Conceptualizing High Functioning in Individuals who Experience First- Episode Psychosis: A Look at Coordinated Specialty Care Clinics
Ananya Saluja (1), Kelsey A. Johnson (1), Raquelle Mesholam-Gately (1, 2) Matcheri Keshavan (1, 2)
1. Psychosis Research Program, Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston, MA
2. Harvard Medical School, Boston, MA
Abstract
Background: The term “high-functioning” has come to connote an individual with a chronic disability or illness who functions at a higher level than others with the same condition. Although “functioning” often receives grim and stigmatizing prognoses in psychosis, particularly compared to disorders such as depression and anxiety, Coordinated Specialty Care (CSC) has demonstrated efficacy in improving symptoms and functioning in individuals who have experienced psychosis. This study analysis examines the conceptualization of and contributors to functioning in a real-world sample of FEP clients.
Method: Data from the Massachusetts Psychosis Network for Early Treatment (MAPNET) were analyzed to explore how factors such as age, gender, race, education, medication, school or work involvement, disability benefits, diagnosis, trauma, and substance use may affect or predict functioning in FEP. Global Social Functioning, Occupational Functioning, and the Brief Assessment of Cognition in Schizophrenia (BACS) were analyzed to determine mean levels of functioning, both social and neurocognitive, for individuals who have experienced a first episode of psychosis.
Results: Participants (n = 556) included individuals of varied ages, genders, and racial identities. We report on variables which predict higher vs. lower functioning, as well as results pertaining to mean levels of social/occupational and cognitive functioning.
Discussion: High functioning, especially in the context of conditions such as depression and anxiety, has been conceptualized in a manner which ties into the productivity of an individual. However, functioning for individuals in FEP treatment is measured using social, occupational, and cognitive domains. The results from this study provide insight into functioning, both high and low, for people who have experienced a first episode of psychosis, and aim to broaden our conceptualization of "high functioning" psychosis. These data have important implications on the ways in which CSC can be used to improve symptoms and functioning, and which variables are considered risk factors.