Health beliefs link to duration of untreated psychosis and attitudes to later treatment in early psychosis.

BACKGROUND: Health beliefs influence health behaviours and have been shown to influence outcomes in a variety of illnesses, treatments and preventative interventions. AIMS: We aimed to measure health beliefs in first episode psychosis with the hypotheses that their structure would resemble that in physical illness (diabetes) and would correlate with prior duration of untreated psychosis and later attitudes to treatment. METHOD: The Multidimensional Health Locus of Control scale was used in a sample of 50 people with schizophrenia during the first episode and at 18-month follow-up, 51 diabetic controls and 51 normal controls. RESULTS: Schizophrenia patients, both at first episode and 18 months later, had a pattern of health beliefs that was similar to those of the patients with diabetes and significantly different to the normal controls. There were significant associations between internal locus of control score and short DUP, and between external locus of control score and a positive attitude to medication as measured by the Drug Attitudes Inventory. CONCLUSIONS: Health beliefs in first episode schizophrenia correlate with determinants of outcome.

Causes and consequences of duration of untreated psychosis in schizophrenia.

BACKGROUND: It is unclear what determines duration of untreated psychosis (DUP) in schizophrenia and why long DUP predicts poor outcome. AIMS: First, to test the hypothesis that specific patterns of symptoms and social functioning acting before treatment prolong DUP. Second, to clarify the mechanisms linking DUP with recovery after treatment. METHOD: Two hundred and forty-eight consecutive first admissions with schizophrenia were interviewed to assess DUP, symptoms and social functioning at admission, and symptoms were re-assessed after 6-12 weeks. RESULTS: Median DUP was 12 weeks. Long DUP was predicted by poor insight, social isolation and preserved coping skills, but not by demographic factors. Even allowing for all these variables, long DUP predicted poor outcome. CONCLUSIONS: Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and relevant others. DUP's relationship to outcome is strongest in the initial months of psychosis. This has implications for targeting early intervention.

Glucagon stimulation of phenylalanine metabolism. The effects of acute and chronic glucagon treatment.

The effects of acute and chronic glucagon treatment on phenylalanine metabolism in vivo in the rat have been investigated. A single, large dose of glucagon (2 mg/kg, i.p.) increased metabolism of a large load of phenylalanine (1.27 g/kg) via hydroxylation and transamination. The increased metabolism was associated with increased activities of hepatic phenylalanine:pyruvate aminotransferase, tyrosine aminotransferase and phenylalanine hydroxylase. In rats administered this amount of phenylalanine, the p-hydroxyphenylpyruvate dioxygenase reaction was apparently rate limiting, as indicated by increased urinary excretion of p-hydroxyphenylpyruvate and p-hydroxyphenyllactate, in addition to urinary excretion of phenylpyruvate and phenyllactate. Chronic glucagon treatment (1.25 mg/kg every 12 hr for 8 days) increased oxidation of the large phenylalanine load and urinary excretion of phenylpyruvate and phenyllactate but not p-hydroxyphenylpyruvate or p-hydroxyphenyllactate. The increased excretion of phenylpyruvate and phenyllactate was associated with an increase in hepatic phenylalanine: pyruvate aminotransferase activity. The absence of p-hydroxyphenylpyruvate in the urine and the increased oxidation of phenylalanine imply that, in rats administered glucagon chronically, flux of p-hydroxyphenylpyruvate through the p-hydroxyphenylpyruvate dioxygenase reaction was increased. A kinetic assay for phenylalanine hydroxylase based on measurement of oxygen consumption in described.