Subjective distress in first‐episode psychosis: role of symptoms and self‐esteem

Background: Patients with psychotic disorders are assumed to experience significant distress, especially during their first episode. It is unclear whether such distress is associated with the level of psychotic or other symptoms and/or to other characteristics such as level of self‐esteem. Methods: One hundred and five patients who presented with first episode psychosis (FEP) (54% male; mean age 22.74 years; 79.4% schizophrenia; 20.6% affective psychosis) were administered the Symptom Checklist 90‐Revised (SCL‐90‐R) at first presentation for treatment. Four indices derived from the SCL‐90‐R were used as measures of distress. Psychopathology was assessed with the Calgary Depression Scale, the Hamilton Anxiety Scale, the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms and self‐esteem with the Self‐esteem Rating Scale.Spearman's Correlation coefficients were calculated, followed by a regression analysis. Results: Measures of distress were highly correlated with depression (rho = 0.44–0.56), and anxiety (rho = 0.38–0.48), modestly with lack of judgement and insight (rho = ?0.28 to ?0.37) and not with positive or negative symptoms of psychosis. In a smaller sample (n = 68) distress measures were also highly correlated with self‐esteem (rho = ?0.55 to ?0.73). Logistic regression confirmed that self‐esteem explained 53% of the total variance explained (57%) by any combination of the independent variables. Conclusion: Distress experienced by individuals suffering from FEP is associated with levels of self‐esteem, depression and anxiety and not with the level of psychotic or negative symptoms. Self‐esteem may play a significant role in the magnitude of distress experienced by patients presenting with a FEP.     

Suicidality in first episode psychosis

Many studies have confirmed that the risk of suicide is high in the period after first presentation. There is relatively little information about the risk of suicide using illness onset as the starting point. We assessed suicidality in a cohort of 166 individuals from an urban catchment area during the period of untreated psychosis and at 4 year follow up. Nearly 10% of individuals attempted suicide prior to presentation. Four years later 18% had made a suicide attempt and 3% completed suicide. Suicide attempts prior to presentation were associated with a longer duration of untreated psychosis.     

Depression and quality of life in first-episode psychosis

AimQuality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL.MethodsWe assessed 208 individuals with first-episode non-affective psychosis using measures of diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), symptoms (Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning), insight (Birchwood Scale), duration of untreated psychosis (Beiser Scale), and QOL World Health Organisation Quality of Life Instrument (WHOQOL-Bref). We used multiple regression to determine the contribution of depressive symptoms to QOL domains while controlling for socio-demographic and other clinical characteristics.ResultsThere were complete data for 146 individuals with FEP. Quality-of-life domains were consistently predicted by depressive symptoms including depressive mood and hopelessness rather than biological symptoms of depression with those experiencing more depressive symptoms reporting worse QOL. Those who were treated as in-patients reported improved QOL, and hospitalization was an independent predictor of most QOL domains. In-patients displayed greater levels of positive symptoms with those involuntarily detained displaying greater levels of bizarre behavior, thought disorder, and delusions.ConclusionsThese findings suggest that QOL is heavily influenced by depressive symptoms at initial presentation; however, as QOL domains are also influenced by admission status with in-patients being more symptomatic in terms of positive symptoms, subjective QOL assessment may be compromised during the acute phase of illness by both positive and depressive symptom severity.     

How does social functioning in the early stages of psychosis relate to depression and social anxiety?

Aims: The study aims to compare social functioning in young people considered to be at risk of psychosis with those meeting criteria for first episode psychosis (FEP) and controls, and to determine the association between social functioning and positive and negative symptoms, depressive symptoms, and social anxiety. Methods: This study examined social functioning in 20 individuals at risk of psychosis, 20 FEP patients and 20 healthy controls. Social functioning was measured using the Social Functioning Scale and World Health Organization Disability Assessment Scale. Psychiatric variables were also measured using the Comprehensive Assessment of At‐Risk Mental States, the Brief Psychiatric Rating Scale, the Brief Social Phobia Scale, and the Depression Anxiety and Stress Scale. Results: At‐risk individuals had comparable social deficits to the FEP group, and both patient groups had significantly poorer social functioning than controls. Importantly, social functioning was most strongly associated with depressive and social anxiety symptoms and to a lesser extent with positive symptoms. However, negative symptoms did not appear to relate to social functioning. Conclusion: Social functioning impairments precede the onset of full‐threshold psychosis and may therefore be a significant marker for the illness. Additionally, associated psychiatric symptoms such as depression and social anxiety may provide an avenue for early interventions of social functioning deficits in psychosis.     

Insight in individuals with an At Risk Mental State

PURPOSE: On average, people with an At Risk Mental State (ARMS) for psychosis are more willing to seek and accept clinical help than patients with psychotic disorders, suggesting that insight in this group is relatively less impaired. We compared the level and quality of insight in the ARMS and in first episode psychosis. MATERIALS AND METHODS: Insight about illness was assessed in subjects with an ARMS and in patients with first episode psychosis (FEP) who were and were not help-seeking, using the Schedule for Assessment of Insight (SAI-E). RESULTS: Insight was impaired in ARMS subjects, but there was considerable variability in the insight displayed between subjects. Compared to FEP subjects, ARMS subjects showed greater insight, particularly with respect to Symptom Relabelling. ARMS subjects were more likely to interpret anomalous experiences as symptoms of illness, and to perceive themselves as needing treatment. CONCLUSIONS: Insight in people at high risk for psychosis is impaired, despite the fact that they are help-seeking. Insight varies between subjects, highlighting the need to comprehensively assess all aspects of insight in those with an ARMS. ARMS subjects are impaired in their ability to appraise anomalous experiences as symptoms of illness, but much less impaired than FEP subjects. This is consistent with cognitive models that propose that the way symptoms are appraised determines whether the individual develops a psychotic illness.     

Group cognitive behavioural therapy for first episode psychosis: who's referred,who attends and who completes it?

Aim: Most national guidelines recommend psychological therapy for people with first‐episode psychosis (FEP) but interventions proven effective in randomized control trials (RCTs) conducted in research settings do not always translate effectively to real‐world clinical environments. In a limited health system, it is important to understand the system and patient barriers to participation in effective treatment. We sought to determine what patient characteristics influenced clinicians' decision to refer or not to refer to group cognitive behavioural therapy for FEP and what characteristics were associated with those referred attending/not attending and adhering/not adhering to the programme. Methods: Between 2006 and 2008, all cases of confirmed FEP from a defined geographical region were examined using the Structured Clinical Interview for DSM‐IV‐TR Axis I Disorders for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) diagnoses, the Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia and Birchwood Insight Scale. Duration of untreated psychosis was established using the Beiser Scale. Results: Of the 124 (77 males, 47 females) people in the final sample, 88 (72%) were referred for cognitive behavioural therapy (CBT), 52 (59%) attended and 12 (23%) did not complete CBT. Those with higher levels of insight into the need for treatment (U = 740.00, z = −2.63, P = 0.008) and higher levels of positive symptoms (t (120) = −3.064, P = 0.003) were more likely to be referred to CBT. Those with higher educational attainment (χ² = 9.48, P = 0.03) and fewer negative symptoms, particularly in relation to global attention (t (85) = 2.32, P = 0.03), were more likely to attend and complete CBT. Conclusion: Within an early intervention service for FEP, it appears that individuals with less education, more negative symptoms and less insight experienced significant barriers to successfully completing group CBT. More information for referring clinicians about the benefits of CBT for FEP could help increase referral rates. Assertive outreach for people at risk of disengaging or non‐adherence should also be considered.     

A comparison of correlates of suicidal ideation prior to initial hospitalization for first-episode psychosis with prior research on correlates of suicide attempts prior to initial treatment seeking

Aim: Individuals with first‐episode psychosis, like those with chronic psychotic disorders, are at elevated risk for suicidal ideation and suicide attempts. However, relatively little is known about suicidality among first‐episode patients prior to their initial presentation for treatment. This analysis was designed as a US‐based examination of recent findings on prior suicide attempts from Dublin, Ireland, here focusing on prevalence and correlates of suicidal ideation during the weeks prior to initial treatment‐seeking. Methods: Participants included 109 first‐episode inpatients with primary psychotic disorders in public‐sector settings that serve an urban, low‐income, socially disadvantaged, predominantly African American population. Eligible patients had received <3 months of prior antipsychotic treatment and had not been hospitalized for psychosis >3 months prior to the index admission, though most were completely treatment naïve. Assessments included the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Birchwood Insight Scale, and a rigorous method for determining age at onset of first psychotic symptoms and duration of untreated psychosis. Results: Disconcertingly, nearly one quarter of patients (23%) endorsed a history of suicidal ideation in the 2 weeks prior to first admission. In the model designed to replicate the prior study in Ireland, Calgary Depression score (calculated omitting hopelessness and suicidal ideation as these were separate variables in the analysis) was a predictor of suicidal ideation (P < 0.01). In separate bivariate analyses analogous to the original study, two domains of insight were associated with suicidal ideation. Conclusions: Findings suggest that depression, insight, and suicidality should be carefully monitored among first‐episode patients initiating treatment and during the early course of illness. As insight improves, coping strategies should be enhanced with a goal of minimizing depression and preventing suicidality.     

Involuntary hospitalization of first-episode psychosis with substance abuse during a 2-year follow-up

Opsal A, Clausen T, Kristensen Ø, Elvik I, Joa I, Larsen TK. Involuntary hospitalization of first‐episode psychosis with substance abuse during a 2‐year follow‐up. Objective: To investigate whether substance abuse (alcohol or illegal drugs) in patients with first‐episode psychosis (FEP) influenced treatment outcomes such as involuntary hospitalization during follow‐up. Method: First‐episode psychosis patients (n = 103) with consecutive admissions to a comprehensive early psychosis program were included and followed for 2 years. Assessment measures were the Positive and Negative Syndrome Scale, Global Assessment of Functioning, and the Clinician Rating Scale (for substance abuse). Results: Twenty‐four per cent of patients abused either alcohol or drugs at baseline. The dropout rate at 2 years was the same for substance abusers as for non‐abusers. Substance use was not reduced over the 2‐year period. At 2‐year follow‐up, 72% of substance abusers and 31% of non‐abusers had experienced at least one occasion of involuntary hospitalization. Patients with substance abuse had significantly higher risk for involuntary hospitalization during follow‐up (OR 5.2). Conclusion: To adequately treat patients with FEP, clinicians must emphasize treatment of the substance abuse disorder, as well as the psychotic illness. Patients with defined comorbid substance use disorders and FEP are likely to have poorer treatment response than those with psychosis alone.     

Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder

OBJECTIVE: To map the development of insight in the 4 years after presentation with first-episode schizophrenia and schizophreniform disorder and to determine the effects of evolving insight on depression and the likelihood of attempted suicide. METHOD: We assessed 101 individuals at presentation, 6 months and 4 years. We measured insight, including recognition of mental illness, recognition of need for treatment and ability to relabel psychotic symptoms. We measured depression and recorded all suicide attempts. RESULTS: Insight improved with time. Recognition of mental illness at 6 months predicted depression and attempted suicide at 4 years. CONCLUSION: Six months after presentation, the greater the acknowledgement by people that they had a mental illness, the more depressed they were at 4 years and the greater the likelihood that they would attempt suicide by 4 years. This may have implications for disclosure of diagnosis.     

Early psychosis intervention outpatient service of the 1st Psychiatric University Clinic in Athens: 3 Years of experience

To present the 3‐year experience of the early intervention in psychosis (EIP) service implementation of the 1st Psychiatric University Clinic in Athens. An overview of: (1) the purpose of our service, (2) the referral network, (3) the selection criteria, (4) the diagnostic procedures, (5) the therapeutic interventions and (6) the research activities. The service was established in 2012 and developed gradually aiming to provide information, early detection, treatment and support to people aged 15 to 40 years with psychotic manifestations, who are either at increased risk of developing psychosis (at‐risk mental state [ARMS]) or with first episode psychosis (FEP). In order to assess individuals with ARMS, we used the comprehensive assessment of at‐risk mental states interview and the Social and Occupational Functioning Assessment Scale The duration of untreated psychosis was estimated by using the Nottingham Onset Schedule. So far we have had 65 referrals, of which 26 were ARMS and 17 FEP. Based on the individual needs, they were offered psychotherapeutic and/or pharmacological treatment. After 3 years, the rate of transition to psychosis was 19.2% and the rate of psychosis relapse was 11.7%. The implementation of our service has had positive results, enabling young people with early psychosis to receive prompt and effective care. The rates of transition to psychosis are the first to be published from a Greek EIP service. Further development of our referral network and inter‐hospital collaboration will allow us to address the needs of a wider part of the population.     

The First‐Episode Psychosis Outcome Study: premorbid and baseline characteristics of an epidemiological cohort of 661 first‐episode psychosis patients

Aims: Studies conducted in first‐episode psychosis (FEP) samples avoid many biases. However, very few studies are based on epidemiological cohorts treated in specialized FEP services. The aim of this file audit study was to examine premorbid and baseline characteristics of a large epidemiological sample of FEP. Methods: File audit study of all patients admitted to the Early Psychosis Prevention and Intervention Centre between 1998 and 2000 using a specialized questionnaire. Results: There were 661 patient files included in the study. Premorbid evaluation revealed high rates of substance use disorder (74.1%), history of psychiatric disorder (47.5%), past traumatic events (82.7%) suicide attempts (14.3%) and family history of psychiatric illness (55.6%). Baseline characteristics revealed high intensity of illness (mean CGI 5.5), high prevalence of lack of insight (62%) and high rate of comorbidity (70%). Conclusion: High rates of traumatic events or episodes of mental illness before treatment for FEP must be considered when designing treatment approaches because a too narrow focus on positive psychotic symptoms will inevitably lead to incomplete treatment. Additionally, early intervention programmes need sufficient range of resources to address the multiple challenges presented by FEP patients such as high severity of illness, comorbidities and functional impairment. Finally, observation of an important degree of functional impairment despite short duration of untreated psychosis suggests that while early detection of FEP is a necessary step in early intervention, it may not be sufficient to improve functional recovery in psychosis and that efforts aimed at identifying people during the prodromal phase of psychotic disorders should be pursued.     

A multi‐site Canadian perspective: examining the functional outcome from first‐episode psychosis

Objective: To examine factors contributing to variance in functional outcome in first‐episode psychosis (FEP) following 1 year of treatment. Method: Naturalistic 1‐year follow‐up of a FEP cohort (n = 200), from programs in four university centers in Ontario, Canada. Functional recovery was defined by ‘Social and Occupational Functioning Assessment Scale’ (SOFAS) score>60. Regression analysis examined the contribution of independent variables to variance in functional outcome. Results: Twelve‐month outcome measures were available for 76.5% of the original cohort. Of these, 70% reported being in school/work and in satisfactory relationships. The functional recovery rate was 51%, compared to 74% attaining symptomatic remission. The greatest contributors to variance in outcome were ongoing symptoms at 6 months and substance abuse comorbidity. Conclusion: After 1 year of treatment, FEP patients show high rates of symptomatic remission and relatively lower rates of functional recovery. Symptoms and substance abuse contribute to variance in outcome.     

Clinical and sociodemographic comparison of people at high‐risk for psychosis and with first‐episode psychosis

Zimbrón J, Ruiz de Azúa S, Khandaker GM, Gandamaneni PK, Crane CM, González‐Pinto A, Stochl J, Jones PB, Pérez J. Clinical and sociodemographic comparison of people at high‐risk for psychosis and with first‐episode psychosis. Objective: To compare clinical and sociodemographic characteristics previously associated with psychosis, between individuals at high‐risk for psychosis (HR) and patients experiencing a first episode psychosis (FEP), to achieve a better understanding of factors associated with psychosis. Method: Cross‐sectional comparison of 30 individuals at HR with 30 age‐gender matched FEP, presenting to an early intervention service for psychosis. Participants were followed‐up for 2 years to establish the proportion of HR who made the transition into FEP. Results: Both groups showed similar socio‐clinical characteristics, including immigration status, employment history, marital status, family history of psychotic illness, self‐harm and alcohol and drug use. The HR group had a lower level of education, higher burden of trauma, earlier onset of psychiatric symptoms and a longer delay in accessing specialised services. A younger onset of symptoms was associated with a longer delay in accessing services in both groups. After a 2 year follow‐up, only three (10%) of the HR group made a transition into FEP. Conclusion: The similarities observed between individuals at HR and those with FEP suggest that known variables associated with psychosis may be equally prevalent in people at HR who do not develop a psychotic disorder.     

Testing Definitions of Symptom Remission in First-Episode Psychosis for Prediction of Functional Outcome at 2 Years

Background: To determine the clinical relevance of different definitions of symptom remission for prediction of functional outcome in first-episode psychosis (FEP). Methods: One hundred forty-one individuals receiving treatment for an FEP at a specialized early intervention service had positive and negative symptoms and functional status rated every month over the first 2 years of treatment using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Social and Occupational Functioning Assessment Scale. Subjects were classified according to 4 definitions of remission varying the criteria for severity (negative symptom inclusion/exclusion) and duration (3/6 mo sustained). Results: Positive symptom remission was achieved by 94% and 84% of subjects for 3 and 6 months, respectively, compared with 70% and 56% for positive and negative symptom remission, respectively. Linear regression analyses showed that only definitions of remission containing both positive and negative symptoms independently predicted functional outcome. This was confirmed by receiver operating characteristic analyses where remission based on positive and negative symptoms was marginally better than positive symptoms alone (difference in area under the curve; z = 1.94, P = .052). There was little difference between a time criterion of remission of positive and negative symptoms of 3 (sensitivity = 100%, specificity = 42%) or 6 (sensitivity = 90%, specificity = 57%) months. Discussion: Consistent with the consensus definition of remission in schizophrenia, severity of both positive and negative symptoms in defining remission in FEP is necessary although a 3-month criterion had equal predictive validity to the 6-month criterion.     

Depression in first episode psychosis: The role of subordination and shame

Depression in early psychosis is linked to poor outcome, relapse and risk of suicide, yet remains poorly understood. This article aims to examine the development of depression in acute and post psychotic phases of first episode psychosis (FEP), and its relationship to persecutors, voices, insight, and recovery. Data were gathered on 92 patients with acute FEP on depression course, severity and experience of positive symptoms, insight and appraisals of illness using validated semi-structured interviews and questionnaires. Measures were repeated at 12 months. Malevolent voices, use of safety behaviours and subordination to persecutors were associated with depression and suicidal behaviour in acute FEP. Loss, Shame, low level continuing positive symptoms and longer duration of untreated psychosis were associated with post psychotic depression. Negative appraisals remained stable despite recovery in other symptom domains. Thus, depression and risk in early psychosis may be propagated by the personal significance and content of positive symptoms experienced. When in recovery, low level symptoms, longer period of illness and negative appraisals are significant factors.     

Scale for the Assessment of Negative Symptoms structure in first episode psychosis

Previous studies in schizophrenia samples suggest negative symptoms can be categorized as expressivity or experiential. This study examines the structure of the Scale for the Assessment of Negative Symptoms (SANS) at two separate interviews in a first episode psychosis (FEP) sample. SANS structure was determined with principal components analysis in a schizophrenia spectrum (SSD, N=191) and non-schizophrenia spectrum (NSSD, N=246) sample at first presentation. Confirmatory factor analysis (CFA) was conducted in the entire FEP sample (N=197) at a follow-up assessment. A three factor model solution was extracted in both SSD and NSSD at first presentation. The three components, consisting of expressivity, experiential and alogia/inattention components, explained 26.1%, 16.6% and 13.6% of the variance respectively in SSD. In NSSD the same three components explained 24.2%, 17.9% and 13.1% of the variance respectively. CFA at follow-up showed similar model fit for both the original SANS five factor and for a three factor model solution. The results indicate that either a three or five factor SANS model solution may be appropriate in a psychosis sample inclusive of both SSD and NSSD. The findings also provide initial support for expressivity and experiential domain research in NSSD.     

Relationships between self-reflectiveness and clinical symptoms in individuals during pre-morbid and early clinical stages of psychosis

BackgroundSelf-reflectiveness, one dimension of cognitive insight, plays a protective role in an individual’s mental state. Both high and low levels of self-reflectiveness have been reported in patients with schizophrenia and individuals at clinical high risk for the illness.AimsThis study aimed to explore the relationship patterns between self-reflectiveness and clinical symptoms in individuals during the pre-morbid and early clinical stages of psychosis.MethodsA total of 181 subjects, including individuals with attenuated positive symptoms (APS, n=122) and patients with first-episode psychosis (FEP, n=59), completed the Beck Cognitive Insight Scale and were evaluated using the Schedule of Assessment of Insight and Positive and Negative Syndrome Scale. All subjects were classified into three groups according to their level of self-reflectiveness: low level (LSR, n=59), medium level (MSR, n=67) and high level (HSR, n=55). Both linear and non-linear relationships between self-reflectiveness and clinical symptoms were explored.ResultsMore individuals with APS were classified into the MSR group, while more patients with FEP were classified into the LSR group. The LSR group demonstrated less awareness of illness than the MSR and HSR groups, more stereotyped thinking and poorer impulse control but less anxiety than the MSR group, and lower levels of blunted affect and guilt feelings than the HSR group. The MSR group demonstrated lower stereotyped thinking than the HSR group. Compared to the LSR group, the MSR group had increased self-reflectiveness, improved awareness of illness, decreased stereotyped thinking, and better impulse control, but increased feelings of guilt. The HSR group showed increased stereotyped thinking when compared to the MSR group, but the other variables did not change significantly between these two groups. Overall, self-reflectiveness demonstrated an approximately inverse S-shaped relationship with the awareness of illness, a U-shaped relationship with stereotyped thinking and poor impulse control, and an almost linear relationship with anxiety and guilt feelings.ConclusionsSelf-reflectiveness demonstrates complex relationships with clinical symptoms and fails to exert significant positive effects when reaching a certain high level.     

When things are not as they seem: detecting first‐episode psychosis upon referral to ultra high risk (‘prodromal’) clinics

The current paper examines a neglected function of ‘ultra high risk’ (UHR) clinics: to detect first‐episode psychosis (FEP) mistakenly identified as a prodrome. A clinical audit was conducted of referrals to a UHR service, the Personal Assessment and Crisis Evaluation Clinic, over a 12‐month period (April 2005–March 2006). In this audit, 11.4% of the total number of referrals (n= 149) and 11.9% of those who attended a first appointment were psychotic on referral. These figures indicate that a substantial proportion of individuals thought to be prodromal are in fact suffering FEP. UHR clinics minimize duration of untreated psychosis for FEP patients mistaken as prodromal.     

Obsessive-compulsive disorder in patients with first-episode schizophrenia

OBJECTIVE: The aim of the present study was to determine the rate of obsessive-compulsive disorder (OCD) in patients with first-episode schizophrenia. METHOD: Fifty patients consecutively hospitalized with first-episode psychosis who met DSM-IV criteria for schizophrenia spectrum disorders were assessed for OCD. The instruments used were the Structured Clinical Interview for DSM-IV, Schedule for the Assessment of Positive Symptoms (SAPS), Schedule for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Seven (14%) of the 50 schizophrenic patients met DSM-IV criteria for OCD and scored significantly lower than schizophrenic patients without OCD on the formal thought disorder subscale of the SAPS and the flattened affect subscale of the SANS. CONCLUSIONS: OCD is relatively frequent in patients with first-episode schizophrenia and may have a "protective" effect on some schizophrenic symptoms, at least in the early stages of the disease.     

Profile and Determinants of Disability in Psychotic Disorders in Nigeria

We compared profile and predictors of disability among 210 patients with schizophrenia, schizoaffective disorder, bipolar I disorder with psychosis and depression with psychosis, respectively in a Nigerian clinical population, using the WHO Disability Assessment Schedule, (2.0). Severity of psychosis was determined with Positive and Negative Symptoms Scale, functioning was assessed using the Global Assessment of Functioning Scale, medication adherence with the Medication Adherence Questionnaire. Analyses were by SPSS 20.0. There were remarkable differences in the predictors of disability across these psychotic disorders. The findings strengthens the significance of psychosocial rehabilitation in patients with psychosis as clinical remission and medication adherence did not equate functional recovery.