Associations between momentary mental states and concurrent social functioning after remission from first episode psychosis: A HAMLETT ecological momentary assessment study

Background: Symptom severity and social functioning are important outcomes after first episode psychosis (FEP), yet current evidence about associations between them is inconsistent and lacks (subclinical) momentary insights. 

Methods: The current Ecological Momentary Assessment (EMA) study was conducted in 58 people in remission from FEP, as part of the HAMLETT (Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment) trial. At baseline, participants were prompted to report momentary mental states and social context 10x/day for eight consecutive days, including psychotic experiences (PEs), motivation/drive and negative affect, that may indicate proxies of (subclinical) psychotic, negative and general affective symptoms, respectively. We employed multilevel mixed-effects regressions to investigate associations between self-reported mental states and concurrent activity or social company and subjective appraisal thereof. We also conducted retrospective clinical assessments of symptoms (PANSS) and social functioning (WHODAS 2.0) and investigated their cross-sectional associations using multivariable linear regression. 

Results: Analyses of 3101 EMA-questionnaires showed that lower motivation/drive was associated with more passive activity and less company (OR = 0.96 [95%CI: 0.96; 0.97], OR = 0.95 [95%CI: 0.93; 0.96], N.B. ORs per 1-point symptom-score change). PEs and negative affect were associated with more proactive activity (OR = 1.02 [95%CI: 1.00; 1.03], OR = 1.02 [95%CI: 1.01; 1.03]). All three mental state domains were associated with lower activity appraisal overall, though activity-specific associations differed. PEs and negative affect were associated with lower company appraisal (B = −0.25 [95%CI: −0.36; −0.14], B = −0.15 [95%CI: −0.23; −0.06]). When assessed retrospectively, only PANSS general psychopathology was associated with poorer social functioning (B = 2.52 [95%CI: 1.69; 3.34]). 

Conclusion: Self-reported PEs, momentary motivation/drive and general affective symptoms are associated with daily-life functioning after remission from FEP. Retrospective observer-rated and momentary self-report assessment methods do not measure the same aspects or intensity of psychopathology.