Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up.
BACKGROUND
Increasing evidence shows attachment security influences symptom expression and adaptation in people diagnosed with schizophrenia and other psychoses.


OBJECTIVE
To describe the distribution of secure and insecure attachment in a cohort of individuals with first-episode psychosis, and to explore the relationship between attachment security and recovery from positive and negative symptoms in the first 12 months.


METHODS
The study was a prospective 12-month cohort study. The role of attachment, duration of untreated psychosis (DUP), baseline symptoms and insight in predicting and mediating recovery from symptoms was investigated using multiple regression analysis and path analysis.


RESULTS
Of the 79 participants, 54 completed the Adult Attachment Interview (AAI): 37 (68.5%) were classified as insecure, of which 26 (48.1%) were insecure/dismissing and 11 (20.4%) insecure preoccupied. Both DUP and insight predicted recovery from positive symptoms at 12 months. Attachment security, DUP and insight predicted recovery from negative symptoms at 12 months.


CONCLUSIONS
Attachment is an important construct contributing to understanding and development of interventions promoting recovery following first-episode psychosis.
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Gumley
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Schwannauer
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Macbeth
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Fisher
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Clark
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Rattrie
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Fraser
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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McCabe
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Blair
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Davidson
A. I. Gumley, BA(Hons), MAppSci, PhD, AFBPsS, CPsychol, Institute of Health and Wellbeing, University of Glasgow, and ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; M. Schwannauer, MA, DPsych, PhD, Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh, and Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Macbeth, DClinPsy, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Medical Sciences, University of Aberdeen, Aberdeen; R. Fisher, PhD, Early Psychosis Support Service, NHS Lothian, Edinburgh, and Department of Clinical & Health Psychology, University of Edinburgh, Edinburgh; S. Clark, MA(Hons), DClinPsychol, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; L. Rattrie, BSc(Hons), MSc, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; G. Fraser, MSc, Early Psychosis Support Service, NHS Lothian, Edinburgh; R. McCabe, MBChB, MPhil, FRCPsych, Early Psychosis Support Service, NHS Lothian, Edinburgh; A. Blair, FRCPsych, ESTEEM First Episode Psychosis Service, NHS Greater Glasgow and Clyde, Glasgow; K. Davidson, MA, MPhil, PhD, FBPsS, CPsychol, Institute of Health and Wellbeing University of Glasgow, and Glasgow Institute for Psychosocial Interventions, NHS Greater Glasgow and Clyde, Glasgow; M. Birchwood, BSc, PhD, DSc, FBPsS, Warwick Medical School, University of Warwick, Warwick, UK.
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Birchwood
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009769:Object Attachment; D011379:Prognosis; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology*; D020127:Recovery of Function; D063189:Symptom Assessment; D016896:Treatment Outcome