Early sustained recovery following first episode psychosis: Evidence from the AESOP10 follow-up study☆
Introduction
A majority of individuals with a first episode psychosis experience symptom remission within the first year following contact with services (Wiersma et al., 1998; Robinson et al., 1999; Morgan et al., 2014). For some, this remission extends into sustained recovery with no subsequent psychotic episodes. For others, there will be relapse of symptoms. This can occur whether on treatment or not, though non-adherence with medication is strongly associated with relapse (Alvarez-Jimenez et al., 2012; Robinson et al., 1999). Other factors which have been identified in meta-analyses to be associated with relapse include premorbid adjustment and ongoing substance use, with some evidence for non-affective symptoms (Alvarez-Jimenez et al., 2012).
A related, but distinct, issue is whether there are useful predictors of sustained recovery following first episode psychosis. Alvarez-Jimenez et al. (2011) found that 16% of individuals aged 16–30 years with a first episode psychosis experienced only a single psychotic episode, defined as an index episode which did not exceed 12 months' duration, no further episodes, and being “virtually symptom-free and showing their premorbid personality” for a minimum of four weeks over a mean 7.5-year follow-up. Predictors of a single psychotic episode included short duration of untreated psychosis (DUP). We used the comprehensive dataset from the AESOP-10 longitudinal follow-up study of first episode psychosis in order to examine this question in a sample aged 18–64 years. We identified all individuals who achieved early sustained recovery. We aimed, first, to compare their demographic and clinical characteristics with those with other course types and, second, to describe patterns of medication use over follow-up in those with early sustained recovery.
Section snippets
Setting
AESOP-10 is a follow-up at approximately 10 years of a cohort of individuals with a first episode of psychosis identified in the South East London and Nottingham centres of the AESOP study (Kirkbride et al., 2006). Full methods are detailed in Morgan et al. (2014).
Cases
Inclusion criteria: aged 16–64 years with a first episode of psychosis; resident within the study catchment areas. Exclusion criteria: evidence of psychotic symptoms precipitated by an organic cause; transient psychotic symptoms
Demographic and clinical characteristics
Of the 458 baseline cases, useable information on clinical course and outcome was available for 345 (75.3% of 458): Early Sustained Recovery (ESR) (n = 43; 12.5%) and Other Course (OC) (n = 302; 87.5%). OC comprised episodic n = 69 (20%), continuous n = 80 (23.2%), and intermediate n = 153 (44.3%). Median age at baseline for the total sample was 29.0 (range 16–62) (mean = 30.5 ± 10.2(SD)) years. Median age for the ESR group was 30.0 (range 17–56) (mean = 31.8 ± 10.5(SD)) years, and for the OC group 29.0 (range
Discussion
One in eight individuals with first episode of psychosis recovered early and never experienced a recurrence over ten-year follow-up. This is important and relevant to clinical decision-making following first episode psychosis, when a key question raised is: what is the risk of relapse (or continued symptoms) following a single episode of psychosis? Our findings suggest around 88% (or 7 in 8). Early sustained recovery was more common among women of any age, those with a short DUP, those with a
Conflict of interest
All authors declare that they have no conflict of interest.
Contributors
Authors Murray, Jones, Craig and Doody conceptualized the study and authors Lappin, Fearon, Morgan, and Dazzan contributed to the design. Authors Lappin, Heslin, Lomas, Doody, Fearon, Dazzan, and Morgan conducted the data collection. Authors Lappin, Morgan, Reininghaus, and Croudace undertook the statistical analysis, and authors Lappin and Morgan wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Role of the funding sources
This work was supported by UK Medical Research Council (Ref: G0500817) and the Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry at King's College London. The funding sources did not partake in the design, data collection, or analysis.
Acknowledgements
The team wishes to thank all the individuals who took part in the AESOP and AESOP-10 studies, and all the researchers involved.
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Department in which work was done: Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.