Predictors of long-term outcome in schizophrenia

Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.
Current Opinion in Psychiatry (Impact Factor: 3.94). 04/2008; 21(2):173-7. DOI: 10.1097/YCO.0b013e3282f33f76
Source: PubMed


Further clarification of factors predicting the outcome in schizophrenia is needed. The present review examines recent research into some of these predictors, focusing on insight, duration of untreated psychosis, cognition and early treatment response. It also addresses the need for standard outcome measures.
There is good evidence that poor insight predicts poor outcome, although perhaps not simply as a consequence of poor compliance. Further support is provided for a link between duration of untreated psychosis and long-term outcome. The relationship between cognition and outcome is complex, with specific cognitive deficits apparently predicting particular outcome domains. Early treatment response is closely related to long-term outcome. Outcome studies may be flawed by sample selection bias, and a lack of standardized outcome measures.
Several predictors are potentially modifiable, indicating that they should be targets for therapeutic intervention. More carefully designed studies are needed. Recently proposed criteria for remission are helpful, and should facilitate cross-sample comparisons.

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    • "Furthermore, identification of predictors of recovery can increase the understanding of the underlying pathophysiology of the illness (Emsley et al., 2008). "
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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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    • "Furthermore, identification of predictors of recovery can increase the understanding of the underlying pathophysiology of the illness (Emsley et al., 2008). "
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    ABSTRACT: Recovery, the optimal goal in treatment, is the attainment of both symptomatic and functional remission over a sustained period of time. Identification of factors that promote recovery can help develop interventions that facilitate good outcomes for people with first episode psychosis. To examine long-term outcomes within a cohort of people with first episode psychosis in relation to symptom remission, functioning and recovery, 10years after diagnosis. The study had a prospective design. Participants from the OPUS trial (1998-2000) (n=496) completed a series of interviews and questionnaires to measure current levels of psychopathology and social/vocational functioning, ten years after diagnosis. Predictors of recovery were identified using socio-demographic and clinical characteristics collected at baseline. A total of 304 participants were interviewed, giving a follow-up rate of 61%. A total of 42 people (14%) met the criteria for symptomatic and psychosocial recovery at 10years. A multivariable binary logistic regression analysis indicated that baseline predictors accounted for 22% of the variance of full recovery. Lower severity of negative symptoms at baseline (Odds Ratio (OR) 0.53, 95% confidence interval CI 0.36-0.78, p<0.001) and earlier age of diagnosis (OR 0.92, 95% CI 0.86-0.99, p<0.05) predicted better rates of recovery at 10years. Results of this study indicated that negative symptoms could play a central role in the process of recovery from schizophrenia. A challenge for clinicians and researchers is to understand the mechanisms behind negative symptoms and develop interventions that can prevent or ameliorate these symptoms in order to promote recovery.
    Schizophrenia Research 08/2013; 150(1). DOI:10.1016/j.schres.2013.07.031 · 3.92 Impact Factor
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    • "Surprisingly, some other factors previously reported as predictors for maintenance treatment outcomes in schizophrenic patients in previous studies could not be corroborated in the present analysis. There were no significant differences found for gender, remission status at baseline, disease history, and age [17-19]. However, there were some differences in the type of patients and follow up duration. "
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    ABSTRACT: Background: This analysis of pooled data evaluates treatment outcomes of patients with schizophrenia receiving maintenance treatment with olanzapine long-acting injection (OLAI) by means of a categorical approach addressing the symptomatic and functional status of patients at different times. Methods: Patients were grouped into 5 categories at baseline, 6 months, and 12 months. Shifts between categories were assessed for individual patients and factors associated with improvement were analyzed. 1182 patients from 3 clinical trials were included in the current analysis. Results: At baseline, 434 (36.8%) patients had minimal Positive and Negative Syndrome Scale (PANSS) symptoms but seriously impaired Heinrich Carpenter's Quality of Life Scale (QLS) functioning; 303 (25.6%) had moderate to severe symptoms and seriously impaired function; 208 (17.6%) had mild to moderate symptoms but good functioning, and 162 (13.7%) had minimal symptoms and good functioning. Baseline category was significantly associated with Clinical Global Impression--Severity (CGI-S), extrapyramidal symptoms, working status, age, and number of previous episodes. The majority of all patients starting OLAI treatment maintained or improved (62% at 6 months and 52% at 12 months) their symptom and functioning levels on OLAI maintenance treatment. Less than 8% of the patients showed worsening of symptoms or functioning. An improvement in category was associated with high PANSS positive and low CGI-S scores at baseline. Conclusions: We present evidence that a composite assessment of schizophrenic patients including symptom severity and functioning is helpful in the evaluation of maintenance treatment outcomes. This approach could also be useful for the assessment of treatment options in clinical practice.The trials from which data are reported here were registered on as NCT00088491, NCT00088465, and NCT00320489.
    BMC Psychiatry 08/2012; 12(1):130. DOI:10.1186/1471-244X-12-130 · 2.21 Impact Factor
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