Predictors of recovery in first episode psychosis: The OPUS cohort at 10 year follow-up
Introduction
Recovery, the optimal goal in treatment, is often conceptualized as the attainment of both symptomatic and functional remission over a sustained period of time (Liberman and Kopelowicz, 2005). The identification of predictors for recovery can directly inform clinical practice. Factors which are modifiable and associated with good outcomes can be targeted or enhanced to promote greater rates on recovery. Furthermore, identification of predictors of recovery can increase the understanding of the underlying pathophysiology of the illness (Emsley et al., 2008).
Rates of recovery within first episode psychosis have varied between 10 and 25%, dependent on diagnosis composition and length of follow-up period (Harrison et al., 2001, Robinson et al., 2004, Harrow et al., 2005, San et al., 2007, Bertelsen et al., 2009, Wunderink et al., 2009, Henry et al., 2010). A recent systematic review of over 50 naturalistic studies found the median rate that meet recovery criteria for schizophrenia was 13.5% (Jaaskelainen et al., 2012).
Studies into predictors of recovery in first episode psychosis have consistently found better pre-morbid functioning (Petersen et al., 2008, Bobes et al., 2009, Wunderink et al., 2009, Albert et al., 2011) lower levels of psychopathology at baseline and shorter duration of untreated psychosis (DUP) (Jeppesen et al., 2008, Wunderink et al., 2009, Chang et al., 2012a, Verma et al., 2012) have been associated with higher rates of recovery. Other factors that have been associated with recovery include better cognition and less depressive symptoms at baseline (Bobes et al., 2009, Faber et al., 2011), higher levels of education at baseline (Chang et al., 2012b, Verma et al., 2012), early response to treatment (Verma et al., 2012, Schennach et al., 2012), the timing of onset of psychosis, no substance abuse at baseline, and adherence to medication (Leung and Chue, 2000, Ascher-Svanum et al., 2006, Petersen et al., 2008, Novick et al., 2009, Albert et al., 2011, Verma et al., 2012). Some studies have indicated females may achieve higher rates of recovery (Leung and Chue, 2000) although this finding does not appear too robust (Jaaskelainen et al., 2012).
Many studies identifying predictors of recovery within first episode psychosis have a number of methodological limitations such as sampling bias, small sample sizes; relatively short follow-up periods, significant attrition and the lack of standardization in the definition and measurement of recovery (Menezes et al., 2006). These problems may compromise the validity and generalizability of findings. Furthermore, there are still relatively few prospective studies that have systematically applied a structured definition for recovery and investigated long-term outcomes within this population.
The following study attempted to address the methodological weaknesses of previous longitudinal studies within FEP cohorts and applied universally recognized definitions of remission and recovery to investigate long-term outcomes. Specifically, the study examined rates of symptom remission and recovery and identified baseline predictors of recovery, within a representative cohort of people with first episode psychosis, 10 years after diagnosis.
Section snippets
Participants
A sample of 496 people with first episode psychosis recruited as part of the OPUS trial (1998–2000) was included in the study. At the time of inclusion participants were between 18 and 45 years old, and had a diagnosis within the schizophrenia spectrum disorder (F20–29). Those people with a schizotypal disorder (F21) were excluded since the study was concerned with people that had experienced psychotic symptoms. Participants had not received more than 12 weeks of anti-psychotic medication. A full
Results
A total of 304 participants were interviewed at 10 year follow-up. Participants were on average 26 years old, 55% were men and 80% had a schizophrenia diagnosis (F20) at baseline. Comparison between participators and non-participators revealed no statistically significant differences on a range of baseline characteristics including psychiatric diagnosis, sex distribution, positive and negative symptoms, educational level, DUP, pre-morbid social/academic functioning or psychiatric admissions in
Rates of recovery
This study examined outcomes and identified predictors of recovery within a cohort of people with first episode psychosis, 10 years after diagnosis. Rates of remission and recovery were comparable with other FEP studies although lower than some studies (Lambert et al., 2008, Wunderink et al., 2009, Henry et al., 2010). The most probable explanation for this lower rate of recovery was the higher proportion of people with a schizophrenia diagnosis in this study compared to those other studies. A
Conclusion
Modest rates of recovery at 10 year follow-up were achieved, highlighting the need to develop more effective interventions to improve prognosis in first episode psychosis. Evidence based interventions that promote re-integration into the workforce may improve rates of recovery.
The early identification and treatment of adult onset psychosis may facilitate social and vocational relationships and thereby assist in the process of recovery. Negative symptoms could play a central role in long-term
Role of funding source
The funding sources had no influence on the analyses or the presentation of the results.
Contributors
MN, OM and SFA conceived the study. MN rose the funding. SFA drafted the first manuscript. CRH, SFA conducted the analysis and interpretation of results. All authors critically revised the manuscript and approved the version submitted for publication.
Conflict of interest
All authors declare they have no conflict of interest.
Acknowledgments
The project received unconditional grants from the Lundbeck, University of Copenhagen, Trygfonden, and Midt-Jylland research fund.
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