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Predictors of 10-year outcome of first-episode psychosis

  • C. White (a1), J. Stirling (a2), R. Hopkins (a1), J. Morris (a1), L. Montague (a1), D. Tantam (a3) and S. Lewis (a1)...
Abstract
Background

Predictors of outcome for psychosis are poorly understood. Duration of untreated psychosis (DUP) appears to predict short-term outcome although its medium- to long-term role remains unclear. Neurodevelopmental indices such as pre-morbid function and/or neurological soft signs may predict longer-term outcome. We aimed to assess the impact of a range of clinical and demographic variables on long-term outcome of a geographically defined, epidemiological first-episode psychosis cohort.

Method

A 10-year follow-up was undertaken of a consecutively presenting sample of 109 cases of first-episode psychosis aged 16–50 years. Baseline assessments included positive, negative and depression symptoms, DUP, neurological soft signs and pre-morbid functioning. Multi-dimensional outcomes were assessed blind to baseline data.

Results

All participants were traced at a mean of 10.5 years post-index admission: 11 had died, 10 from non-natural causes. Of the surviving cases, 70% were comprehensively re-assessed by interview. Summary data on the remainder were collected from their family practitioner and chart review. Poor 10-year outcomes were predicted independently by poor pre-morbid functioning, baseline negative symptoms and longer DUP. The same measures, plus neurological soft signs, appeared to predict outcomes in a DSM-IV schizophrenia/schizo-affective subgroup.

Conclusions

Poor pre-morbid functioning, baseline symptoms, DUP and neurological soft signs at onset independently predict poor long-term outcome in first-episode psychosis.

Copyright
Corresponding author
*Address for correspondence: J. Stirling, D.Phil., Department of Psychology and Speech Pathology, Manchester Metropolitan University, Hathersage Road, Manchester M13 0JA, UK. (Email: j.stirling@mmu.ac.uk)
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J Addington , S Van Mastrigt , D Addington (2004). Duration of untreated psychosis: impact on two year outcome. Psychological Medicine 34, 277284.

AC Altamura , R Bassetti , F Sassella , D Salvadori , E Mundo (2001). Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study. Schizophrenia Research 52, 2936.

NC Andreasen (1999). Understanding the causes of schizophrenia. New England Journal of Medicine 340, 645647.

P Baldwin , D Browne , PJ Scully , JF Quinn , MG Morgan , A Kinsella , JM Owens , V Russell , E O'Callaghan , JL Waddington (2005). Epidemiology of first-episode psychosis: illustrating the challenges across diagnostic boundaries through the Cavan-Monaghan study at 8 years. Schizophrenia Bulletin 31, 624638.

TR Barnes , SB Hutton , MJ Chapman , S Mutsatsa , BK Puri , EM Joyce (2000). West London first-episode study of schizophrenia. Clinical correlates of duration of untreated psychosis. British Journal of Psychiatry 177, 207211.

R Bilder , G Reiter , J Bates , T Lencz , P Szeszko , R Goldman , D Robinson , J Lieberman , J Kane (2006). Cognitive development in schizophrenia: follow-back from the first episode. Journal of Clinical and Experimental Neuropsychology 28, 270282.

I Bombin , C Arango , RW Buchanan (2005). Significance and meaning of neurological signs in schizophrenia: two decades later. Schizophrenia Bulletin 31, 962977.

R Bottlender , T Sato , R Jager , U Wegener , J Wittmann , A Strauss , HJ Moller (2003). The impact of the duration of untreated psychosis prior to first psychiatric admission on the 15 year outcome in schizophrenia. Schizophrenia Research 62, 3744.

RW Buchanan , DW Heinrichs (1989). The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Research 27, 335350.

TD Cannon , TG Van Erp , DC Glahn (2002). Elucidating continuities and discontinuities between schizotypy and schizophrenia in the nervous system. Schizophrenia Research 54, 151156.

HE Cannon-Spoor , SG Potkin , RJ Wyatt (1982). Measurement of pre-morbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.

EY Chen , CL Hui , R Chan , EL Dunn , M Miao , W Yeung , C Wong , W Chan , W Tang (2005). A 3 year prospective study of neurological soft signs in first episode schizophrenia. Schizophrenia Research 75, 4554.

RJ Drake , CJ Haley , S Akhtar , SW Lewis (2000). Causes and consequences of duration of untreated psychosis in schizophrenia. British Journal of Psychiatry 177, 511515.

R Emsley , HJ Turner , PP Oosthuizen , J Carr (2005). Neurological abnormalities in first-episode schizophrenia: temporal stability and clinical outcome correlates. Schizophrenia Research 75, 3544.

WS Fenton , TH McGlashan (1991). Natural history of schizophrenia subtypes II. Positive and negative symptoms and long-term course. Archives of General Psychiatry 48, 978986.

A Foerster , SW Lewis , MJ Owen , RM Murray (1991). Pre-morbid adjustment and personality in psychosis: effects of sex and diagnosis. British Journal of Psychiatry 158, 171176.

S Friis , I Melle , TK Larsen , U Haahr , JO Johannessen , E Simonsen , S Opjordsmoen , P Vaglum , TH McGlashan (2004). Does duration of untreated psychosis bias study samples of first-episode psychosis? Acta Psychiatrica Scandinavica 110, 286291.

SM Harrigan , PD McGorry , H Krtsev (2003). Does treatment delay in first episode psychosis really matter? Psychological Medicine 33, 97110.

MG Harris , LP Henry , SM Harrigan , R Purcell , OS Schwartz , SE Farrelly , AL Prosser , HJ Jackson , PD McGorry (2005). The relationship between duration of untreated psychosis and outcome: an eight year prospective study. Schizophrenia Research 79, 8593.

G Harrison , P Mason , C Glazebrook , I Medley , T Croudace , S Docherty (1994). Residence of incident cohort of psychotic patients after 13 years follow up. British Medical Journal 308, 813816.

DW Heinrichs , TE Hanlon , WE Carpenter Jr. (1984). The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388398.

BC Ho , NC Andreasen , M Flaum , P Napoulos , D Miller (2000). Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. American Journal of Psychiatry 157, 163171.

H Jarbin , Y Ott , A-L Von Knorring (2003). Adult outcome of social function in adolescent-onset schizophrenia and affective psychosis. Child and Adolescent Psychiatry 42, 176183.

JO Johannessen , TH McGlashan , TK Larsen , M Horneland , I Joa , S Mardal , R Kvebaek , S Friis , I Melle , S Opjordsmoen , E Simonsen , H Ulrik , P Vaglum (2001). Early detection strategies for untreated first-episode psychosis. Schizophrenia Research 51, 3946.

P Jones , B Rodgers , M Marmot , R Murray (1994). Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344, 13981402.

SR Kay , A Fisbein , LA Opler (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.

MS Keshavan (1999). Development, disease and degeneration in schizophrenia: a unitary pathophysiological model. Journal of Psychiatric Research 33, 513521.

H Krstev , S Carbone , S Harrigan (2004). Early intervention in first episode psychosis: the impact of a community development campaign. Social Psychiatric Epidemiology 39, 711719.

TK Larsen , I Melle , B Auestad , S Friis , U Haahr , JO Johannessen , S Opjordsmoen , BR Rund , E Simonsen , P Vaglum , T McGlashan (2006). Early detection of first episode psychosis: the effect on one year outcome. Schizophrenia Bulletin 32, 758764.

TK Larsen , LC Moe , L Vibe-Hansen , JO Johannessen (2000). Pre-morbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophrenia Research 45, 19.

SJ Leask , DJ Done , TJ Crow (2002). Adult psychosis, common childhood infections and neurological soft signs in a national birth cohort. British Journal of Psychiatry 181, 387392.

JA Lieberman , D Perkins , A Belger , M Chakos , F Jarskog , K Boteva , J Gilmore (2001). The early stages of schizophrenia: speculations on pathogenesis, pathophysiology and therapeutic approaches. Biological Psychiatry 50, 884897.

A Malla , J Payne (2005). First episode psychosis: psychopathology, quality of life and functional outcome. Schizophrenia Bulletin 31, 650671.

AK Malla , RM Norman , J Takhar , R Manchanda , L Townsend , D Scholten , R Haricharan (2004). Can patients at risk for persistent negative symptoms be identified during their first episode of psychosis? Journal of Nervous and Mental Disease 192, 455463.

M Marshall , SW Lewis , A Lockwood , RJ Drake , PJ Jones , T Croudace (2005). The association between duration of untreated psychosis and outcome in cohorts of first episode patients. Archives of General Psychiatry 62, 975983.

TH McGlashan (1999). Duration of untreated psychosis in first episode schizophrenia: marker or determinant of course? Biological Psychiatry 46, 899907.

PD McGorry , J Edwards , C Hihalopoulos (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305306.

P Milev , BC Ho , S Arndt , N Andreasen (2005). Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first episode study with 7 year follow-up. American Journal of Psychiatry 162, 495506.

HJ Moller , R Bottlender , A Grosz , P Hoff , J Wittmann , U Wegner , A Strausz (2002). The Kraepelinian dichotomy: preliminary results of a 15 year follow-up study on functional psychosis: focus on negative symptoms. Schizophrenia Research 56, 8794.

LR Montague , D Tantam , D Newby , P Thomas , N Ring (1989). The incidence of negative symptoms in early schizophrenia, mania and other psychoses. Acta Psychiatrica Scandinavica 79, 613618.

SA Montgomery , M Asberg (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382389.

C Pantelis , D Velakoulis , PD McGorry , SJ Wood , J Suckling , LJ Phillips , A Yung , ET Bullmore , W Brewer , B Soulsby , P Desmond , PK McGuire (2003). Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet 361, 281288.

DO Perkins , H Gu , K Boteva , JA Lieberman (2005). Relationship between duration of untreated psychosis and outcome in first episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 17851804.

N Ring , D Tantam , L Montague , J Morris (1991). Negative symptoms in chronic schizophrenia: relationship to duration of illness. British Journal of Psychiatry 159, 495499.

B Ropcke , C Eggers (2005). Early onset schizophrenia: a 15 year follow-up. European Child and Adolescent Psychiatry 14, 341350.

A Rossi , S DeCataldo , V DiMichele , V Manna , S Ceccoli , PC Stratta (1990). Neurological soft signs in schizophrenia. British Journal of Psychiatry 157, 735739.

RE Scheffer (2004). Abnormal neurological signs at the onset of psychosis. Schizophrenia Research 70, 1926.

SJ Seigel , F Irani , CM Brensinger , CG Kohler , WB Bilker , JD Ragland , SJ Kanes , RC Gur , RE Gur (2006). Prognostic variables at intake and long-term level of function in schizophrenia. American Journal of Psychiatry 163, 433441.

RL Spitzer , J Endicott , JB Williams (1979). Research diagnostic criteria. Archives of General Psychiatry 36, 13811383.

J Stirling , C White , SW Lewis , RS Hopkins , D Tantam , A Huddy , L Montague (2003). Neurocognitive function and outcome in first episode schizophrenia: a 10 year follow-up of an epidemiological cohort. Schizophrenia Research 65, 7586.

J Van Os , P Jones , P Sham , P Bebbington , RM Murray (1998). Risk factors for onset and persistence of psychosis. Social Psychiatry and Psychiatric Epidemiology 33, 596605.

H Verdoux , F Liraud , C Bergey , F Assens , F Abalan , J Van Os (2001). Is the association between duration of untreated psychosis and outcome confounded? A two-year follow-up study of first-admitted patients. Schizophrenia Research 49, 231241.

A Vourdas , R Pipe , R Corrigall , S Frangou (2003). Increased developmental deviance and premorbid dysfunction in early onset schizophrenia. Schizophrenia Research 62, 1322.

J Waddington , P Sculley , H Youssef (1997). Developmental trajectory and disease progression in schizophrenia: the conundrum and insights from a 12 year follow up study. Schizophrenia Research 23, 107118.

IM Wieselgren , LH Lindstrom (1996). A prospective 1–5 year outcome study in first-admitted and readmitted schizophrenic patients; relationship to heredity, pre-morbid adjustment, duration of disease and education level at index admission and neuroleptic treatment. Acta Psychiatrica Scandinavica 93, 919.

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Psychological Medicine
  • ISSN: 0033-2917
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