First-episode psychosis in emerging adulthood: exploring cognitive functioning, symptomatology, quality of life, and potential strengths

Lichtenstein, Sidney (2024) First-episode psychosis in emerging adulthood: exploring cognitive functioning, symptomatology, quality of life, and potential strengths. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

This thesis is an exploration of first-episode psychosis in emerging adults. Emerging adulthood is a developmental period comprised of critical psychosocial milestones (e.g., transitioning to independence, educational/occupational achievement, establishing one’s social network, identity formation) and neurocognitive milestones (e.g., frontal lobe development). First-episode psychosis can severely disrupt milestone attainment during this period, leading to adverse personal and societal costs. Therefore, this thesis elucidates how first-episode psychosis presents in emerging adults and explores potential strengths in this group with the intention of helping early intervention programs support emerging adults in meeting their milestones and thus reducing the risk of adverse outcomes. The methodology of this study is naturalistic. Cross-sectional and two-year longitudinal secondary data on the cognitive functioning, symptomatology and quality of life of 41 emerging adults was analyzed following an Exploratory Data Analysis framework. Executive functioning and letter fluency predicted global quality of life and productivity quality of life one year into treatment. Letter fluency and baseline negative symptoms predicted social quality of life one year into treatment. None of these variables predicted any area of quality of life at two years into treatment. These findings suggest that first-episode psychosis during the period of emerging adulthood presents similarly to first-episode psychosis at other stages of life. However, emerging adults appear unique in that the severity of baseline negative symptoms did not impact global and productivity quality of life in the first year of treatment. This finding might distinguish first-episode psychosis during emerging adulthood from other developmental periods by suggesting that, unlike at other ages, occupational functioning during this period of development is less destabilized by early negative symptoms. The domains of executive functioning and letter fluency also appear to be assets that could protect emerging adults from risks to their academic/occupational milestones in the first year following initiation of treatment. Moreover, the social milestone may be protected by letter fluency in the first year of treatment. To build towards developmentally-informed, strengths-based early interventions, more research into the assets identified in this study and other possible strengths is needed to help emerging adults with first-episode psychosis meet their milestones.

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