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

Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.41). 02/2012; 46(2):100-8. DOI: 10.1177/0004867411428015
Source: PubMed


The aim of the current study was to investigate the rates and predictors of symptomatic remission and recovery in patients presenting with first-episode psychosis 3 years after treatment initiation.
Seven hundred participants aged 15-25 years consecutively enrolled in a territory-wide early intervention programme in Hong Kong from July 2001 to August 2003 fulfilled study inclusion criteria, with 539 completing 3-year follow-up. Baseline and follow-up variables were collected via systematic medical file review. The operational criteria for recovery were based on clinical definition incorporating both symptom and functional dimensions.
By the end of 3-year follow-up, 58.8% (n = 317) and 17.4% (n = 94) of participants met criteria for symptomatic remission and recovery, respectively. Around half (51.2%, n = 276) were not remitted either symptomatically or functionally in the last 12 months of follow-up. Of those who achieved sustained symptomatic remission, only 43.1% were also in functional remission. Patients in symptomatic remission had lower rate of admissions, shorter duration of hospitalisations and more favourable psychosocial functioning than non-remitted counterparts. Logistic regression analysis revealed that female sex, older age of onset of psychosis, shorter duration of untreated psychosis (DUP) and early symptom resolution predicted symptomatic remission at the end of follow-up. Higher educational attainment, superior baseline occupational status and shorter DUP were found to be predictive of recovery.
In a large representative cohort of Chinese young people presenting with first-episode psychosis, although more than half achieved symptomatic remission 3 years after service entry, the rates of functional remission and recovery were low. More intensive psychosocial interventions may be required to further improve patients' functional outcome.

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    • "Studies into predictors of recovery in first episode psychosis have consistently found better pre-morbid functioning (Petersen et al., 2008; Bobes et al., 2009; Wunderink et al., 2009; Albert et al., 2011) lower levels of psychopathology at baseline and shorter duration of untreated psychosis (DUP) (Jeppesen et al., 2008; Wunderink et al., 2009; Chang et al., 2012a; Verma et al., 2012) have been associated with higher rates of recovery. Other factors that have been associated with recovery include better cognition and less depressive symptoms at baseline (Bobes et al., 2009; Faber et al., 2011), higher levels of education at baseline (Chang et al., 2012b; Verma et al., 2012), early response to treatment (Verma et al., 2012; Schennach et al., 2012), "
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    ABSTRACT: Knowledge about course of illness can help clinicians to develop effective interventions and improve treatment outcomes. The goal of this study was to construct positive and negative symptom trajectories based on structured clinical assessments collected over 10years within a cohort of people with first episode psychosis. A cohort of 496 people with first episode psychosis (ICD-10, F20-28) originally recruited for the OPUS study (1998-2000) and treated in community psychiatric services were rated on clinical symptoms at 5 different occasions across ten years. Psychopathology was assessed using the Scales for Assessment of Positive and Negative Symptoms. Symptom trajectories were constructed using Latent Class Analysis. Five distinct trajectories were identified for positive symptoms (response - 47%, delayed response - 12%, relapse - 15%, non-response - 13% and episodic response - 13%). Four distinct trajectories were identified for negative symptoms (response - 28%, delayed response - 19%, relapse - 26% and non-response - 27%). Multivariable regression analysis of baseline characteristics identified that longer duration of untreated psychosis (OR 1.27-1.47, p<0.05) and substance abuse (OR 3.47-5.90, p<0.01) were associated with poorer positive symptom trajectories (higher levels of psychotic symptoms) while poor social functioning (OR 1.34-5.55, p<0.05), disorganized symptoms (OR 2.01-2.38, p<0.05) and schizophrenia diagnosis (OR 5.70-8.86, p<0.05) were associated with poorer negative symptom trajectories (higher levels of negative symptoms). A proportion of people displayed significant changes in symptoms several years after diagnosis. Trajectories of illness for positive and negative symptoms were heterogeneous among people with first episode psychosis. Positive symptoms showed a general pattern of reduction and stabilization over time while negative symptoms typically showed less variation over the ten years. Results have implications for the focus, timing and length of interventions in first episode psychosis. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 08/2015; 168(1). DOI:10.1016/j.schres.2015.07.021 · 3.92 Impact Factor
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    • "The literature regarding the independent role of education in the presentation of individual positive symptoms is sparse. In general, the available literature suggests that higher levels of education can be protective due to greater cognitive resources and more advanced coping strategies (Austin et al., 2013; Chang et al., 2012; Jonsson and Nyman, 1984; Verma et al., 2012; Wieselgren and Lindstrom, 1996). It has also been suggested, however, that greater abstract thinking ability may intensify the presentation of some ideational psychotic processes (Chen et al., 1997). "
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    ABSTRACT: It is now well established that the utilization of standardized clinical criteria can enhance prediction of psychosis. These criteria are primarily concerned with the presence and severity of attenuated positive symptoms. Because these symptom criteria are used to derive algorithms for designating clinical high risk (CHR) status and for maximizing prediction of psychosis risk, it is important to know whether the symptom ratings vary as a function of demographic factors that have previously been linked with symptoms in diagnosed psychotic patients. Using a sample of 356 CHR individuals from the NAPLS-II multi-site study, we examined the relation of three sex, age, and educational level, with the severity of attenuated positive symptom scores from the Scale of Prodromal Symptoms (SOPS). Demographic factors accounted for little of the variance in symptom ratings (5-6%). Older CHR individuals manifested more severe suspiciousness, and female CHR participants reported more unusual perceptual experiences than male participants. Contrary to prediction, higher educational level was associated with more severe ratings of unusual thought content, but less severe perceptual abnormalities. Overall, sex, age and education were modestly related to unusual thought content and perceptual abnormalities, only, suggesting minimal implication for designating CHR status and predicting psychosis-risk. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 05/2015; 166(1-3). DOI:10.1016/j.schres.2015.04.035 · 3.92 Impact Factor
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    • "However, we would contend, even if elevated metacognitions are a result of hallucinatory experiences, it does not rule out the possibility that some metacognitions remain elevated after the first episode and potentially contribute to subsequent vulnerability . In order to determine if metacognitive beliefs significantly contribute to course of illness, this study will control for a range of factors known to potentially impact on psychotic symptoms such as gender, age, duration of untreated psychosis (DUP) and substance abuse (Perkins et al. 2005; Jeppesen et al. 2008; Chang et al. 2012; Leung and Chue 2000; Albert et al. 2011; Verma et al. 2012). This study will also control for factors that can influence metacognitive beliefs such as co-morbid anxiety and depression (Varese and Bentall 2011). "
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    ABSTRACT: The Self Regulatory Executive Function (S-REF) model implicates maladaptive metacognitive beliefs and processes in the predisposition and/or maintenance of positive psychotic symptoms. In the model, metacognitive beliefs guide cognitive and behavioural responses to cognitive experiences. This study tested for relationships between course of illness and levels of specific metacognitions in schizophrenia spectrum disorders. A large cohort of people with first episode psychosis (n = 578) recruited as part the OPUS trial (1998-2000) were tested. Information about course of illness (remitted, episodic or continually psychotic) and metacognitive belief ratings were collected. Data obtained from 367 participants revealed that levels of maladaptive metacognitive beliefs varied as a function of course of illness and distinguished between remitted patients and non-patients. Metacognitive beliefs explained 17 % additional variance displayed in course of illness in a multinomial regression analysis when controlling for other causal factors. In addition, beliefs concerning Need to Control thoughts (RR 1.13, 95 % CI 1.03-1.22, p < 0.01) predicted a continually psychotic course of illness. Elevations in metacognitive beliefs were associated with the severity and duration of psychotic symptoms, consistent with the S-REF model. Moreover, metacognition was a better predictor of course of illness than anxiety and depression. If these associations are shown to be causal, clinical interventions that modify metacognitive beliefs may also impact on positive symptoms and course of illness within schizophrenia.
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