Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-15T08:21:25.490Z Has data issue: false hasContentIssue false
  • English
  • Français

Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years

Published online by Cambridge University Press:  19 August 2011

M. Álvarez-Jiménez ,
J. F. Gleeson ,
L. P. Henry ,
S. M. Harrigan ,
M. G. Harris ,
E. Killackey ,
S. Bendall ,
G. P. Amminger ,
A. R. Yung  and
H. Herrman
...Show all authors
M. Álvarez-Jiménez*
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
J. F. Gleeson
Affiliation:
Orygen Youth Health Research Centre, Melbourne, Australia Australian Catholic University, Department of Psychology, Melbourne, Australia
L. P. Henry
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
S. M. Harrigan
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
M. G. Harris
Affiliation:
School of Population Health, The University of Queensland, Brisbane, Australia
E. Killackey
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
S. Bendall
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
G. P. Amminger
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
A. R. Yung
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
H. Herrman
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
H. J. Jackson
Affiliation:
The Department of Psychology, The University of Melbourne, Melbourne, Australia
P. D. McGorry
Affiliation:
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia Orygen Youth Health Research Centre, Melbourne, Australia
*
*Address for correspondence: Dr M. Álvarez-Jiménez, Centre for Youth Mental Health, The University of Melbourne, Australia. (Email: malvarez@unimelb.edu.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In recent years there has been increasing interest in functional recovery in the early phase of schizophrenia. Concurrently, new remission criteria have been proposed and several studies have examined their clinical relevance for prediction of functional outcome in first-episode psychosis (FEP). However, the longitudinal interrelationship between full functional recovery (FFR) and symptom remission has not yet been investigated. This study sought to: (1) examine the relationships between FFR and symptom remission in FEP over 7.5 years; (2) test two different models of the interaction between both variables.

Method

Altogether, 209 FEP patients treated at a specialized early psychosis service were assessed at baseline, 8 months, 14 months and 7.5 years to determine their remission of positive and negative symptoms and functional recovery. Multivariate logistic regression and path analysis were employed to test the hypothesized relationships between symptom remission and FFR.

Results

Remission of both positive and negative symptoms at 8-month follow-up predicted functional recovery at 14-month follow-up, but had limited value for the prediction of FFR at 7.5 years. Functional recovery at 14-month follow-up significantly predicted both FFR and remission of negative symptoms at 7.5 years, irrespective of whether remission criteria were simultaneously met. The association remained significant after controlling for baseline prognostic indicators.

Conclusions

These findings provided support for the hypothesis that early functional and vocational recovery plays a pivotal role in preventing the development of chronic negative symptoms and disability. This underlines the need for interventions that specifically address early psychosocial recovery.

Keywords

First-episode psychosisfunctional recoveryremission
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 3 , March 2012 , pp. 595 - 606
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alvarez-Jimenez, M, Gleeson, JF, Henry, LP, Harrigan, SM, Harris, MG, Amminger, GP, Killackey, E, Yung, AR, Herrman, H, Jackson, HJ, McGorry, PD (2011). Prediction of a single psychotic episode: a 7.5-year, prospective study in first-episode psychosis. Schizophrenia Research 125, 236–246.CrossRefGoogle ScholarPubMed
Andreasen, NC (1984). Scale for Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.Google Scholar
Andreasen, NC, Carpenter, WT Jr., Kane, JM, Lasser, RA, Marder, SR, Weinberger, DR (2005). Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.CrossRefGoogle ScholarPubMed
APA (1987). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2008). Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65, 762–771.CrossRefGoogle ScholarPubMed
Birchwood, M, Todd, P, Jackson, C (1998). Early intervention in psychosis. The critical period hypothesis. British Journal of Psychiatry Supplement 172, 53–59.CrossRefGoogle ScholarPubMed
Boden, R, Sundstrom, J, Lindstrom, E, Lindstrom, L (2009). Association between symptomatic remission and functional outcome in first-episode schizophrenia. Schizophrenia Research 107, 232–237.CrossRefGoogle ScholarPubMed
Boyle, PA, Buchman, AS, Barnes, LL, Bennett, DA (2010). Effect of a purpose in life on risk of incident Alzheimer disease and mild cognitive impairment in community-dwelling older persons. Archives of General Psychiatry 67, 304–310.CrossRefGoogle ScholarPubMed
Cassidy, CM, Norman, R, Manchanda, R, Schmitz, N, Malla, A (2010). Testing definitions of symptom remission in first-episode psychosis for prediction of functional outcome at 2 years. Schizophrenia Bulletin 36, 1001–1008.CrossRefGoogle ScholarPubMed
Crumlish, N, Whitty, P, Clarke, M, Browne, S, Kamali, M, Gervin, M, McTigue, O, Kinsella, A, Waddington, JL, Larkin, C, O'Callaghan, E (2009). Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis. British Journal of Psychiatry 194, 18–24.CrossRefGoogle ScholarPubMed
Eaton, WW, Thara, R, Federman, E, Tien, A (1998). Remission and relapse in schizophrenia: the Madras Longitudinal Study. Journal of Nervous and Mental Disease 186, 357–363.CrossRefGoogle ScholarPubMed
Fredrickson, BL, Cohn, MA, Coffey, KA, Pek, J, Finkel, SM (2008). Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology 95, 1045–1062.CrossRefGoogle ScholarPubMed
Fredrickson, BL, Joiner, T (2002). Positive emotions trigger upward spirals toward emotional well-being. Psychological Science 13, 172–175.CrossRefGoogle ScholarPubMed
Fredrickson, BL, Tugade, MM, Waugh, CE, Larkin, GR (2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology 84, 365–376.CrossRefGoogle ScholarPubMed
Geschwind, N, Peeters, F, Jacobs, N, Delespaul, P, Derom, C, Thiery, E, van Os, J, Wichers, M (2010). Meeting risk with resilience: high daily life reward experience preserves mental health. Acta Psychiatrica Scandinavica 122, 129–138.CrossRefGoogle ScholarPubMed
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising Axis-V for DSM-IV – a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google ScholarPubMed
Harrow, M, Sands, JR, Silverstein, ML, Goldberg, JF (1997). Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study. Schizophrenia Bulletin 23, 287–303.CrossRefGoogle ScholarPubMed
Heinrichs, DW, Hanlon, TE, Carpenter, WT Jr., (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388–398.CrossRefGoogle ScholarPubMed
Henry, L, Harris, MG, Amminger, GP, Yuen, HP, Harrigan, SM, Lambert, M, Conus, P, Schwartz, O, Prosser, A, Farrelly, S, Purcell, R, Herrman, H, Jackson, HJ, PD., M (2007). The EPPIC long term follow-up study of first episode psychosis: methodology and baseline characteristics. Early Intervention in Psychiatry 1, 49–60.CrossRefGoogle ScholarPubMed
Henry, LP, Amminger, GP, Harris, MG, Yuen, HP, Harrigan, SM, Prosser, AL, Schwartz, OS, Farrelly, SE, Herrman, H, Jackson, HJ, McGorry, PD (2010). The EPPIC follow-up study of first-episode psychosis: longer-term clinical and functional outcome 7 years after index admission. Journal of Clinical Psychiatry 71, 716–728.CrossRefGoogle ScholarPubMed
Ho, BC, Andreasen, NC, Flaum, M, Nopoulos, P, Miller, D (2000). Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. American Journal of Psychiatry 157, 808–815.CrossRefGoogle ScholarPubMed
Kane, JM, Leucht, S, Carpenter, D, Docherty, JP (2003). The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. Journal of Clinical Psychiatry 64 (Suppl. 12), 5–19.Google ScholarPubMed
Killackey, E, Jackson, HJ, McGorry, PD (2008). Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. British Journal of Psychiatry 193, 114–120.CrossRefGoogle ScholarPubMed
Kline, RB (1998). Principles and Practice of Structural Equation Modeling. The Guilford Press: New York.Google Scholar
Kok, BE, Fredrickson, BL (2010). Upward spirals of the heart: autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness. Biological Psychology 85, 432–436.CrossRefGoogle ScholarPubMed
Lieberman, J, Jody, D, Geisler, S, Alvir, J, Loebel, A, Szymanski, S, Woerner, M, Borenstein, M (1993). Time course and biologic correlates of treatment response in first-episode schizophrenia. Archives of General Psychiatry 50, 369–376.CrossRefGoogle ScholarPubMed
Loebel, AD, Lieberman, JA, Alvir, JM, Mayerhoff, DI, Geisler, SH, Szymanski, SR (1992). Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry 149, 1183–1188.Google ScholarPubMed
Lukoff, D, Liberman, RP, Nuechterlein, KH (1986). Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin 12, 578–593.CrossRefGoogle ScholarPubMed
McGorry, PD, Copolov, DL, Singh, BS (1990). Royal Park Multidiagnostic Instrument for Psychosis: Part I. Rationale and review. Schizophrenia Bulletin 16, 501–515.CrossRefGoogle Scholar
Malla, A, Norman, R, Schmitz, N, Manchanda, R, Bechard-Evans, L, Takhar, J, Haricharan, R (2006). Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study. Psychological Medicine 36, 649–658.CrossRefGoogle ScholarPubMed
Malla, A, Payne, J (2005). First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin 31, 650–671.CrossRefGoogle ScholarPubMed
Nagelkerle, N (1991). A note on general definition of the coefficient of determination. Biometrika 78, 791–792.Google Scholar
Robinson, DG, Woerner, MG, McMeniman, M, Mendelowitz, A, Bilder, RM (2004). Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry 161, 473–479.CrossRefGoogle ScholarPubMed
Rosenheck, R, Leslie, D, Keefe, R, McEvoy, J, Swartz, M, Perkins, D, Stroup, S, Hsiao, JK, Lieberman, J (2006). Barriers to employment for people with schizophrenia. American Journal of Psychiatry 163, 411–417.CrossRefGoogle ScholarPubMed
Seligman, ME, Rashid, T, Parks, AC (2006). Positive psychotherapy. The American Psychologist 61, 774–788.CrossRefGoogle ScholarPubMed
WHO (1992). Life Chart Schedule. World Health Organization: Geneva.Google Scholar
Wunderink, L, Nienhuis, FJ, Sytema, S, Wiersma, D (2007). Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics. Schizophrenia Bulletin 33, 792–796.CrossRefGoogle ScholarPubMed