Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1982. A 63-year-old man with recurrent gastrointestinal bleeding

Quality of life in first episode psychosis: a cluster analytic approach

PURPOSE

Quality of life is increasingly recognised as an important outcome for young people with first episode psychosis (FEP). The first aim was to determine whether distinct homogenous subgroups of young people with FEP could be delineated based on profiles on quality of life domains (Physical Health, Psychological, Social relationships and Environmental). The second aim was to examine the discriminant validity of these subgroups with respect to demographic, functioning and clinical features of FEP.

METHOD

Quality of life, demographic characteristics, clinical characteristics, cognition and functioning were assessed in 145 people with FEP. Cluster analysis using Ward's methods and Squared Euclidean Distance with a k-means verification were employed to identify subgroups with homogenous quality of life profiles. The clusters were externally validated using multinomial logistic regressions.

RESULTS

Three distinct quality of life profiles were identified: one with good quality of life across all domains (30%), one with poor quality of life particularly in Psychological and Social relationships domains (28%), and one 'intermediate' group with comparatively low Psychological quality of life (42%). Depression, semantic verbal fluency, social inclusion and social/occupational functioning showed associations with group membership.

CONCLUSION

Our results suggest the potential of maintaining relatively good quality of life despite the experience of FEP. Future research on interventions to improve quality of life may consider the potential of addressing depression, social inclusion and social/occupational functioning.

Enteroclysis in the diagnosis of chronic unexplained gastrointestinal bleeding

In a six-year period (1977-83), lesions were identified by enteroclysis in 26 patients with melena or recurrent gastrointestinal bleeding undiagnosed by other modalities. These included nine Meckel's diverticula, three metastatic lesions, three primary carcinomas, one lipoma, four leiomyomas, five surgically created blind pouches, one carcinoid, and one idiopathic dilatation of the ileum. Our experience suggests that, when the standard diagnostic procedures used to investigate chronic gastrointestinal blood loss are unrevealing, enteroclysis should be performed. The method is fast, accurate, is done in one sitting, and can be productive in the diagnostically difficult patient.