title: Service engagement in first episode psychosis: clinical and premorbid correlates.
abstract: Engagement can be understood as a multifactorial process, incorporating acceptance of treatment, therapeutic rapport, and collaboration in a shared goal of clinical and functional recovery. Difficulties in engagement with clinical services represent a risk factor for treatment discontinuation in first episode psychosis. The current study explored the associations between engagement, clinical, and preonset variables. We report the cross-sectional data on a Scottish sample with first episode psychosis, characterized in terms of psychotic symptoms, premorbid adjustment, duration of untreated psychosis, and clinician-rated engagement. Poorer clinician-rated engagement was associated with greater positive and negative symptoms, greater general psychopathology, and poorer premorbid social adjustment. In a regression analysis, only severity of negative symptoms predicted engagement. The study highlights the role of negative symptoms and impairments in social functioning as factors associated with poorer engagement with clinical services. The value of detailed assessment of social and premorbid functioning is highlighted.
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. angus.macbeth@nhs.net
authors.forename: Angus
authors.initials: A
authors.lastname: Macbeth
authors.forename: Andrew
authors.initials: A
authors.lastname: Gumley
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwannauer
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy; D012737:Sex Factors; D012917:Social Adjustment; D055815:Young Adult