Predictors of recovery from psychosis: Analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5 years

Psychiatric Center Copenhagen, Copenhagen University, Faculty of Health Sciences, Copenhagen, Denmark.
Schizophrenia Research (Impact Factor: 3.92). 11/2010; 125(2-3):257-66. DOI: 10.1016/j.schres.2010.10.013
Source: PubMed


This paper aims to investigate the predictors of good outcome after first-episode non-affective psychosis and the clinical and social trajectories of those that recover.
A cohort of 255 patients with first-episode non-affective psychosis was interviewed 5 years after first diagnosis and treatment. Recovery was defined as working or studying, having a GAF-function score of 60 or above, having remission of negative and psychotic symptoms, and not living in a supported housing facility or being hospitalized during the last 2 years before the five-year follow-up interview.
A total of 40 (15.7%) were found to be recovered, and 76 (29.8%) had a job or were studying after 5 years. Of those working, as many as 20 still had psychotic symptoms. Also notable is that out of the 40 recovered, less than half were recovered after 2 years. Recovery after 5 years was predicted by female sex (OR 2.4, 95% CI 1.0-5.8), higher age (OR 0.91, 95% CI 0.83-0.99), pre-morbid social adaptation (OR 0.72, 95% CI 0.56-0.93), growing up with both parents (OR 2.6, 95% CI 1.0-6.8) and low level of negative symptoms (OR 0.51, 95% CI 0.33 to 0.77) at baseline.
Our findings suggest that a stable social life with normal social functioning has a predictive value for good outcome. These measures might be influenced by negative symptoms, but in the multivariate analysis with negative symptoms included they have an independent effect. Also our findings suggest that, after first-episode psychosis, some patients can still experience psychotic symptoms, but have a job and a fairly stable life.

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    • "Full recovery was defined as the stable remission of both negative and positive symptoms, no psychiatric admissions to hospital or living in supported accommodation for the past two years, currently engaged in work or study and a GAF/PSP score of over 60 (Liberman and Kopelowicz, 2005). Institutionalization was defined as living in supported accommodation or hospital for at least 50% of the time in the past two years and having significant psychotic symptoms as rated by SAPS (Albert et al., 2011). "
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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.
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    • " better functional outcomes and improvement in self - esteem ( Davis , Kurzban , & Brekke , 2012 ) . It is noteworthy that most of the investigated clinical vari - ables—length of illness , medication use , and substance use— did not predict recovery in this sample , although converse effects were documented in studies of first - episode samples ( Albert et al . , 2011 ; Bertelsen et al . , 2009 ; Petersen et al . , 2008 ; Verma et al . , 2012 ) . There are several possible explanations for our statistically nonsignificant findings . First , the data had limited variation in values of medication use and substance use because the majority of participants reported high medi - cation use and no substance"
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    ABSTRACT: Objective: We assessed the prevalence of recovery from schizophrenia during the first year of community-based psychosocial rehabilitation and whether psychosocial attributes predicted the achievement of recovery beyond demographic and clinical characteristics. Method: We used data from 246 individuals with schizophrenia spectrum disorder collected at baseline and 6 and 12 months after admission to psychosocial rehabilitation. Results: The proportion of participants who showed recovery for either 6-month period and for 1-year period during the follow-up period was 19.86% and 7.53%, respectively. Although predictors of recovery for 1-year period could not be reliably estimated due to its low prevalence, higher levels of intrinsic motivation and more positive family relationships at baseline predicted recovery for either 6-month period after controlling for initial functioning capacity. Conclusion: In the context of psychosocial rehabilitation, individuals with schizophrenia have highly heterogeneous trajectories. Psychosocial attributes at the start of treatment are important contributors to successful recovery.
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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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