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Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study

Published online by Cambridge University Press:  06 March 2006

ASHOK MALLA ,
ROSS NORMAN ,
NORBERT SCHMITZ ,
RAHUL MANCHANDA ,
LAURA BÉCHARD-EVANS ,
JATINDER TAKHAR  and
RAJ HARICHARAN
ASHOK MALLA
Affiliation:
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Montreal, Quebec, Canada Prevention and Early intervention Program for Psychoses (PEPP – Montréal), Douglas Hospital Research Centre, Montreal, Quebec, Canada
ROSS NORMAN
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada Prevention and Early Intervention Program for Psychosis (PEPP – London, Ontario), Canada
NORBERT SCHMITZ
Affiliation:
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Montreal, Quebec, Canada
RAHUL MANCHANDA
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada Prevention and Early Intervention Program for Psychosis (PEPP – London, Ontario), Canada
LAURA BÉCHARD-EVANS
Affiliation:
Prevention and Early intervention Program for Psychoses (PEPP – Montréal), Douglas Hospital Research Centre, Montreal, Quebec, Canada
JATINDER TAKHAR
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
RAJ HARICHARAN
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada Prevention and Early Intervention Program for Psychosis (PEPP – London, Ontario), Canada
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Abstract

Background. The evidence regarding the independent influence of duration of untreated psychosis (DUP) on rate and time to remission is far from unequivocal. The goal of the current study was to examine the role of predictors for rate and time to remission in first-episode psychosis (FEP).

Method. The differential effect of age, gender, age of onset, duration of untreated psychosis (DUP), duration of untreated illness (DUI), pre-morbid adjustment, co-morbid diagnosis of substance abuse and adherence to medication on the rate of and time to remission were estimated using a logistic and Poisson regression, and survival analysis respectively, in FEP patients.

Results. In a sample of 107 FEP patients 82·2% achieved remission over a period of 2 years after a mean of 10·3 weeks (range 1–72). Regression analysis, based on complete data on all variables of interest (n=80), showed status of remission to be positively influenced by better pre-morbid adjustment (RR 0·57, 95% CI 0·34–0·95, p<0·05), later age of onset (RR 1·09, 95% CI 1·05–1·13, p<0·0001), higher level of adherence to medication (RR 1·96, 95% CI 1·38–2·76, p<0·001) and shorter DUI (RR 0·99, 95% CI 0·997–0·999, p<0·005). Time to remission was influenced by age of onset (HR 1·04, 95% CI 1·00–1·08, p<0·04) and adherence to medication (HR 1·58, 95% CI 1·11–2·23, p<0·01).

Conclusions. Improving adherence to medication early in the course of treatment may be an important intervention to improve short-term outcome.

Type
Original Article
Information
Psychological Medicine , Volume 36 , Issue 5 , May 2006 , pp. 649 - 658
Copyright
2006 Cambridge University Press

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Footnotes

These data have not been presented previously. A different analysis on a portion of these data has been presented at the International Congress of Schizophrenia Research, Savannah, GA, USA, April 2005.