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Predictors of outcome in first-episode schizophrenia over the first 4 years of illness

Published online by Cambridge University Press:  30 April 2008

P. Whitty ,
M. Clarke ,
O. McTigue ,
S. Browne ,
M. Kamali ,
A. Kinsella ,
C. Larkin  and
E. O'Callaghan
P. Whitty
Affiliation:
Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
M. Clarke
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
O. McTigue
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
S. Browne
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
M. Kamali
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
A. Kinsella
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
C. Larkin
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland Department of Adult Psychiatry, University College Dublin, Ireland
E. O'Callaghan*
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland Department of Adult Psychiatry, University College Dublin, Ireland DELTA/DETECT Early Intervention in Psychosis Service, Blackrock, Co. Dublin, Ireland
*
*Address for correspondence: E. O'Callaghan, M.D., FRCPsych, DELTA/DETECT Early Intervention in Psychosis Service, Avila House, Block 5, The Bell Tower, Blackrock Business Park, Carysfort Avenue, Blackrock, Co. Dublin, Ireland. (Email: eadbhard@gmail.com)
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Abstract

Background

The outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.

Method

We conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.

Results

There were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=−3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=−2.77, p<0.01) significantly predicted a better outcome at follow-up.

Conclusions

The outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.

Keywords

First episodeoutcomepsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1141 - 1146
Copyright
Copyright © 2008 Cambridge University Press

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References

Addington, D, Addington, J, Patten, S (2003). Symptom outcome 1 year after admission to an early psychosis program. Canadian Journal of Psychiatry 48, 204–207.CrossRefGoogle Scholar
Addington, J, Van Mastrigt, S, Addington, D (2004). Duration of untreated psychosis: impact on 2-year outcome. Psychological Medicine 34, 277–284.CrossRefGoogle ScholarPubMed
Addington, J, Addington, D (2005). Patterns of premorbid functioning in first episode psychosis: relationship to 2-year outcome. Acta Psychiatrica Scandinavica 112, 40–46.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington DC.Google Scholar
Bachrach, LL (2000). Psychosocial rehabilitation and psychiatry in the treatment of schizophrenia – what are the boundaries? Acta Psychiatrica Scandinavica (Suppl. 407) 102, 6–10.Google Scholar
Beiser, M, Erickson, D, Fleming, JA, Iacono, WG (1993). Establishing the onset of psychotic illness. American Journal of Psychiatry 150, 1349–1354.Google Scholar
Bottlender, R, Strauss, A, Moller, H (2000). Impact of duration of symptoms prior to first hospitalization on acute outcome in 998 schizophrenic patients. Schizophrenia Research 44, 145–150.Google Scholar
Brier, A, Schreiber, JL, Dyer, J, Pickar, D (1991). National Institute of Mental Health longitudinal study of chronic schizophrenia, prognosis and predictors of outcome. Archives of General Psychiatry 48, 239–246.Google Scholar
Browne, S, Larkin, C, O'Callaghan, E (1999). Outcome studies in schizophrenia. Irish Journal of Psychological Medicine 16, 140–144.Google Scholar
Clarke, M, Whitty, P, Browne, S, McTigue, O, Kamali, M, Gervin, M, Kinsella, A, Waddington, JL, Larkin, C, O'Callaghan, E (2006). Untreated illness and outcome of psychosis. British Journal of Psychiatry 189, 235–240.CrossRefGoogle ScholarPubMed
DeQuardo, JR, Goldman, RS, Tandon, R, McGrath-Giroux, M, Kim, L (1995). Comparison of indices of premorbid function in schizophrenia. Schizophrenia Research 15, 283–290.Google Scholar
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321–330.Google ScholarPubMed
Harvey, PD, Bertisch, H, Friedman, JI, Marcus, S, Parrella, M, White, L, Davis, KL (2003). The course and functional decline in geriatric patients with schizophrenia: cognitive-functional and clinical symptoms as determinants of change. American Journal of Geriatric Psychiatry 11, 610–619.Google ScholarPubMed
Huber, G, Gross, G, Schlutter, R (1975). A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatrica Scandinavica 52, 49–57.Google Scholar
Jonsson, H, Nyman, AK (1984). Prediction of outcome in schizophrenia. Acta Psychiatrica Scandinavica 69, 274–291.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Larsen, TK, Moe, LC, Vibe-Hansen, L, Johannessen, JO (2000). Premorbid functioning versus duration of untreated psychosis in 1-year outcome in first-episode psychosis. Schizophrenia Research 45, 1–9.CrossRefGoogle Scholar
Lastra, I, Vazquez-Barquero, JL, Herrera Castanedo, S, Cuesta, MJ, Vazquez-Bourgon, ME, Dunn, G (2000). The classification of first episode schizophrenia: a cluster-analytical approach. Acta Psychiatrica Scandinavica 102, 26–31.Google Scholar
Lieberman, JA (1999). Is schizophrenia a neurodegenerative disorder? A clinical and neurobiological perspective. Biological Psychiatry 46, 729–739.Google Scholar
Lieberman, JA, Phillips, M, Gu, H, Stroup, S, Zhang, P, Kong, L, Ji, Z, Koch, G, Hammer, RM (2003). Atypical and conventional antipsychotic drugs in treatment-naïve first-episode schizophrenia: a 52-week randomized controlled trial of clozapine vs chlorpromazine. Neuropsychopharmacology 28, 995–1003.Google Scholar
Malla, AK, Norman, RM, Manchanda, R, Townsend, L (2002). Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychological Medicine 32, 1109–1119.CrossRefGoogle ScholarPubMed
Malla, A, Payne, J (2005). First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin 31, 650–71.Google Scholar
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients. Archives of General Psychiatry 62, 975–983.Google Scholar
Melle, I, Larsen, TK, Haahr, U, Friis, S, Johannessen, JO, Opjordsmoen, S, Simonsen, E, Rund, BR, Valgum, P, McGlashan, T (2004). Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Archives of General Psychiatry 61, 143–150.CrossRefGoogle ScholarPubMed
Menezes, NM, Arenovich, T, Zipursky, RB (2006). A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36, 1349–1362.CrossRefGoogle ScholarPubMed
Norman, R, Malla, A (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381–400.Google Scholar
Olin, SC, Mednick, SA, Cannon, T, Jacobsen, B, Parnas, J, Schulsinger, F, Schulsinger, H (1998). School teacher ratings predictive of psychiatric outcome 25 years later. British Journal of Psychiatry 172, 7–13.CrossRefGoogle ScholarPubMed
Robinson, D, Woerner, MG, Alvir, JM, Bilder, R, Goldman, R, Geisler, S, Koreen, A, Sheitman, B, Chakos, M, Mayerhoff, D, Lieberman, JA (1999 b). Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry 56, 241–247.Google Scholar
Robinson, DG, Woerner, MG, Alvir, JM, Geisler, S, Koreen, A, Sheitman, B, Chakos, M, Mayerhoff, D, Bilder, R, Goldman, R, Lieberman, JA (1999 a). Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry 156, 544–549.Google Scholar
Siegel, SJ, Irani, F, Brensinger, CM, Kohler, CG, Bilker, WB, Ragland, JD, Kanes, SJ, Gur, RC, Gur, RE (2006). Prognostic variables at intake and long-term level of function in schizophrenia. American Journal of Psychiatry 163, 433–442.CrossRefGoogle ScholarPubMed
Simonsen, E, Friis, S, Haahr, U, Johannessen, JO, Larsen, TK, Melle, I, Opjordsmoen, S, Rund, BR, Valgum, P, McGlashan, T (2007). Clinical epidemiologic first-episode psychosis: 1-year outcome and predictors. Acta Psychiatrica Scandinavica 116, 54–61.Google Scholar
Singh, S, Croudace, T, Amin, S, Kwiecinski, R, Medley, I, Jones, P (2000). Three-year outcome in first-episode psychoses in an established community psychiatric service. British Journal of Psychiatry 176, 210–216.CrossRefGoogle Scholar
Spitzer, RL, Williams, JB, Gibbon, M, First, MB (1995). Structured Clinical Interview for DSM-IV – Patient Edition (SCID-P). American Psychiatric Press: Washington DC.Google Scholar
Stirling, J, White, C, Lewis, S, Hopkins, R, Tantam, D, Huddy, A, Montague, L (2003). Neurocognitive function and outcome in first-episode schizophrenia: a 10 year follow-up of an epidemiological cohort. Schizophrenia Research 65, 75–86.Google Scholar
Strauss, JS, Carpenter, WT (1972). The prediction of outcome in schizophrenia I. Characteristics of outcome. Archives of General Psychiatry 27, 739–746.Google Scholar
Wiersma, D, Nienhuis, F, Sloof, CJ, Giel, R (1998). Natural course of schizophrenic disorders: a 15 year follow-up of a Dutch incidence cohort. Schizophrenia Bulletin 24, 75–85.CrossRefGoogle ScholarPubMed
Wieselgren, IM, Lindstrom, LH (1996). A prospective 1–5 year outcome study in first-admitted and readmitted schizophrenic patients; relationship to heredity, premorbid adjustment, duration of disease and education level at index admission and neuroleptic treatment. Acta Psychiatrica Scandinavica 93, 9–19.Google Scholar
Whitty, P, Clarke, M, McTigue, O, Browne, S, Kamali, M, Larkin, C, O'Callaghan, E (2005). Diagnostic stability four years after a first episode of psychosis. Psychiatric Services 56, 1084–1088.Google Scholar
Whitty, P, Lydon, C, Turner, N, O'Callaghan, E (2006). The influence of psychosocial rehabilitation on patients with a first episode of psychosis. International Journal of Psychosocial Rehabilitation 10, 17–27.Google Scholar