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Franco-Rubio L, Puente-Martínez A, Ubillos-Landa S. Factors associated with recovery during schizophrenia and related disorders: A review of meta-analysis. Schizophr Res 2024; 267:201-212. [PMID: 38569393 DOI: 10.1016/j.schres.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/01/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The spectrum of schizophrenia disorders (SSD) is a severe mental disorder. It is one of the main medical causes of disability that generates high health and social costs. OBJECTIVE To analyze the factors associated with clinical recovery (CR) (symptomatic remission-SR and functional recovery-FR) and personal recovery (PR) in people diagnosed with SSD. METHODS 14 meta-analyses focused on recovery were reviewed following the PRISMA model statements. 95 % of CI was established. RESULTS Shorter Duration of Untreated Psychosis (Zr = 0.24, [0.17, 0.30]) and total Duration of Untreated Illness (Zr = 0.34, [0.20, 0.48]) were related to greater SR and general functioning, respectively. Resilience was the variable with the greatest effect on FR (Zr = 0.67, [0.63, 0.71]). Premorbid adjustment (Zr = 0.34, [0.18, 0.49]) and physical intervention (Zr = 0.71, [0.55, 0.86]) had the greatest effect on occupational and social functioning, respectively. Less severe affective symptoms were related to greater PR (Zr = 0.46, [0.42, 0.50]). There are differences between affective SR and the other types of SR (Zr(SR-A - SR-) = 0.13, Qb = 6.51, p = 0.011), (Zr(SR-A - SR+) = 0.20, Qb = 8.52, p = 0.004), (Zr(SR-A - SR) = 0.18, Qb = 19.29, p = 0.0001). In all, resilience was associated with greater recovery (Zr = 0.67, [0.53, 0.80]), with the global effect being greater on PR than on CR (Zr(PR-CR) = 0.07, Qb = 3.45, p = 0.05). CONCLUSIONS Resilience was the variable most strongly associated with recovery. Symptomatic or functional improvement obtained less statistical weight.
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Affiliation(s)
- Laura Franco-Rubio
- Department of Psychiatry, Complejo Asistencial Universitario de Burgos, Fuente Bermeja Hospital, C/Francisco Salinas s/n, 09003 Burgos, Spain.
| | - Alicia Puente-Martínez
- Department of Social Psychology and Anthropology, University of Salamanca (USAL), Faculty of Social Sciences, Campus Miguel de Unamuno, Paseo Francisco Tomás y Valiente, s/n, 37007 Salamanca, Spain.
| | - Silvia Ubillos-Landa
- Department of Social Psychology, University of Burgos (UBU), Faculty of Health Science, c/Villadiego, s/n, 09001 Burgos, Spain.
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Cohen DA, Klodnick VV, Reznik SJ, Lopez MA. Expanding Early Psychosis Care across a Large and Diverse State: Implementation Lessons Learned from Administrative Data and Clinical Team Leads in Texas. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:861-875. [PMID: 37530982 PMCID: PMC10543575 DOI: 10.1007/s10488-023-01285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/03/2023]
Abstract
The U.S. is facing an unprecedented youth mental health crisis. Translating the findings from mental health intervention trials into large scale, accessible community-based services poses substantial challenges. Examination of state actions as a result of research-informed federal policy to improve youth access to quality mental healthcare is necessary. This mixed-methods study examines the implementation of evidence-informed multidisciplinary coordinated specialty care (CSC) for first-episode psychosis (FEP) services across Texas. The study explores CSC service model components, site location and participant characteristics, and implementation barriers. This cross-sectional study analyzes State of Texas public mental health administrative data from 2015 to 2020, including CSC site (n = 23) characteristics and CSC participant (n = 1682) demographics. Texas CSC site contracts were compared to OnTrackNY, a leading CSC model in the U.S. for CSC service element comparison. In-depth interviews with CSC Team Leads (n = 22) were analyzed to further understand CSC service elements and implementation barriers using qualitative content analysis. CSC was implemented across three waves in 2015, 2017, and 2019-serving 1682 participants and families. CSC sites were located in adult mental health programs; approximately one third of CSC participants were under 18 years. CSC implementation challenges reported by Team Leads included: staff role clarification, collaboration and turnover, community outreach and referrals, child and adult service billing issues, and adolescent and family engagement. Study findings have implications for large state-wide evidence-based practice implementation in transition-to-adulthood community mental health.
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Affiliation(s)
- Deborah A Cohen
- Dell Medical School Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, 1601 Trinity St., Bldg, B., Austin, TX, 78712, USA.
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
| | - Vanessa V Klodnick
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Samantha J Reznik
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Molly A Lopez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
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3
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Matéos M, Hacein-Bey L, Hanafi R, Mathys L, Amad A, Pruvo JP, Krystal S. Advanced imaging in first episode psychosis: a systematic review. J Neuroradiol 2023; 50:464-469. [PMID: 37028754 DOI: 10.1016/j.neurad.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023]
Abstract
First-episode psychosis (FEP) is defined as the first occurrence of delusions, hallucinations, or psychic disorganization of significant magnitude, lasting more than 7 days. Evolution is difficult to predict since the first episode remains isolated in one third of cases, while recurrence occurs in another third, and the last third progresses to a schizo-affective disorder. It has been suggested that the longer psychosis goes unnoticed and untreated, the more severe the probability of relapse and recovery. MRI has become the gold standard for imaging psychiatric disorders, especially first episode psychosis. Besides ruling out some neurological conditions that may have psychiatric manifestations, advanced imaging techniques allow for identifying imaging biomarkers of psychiatric disorders. We performed a systematic review of the literature to determine how advanced imaging in FEP may have high diagnostic specificity and predictive value regarding the evolution of disease.
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Affiliation(s)
- Marjorie Matéos
- Lille University Hospital Center, Department of Neuroradiology, Lille, France.
| | - Lotfi Hacein-Bey
- Neuroradiology, Radiology Department, University of California Davis School of Medicine, Sacramento, CA, 95817, USA
| | - Riyad Hanafi
- Lille University Hospital Center, Department of Neuroradiology, Lille, France; Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Luc Mathys
- Lille University Hospital Center, Department of Neuroradiology, Lille, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; Department of neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jean-Pierre Pruvo
- Lille University Hospital Center, Department of Neuroradiology, Lille, France; Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Sidney Krystal
- Lille University Hospital Center, Department of Neuroradiology, Lille, France; Radiology Department, A. de Rothschild Foundation Hospital, Paris, France; Neurospin, CEA, Université Paris-Saclay, Gif-Sur-Yvette, Paris, France
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4
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Hui CLM, Wong AKH, Ho ECN, Lam BST, Hui PWM, Tao TJ, Chang WC, Chan SKW, Lee EHM, Suen YN, Lam MML, Chiu CPY, Li FWS, Leung KF, McGhee SM, Law CW, Chung DWS, Yeung WS, Yiu MGC, Pang EPF, Tso S, Lui SSY, Hung SF, Lee WK, Yip KC, Kwan KL, Ng RMK, Sham PC, Honer WG, Chen EYH. Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial. Psychol Med 2023; 53:2339-2351. [PMID: 35144700 DOI: 10.1017/s0033291721004189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention. METHODS 360 psychosis patients aged 26-55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years. RESULTS Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001-0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004-0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year. CONCLUSIONS Specialized EI treatment for psychosis patients aged 26-55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
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Affiliation(s)
| | | | - Elise Chun Ning Ho
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | | | | | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - May Mei Ling Lam
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Cindy Pui Yu Chiu
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Frendi Wing Sai Li
- Department of Psychology, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kwok Fai Leung
- Department of Occupational Therapy, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Sarah M McGhee
- School of Public Health, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chi Wing Law
- Department of Psychiatry, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Wai Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | | | - Edwin Pui Fai Pang
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong
| | - Steve Tso
- Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong
| | - Simon Sai Yu Lui
- Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong
| | - Se Fong Hung
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong
| | - Wing King Lee
- Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong
| | - Ka Chee Yip
- Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
| | - Ka Lik Kwan
- Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
| | - Roger Man Kin Ng
- Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
| | - Pak Chung Sham
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Psychiatry, King's College London, London, UK
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Eric Yu Hai Chen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
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5
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Yu M, Tan Q, Wang Y, Xu Y, Wang T, Liu D, Chen D, Deng P, Huang C, Liang X, Liu K, Xiang B. Correlation between duration of untreated psychosis and long-term prognosis in chronic schizophrenia. Front Psychiatry 2023; 14:1112657. [PMID: 36873212 PMCID: PMC9978092 DOI: 10.3389/fpsyt.2023.1112657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE To explore the relationship between the Duration of Untreated Psychosis (DUP) and long-term clinical outcome, cognitive and social function in patients with chronic schizophrenia (SCZ). METHODS A total of 248 subjects with chronic SCZ were enrolled in this study, including 156 in the short DUP group and 92 in the long DUP group. The Positive and Negative Symptoms Scale (PANSS), the Brief Negative Symptoms Scale (BNSS), the Global Assessment of Functioning (GAF) scale and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to assess all of the subjects. RESULTS The negative symptom scores (the PANSS and BNSS) of subjects with long DUP were significantly higher than that in subjects with short DUP. The scores of visual span and speech function in the short DUP group were significantly higher, indicative of decreasing cognitive function with time. In terms of social function, the short DUP group scored higher, with a statistically significant difference. Meanwhile, we found that the length of DUP was positively correlated with the negative symptom score of the PANSS, negatively correlated with visual span scores, and GAF scores. CONCLUSION This study demonstrated that the DUP remained a significant association with negative symptom and cognition in long period of chronic SCZ.
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Affiliation(s)
- Minglan Yu
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Qingyu Tan
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Department of Psychosomatic Medicine, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Yan Wang
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tingting Wang
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dongmei Liu
- Department of Psychiatry, Yibin Fourth People's Hospital, Yibin, Sichuan, China
| | - Dechao Chen
- Department of Psychiatry, Yibin Fourth People's Hospital, Yibin, Sichuan, China
| | - Peiying Deng
- Department of Psychiatry, Yibin Fourth People's Hospital, Yibin, Sichuan, China
| | - Chaohua Huang
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xuemei Liang
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Kezhi Liu
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Bo Xiang
- Department of Psychiatry, Laboratory of Neurological Diseases and Brain Function, Medical Laboratory Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China.,Central Nervous System Drug Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
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6
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Joseph HL, de Andino AM, Wood K. Group Cognitive-Behavioral Therapy via Telebehavioral Health for Those With Psychotic Spectrum Disorders: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:716-729. [PMID: 35283617 PMCID: PMC8904411 DOI: 10.1016/j.cbpra.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/19/2021] [Indexed: 11/25/2022]
Abstract
Telebehavioral health emerged as an important practice during the coronavirus disease 2019 (COVID-19) pandemic as an opportunity for continued evidence-based mental health intervention, while minimizing exposure to coronavirus contagion. Though preliminary research suggests feasibility and positive outcomes of telebehavioral health practice for people with schizophrenia spectrum and other psychotic disorders, there is limited research about implementation and effectiveness of this practice (Kasckow et al., 2014). This case series highlights the transition from in-person to telebehavioral health practice of a Cognitive Behavioral Social Skills Training for Schizophrenia group due to the COVID-19 pandemic. This article summarizes: (a) the staff procedures needed to transition the group from in-person to telebehavioral health, (b) participant outcome data, (c) session attendance data, and (d) survey results from facilitators and participants about barriers and facilitators of the transition to telebehavioral health, and about how the virtual platform altered the therapeutic relationship and engagement. Participant outcome and engagement data suggest that, not only were two participants able to transition to telehealth and complete the program, but both participants also showed notable improvement in treatment engagement, goal progress, and skill acquisition. Surveys of six facilitators and one participant highlight how the transition to telebehavioral health had treatment advantages (e.g., therapeutic relationship, treatment engagement, group dynamics). Though survey results highlighted several implementation challenges in using the new virtual platform (e.g., technological connectivity, confidential space for engagement), no survey respondents reported that participation in this program resulted in harm to facilitators or participants. All facilitators and one participant agreed that the transition from in-person to virtual services was easy and reduced transportation barriers. Given the limited treatment engagement for this population (Lora et al., 2012) and the importance of early intervention to maximize clinical outcomes (Black et al., 2001; Bottlender et al., 2003), unanimous facilitator and participant report about improved patient attendance and participation in treatment after the transition to telebehavioral health was critically important. Though results of this case study are promising in suggesting telebehavioral health could be a viable modality for providing psychosocial treatment to people with schizophrenia spectrum and other psychotic disorders, more rigorous study is needed.
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Greenwood K, Webb R, Gu J, Fowler D, de Visser R, Bremner S, Abramowicz I, Perry N, Clark S, O'Donnell A, Charlton D, Jarvis R, Garety P, Nandha S, Lennox B, Johns L, Rathod S, Phiri P, French P, Law H, Hodgekins J, Painter M, Treise C, Plaistow J, Irwin F, Thompson R, Mackay T, May CR, Healey A, Hooper R, Peters E. The Early Youth Engagement in first episode psychosis (EYE-2) study: pragmatic cluster randomised controlled trial of implementation, effectiveness and cost-effectiveness of a team-based motivational engagement intervention to improve engagement. Trials 2021; 22:272. [PMID: 33845856 PMCID: PMC8042707 DOI: 10.1186/s13063-021-05105-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Early Intervention in Psychosis (EIP) services improve health outcomes for young people with psychosis in the medium-long term, but 25% of young people disengage in the first 12 months with costs to their mental health, families, society and the NHS. This study will evaluate the effectiveness, cost-effectiveness and implementation of a team-based motivational Early Youth Engagement (EYE-2) intervention. METHOD The study design is a cluster randomised controlled trial (RCT) with economic evaluation, comparing the EYE-2 intervention + standardised EIP service to standardised EIP service alone, with randomisation at the team level. A process evaluation will evaluate the delivery of the intervention qualitatively and quantitatively across contexts. The setting is 20 EIP teams in 5 sites: Manchester, South London, East Anglia, Thames Valley and Hampshire. Participants are young people (14-35 years) with first episode psychosis, and EIP staff. The intervention is the team-based motivational engagement (EYE-2) intervention, delivered alongside standardised EIP services, and supported by additional training, website, booklets and social groups. The comparator is the standardised EIP service. Both interventions are delivered by EIP clinicians. The primary outcome is time to disengagement (time in days from date of allocation to care coordinator to date of last contact following refusal to engage with EIP service, or lack of response to EIP contact for a consecutive 3-month period). Secondary outcomes include mental and physical health, deaths, social and occupational function, recovery, satisfaction and service use at 6, 12, 18 and 24 months. A 12-month within-trial economic evaluation will investigate cost-effectiveness from a societal perspective and from an NHS perspective. DISCUSSION The trial will provide the first test of an engagement intervention in standardised care, with the potential for significant impact on the mental health and wellbeing of young people and their families, and economic benefits for services. The intervention will be highly scalable, supported by the toolkit including manuals, commissioning guide, training and resources, adapted to meet the needs of the diverse EIP population, and based on an in-depth process evaluation. TRIAL REGISTRATION ISRCTN 51629746 prospectively registered 7th May 2019. Date assigned 10th May 2019.
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Affiliation(s)
- Kathryn Greenwood
- R&D, Sussex Partnership NHS Foundation Trust, Hove, UK. .,School of Psychology, University of Sussex, Falmer, UK.
| | - Rebecca Webb
- School of Psychology, University of Sussex, Falmer, UK
| | - Jenny Gu
- School of Psychology, University of Sussex, Falmer, UK
| | - David Fowler
- R&D, Sussex Partnership NHS Foundation Trust, Hove, UK.,School of Psychology, University of Sussex, Falmer, UK.,University of East Anglia, Norwich, UK
| | | | - Stephen Bremner
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Iga Abramowicz
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Nicky Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Stuart Clark
- Sussex Partnership NHS Foundation Trust, Hove, UK
| | | | - Dan Charlton
- Sussex Partnership NHS Foundation Trust, Hove, UK
| | | | - Philippa Garety
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sunil Nandha
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Johns
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Paul French
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK.,Manchester Metropolitan University, Manchester, UK
| | - Heather Law
- Greater Manchester Mental Health NHS Foundation Trust, Greater Manchester, UK
| | | | | | - Cate Treise
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Francis Irwin
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | | | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andy Healey
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Richard Hooper
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Emmanuelle Peters
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
BACKGROUND The outcome of schizophrenia and related psychoses is generally modest, and patients display high rates of disability. AIMS The aim of the review is to present an up-to-date account of the research on the very long-term outcome of psychotic disorders. METHOD We conducted a search in the PubMed and Scopus databases for articles published since the publication of the very long-term data of the World Health Organization's International Study of Schizophrenia (the ISoS study), over the last 18 years (from 2002 to 2019). Studies were included if they reported on at least 15-year outcome and if they had used valid and reliable tools for the estimation of the patients' outcome in terms of symptomatology and functioning. RESULTS A total of 16 studies were included in this review, involving 1,391 patients with schizophrenia and related psychoses. Most were single-center studies, with moderate size samples of patients, and 11 were prospective studies. Very long-term outcome of psychotic disorders varies considerably among studies. Good outcome ranges from 8% to 73.8%, and it appears to be better in developing countries, whereas differences are less apparent among Western countries (8%-40.3%). Studies in different settings have used different methods involving a variety of samples of patients to estimate their outcome, whereas definitions of good and poor outcome also varied among studies. Longer duration of untreated psychosis was associated with worse outcome in some studies. Schizophrenia was found to have poorer long-term prognosis compared to other schizophrenia spectrum disorders. A large proportion of patients, ranging from 19% to 48.2%, were not on medication. CONCLUSION Recent evidence on the very long-term outcome of psychotic disorders is in line with previous reports and suggests that prognosis remains rather modest. There are several limitations of current research regarding outcome definitions and study design that should be addressed by future research.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Afroditi Gogou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, Thrace, Greece
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9
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Altamura AC, Dell'Osso B, Vismara S, Mundo E. May duration of untreated illness influence the long-term course of major depressive disorder? Eur Psychiatry 2020; 23:92-6. [DOI: 10.1016/j.eurpsy.2007.11.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 11/13/2007] [Accepted: 11/17/2007] [Indexed: 11/27/2022] Open
Abstract
AbstractThe aim of this naturalistic study was to investigate the possible influence of the duration of untreated illness (DUI) on the long-term course of Major Depressive Disorder (MDD). One hundred and thirteen patients with recurrent MDD, according to DSM-IV-TR criteria, followed up for 5 years, were selected, interviewed and their clinical charts were reviewed. The DUI was defined as the interval between the onset of the first depressive episode and the first adequate antidepressant treatment. The sample was divided into two groups according to the DUI: one group with a DUI ≤ 12 months (n = 75), and the other with a DUI > 12 months (n = 38). The main demographic and clinical course variables were compared between the two groups using Student's t-tests or chi-square tests. Patients with a longer DUI showed an earlier age at onset (t = 2.82, p = 0.006) and a longer duration of illness (t = 3.20, p = 0.002) compared to patients with a shorter DUI. In addition, the total number of depressive episodes occurring before the first antidepressant treatment was higher in the group with a longer DUI (t = −2.223, p < 0.03). Even though limited by the retrospective nature of the study, these preliminary findings would suggest that a longer DUI may negatively influence the course of MDD. Larger prospective studies are warranted to further investigate the role of the DUI within MDD.
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Very Long-Term Outcome of Community-Dwelling Patients With Schizophrenia Spectrum Disorders in Rural Greece. J Nerv Ment Dis 2019; 207:1012-1018. [PMID: 31703035 DOI: 10.1097/nmd.0000000000001068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of the present study was to measure the very long-term outcome in community-dwelling patients with a diagnosis of psychosis and to search for possible correlations of outcome with clinical factors. The sample included 55 psychotic patients with at least 15 years of disease duration (M = 32.1 years). For the estimation of the outcome, the Health of the Nations Outcome Scale and the Clinical Global Impression Scale were used. A total of 34.5% of the patients had a good outcome, whereas 27.3% had poor outcome. Outcome was found to be correlated to symptoms, and it was significantly worse in patients living with other severely mentally ill family members. In our study, outcome was good in more than a third of patients. Both symptoms and social functioning were associated with outcome. This study may have some implications for mental healthcare delivery.
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Hui CL, Honer WG, Lee EH, Chang WC, Chan SK, Chen ES, Pang EP, Lui SS, Chung DW, Yeung WS, Ng RM, Lo WT, Jones PB, Sham P, Chen EY. Predicting first-episode psychosis patients who will never relapse over 10 years. Psychol Med 2019; 49:2206-2214. [PMID: 30375301 DOI: 10.1017/s0033291718003070] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode. METHOD Patients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning. RESULTS Out of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders. CONCLUSIONS Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.
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Affiliation(s)
- Christy Lm Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Edwin Hm Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - W C Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Sherry Kw Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Emily Sm Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - Edwin Pf Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Simon Sy Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | | | - W S Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Roger Mk Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - William Tl Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Pak Sham
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
- Centre for Genomic Sciences, University of Hong Kong, Hong Kong
| | - Eric Yh Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
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Yoshimura B, Sato K, Takaki M, Yamada N. Algorithm-based pharmacotherapy for first-episode schizophrenia involuntarily hospitalized: A retrospective analysis of real-world practice. Early Interv Psychiatry 2019; 13:39-46. [PMID: 28523839 DOI: 10.1111/eip.12442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/05/2017] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the clinical outcomes of severely ill patients with first-episode schizophrenia spectrum disorders (FES) who are considered to lack the capacity to consent to clinical trials. We investigated the feasibility of an algorithm-based pharmacotherapy (ABP) and clinical outcomes of patients with FES involuntarily hospitalized and treated with ABP. METHODS We conducted a retrospective chart review of 160 patients admitted involuntarily between October 2012 and October 2015. Our algorithm aimed to delay olanzapine, standardize medications and suggest initiation of clozapine after failure (non-response or intolerability) of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at optimal dosage was 4 weeks or more. RESULTS The physician adherence rate to ABP was 95%. Response and remission rates were 76.0% and 48.6% in the first adequate antipsychotic trial (Phase I, n = 146), 62.5% and 25.0% in the second adequate antipsychotic trial (Phase II, n = 32), and 16.7% and 0% in the third adequate antipsychotic trial (Phase III, n = 6). Response and remission rates in the clozapine trial (n = 9) increased to nearly the level of Phase I (66.7% and 44.4%). The treatment-resistance rate was 8.4% to 10.3%. CONCLUSIONS These findings suggested the validity of ABP and initiation of clozapine for treatment-resistant psychotic symptoms for even severely ill involuntarily hospitalized patients with FES.
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Affiliation(s)
- Bunta Yoshimura
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan.,Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kojiro Sato
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Manabu Takaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Bozzatello P, Bellino S, Rocca P. Predictive Factors of Treatment Resistance in First Episode of Psychosis: A Systematic Review. Front Psychiatry 2019; 10:67. [PMID: 30863323 PMCID: PMC6399388 DOI: 10.3389/fpsyt.2019.00067] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/29/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Clinical and functional outcome improvement in psychotic disorders is a challenge for the investigators. Recent advances offered opportunities for ameliorating the course of the illness during its early stages and for identifying treatment-resistant patients. Patients who had not response to two different antipsychotics, administered at correct doses for a sufficient period, can be operationally considered treatment-resistant. Available evidence suggested that the response's trajectory to the antipsychotic treatment revealed that a small proportion of subjects are poor responders (8.2%), the majority of patients have a moderate response (76.4%), and only 15.4% can be considered rapid responders with the greatest magnitude of response. Patients with first episode of psychosis generally obtain a more favorable response profile. Nevertheless, in around 25% of these patients symptoms of psychosis persist with a worse long-term course of illness. Objectives: The aim of this review is to report current evidences on the main predictors of treatment non-response in patients at early stage of psychosis. Methods: We used a specific string that guaranteed a high sensitive search in pubmed. We included the following types of publications: randomized-controlled trials, observational studies, longitudinal studies, retrospective studies, case-control studies, open-label investigations, cohort studies, and reviews. Publications must concern predictors of treatment resistance in early psychosis. Results: Forty-seven records were included: 5 reviews, 3 meta-analyses, 22 longitudinal studies, 2 retrospective studies, 1 naturalistic study, 6 randomized controlled trials, 2 open-label studies, 2 case-control studies, 4 cohort studies, 2 retrospective studies. Several factors were identified as predictors of treatment resistance: lower premorbid functioning; lower level of education; negative symptoms from first psychotic episode; comorbid substance use; younger age at onset; lack of early response; non-adherence to treatment; and longer duration of untreated psychosis. The role of gender and marital status is still controversial. More evidences are needed about neurobiological, genetic, and neuroimaging factors. Conclusions: The identification of specific predictive factors of treatment resistance in patients with first episode of psychosis ameliorates the quality of clinical management of these patients in the critical early phase of schizophrenia.
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Affiliation(s)
| | - Silvio Bellino
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
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Kaligis F, Ismail Marsubrin RI, Wiguna T, Noorhana SW, Almasyhur AF. Translation and validation study of the prodromal questionnaire brief version into Indonesian language. Asian J Psychiatr 2018; 37:96-101. [PMID: 30170200 DOI: 10.1016/j.ajp.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIM Psychosis is a mental disorder resulting in high disability impacts. Many studies show that early detection of prodromal symptoms may improve prognosis. Psychotic prodromal symptoms may mimic other mental health conditions such as depression, anxiety or learning difficulties. The aim of this study was to analyze validity, reliability, sensitivity and specificity of the Prodromal Questionnaire Brief Version (PQ-B) Indonesian version to detect psychotic prodromal symptoms. METHOD The PQ-B was translated into Indonesian then back-translated into English. Subjects included in this study were 50 children and adolescent psychiatric patients from Cipto Mangunkusumo National Hospital, aged 10-18 years old. Validity measurement was performed by comparing the total score and distress score of PQ-B with the categorical scale of Structured Interview for Prodromal Symptoms (SIPS) as the gold standard using Spearman correlation. Total scale and subscale reliability were examined using the Cronbach's Alpha. RESULTS Analysis with Spearman correlation showed significant results of both PQ-B total score with diagnosis of SIPS (r = 0.374 and p = 0.007); and PQ-B distress score with diagnosis of SIPS (r = 0.400 and p = 0.004). Cronbach Alpha coefficient was equal to 0.853 for all scales. The sensitivity of the PQ-B in the Indonesian language is 70%, and the specificity is 72%, whereas, in the original language (English), the sensitivity and specificity is 88% and 68%. CONCLUSION This study provides evidence of good validity, reliability, sensitivity, and specificity of PQ-B Indonesian language to detect prodromal symptoms of those who seek help in the psychiatric outpatient clinic.
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Affiliation(s)
- Fransiska Kaligis
- Child and Adolescent Psychiatry Division Department of Psychiatry, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia.
| | - Raden Irawati Ismail Marsubrin
- Child and Adolescent Psychiatry Division Department of Psychiatry, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia
| | - Tjhin Wiguna
- Child and Adolescent Psychiatry Division Department of Psychiatry, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia
| | - S W Noorhana
- Child and Adolescent Psychiatry Division Department of Psychiatry, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia
| | - Alfi Fajar Almasyhur
- Child and Adolescent Psychiatry Division Department of Psychiatry, Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia
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Ran MS, Xiao Y, Chui CHK, Hu XZ, Yu YH, Peng MM, Mao WJ, Liu B, Chen Eric YH, Chan CLW. Duration of untreated psychosis (DUP) and outcome of people with schizophrenia in rural China: 14-year follow-up study. Psychiatry Res 2018; 267:340-345. [PMID: 29957551 DOI: 10.1016/j.psychres.2018.06.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
This study aims to examine the relationship between the duration of untreated psychosis (DUP) and 14-year outcomes of schizophrenia in a Chinese rural area. Participants with schizophrenia (n = 510) were identified in an epidemiological investigation of 123 572 people aged 15 years and older in 1994 and followed up in 2008 in Xinjin, Chengdu, China. Longer DUP (>6 months) was common in participants (27.3%). In 1994, participants with DUP ≤ 6 months were more likely to have a significantly lower rate of suicide attempts, shorter duration of illness and higher rate of full remission compared with those with DUP > 6 months. No significant differences were found regarding the rates of survival, suicide, death due to other causes and homelessness between individuals with shorter and longer DUP in 2008. Nevertheless, longer DUP (>6 months) of participants in 2008 was significantly associated with higher mean of PANSS total negative and general mental scores, longer duration of illness and higher rate of live alone in the logistic regression model. Earlier identification, treatment and rehabilitation, and family intervention should be addressed when developing mental health policies and delivering community mental health services.
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
| | - Yunyu Xiao
- Silver School of Social Work, New York University, New York, United States
| | - Cheryl H K Chui
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Xian-Zhang Hu
- Institute of Psychiatry and Neuroscience, Xinxiang Medical University, Henan 453002, China
| | - Yue-Hui Yu
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Man-Man Peng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Wen-Jun Mao
- Chengdu Mental Health Center, Chengdu 610036, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei 434000, China
| | - Yu-Hai Chen Eric
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
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Hasegawa T, Hashimoto T, Kanahara N, Yamanaka H, Ishige M, Sato Y, Iyo M. Identifying improvable employment-related factors in schizophrenia patients. Psychiatry Res 2018; 266:199-205. [PMID: 29870957 DOI: 10.1016/j.psychres.2018.05.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 05/03/2018] [Accepted: 05/25/2018] [Indexed: 11/17/2022]
Abstract
Although many studies report various factors related to future employment of schizophrenia patients, few identify the treatable or improvable ones. The responses to the first year of treatment and daily antipsychotic drug doses may be the treatable and improvable factors. We surveyed 235 schizophrenia outpatients in three facilities, of whom 129 and 106 were employed and unemployed, respectively. Through face-to-face interviews and medical record reviews, we investigated symptomatic and social functioning responses to the first year of treatment using the Global Assessment of Psychopathology Scale (GAPS) and the Social and Occupational Functioning Assessment Scale (SOFAS). We investigated daily antipsychotic drug doses and other clinical assessments at the interview time. Finally, we used multivariable logistic regression analysis. SOFAS-measured improvements in the period 6 to 12 months after beginning treatment and daily antipsychotic drug doses equivalent to less than 600 mg of chlorpromazine were identified as an employment-related factor, but GAPS-measure improvements were not. Social functioning improvements in the period 6 to 12 months after beginning treatment and low-to-moderate daily antipsychotic drug doses were detected as employment-related factors, suggesting that early efforts to improve social functioning and optimize antipsychotic drug doses could lead to future employment for schizophrenia patients.
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Affiliation(s)
- Tadashi Hasegawa
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Tasuku Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan.
| | - Nobuhisa Kanahara
- Center for Forensic Mental Health Research and Education, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan
| | - Hiroshi Yamanaka
- Department of Psychiatry, Chiba Psychiatric Medical Center, 5 Toyosuna, Mihama-ku, Chiba 261-0024, Japan
| | - Minoru Ishige
- Department of Psychiatry, Satsuki-kai Sodegaura-satsukidai Hospital, 5-21 Nagaura-ekimae, Sodegaura-shi, Chiba 299-0246, Japan
| | - Yasunori Sato
- Department of Global Clinical Research, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan; Center for Forensic Mental Health Research and Education, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan
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17
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Volavka J, Vevera J. Very long-term outcome of schizophrenia. Int J Clin Pract 2018; 72:e13094. [PMID: 29691957 DOI: 10.1111/ijcp.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. METHOD PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5 years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. RESULTS The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. CONCLUSION The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.
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Affiliation(s)
- Jan Volavka
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Predictors of functional recovery in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies. Clin Psychol Rev 2017; 58:59-75. [DOI: 10.1016/j.cpr.2017.09.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/16/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022]
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Tabo A, Aydın E, Yumrukçal H, Yiğit S, Uzun UE, Karamustafalıoğlu O. Longer Duration of Untreated Psychosis Hinders Improvement in Treatment of Chronic Schizophrenia: Community Based Early Intervention is an Evidence Based Option. Community Ment Health J 2017; 53:929-935. [PMID: 28188388 DOI: 10.1007/s10597-017-0088-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
To determine the effects of community-based mental health services on the quality of life and disease symptoms of chronic schizophrenia patients and to determine the effects of duration of untreated psychosis on outcome. The first year records of schizophrenia patients who had been followed up at Zeytinburnu CMHC for at least 12 months, have been used to asses outcome using initial and 12th month quality of life (QoL), positive and negative symptom scale (PANSS) scores. Highly significant improvements were shown in the QoL and PANSS scores. There were significant differences between the two study groups (duration of untreated psychosis >2 years, versus duration of untreated psychosis <2 years) in terms of improvements in QoL and PANSS scores. Formation of early intervention teams that seek to provide preventive activities (i.e. for schizophrenia) in countries that have changed to community based mental health systems is a sound mental health implementation.
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Affiliation(s)
- Abdülkadir Tabo
- Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Zuhuratbaba M.Karabal C. No.20 D.6 Bakırkoy, Istanbul, Turkey
| | - Erkan Aydın
- Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Zuhuratbaba M.Karabal C. No.20 D.6 Bakırkoy, Istanbul, Turkey.
| | - Hüseyin Yumrukçal
- Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Zuhuratbaba M.Karabal C. No.20 D.6 Bakırkoy, Istanbul, Turkey
| | - Sadık Yiğit
- , Çırpıcı Mah. Prof. Dr.Turan Güneş Cad.No: 159/1-A, Zeytinburnu, Istanbul, Turkey
| | - Uğraş Erman Uzun
- Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery, Zuhuratbaba M.Karabal C. No.20 D.6 Bakırkoy, Istanbul, Turkey
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Turner N, Jackson D, Renwick L, Sutton M, Foley S, McWilliams S, Kinsella A, O'Callaghan E. What Influences Purpose in Life in First-Episode Psychosis? Br J Occup Ther 2016. [DOI: 10.1177/030802260707000906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although purpose in life (PIL) is significant to psychological wellbeing, there is little published research on PIL among those with a mental illness. This prospective study of first-episode psychosis (n = 54) included assessment of symptomatology, PIL and duration of untreated psychosis. The results showed that the baseline PIL scores of those with first-episode psychosis were lower than those of other populations. This was worsened by a long duration of untreated psychosis and was linked to depression. The study concludes that psychosis results in many losses for the individual, including PIL. Meaningful occupation can address this lost sense of purpose and the occupational difficulties associated with psychosis.
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Ran MS, Weng X, Chan CLW, Chen EYH, Tang CP, Lin FR, Mao WJ, Hu SH, Huang YQ, Xiang MZ. Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China. Br J Psychiatry 2015; 207:495-500. [PMID: 26382951 PMCID: PMC4664855 DOI: 10.1192/bjp.bp.114.157685] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/21/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The long-term outcome of never-treated patients with schizophrenia is unclear. AIMS To compare the 14-year outcomes of never-treated and treated patients with schizophrenia and to establish predictors for never being treated. METHOD All participants with schizophrenia (n = 510) in Xinjin, Chengdu, China were identified in an epidemiological investigation of 123 572 people and followed up from 1994 to 2008. RESULTS The results showed that there were 30.6%, 25.0% and 20.4% of patients who received no antipsychotic medication in 1994, 2004 and 2008 respectively. Compared with treated patients, those who were never treated in 2008 were significantly older, had significantly fewer family members, had higher rates of homelessness, death from other causes, being unmarried, living alone, being without a caregiver and poor family attitudes. Partial and complete remission in treated patients (57.3%) was significantly higher than that in the never-treated group (29.8%). Predictors of being in the never-treated group in 2008 encompassed baseline never-treated status, being without a caregiver and poor mental health status in 1994. CONCLUSIONS Many patients with schizophrenia still do not receive antipsychotic medication in rural areas of China. The 14-year follow-up showed that outcomes for the untreated group were worse. Community-based mental healthcare, health insurance and family intervention are crucial for earlier diagnosis, treatment and rehabilitation in the community.
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Affiliation(s)
- Mao-Sheng Ran
- Mao-Sheng Ran, MMed, PhD, Xue Weng, BSW, Cecilia Lai-Wan Chan, PhD, Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; Eric Yu-Hai Chen, MD, Department of Psychiatry, University of Hong Kong, Hong Kong; Cui-Ping Tang, RN, Fu-Rong Lin, MD, Xinjin Mental Hospital, Xinjin, Chengdu, China; Wen-Jun Mao, MD, Shi-Hui Hu, MD, Chengdu Mental Health Center, Chengdu, China; Yue-Qin Huang, PhD, Institute of Mental Health, Peking University, Beijing, China; Meng-Ze Xiang, MD, Department of Psychiatry, Sichuan University, China
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Carbon M, Correll CU. Clinical predictors of therapeutic response to antipsychotics in schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25733955 PMCID: PMC4336920 DOI: 10.31887/dcns.2014.16.4/mcarbon] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The search for clinical outcome predictors for schizophrenia is as old as the field of psychiatry. However, despite a wealth of large, longitudinal studies into prognostic factors, only very few clinically useful outcome predictors have been identified. The goal of future treatment is to either affect modifiable risk factors, or use nonmodifiable factors to parse patients into therapeutically meaningful subgroups. Most clinical outcome predictors are nonspecific and/or nonmodifiable. Nonmodifiable predictors for poor odds of remission include male sex, younger age at disease onset, poor premorbid adjustment, and severe baseline psychopathology. Modifiable risk factors for poor therapeutic outcomes that clinicians can act upon include longer duration of untreated illness, nonadherence to antipsychotics, comorbidities (especially substance-use disorders), lack of early antipsychotic response, and lack of improvement with non-clozapine antipsychotics, predicting clozapine response. It is hoped that this limited capacity for prediction will improve as pathophysiological understanding increases and/or new treatments for specific aspects of schizophrenia become available.
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Affiliation(s)
- Maren Carbon
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA; Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA
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Jaracz K, Górna K, Kiejda J, Grabowska-Fudala B, Jaracz J, Suwalska A, Rybakowski JK. Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia. Eur Psychiatry 2015; 30:907-13. [PMID: 26647865 DOI: 10.1016/j.eurpsy.2015.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/30/2015] [Accepted: 08/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors. METHODS Sixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4-6 years (T3), and 7-11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients' psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome. RESULTS Among them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1. CONCLUSIONS Our results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.
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Affiliation(s)
- K Jaracz
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland.
| | - K Górna
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland
| | - J Kiejda
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland
| | - B Grabowska-Fudala
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland
| | - J Jaracz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - A Suwalska
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - J K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Ramdour S, Duxbury JA, Becket G, Wilson S. A cross-sectional observational study of healthcare professional views of factors affecting teenage adherence with antipsychotic medication. J Psychiatr Ment Health Nurs 2015; 22:491-501. [PMID: 25990303 DOI: 10.1111/jpm.12210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
Delays in effective treatment of a first episode psychosis can result in more severe symptoms, a longer time to achieve symptom control and a poorer quality of life; yet around 40% do not take antipsychotic medication as prescribed. There is evidence that patients and staff have different perceptions of what affects adherence with medication. Research in adults suggests healthcare professionals and patients understand the importance of good insight in promoting adherence with medication for schizophrenia; however, healthcare staff may overestimate the impact of side effects and underestimate the importance of medication effectiveness. There is also some evidence to suggest that motivations to take prescribed medication may differ in first and multi-episode psychosis. This research therefore sought views of staff working with adolescents diagnosed with first episode psychosis about what factors affected adherence with antipsychotic medication. Staff responding to the survey felt that young people were more likely to take medication if they felt it would make them better, prevent relapse and if they had a positive rapport with staff. As in an adult population, side effects, particularly weight gain, sedation and muscular side effects, were expressed as a common reason for poor adherence. Doctors and nurses assigned differing importance to parameters such as family views of medication, fear of admission and a preference for cannabis over medication suggesting that views may differ between professional groups Views of young people will be obtained in the next phase of the research study to enable comparison with staff views and consideration of staff interventions to better promote medication adherence. Antipsychotic medication is an effective treatment for first episode psychosis; yet 40% of patients do not take medication as prescribed. Previous research in adults with schizophrenia comparing healthcare professional and patient views suggests that while healthcare professionals recognize the importance of insight in promoting medication adherence, they underestimate the importance of medication efficacy and overestimate the impact of side effects. It was hypothesized that staff in this study would also recognize the importance of insight and positive medication attitudes in teenagers with psychosis, but overestimate the impact of side effects on medication adherence. This cross-sectional observational study sought staff views about factors affecting antipsychotic medication adherence in those aged between 14 and 18 years. An online survey was distributed and 60 responses were subsequently returned. Staff felt that good medication insight as well as positive relationships with staff were important determinants of good medication adherence. The most important influences of poor adherence were poor insight, side effects of medication and a wish to exert personal control around medication decisions. The results therefore confirmed the initial hypothesis. Published literature also provides support for some, but not all, of the staff views expressed in survey responses.
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Affiliation(s)
- S Ramdour
- Pharmacy, Lancashire Care NHS Foundation Trust, Preston, Lancashire, UK
| | - J A Duxbury
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - S Wilson
- School of Pharmacy and Biomedical Sciences
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Palaniyappan L, Maayan N, Bergman H, Davenport C, Adams CE, Soares‐Weiser K. Voxel-based morphometry for separation of schizophrenia from other types of psychosis in first episode psychosis. Cochrane Database Syst Rev 2015; 2015:CD011021. [PMID: 26252640 PMCID: PMC7104330 DOI: 10.1002/14651858.cd011021.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Schizophrenia is a psychiatric disorder which involves distortions in thought and perception, blunted affect, and behavioural disturbances. The longer psychosis goes unnoticed and untreated, the more severe the repercussions for relapse and recovery. There is some evidence that early intervention services can help, and diagnostic techniques that could contribute to early intervention may offer clinical utility in these situations. The index test being evaluated in this review is the structural magnetic resonance imaging (MRI) analysis technique known as voxel-based morphometry (VBM) that estimates the distribution of grey matter tissue volume across several brain regions. This review is an exploratory examination of the diagnostic 'potential' of VBM for use as an additional tool in the clinical examination of patients with first episode psychosis to establish whether an individual will progress on to developing schizophrenia as opposed to other types of psychosis. OBJECTIVES To determine whether VBM applied to the brain can be used to differentiate schizophrenia from other types of psychosis in participants who have received a clinical diagnosis of first episode psychosis. SEARCH METHODS In December 2013, we updated a previous search (May 2012) of MEDLINE, EMBASE, and PsycInfo using OvidSP. SELECTION CRITERIA We included retrospective and prospective studies that consecutively or randomly selected adolescent and adult participants (< 45 years) with a first episode of psychosis; and that evaluated the diagnostic accuracy of VBM for differentiating schizophrenia from other psychoses compared with a clinical diagnosis made by a qualified mental health professional, with or without the use of standard operational criteria or symptom checklists. We excluded studies in children, and in adult participants with organic brain disorders or who were at high risk for schizophrenia, such as people with a genetic predisposition. DATA COLLECTION AND ANALYSIS Two review authors screened all references for inclusion. We assessed the quality of studies using the QUADAS-2 instrument. Due to a lack of data, we were not able to extract 2 x 2 data tables for each study nor undertake any meta-analysis. MAIN RESULTS We included four studies with a total of 275 participants with first episode psychosis. VBM was not used to diagnose schizophrenia in any of the studies, instead VBM was used to quantify the magnitude of differences in grey matter volume. Therefore, none of the included studies reported data that could be used in the analysis, and we summarised the findings narratively for each study. AUTHORS' CONCLUSIONS There is no evidence to currently support diagnosing schizophrenia (as opposed to other psychotic disorders) using the pattern of brain changes seen in VBM studies in patients with first episode psychosis. VBM has the potential to discriminate between diagnostic categories but the methods to do this reliably are currently in evolution. In addition, the lack of applicability of the use of VBM to clinical practice in the studies to date limits the usefulness of VBM as a diagnostic aid to differentiate schizophrenia from other types of psychotic presentations in people with first episode of psychosis.
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Affiliation(s)
- Lena Palaniyappan
- The University of NottinghamDivison of Psychiatry, Institute of Mental HealthRoom 09, C FloorInnovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Nicola Maayan
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Hanna Bergman
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Clare Davenport
- University of BirminghamPublic Health, Epidemiology and BiostatisticsBirminghamUKB15 2TT
| | - Clive E Adams
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthInnovation Park, Triumph Road,NottinghamUKNG7 2TU
| | - Karla Soares‐Weiser
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
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Schiffman J, Stephan SH, Hong LE, Reeves G. School-based approaches to reducing the duration of untreated psychosis. Child Adolesc Psychiatr Clin N Am 2015; 24:335-51. [PMID: 25773328 DOI: 10.1016/j.chc.2014.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Students with emerging psychosis often experience delays in diagnosis and treatment that impact mental health and academic outcomes. School systems have tremendous potential to improve early identification and treatment of adolescent psychosis. As a community-based resource, schools can support outreach, education, and screening for adolescents with psychosis and engage identified students and their families for treatment. The concept of duration of untreated psychosis (DUP; the gap between symptom onset and treatment initiation) in adolescent psychosis and the potential role of schools in reducing DUP are reviewed. Future directions for clinical care and research needed to support school-based interventions are proposed.
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Affiliation(s)
- Jason Schiffman
- Department of Psychology, University of Maryland, 1000 Hilltop Circle, Baltimore County, Baltimore, MD 21250, USA.
| | - Sharon Hoover Stephan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 Pratt Street, Baltimore, MD 21201, USA
| | - L Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, MPRC - Tawes, PO Box 21247, Baltimore, MD 21228, USA
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 Pratt Street, Baltimore, MD 21201, USA
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Soares-Weiser K, Maayan N, Bergman H, Davenport C, Kirkham AJ, Grabowski S, Adams CE. First rank symptoms for schizophrenia. Cochrane Database Syst Rev 2015; 1:CD010653. [PMID: 25879096 PMCID: PMC7079421 DOI: 10.1002/14651858.cd010653.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early and accurate diagnosis and treatment of schizophrenia may have long-term advantages for the patient; the longer psychosis goes untreated the more severe the repercussions for relapse and recovery. If the correct diagnosis is not schizophrenia, but another psychotic disorder with some symptoms similar to schizophrenia, appropriate treatment might be delayed, with possible severe repercussions for the person involved and their family. There is widespread uncertainty about the diagnostic accuracy of First Rank Symptoms (FRS); we examined whether they are a useful diagnostic tool to differentiate schizophrenia from other psychotic disorders. OBJECTIVES To determine the diagnostic accuracy of one or multiple FRS for diagnosing schizophrenia, verified by clinical history and examination by a qualified professional (e.g. psychiatrists, nurses, social workers), with or without the use of operational criteria and checklists, in people thought to have non-organic psychotic symptoms. SEARCH METHODS We conducted searches in MEDLINE, EMBASE, and PsycInfo using OvidSP in April, June, July 2011 and December 2012. We also searched MEDION in December 2013. SELECTION CRITERIA We selected studies that consecutively enrolled or randomly selected adults and adolescents with symptoms of psychosis, and assessed the diagnostic accuracy of FRS for schizophrenia compared to history and clinical examination performed by a qualified professional, which may or may not involve the use of symptom checklists or based on operational criteria such as ICD and DSM. DATA COLLECTION AND ANALYSIS Two review authors independently screened all references for inclusion. Risk of bias in included studies were assessed using the QUADAS-2 instrument. We recorded the number of true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN) for constructing a 2 x 2 table for each study or derived 2 x 2 data from reported summary statistics such as sensitivity, specificity, and/or likelihood ratios. MAIN RESULTS We included 21 studies with a total of 6253 participants (5515 were included in the analysis). Studies were conducted from 1974 to 2011, with 80% of the studies conducted in the 1970's, 1980's or 1990's. Most studies did not report study methods sufficiently and many had high applicability concerns. In 20 studies, FRS differentiated schizophrenia from all other diagnoses with a sensitivity of 57% (50.4% to 63.3%), and a specificity of 81.4% (74% to 87.1%) In seven studies, FRS differentiated schizophrenia from non-psychotic mental health disorders with a sensitivity of 61.8% (51.7% to 71%) and a specificity of 94.1% (88% to 97.2%). In sixteen studies, FRS differentiated schizophrenia from other types of psychosis with a sensitivity of 58% (50.3% to 65.3%) and a specificity of 74.7% (65.2% to 82.3%). AUTHORS' CONCLUSIONS The synthesis of old studies of limited quality in this review indicates that FRS correctly identifies people with schizophrenia 75% to 95% of the time. The use of FRS to diagnose schizophrenia in triage will incorrectly diagnose around five to 19 people in every 100 who have FRS as having schizophrenia and specialists will not agree with this diagnosis. These people will still merit specialist assessment and help due to the severity of disturbance in their behaviour and mental state. Again, with a sensitivity of FRS of 60%, reliance on FRS to diagnose schizophrenia in triage will not correctly diagnose around 40% of people that specialists will consider to have schizophrenia. Some of these people may experience a delay in getting appropriate treatment. Others, whom specialists will consider to have schizophrenia, could be prematurely discharged from care, if triage relies on the presence of FRS to diagnose schizophrenia. Empathetic, considerate use of FRS as a diagnostic aid - with known limitations - should avoid a good proportion of these errors.We hope that newer tests - to be included in future Cochrane reviews - will show better results. However, symptoms of first rank can still be helpful where newer tests are not available - a situation which applies to the initial screening of most people with suspected schizophrenia. FRS remain a simple, quick and useful clinical indicator for an illness of enormous clinical variability.
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Affiliation(s)
- Karla Soares-Weiser
- Enhance Reviews Ltd, Central Office, Cobweb Buildings, The Lane, Lyford, Wantage, OX12 0EE, UK. .
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Zhang F, Si T, Chiou CF, Harris AW, Kim CY, Jahagirdar P, Ascher S. Efficacy, safety, and impact on hospitalizations of paliperidone palmitate in recent-onset schizophrenia. Neuropsychiatr Dis Treat 2015; 11:657-68. [PMID: 25792835 PMCID: PMC4362974 DOI: 10.2147/ndt.s77778] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy, safety, and impact on hospitalizations of long-acting injectable paliperidone palmitate (PP) treatment, in patients with recent-onset schizophrenia who had not responded satisfactorily to oral antipsychotics. METHODS In this 18-month, open-label, Phase-IIIb study from Asia-Pacific region, patients (18-50 years) with recent-onset (≤5 years) schizophrenia unsatisfactorily treated with previous oral antipsychotics were initiated on PP 150 mg eq on day 1, 100 mg eq on day 8, followed by flexible once monthly maintenance doses of 50-150 mg eq. The number and duration of hospitalizations were compared using a mirror analysis method between two periods: retrospective (12 months before PP initiation) and prospective (12 and 18 months after PP treatment) periods. RESULTS A total of 303 out of 521 (58%) patients (mean age, 28.7 years; 65.5% men, 92.5% Asian) completed the study. Positive and Negative Syndrome Scale (PANSS) total score improved significantly from baseline to month 18 (mean [standard deviation, SD] change: -11.3 [21.38], P<0.0001, primary endpoint). Subgroup analysis revealed greater improvements among patients with worse disease severity at baseline: PANSS ≥70 versus <70 (mean [SD] change: -23.1 [24.62] vs -4.7 [15.98], P<0.0001 each). Secondary efficacy endpoints such as Clinical Global Impression of Schizophrenia (CGI-SCH), Medication Satisfaction Questionnaire (MSQ) scores showed significant improvements (P<0.0001) from baseline; 33.3% patients achieved symptom remission. In mirror analyses set (N=474), PP significantly (P<0.0001) reduced mean number of hospitalization days/person/year (12-month: 74.3 vs 19.7; 18-month: 74.3 vs 18.9) as well as percentage of patients requiring hospitalization in past 12 months (12-month: 39.7% vs 24.6%; 18-month: 39.7% vs 25%), and PP treatment increased the proportion of patients not requiring hospitalization (12-month: 60.3% vs 75.4%; 18-month: 60.3% vs 75%) from retrospective to prospective period. Adverse events (≥15%) were extrapyramidal symptoms-related (31.3%), injection-site pain (18.6%), and insomnia (15.2%). CONCLUSION PP was efficacious and generally tolerable with significant reductions observed in both number of hospitalizations and days spent in hospital.
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Affiliation(s)
- Fan Zhang
- Xian Janssen Pharmaceuticals, Beijing, People's Republic of China
| | - Tianmei Si
- Department of Clinical Psychopharmacology, Peking University Institute of Mental Health, Beijing, People's Republic of China ; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, People's Republic of China
| | | | - Anthony Wf Harris
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Australia and Brain Dynamics Center, Westmead Millennium Institute for Medical Research, Westmead, NSW, Australia
| | - Chang Yoon Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Steve Ascher
- Janssen Research and Development, LLC, Titusville, NJ, USA
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Register-Brown K, Hong LE. Reliability and validity of methods for measuring the duration of untreated psychosis: a quantitative review and meta-analysis. Schizophr Res 2014; 160:20-6. [PMID: 25464915 DOI: 10.1016/j.schres.2014.10.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The duration of untreated psychosis (DUP) has been associated with a wide range of clinical outcomes, and is considered to be one of the key parameters in managing clinical high risk and first episode psychosis patients. However, considerable discrepancies exist in the way that DUP is estimated in different studies. There is no standard or consensus on which method is most reliable and valid for assessing DUP. METHODS This review aimed to quantitatively assess different DUP measurement instruments and definitions by comparing their inter-rater reliability, and their strength of validity in predicting biological and clinical outcomes. RESULTS Nine instruments designed for measuring DUP were found. Their inter-rater reliability were found to be adequate to excellent, although quite varied. This analysis did not show that any instrument was clearly outstanding compared to the others, although the limited available data do not exclude this possibility. DUP was also significantly associated with a range of outcomes, although mostly with small effect sizes. However, non-instrument based, ad hoc clinical interviews remained the most common way of measuring DUP. Definitions of onset of psychosis and onset of treatment were inconsistent among studies. CONCLUSIONS This review did not find quantitative evidence to support the use of one instrument over another. DUP remains a promising modifiable risk factor for a range of long-term clinical outcomes. Future research should quantify and improve the reliability and validity of the structured instruments for DUP measurement.
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Affiliation(s)
- Kelly Register-Brown
- University of Maryland/Sheppard Pratt Psychiatry Residency Training Program, University of Maryland. 701W. Pratt St., 4th Floor, Baltimore, MD 21201, USA.
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD. Tawes Ct., Catonsville, MD 21228, USA
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Cechnicki A, Cichocki Ł, Kalisz A, Błądziński P, Adamczyk P, Franczyk-Glita J. Duration of untreated psychosis (DUP) and the course of schizophrenia in a 20-year follow-up study. Psychiatry Res 2014; 219:420-5. [PMID: 24999174 DOI: 10.1016/j.psychres.2014.05.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 04/03/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
Our aims were to analyze the relationship between the duration of psychosis (DUP) and short- and long-term outcomes of treatment, and to determine the cut-off point between short and long DUP at which differences in treatment outcomes are most significant. We assessed 80 participants with schizophrenia at the point of their first hospitalization. Fifty participated in all four follow-ups over 20 years. DUP was divided into short (up to 6 months) and long (over 6 months). ANOVA and Chi-square tests were employed to identify significant differences in both clinical and social indicators of functioning. ROC curves were used to estimate the best DUP division point. Significant differences favoring the short-DUP group were found for: GAF, total severity of symptoms and severity of positive symptoms, social functioning measured according to DSM-III criteria, employment, and social contacts. The optimal cut-off point for DUP was the 23rd week. We concluded that: (1) the relationship between longer DUP and worse overall treatment outcomes was sustained throughout the 20 years, (2) a positive correlation between DUP and the severity of psychopathological symptoms was observed over the first 12 years of illness, (3) the results indicate the efficacy of early therapeutic interventions in psychosis.
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Affiliation(s)
- Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University in Cracow, Pl. Sikorskiego 2/8, 31-115 Krakow, Poland.
| | - Łukasz Cichocki
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University in Cracow, Pl. Sikorskiego 2/8, 31-115 Krakow, Poland
| | - Aneta Kalisz
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University in Cracow, Pl. Sikorskiego 2/8, 31-115 Krakow, Poland
| | - Piotr Błądziński
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University in Cracow, Pl. Sikorskiego 2/8, 31-115 Krakow, Poland
| | - Przemysław Adamczyk
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University in Cracow, Pl. Sikorskiego 2/8, 31-115 Krakow, Poland
| | - Joanna Franczyk-Glita
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University in Cracow, Pl. Sikorskiego 2/8, 31-115 Krakow, Poland
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Apeldoorn SY, Sterk B, van den Heuvel ER, Schoevers RA, Islam MA, Bruggeman R, Cahn W, deHaan L, Kahn RS, Meijer CJ, Myin-Germeys I, van Os J, Wiersma D. Factors contributing to the duration of untreated psychosis. Schizophr Res 2014; 158:76-81. [PMID: 25043913 DOI: 10.1016/j.schres.2014.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/25/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shortening the duration of untreated psychosis (DUP) - with the aim of improving the prognosis of psychotic disorders - requires an understanding of the causes of treatment delay. Current findings concerning several candidate risk factors of a longer DUP are inconsistent. Our aim was to identify factors contributing to DUP in a large sample that represents the treated prevalence of non-affective psychotic disorders. METHOD Patients with a non-affective psychotic disorder were recruited from mental health care institutes from 2004 to 2008. Of the 1120 patients enrolled, 852 could be included in the present analysis. Examined candidate factors were gender, educational level, migration status, premorbid adjustment and age at onset of the psychotic disorder. DUP was divided into five ordinal categories: less than one month, one month to three months, three months to six months, six months to twelve months and twelve months and over. An ordinal logistic regression analysis was used to identify the risk factors of a longer DUP. RESULTS Median DUP was less than one month (IQR 2). The factors migration status (p=0.028), age at onset of the psychotic disorder (p=0.003) and gender (p=0.034) were significantly associated with DUP in our analysis. CONCLUSION First generation immigrant patients, patients with an early onset of their psychotic disorder and male patients seem at risk of a longer DUP. These findings can assist in designing specific interventions to shorten treatment delay.
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Affiliation(s)
- S Y Apeldoorn
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands; Rob Giel Research Centre, University Medical Centre Groningen, University of Groningen, the Netherlands.
| | - B Sterk
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, the Netherlands; Department of Psychiatry, University Medical Centre Nijmegen, the Netherlands
| | - E R van den Heuvel
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - R A Schoevers
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - M A Islam
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands; Rob Giel Research Centre, University Medical Centre Groningen, University of Groningen, the Netherlands
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Penttilä M, Jääskeläinen E, Hirvonen N, Isohanni M, Miettunen J. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 2014; 205:88-94. [PMID: 25252316 DOI: 10.1192/bjp.bp.113.127753] [Citation(s) in RCA: 439] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear. AIMS To analyse the associations between DUP and long-term outcomes of schizophrenia. METHOD A systematic literature search was performed using seven electronic databases and manual searches. Random effects weighted meta-analysis with correlation coefficients was used to pool the results. RESULTS We identified 3493 unique publications, from which 33 samples met our predefined selection criteria. Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13-0.18). Long DUP was not associated with employment, quality of life or hospital treatment. CONCLUSIONS The small but mostly consistent correlation between long DUP and poor outcome indicates that early intervention in psychosis may have at least subtle positive effects on the long-term course of illness.
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Affiliation(s)
- Matti Penttilä
- Matti Penttilä, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Erika Jääskeläinen, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu; Noora Hirvonen, MSc, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Faculty of Humanities, Information Studies, Oulu; Matti Isohanni, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Jouko Miettunen, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu, Finland
| | - Erika Jääskeläinen
- Matti Penttilä, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Erika Jääskeläinen, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu; Noora Hirvonen, MSc, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Faculty of Humanities, Information Studies, Oulu; Matti Isohanni, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Jouko Miettunen, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu, Finland
| | - Noora Hirvonen
- Matti Penttilä, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Erika Jääskeläinen, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu; Noora Hirvonen, MSc, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Faculty of Humanities, Information Studies, Oulu; Matti Isohanni, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Jouko Miettunen, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu, Finland
| | - Matti Isohanni
- Matti Penttilä, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Erika Jääskeläinen, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu; Noora Hirvonen, MSc, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Faculty of Humanities, Information Studies, Oulu; Matti Isohanni, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Jouko Miettunen, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu, Finland
| | - Jouko Miettunen
- Matti Penttilä, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Erika Jääskeläinen, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu; Noora Hirvonen, MSc, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Faculty of Humanities, Information Studies, Oulu; Matti Isohanni, MD, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Oulu University Hospital, Oulu; Jouko Miettunen, PhD, University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, and Institute of Health Sciences, and Oulu University Hospital, and Medical Research Center Oulu, Finland
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Hui CLM, Chang WC, Chan SKW, Lee EHM, Tam WWY, Lai DC, Wong GHY, Tang JYM, Li FWS, Leung KF, McGhee SM, Sham PC, Chen EYH. Early intervention and evaluation for adult-onset psychosis: the JCEP study rationale and design. Early Interv Psychiatry 2014; 8:261-8. [PMID: 23445124 DOI: 10.1111/eip.12034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 12/09/2012] [Indexed: 11/28/2022]
Abstract
AIM Psychotic disorders incur substantial long-term burdens to patients and society. Early intervention (EI) during the initial years of psychotic disorders can improve long-term outcome. In Hong Kong, a pilot EI programme (EASY, Early Assessment Service for Young people with psychosis) had been set up since 2001 to serve clients under 25 years of age. Although EASY has been effective in improving outcome, consolidation of early psychosis work requires further development. METHODS The present paper describes a new EI development which targets adult patients with psychosis in Hong Kong. The Jockey Club Early Psychosis (JCEP) project was launched in 2009. Expanding the service to patients above 25 years old, JCEP aims to deliver a territory-wide specialized EI service to adult-onset psychosis patients, to promote public awareness on early psychosis, and to research on the optimal intervention model and duration for early psychosis in a 4-year randomized controlled trial (RCT). Participants were randomly assigned to receive either 4 years of EI service, 2 years of EI service, or 4 years of standard care. Their symptoms, neurocognitive functions, psychosocial well-being and health economics were regularly assessed. RESULTS To date, 360 patients were recruited into the RCT, and 740 patients were recruited in a 2-year naturalistic study. Prospective, longitudinal follow-up assessments of these patients are still underway. CONCLUSIONS JCEP is the first EI project to provide adult early psychosis service in Chinese population. Future data would help to address the optimal duration of EI and its cost-effectiveness. This would also assist regional and international mental health development.
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Affiliation(s)
- Christy L M Hui
- Departments of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China
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Bergman H, Khodabakhsh A, Maayan N, Kirkham AJ, Adams CE, Soares-Weiser K. Operational Criteria Checklist for Psychotic Illness and Affective Illness (OPCRIT+) for diagnosing schizophrenia in people with psychotic symptoms. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hanna Bergman
- Enhance Reviews Ltd; Central Office, Cobweb buildings The Lane, Lyford Wantage UK OX12 0EE
| | | | - Nicola Maayan
- Enhance Reviews Ltd; Central Office, Cobweb buildings The Lane, Lyford Wantage UK OX12 0EE
| | - Amanda J Kirkham
- University of Birmingham; Department of Public Health, Epidemiology and Biostatistics; Birmingham UK
| | - Clive E Adams
- The University of Nottingham; Cochrane Schizophrenia Group; Institute of Mental Health University of Nottingham Innovation Park, Triumph Road, Nottingham UK NG7 2TU
| | - Karla Soares-Weiser
- Enhance Reviews Ltd; Central Office, Cobweb buildings The Lane, Lyford Wantage UK OX12 0EE
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Tang JYM, Chang WC, Hui CLM, Wong GHY, Chan SKW, Lee EHM, Yeung WS, Wong CK, Tang WN, Chan WF, Pang EPF, Tso S, Ng RMK, Hung SF, Dunn ELW, Sham PC, Chen EYH. Prospective relationship between duration of untreated psychosis and 13-year clinical outcome: a first-episode psychosis study. Schizophr Res 2014; 153:1-8. [PMID: 24529612 DOI: 10.1016/j.schres.2014.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/01/2014] [Accepted: 01/22/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP-outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined. OBJECTIVE To explore the relationship between DUP and long-term symptomatic remission. METHODS This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤30days), medium (31-180days) and long (>180days) DUP groups. RESULTS The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission. CONCLUSION The findings support the threshold theory that DUP longer than 30days adversely impacts the long-term outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on long-term outcomes based on well-defined criteria and adequate statistical adjustment.
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Affiliation(s)
| | - Wing-Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | | | | | - Wai-Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Chi-Keung Wong
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Wai-Nang Tang
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Wah-Fat Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Edwin Pui-Fai Pang
- Department of Psychiatry, United Christian Hospital, Hospital Authority, Hong Kong
| | - Steve Tso
- Department of Psychiatry, Castle Peak Hospital, Hospital Authority, Hong Kong
| | - Roger Man-Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hospital Authority, Hong Kong
| | - Se-Fong Hung
- Department of Psychiatry, Kwai Chung Hospital, Hospital Authority, Hong Kong
| | - Eva Lai-Wah Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
| | - Pak-Chung Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Eric Yu-Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Kanahara N, Yoshida T, Oda Y, Yamanaka H, Moriyama T, Hayashi H, Shibuya T, Nagaushi Y, Sawa T, Sekine Y, Shimizu E, Asano M, Iyo M. Onset Pattern and Long-Term Prognosis in Schizophrenia: 10-Year Longitudinal Follow-Up Study. PLoS One 2013; 8:e67273. [PMID: 23840649 PMCID: PMC3693949 DOI: 10.1371/journal.pone.0067273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although the duration of untreated psychosis (DUP) plays an important role in the short-term prognosis of patients with schizophrenia, their long-term prognosis generally is not determined by DUP alone. It is important to explore how other clinical factors in the early stage are related to DUP and consequent disease courses. METHODS A total of 664 patients with untreated psychosis were surveyed for this study. At the first examination, we divided them into the severe positive symptoms cases (SC) or the less severe cases (NonSC) and compared the prognosis among the two groups after a 10-year follow-up. In all, 113 patients in the SC group and 43 patients in the NonSC group were follow-up completers. RESULTS Whereas DUP was not different between the two groups, patients with nonacute onset in both groups had significantly longer DUP than those in patients with acute onset. For all clinical measures, there was no difference in prognosis between the two groups or among the four groups classified by mode of onset (MoO) and initial severity of positive symptoms. However, the degree of improvement of global assessment of functioning (GAF) was significantly smaller in the NonSC-nonacute group than in the SC-acute and SC-nonacute groups. CONCLUSIONS These results suggest that neither DUP nor MoO alone necessarily affects the initial severity of positive symptoms. Moreover, it is possible that patients with low impetus of positive symptoms onset within long DUP experience profound pathologic processes. Therefore, the current study results indicated that long DUP and nonacute onset were related to poor long-term prognosis, regardless of initial positive symptoms.
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Affiliation(s)
- Nobuhisa Kanahara
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba City, Chiba, Japan
- * E-mail:
| | - Taisuke Yoshida
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Yasunori Oda
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Hiroshi Yamanaka
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Toshihiro Moriyama
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Hideaki Hayashi
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Takayuki Shibuya
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Yasunori Nagaushi
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Takashi Sawa
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Yoshimoto Sekine
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba City, Chiba, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Makoto Asano
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba City, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
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Comparison of psychosocial determinants in inpatients with first-episode and chronic schizophrenia in china. Arch Psychiatr Nurs 2013; 27:32-41. [PMID: 23352023 DOI: 10.1016/j.apnu.2012.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022]
Abstract
This study aimed at comparing psychosocial factors in inpatients with first-episode and chronic schizophrenia in China. A sample of 197 first-episode schizophrenia inpatients was compared with 392 chronic schizophrenics using Positive and Negative Syndrome Scale, Social Support Rating Scale and Childhood Traumatic Questionnaire. Our findings showed that chronic schizophrenic patients had significant higher negative symptoms but lower on positive symptoms. They were also less likely to receive social support. Our results provide understanding on the existing differences between first-episode and chronic schizophrenia. Therefore, comprehensive nursing interventions are needed to facilitate social support and medication adherence in order to prevent relapses.
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Penttilä M, Miettunen J, Koponen H, Kyllönen M, Veijola J, Isohanni M, Jääskeläinen E. Association between the duration of untreated psychosis and short- and long-term outcome in schizophrenia within the Northern Finland 1966 Birth Cohort. Schizophr Res 2013. [PMID: 23178106 DOI: 10.1016/j.schres.2012.10.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Long duration of untreated psychosis (DUP) may relate to poor outcome in schizophrenia. However, the associations between DUP and outcomes, particularly in later course of illness, remain unclear. Our aim was to explore the associations between DUP and short- and long-term outcomes in schizophrenia. METHODS Data was collected for subjects with schizophrenia (n=89) in the population-based Northern Finland 1966 Birth Cohort. DUP was obtained from medical records, and its associations with short- (under 2years) and long-term clinical and social outcomes were assessed extending to 20years after the onset of the illness. RESULTS Longer DUP predicted longer length of first hospitalisation and increased the risk of rehospitalisation during the first two years. Longer DUP associated with decreased probability of disability pension, smaller amount of time spent in hospital, and higher proportion of time at work during the first 10years of the follow-up. CONCLUSIONS Regarding early outcome, long DUP may be a modest marker and proxy measure of a more severe clinical phenotype. The divergent results of earlier studies and the association between long DUP and better long-term outcome in our study, indicate that the length of DUP does not necessarily predict poor outcome in long-term follow-up. This may also be due to methodical difficulties, e.g. insufficient power and residual confounding linked to long follow-up studies.
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Affiliation(s)
- Matti Penttilä
- University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, Oulu, Finland.
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39
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Cognitive disorganisation in schizotypy is associated with deterioration in visual backward masking. Psychiatry Res 2012; 200:652-9. [PMID: 22921599 DOI: 10.1016/j.psychres.2012.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 06/28/2012] [Accepted: 07/02/2012] [Indexed: 11/22/2022]
Abstract
To understand the causes of schizophrenia, a search for stable markers (endophenotypes) is ongoing. In previous years, we have shown that the shine-through visual backward masking paradigm meets the most important characteristics of an endophenotype. Here, we tested masking performance differences between healthy students with low and high schizotypy scores as determined by the self-report O-Life questionnaire assessing schizotypy along three dimensions, i.e. positive schizotypy (unusual experiences), cognitive disorganisation, and negative schizotypy (introvertive anhedonia). Forty participants performed the shine-through backward masking task and a classical cognitive test, the Wisconsin Card Sorting Task (WCST). We found that visual backward masking was impaired for students scoring high as compared to low on the cognitive disorganisation dimension, whereas the positive and negative schizotypy dimensions showed no link to masking performance. We also found group differences for students scoring high and low on the cognitive disorganisation factor for the WCST. These findings indicate that the shine-through paradigm is sensitive to differences in schizotypy which are closely linked with the pathological expression in schizophrenia.
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40
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Hill M, Crumlish N, Clarke M, Whitty P, Owens E, Renwick L, Browne S, Macklin EA, Kinsella A, Larkin C, Waddington JL, O'Callaghan E. Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12 years. Schizophr Res 2012; 141:215-21. [PMID: 23006501 DOI: 10.1016/j.schres.2012.08.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The duration of untreated psychosis is well recognised as an independent predictor of symptomatic and functional outcome in the short term and has facilitated the development of worldwide early intervention programmes. However, the extent and mechanisms by which it might influence prognosis beyond a decade remain poorly understood. METHODS The authors examined the relationship between duration of untreated psychosis and outcome 12years after a first episode of psychosis and assessed whether its relationship with function is affected by symptoms in a prospective, 12-year follow-up of an epidemiologically-based inception cohort. RESULTS Longer duration of untreated psychosis predicted poorer remission status, more severe positive and negative symptoms, and greater impairment in general functioning, social functioning and quality of life at 12years on standardised measures, independent of other factors at baseline. It was not associated with gainful employment, for which education was the only predictor, or independent living, for which age was the only predictor. The relationship between duration of untreated psychosis and functional outcome was mediated by concurrent psychopathology, particularly negative symptoms. CONCLUSIONS These results provide qualified support for the potential long-term benefit of reduction in the duration of untreated psychosis in terms of improvement in symptoms and functional outcome. Its failure to predict real-life outcomes such as independent living and gainful employment could reflect the importance of pre-existing socio-cultural factors such as individual opportunity. The relationship between duration of untreated psychosis and negative symptoms was largely responsible for its effect on function, suggesting a possible long-term protective mechanism against disability.
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Affiliation(s)
- Michele Hill
- Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Co., Dublin, Ireland.
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VAN Wel TF, Landsheer JA. Societal participation: examining the impact of a rehabilitation approach for young people with schizophrenia. J Psychiatr Ment Health Nurs 2012; 19:792-8. [PMID: 22212238 DOI: 10.1111/j.1365-2850.2011.01854.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper is based on research that focuses on the impact of a rehabilitation approach with respect to 99 young people diagnosed with schizophrenia in a Dutch mental health facility. The approach focused on societal participation goals. Nurses and social workers play a key role in such treatment. The research focused on developmental trajectories and showed significant improvement with respect to societal participation levels. Impairment scores remained stable. The results indicate that rehabilitation counselling by nurses and social workers, in addition to medication and psychosocial treatment and integrated in a multidisciplinary team, can make a difference in a patient's societal participation.
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Affiliation(s)
- T F VAN Wel
- Department of ABC, Altrecht Mental Health Care Institute, Utrecht, The Netherlands.
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Ackenheil M, Weber K. Differing response to antipsychotic therapy in schizophrenia: pharmacogenomic aspects. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22034253 PMCID: PMC3181786 DOI: 10.31887/dcns.2004.6.1/mackenheil] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Treatment-resistance in schizophrenia remains a public health problem: about 20% to 30% of patients do not respond to antipsychotic therapy. Clozapine has been shown to be effective in about one-third of patients, but the medical risks and weekly blood tests limit its broad application. While the heterogeneity of the disease and the duration of untreated psychosis are important, pharmacogenomic aspects must also be considered. Pharmacogenomic investigations offer the opportunity to individualize antipsychotic therapy according to the growing knowledge of the function and effect of the genetic polymorphisms that affect the pharmacokinetics and pharmacodynamics of antipsychotics. On the pharmacokinetic level, polymorphic phase I and II drug-metabolizing enzymes and transport proteins affect drug concentration at the target structure. The cytochrome P450 enzymes, N-acetyltransferase, and multidrug resistance protein (MDR1) particularly influence this parameter. Genetic alterations affecting drug pharmacodynamic properties have an impact on therapeutic outcome that is generally independent of the applied dosage regimen. A combined analysis of genetic polymorphisms in the dopaminergic and serotonergic receptors, neurotransmitter transporters, and other target structures involved in psychiatric disorders is already a powerful predictor of therapeutic outcome. An understanding of other factors influencing gene expression and protein production will facilitate individualized therapy in the future.
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Schennach R, Riedel M, Musil R, Möller HJ. Treatment Response in First-episode Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2012; 10:78-87. [PMID: 23430971 PMCID: PMC3569147 DOI: 10.9758/cpn.2012.10.2.78] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/31/2012] [Indexed: 12/18/2022]
Abstract
First episode schizophrenia (FES) patients tend to be more responsive to treatment. An adequate response has been associated with a favourable long-term course in FES patients. Yet, despite the generally very favourable response profile around one quarter of the patients shows persisting symptoms of psychosis. To improve the outcome and course of psychosis great effort has emerged in identifying biological and clinical variables associated with non-response in order to identify non-responders as early as possible and adopt specific treatment strategies improving illness outcome. Different antipsychotic treatment regimens have been evaluated in terms of their efficacy in reducing symptoms of FES with psychological interventions gaining increasing importance in the treatment concept of patients suffering from their first illness episode. Therefore, aim of this review is to summarize current evidence on the response patterns, the most important predictors of response/non-response as well as on effective treatment interventions in FES patients.
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Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
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44
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One-year functional outcomes of naturalistically treated patients with schizophrenia. Psychiatry Res 2012; 198:378-85. [PMID: 22421065 DOI: 10.1016/j.psychres.2011.12.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 12/02/2011] [Accepted: 12/30/2011] [Indexed: 11/23/2022]
Abstract
Against the background of the growing evidence that the patient's functioning significantly influences the course and outcome of schizophrenia, the aims of this analysis were to examine what proportion of patients achieve functional outcome criteria after 1 year, and to identify clinical and sociodemographic predictive factors for functional remission. Patients with the diagnosis of schizophrenia who were treated as inpatients at the beginning of the study were examined within a naturalistic follow-up trial. The present study reports on the time frame from admission to discharge of an inpatient treatment period and the 1-year follow-up assessment. The Global Assessment of Functioning (GAF) Scale and Social and Occupational Functioning Assessment Scale (SOFAS) were evaluated with respect to functional outcome, whereas Positive and Negative Syndrome Scale (PANSS) scores were rated as psychopathological outcome measures. Functional remission thresholds were defined according to a GAF score of ≥61 points and a SOFAS score ≥61 points. Symptomatic remission criteria were applied according to the remission criteria of the Schizophrenia Working Group. The Strauss-Carpenter Prognostic Scale (SCPS), the Phillips Premorbid Adjustment Scale, medical history, sociodemographic and psychopathologic parameters were evaluated in order to find valuable predictors for functional remission. One year after discharge from inpatient treatment, 211 out of 474 patients were available for analysis according to both rating scales used to assess functional remission (GAF and SOFAS). Forty-seven percent of patients fulfilled criteria for functional remission (GAF and SOFAS) at discharge and 51% of patients at the 1-year follow-up visit. With regard to symptomatic remission criteria, the corresponding remitter rates were 61% of patients at discharge and 54% at the 1-year follow-up visit. Forty-two percent of patients fulfilled both remission criteria at discharge and 37% at the 1-year follow-up visit. A significant association was found between functional and symptomatic remission at discharge and at the 1-year follow-up visit. The strongest predictors for functional remission at the 1-year follow-up visit were: a higher SCPS total score at admission, a lower number of previous hospitalizations, a status of employment, lower scores in all PANSS subscales at discharge, a better premorbid social adjustment, the occurrence of a first psychotic episode, a younger age, a lower PANSS negative subscore at admission, a status of being an early responder, a shorter duration of inpatient treatment, a later age of onset, and female gender.
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Chang WC, Tang JYM, Hui CLM, Lam MML, Wong GHY, Chan SKW, Chiu CPY, Chung DWS, Law CW, Tso S, Chan K, Hung SF, Chen EYH. Duration of untreated psychosis: relationship with baseline characteristics and three-year outcome in first-episode psychosis. Psychiatry Res 2012; 198:360-5. [PMID: 22425475 DOI: 10.1016/j.psychres.2011.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 07/12/2011] [Accepted: 09/10/2011] [Indexed: 12/01/2022]
Abstract
Duration of untreated psychosis (DUP) has been considered as one of the few potentially malleable prognostic factors in psychotic illness. The literature demonstrated that prolonged DUP predicted the level of positive symptoms, but its relationships with negative symptoms and functional outcome were less clear-cut. Thus far, most first-episode studies have been conducted in western countries. Yet, it is known that illness outcome might be modified by socio-cultural factors. In this study, we aimed to examine the impact of DUP on baseline characteristics, clinical and vocational outcomes over 3 years in 700 Chinese young people who presented with first-episode psychosis to a specialized early intervention service in Hong Kong. Our results showed that prolonged DUP was associated with male sex, younger age of onset, schizophrenia-spectrum diagnosis, insidious development of psychosis, fewer baseline positive symptoms and less likelihood of hospitalization at intake. Regression analyses revealed that prolonged DUP was significantly predictive of outcome on positive symptoms, recovery and sustained full-time employment in our first-episode psychosis cohort. Taken together, our study provided further supportive evidence regarding the prognostic value of DUP on illness outcome. Additionally, it suggested that an adverse impact of treatment delay for psychosis may likely be applied across regions of various ethno-cultural backgrounds.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
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Primavera D, Bandecchi C, Lepori T, Sanna L, Nicotra E, Carpiniello B. Does duration of untreated psychosis predict very long term outcome of schizophrenic disorders? results of a retrospective study. Ann Gen Psychiatry 2012; 11:21. [PMID: 22856624 PMCID: PMC3416650 DOI: 10.1186/1744-859x-11-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/27/2012] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Studies performed to assess the relevance of duration of untreated psychosis (DUP) as a predictor of long-term outcome (i.e. follow-ups of ten years or more) are somewhat limited. The aim of this study was to evaluate the potential association between DUP and very long-term outcome (16-33 yrs) of schizophrenia by means of a retrospective design. METHODS Retrospective data obtained from clinical records were collected regarding DUP and outcome variables (number of hospitalizations; number of attempted suicides; course of illness; GAF scores at last observation) for a cohort of 80 outpatients (52 Males, 28 Females, mean age 51.0+/-11.58 years) affected by schizophrenia according to DSMIVTR attending a university community mental health centre. RESULTS Mean duration of follow up was 25.2 +/- 8.68 years; mean duration of untreated psychosis was 49.00 months (range 1-312 mo), with no significant difference according to gender. Patients with a shorter DUP (=/< 1 year) displayed more frequent "favourable" courses of illness (28.9% vs 8.6%) (p = 0.025), more frequent cases with limited (=/< 3) number of hospital admissions (85.7% vs 62.1%) (p = 0.047) and a better functioning (mean GAF score = 50.32+/-16.49 vs 40.26+/-9.60, p = 0.002); regression analyses confirmed that shorter DUP independently predicted a more positive outcome in terms of number of hospital admissions, course of illness, functioning (GAF scores). CONCLUSION A shorter DUP appears to act as a significant predictor of better outcome in schizophrenia even in the very long-term.
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Affiliation(s)
- Diego Primavera
- Department of Public Health, Section of Psychiatry and Psychiatric Clinic, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
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Norman RMG, Manchanda R, Windell D, Harricharan R, Northcott S, Hassall L. The role of treatment delay in predicting 5-year outcomes in an early intervention program. Psychol Med 2012; 42:223-233. [PMID: 21767442 DOI: 10.1017/s0033291711001140] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Past research on the relationship between treatment delay and outcomes for first-episode psychosis has primarily focused on the role of duration of untreated psychosis (DUP) in predicting symptomatic outcomes up to 2 years. In the current study we examine the influence of both DUP and duration of untreated illness (DUI) on symptoms and functioning at 5 years follow-up while controlling for other early characteristics. METHOD A total of 132 patients with first-episode psychosis and treated in an early intervention program were prospectively followed up for 5 years. Outcomes assessed included positive and negative symptoms, overall functioning, weeks on disability pension and weeks of full-time competitive employment. RESULTS While DUP showed a significant correlation with level of positive symptoms at follow-up, this was not independent of pre-morbid social adjustment. DUI emerged as a more robust independent predictor of negative symptoms, social and occupational functioning and use of a disability pension. CONCLUSIONS Delay between onset of non-specific symptoms and treatment may be a more important influence on long-term functioning for first-episode patients than DUP. This suggests the possible value of treating such signs and symptoms as early as possible regardless of the effectiveness of such interventions in reducing likelihood or severity of psychotic symptoms.
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Affiliation(s)
- R M G Norman
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - R Manchanda
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - D Windell
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - R Harricharan
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - S Northcott
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
| | - L Hassall
- Prevention and Early Intervention Program for Psychoses (PEPP), London Health Sciences Centre, London, ON, Canada
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1 H-MR spectroscopy in ultra-high risk and first episode stages of schizophrenia. J Psychiatr Res 2011; 45:1135-9. [PMID: 21397254 DOI: 10.1016/j.jpsychires.2011.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 01/13/2011] [Accepted: 02/10/2011] [Indexed: 11/22/2022]
Abstract
Using proton magnetic resonance spectroscopy biochemical characteristics in early stages of schizophrenia were examined. N-acetylaspartate, choline and creatine were measured in hippocampus, anterior cingulate gyrus (ACC) and medial prefrontal cortex (mPFC) of 24 first episode and 30 ultra-high risk patients. Careful LCModel analyses revealed no differences between the patient groups and 31 healthy controls, casting doubt upon the idea of metabolic changes in early stages of psychosis.
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Kiviniemi M, Suvisaari J, Pirkola S, Läksy K, Häkkinen U, Isohanni M, Hakko H. Five-year follow-up study of disability pension rates in first-onset schizophrenia with special focus on regional differences and mortality. Gen Hosp Psychiatry 2011; 33:509-17. [PMID: 21802735 DOI: 10.1016/j.genhosppsych.2011.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/24/2011] [Accepted: 05/27/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the rate and regional determinants of disability pension in first-admission schizophrenia. In addition, we investigated whether patients with disability pension had increased mortality rates during follow-up. METHOD A nationwide register-based 5-year follow-up study of all patients with onset of schizophrenia between 1998 and 2001 (n=3,875). RESULTS A total of 1944 (50.2%) first-onset schizophrenia patients retired on disability pension during the 5-year follow-up. Males retired on pension at an earlier age and more often than females. Regional disability pension rates and retirement times for schizophrenia varied between hospital districts. Patients on disability pension had lower overall and suicide mortality, and they had less physical illness, depression and more psychotropic medication use than patients without disability pension. In regions with a short median time from onset time to retirement, there was significantly higher regional overall mortality and suicide mortality. Disability pension rates were also higher in regions with high involuntary treatment rate. CONCLUSION Half of the schizophrenia patients were pensioned off in 5 years. Lower mortality, especially suicide mortality among disability pensioners, suggests that the decision on a permanent disability pension, indicating for its part the activation of the service system, might be a relief to schizophrenic patients, helping them cope with illness. The retirement process has regional differences, which may be caused by the regional nature of treatment and resources.
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Cechnicki A, Hanuszkiewicz I, Polczyk R, Bielańska A. Prognostic value of duration of untreated psychosis in long-term outcome of schizophrenia. Med Sci Monit 2011; 17:CR277-83. [PMID: 21525810 PMCID: PMC3539595 DOI: 10.12659/msm.881768] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The goal of this prognostic study was to investigate whether the duration of untreated psychosis (DUP) may have a prognostic value with regard to the further course of the illness. Material/Methods Fifty-eight patients (77% of the original study group) diagnosed with DSM III schizophrenia and later re-diagnosed with DSM IV T-R were assessed at 4 time points. Number of relapses, average time of inpatient treatment, number of inpatient readmissions, and severity of psychopathological symptoms were assessed at 1-, 3-, 7- and 12-year follow-ups. DUP information was obtained by clinical interview with patients and their families. The severity of symptoms was assessed using BPRS-SA, UCLA version. Results Increases in the number of relapses at follow-ups were more prominent in the group with a longer DUP (p<0.001). Decreases in the results of BPRS (symptom improvement) were more prominent in patients with a shorter DUP. The latter had significantly lower results than patients with a long DUP at each assessment except the index hospitalization (p equalled, respectively: 0.449; 0.002; 0.012; 0.034 and 0.014). Decreases in positive symptoms were greater in patients with a short DUP – significant at all except the 7-year follow-up (p equalled respectively: 0.230; <0.001; 0.011; 0.214; <0.001). Conclusions 1) A positive correlation was found between DUP and the dynamics of general and positive symptoms and the number of relapses. 2) There was no significant relationship between DUP and the dynamics of negative symptoms, whereas the relationship between the time and number of re-hospitalizations was marginally significant.
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Affiliation(s)
- Andrzej Cechnicki
- Community Psychiatry Unit, Chair of Psychiatry, Collegium Medicum, Jagiellonian University, Cracow, Poland.
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