title: Depression in first episode psychosis: the role of subordination and shame.
abstract: 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.
authors.affiliation: University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK. Electronic address: r.upthegrove@bham.ac.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Upthegrove
authors.affiliation: Wolverhampton Early Intervention Service, Wolverhampton, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Ross
authors.affiliation: University of Birmingham, School of Psychology, Birmingham, UK.
authors.forename: Katerine
authors.initials: K
authors.lastname: Brunet
authors.affiliation: Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: McCollum
authors.affiliation: University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jones
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D004291:Dominance-Subordination; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011618:Psychotic Disorders / Q000523:psychology*; D012752:Shame; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Appraisals; Depression; First Episode; Psychosis; Schizophrenia