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

  • M. Álvarez-Jiménez (a1) (a2), J. F. Gleeson (a2) (a3), L. P. Henry (a1) (a2), S. M. Harrigan (a1) (a2), M. G. Harris (a4), E. Killackey (a1) (a2), S. Bendall (a1) (a2), G. P. Amminger (a1) (a2) (a5), A. R. Yung (a1) (a2), H. Herrman (a1) (a2), H. J. Jackson (a6) and P. D. McGorry (a1) (a2)...
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.

Copyright
Corresponding author
*Address for correspondence: Dr M. Álvarez-Jiménez, Centre for Youth Mental Health, The University of Melbourne, Australia. (Email: malvarez@unimelb.edu.au)
References
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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, 236246.
Andreasen NC (1984). Scale for Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.
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, 441449.
APA (1987). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington DC.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.
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, 762771.
Birchwood M, Todd P, Jackson C (1998). Early intervention in psychosis. The critical period hypothesis. British Journal of Psychiatry Supplement 172, 5359.
Boden R, Sundstrom J, Lindstrom E, Lindstrom L (2009). Association between symptomatic remission and functional outcome in first-episode schizophrenia. Schizophrenia Research 107, 232237.
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, 304310.
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, 10011008.
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, 1824.
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, 357363.
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, 10451062.
Fredrickson BL, Joiner T (2002). Positive emotions trigger upward spirals toward emotional well-being. Psychological Science 13, 172175.
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, 365376.
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, 129138.
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, 11481156.
Harrow M, Sands JR, Silverstein ML, Goldberg JF (1997). Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study. Schizophrenia Bulletin 23, 287303.
Heinrichs DW, Hanlon TE, Carpenter WT Jr., (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388398.
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, 4960.
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, 716728.
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, 808815.
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.
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, 114120.
Kline RB (1998). Principles and Practice of Structural Equation Modeling. The Guilford Press: New York.
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, 432436.
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, 369376.
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, 11831188.
Lukoff D, Liberman RP, Nuechterlein KH (1986). Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin 12, 578593.
McGorry PD, Copolov DL, Singh BS (1990). Royal Park Multidiagnostic Instrument for Psychosis: Part I. Rationale and review. Schizophrenia Bulletin 16, 501515.
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, 649658.
Malla A, Payne J (2005). First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin 31, 650671.
Nagelkerle N (1991). A note on general definition of the coefficient of determination. Biometrika 78, 791792.
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, 473479.
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, 411417.
Seligman ME, Rashid T, Parks AC (2006). Positive psychotherapy. The American Psychologist 61, 774788.
WHO (1992). Life Chart Schedule. World Health Organization: Geneva.
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, 792796.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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