaller significant proportions have use disorders related to cocaine, amphetamines, barbiturates, and other drugs. Overall, approximately half of all clients with first episode of psychosis present for treatment with a current substance use disorder. Once in treatment, continued use of alcohol and other drugs is associated with increased symptoms, adjustment difficulties, treatment non-adherence, relapses, and hospital admissions. Thus, substance use disorder constitutes a major risk for these new clients who present with brief psychotic disorders. Nevertheless, little is known about the course and treatment of co-occurring substance abuse among clients with FEP, (Wisdom et al., 2011).
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In a review article by Rinaldi et al. (2010), for most people work is a normal part of everyday life. More than this, a job is the central hub from which many of our other areas of functioning emanate. For this reason, employment can be considered to be one of the most important factors in promoting recovery and social inclusion. It only provides financial independence but also structure and purpose, opportunities for socialising and developing new relationships, a sense of identity, self-worth, and meaning in life (Rinaldi et al., 2010). Furthermore, work enables people who have experienced mental health conditions to take on a stigma-free social role that in most societies is associated with positive identity, status as an employed person, and a contributing member of society. A FEP typically occurs at a critical developmental life stage in terms of personality, social role, educational or vocational achievement. It is a stage where career and romance choices are being evaluated and chosen, one’s place is being defined. It is also a time where the family’s hopes and dreams for a child their child are usually beginning to realised. However, with the onset of FEP is frequently associated with a pronounced decline in education and employment, and by the time young people present to mental health services, close to half are already unemployed. In addition, evidence suggests that unemployment is a risk factor for the development or exacerbation of mental health conditions and misuse of substances (Rinaldi et al., 2010).
The issues are much better understood among patients with long-term psychotic disorders. For this population, substance use disorders are common and associated with multiple adverse outcomes, including treatment dropout, recurrent hospitalization, violence, homelessness, incarceration, relapse, and victimization, as well as medical problems such as HIV and Hepatitis. The course of substance use disorders in this population tends to be chronic and relapsing. Traditional parallel treatment approaches (in separate settings) are effective, are fragmented, and result in treatment nonadherence and dropout. The negative outcomes associated with traditional approaches have led to integrated treatments designed to target co-occurring mental and substance use disorders concurrently in the same setting, (Wisdom et al., 2011).
In an article the relationship between premorbid functioning and symptom severity as assessed at first episode of psychosis by Robinowitz et al. (2002), concluded that more than half of the subjects, who were interviewed during their first episode of psychotic disorder, had evident premorbid behavioral disturbances. Furthermore, Poor premorbid functioning before onset of psychosis was associated with more severe symptoms and more cognitive manifestations of illness during the first illness episode (Robinowitz et al., 2002).
There is consistent evidence that many, but not all, persons affected by schizophrenia and schizophrenia-like psychosis manifest poor social adjustment and subtle deviations from cognitive norms much better the illness is formally diagnosed. However, despite the many studies on this topic, the prevalence, course, characteristics, and correlates of the premorbid and prodromal impairments are far from clear. By studying the events preceding the first episode of psychosis and multiple domains of psychosocial and educational functioning, it may be possible to detect protective or vulnerability factors and perhaps to devise interventions aimed at secondary prevention such as supplementary educational and vocational programs and other supportive measures, (Robinowitz et al. 2002).
In a study in Christchurch, New Zealand, several studies were examined were clinical and sociodemographic factors associated with the risk of hospitalization for First-episode psychosis. These factors include presence and persistence of positive symptoms, lack of clinical improvement, poor medication adherence, substance abuse, diagnosis of schizophrenia, earlier hospitalization, younger age at first admission, male gender, racial or ethnic minority status, unemployment, low social support, low social status, and homelessness, (Turner et al., 2013).
In a study in the UK by Cantwell et al. (1999), confirmed high rates of 37% of substance abuse at onset of first episode of psychosis. It further showed that young males to be in the group most at risk.
In a study of first episode of psychosis and substance abuse by Strakowski et al., (1993), it was found that 56% of first episode of psychosis patients met the criteria for substance abuse, making it the most common co-morbid diagnosis. Linszen et al., (1999), found that cannabis abuse preceded the onset of psychotic symptoms in first episode of psychosis by 1 year.
In a study in the UK by Rinaldi et al. (2010), which looked at the first episode of psychosis and employment, showed that young people with a first episode of psychosis begin to lose jobs when they experience the first symptom of psychosis. Yet, coming into contact with mental health services didn’t appear to ameliorate this situation, with clear evidence of employment rates continuing to decrease rapidly within the first couple of years with services. Despite this, young people with first episode of psychosis appear to have the desire to work and maintain contact with their social networks. However, in the context of their contact with mental health services, encouragement, support, and hope for a working future do not appear to be common experiences.
In an article predictors of outcome in early psychosis in the early course of first episode of psychosis by Gomez-de-Regil et al (2010), found that patients who are male who had never been married nor lived with a stable a partner at the time of first admission, or had a poor premorbid adjustment, were significantly more likely to suffer from residual symptoms at the
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