Elsevier

Schizophrenia Research

Volume 150, Issue 1, October 2013, Pages 163-168
Schizophrenia Research

Predictors of recovery in first episode psychosis: The OPUS cohort at 10 year follow-up

https://doi.org/10.1016/j.schres.2013.07.031Get rights and content

Abstract

Background

Recovery, the optimal goal in treatment, is the attainment of both symptomatic and functional remission over a sustained period of time. Identification of factors that promote recovery can help develop interventions that facilitate good outcomes for people with first episode psychosis.

Aim

To examine long-term outcomes within a cohort of people with first episode psychosis in relation to symptom remission, functioning and recovery, 10 years after diagnosis.

Method

The study had a prospective design. Participants from the OPUS trial (1998–2000) (n = 496) completed a series of interviews and questionnaires to measure current levels of psychopathology and social/vocational functioning, ten years after diagnosis. Predictors of recovery were identified using socio-demographic and clinical characteristics collected at baseline.

Results

A total of 304 participants were interviewed, giving a follow-up rate of 61%. A total of 42 people (14%) met the criteria for symptomatic and psychosocial recovery at 10 years. A multivariable binary logistic regression analysis indicated that baseline predictors accounted for 22% of the variance of full recovery. Lower severity of negative symptoms at baseline (Odds Ratio (OR) 0.53, 95% confidence interval CI 0.36–0.78, p < 0.001) and earlier age of diagnosis (OR 0.92, 95% CI 0.86–0.99, p < 0.05) predicted better rates of recovery at 10 years.

Conclusion

Results of this study indicated that negative symptoms could play a central role in the process of recovery from schizophrenia. A challenge for clinicians and researchers is to understand the mechanisms behind negative symptoms and develop interventions that can prevent or ameliorate these symptoms in order to promote recovery.

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.

References (62)

  • G. Pedersen et al.

    Generalizability studies of the Global Assessment of Functioning—split version

    Compr. Psychiatry

    (2007)
  • J. Rabinowitz et al.

    A population based elaboration of the role of age of onset on the course of schizophrenia

    Schizophr. Res.

    (2006)
  • J. Rabinowitz et al.

    Negative symptoms have greater impact on functioning than positive symptoms in schizophrenia: analysis of CATIE data

    Schizophr. Res.

    (2012)
  • L. San et al.

    Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: prevalence and associations in a cross-sectional study

    Eur. Psychiatry

    (2007)
  • R. Schennach-Wolff et al.

    Defining and predicting functional outcome in schizophrenia and schizophrenia spectrum disorders

    Schizophr. Res.

    (2009)
  • G.P. Strauss et al.

    Negative symptoms and depression predict lower psychological well-being in individuals with schizophrenia

    Compr. Psychiatry

    (2012)
  • H. Verdoux et al.

    Is the association between duration of untreated psychosis and outcome confounded? A two year follow-up study of first-admitted patients

    Schizophr. Res.

    (2001)
  • L. Alphs

    An industry perspective on the NIMH consensus statement on negative symptoms

    Schizophr. Bull.

    (2006)
  • M. Alvarez-Jimenez et al.

    Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years

    Psychol. Med.

    (2012)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorder

    (1994)
  • N.C. Andreasen et al.

    Remission in schizophrenia: proposed criteria and rationale for consensus

    Am. J. Psychiatry

    (2005)
  • S. Arndt et al.

    A longitudinal study of symptom dimensions in schizophrenia. Prediction and patterns of change

    Arch. Gen. Psychiatry

    (1995)
  • H. Ascher-Svanum et al.

    Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care

    J. Clin. Psychiatry

    (2006)
  • M. Bertelsen et al.

    Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial

    Arch. Gen. Psychiatry

    (2008)
  • G.R. Bond et al.

    An update on randomized controlled trials of evidence-based supported employment

    Psychiatr. Rehabil. J.

    (2008)
  • K. Campbell et al.

    Who benefits from supported employment: a meta-analytic study

    Schizophr. Bull.

    (2011)
  • H.E. Cannon-Spoor et al.

    Measurement of premorbid adjustment in chronic schizophrenia

    Schizophr. Bull.

    (1982)
  • W.C. Chang et al.

    Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study

    Psychol. Med.

    (2012)
  • W.C. Chang et al.

    Prediction of remission and recovery in young people presenting with first-episode psychosis in Hong Kong: a 3-year follow-up study

    Aust. N. Z. J. Psychiatry

    (2012)
  • R. Emsley et al.

    Predictors of long-term outcome in schizophrenia

    Curr. Opin. Psychiatry

    (2008)
  • S.M. Erhart et al.

    Treatment of schizophrenia negative symptoms: future prospects

    Schizophr. Bull.

    (2006)
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