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Predicting first-episode psychosis patients who will never relapse over 10 years

Published online by Cambridge University Press:  30 October 2018

Christy LM Hui Open the ORCID record for Christy LM Hui [Opens in a new window] ,
William G Honer ,
Edwin HM Lee ,
WC Chang ,
Sherry KW Chan ,
Emily SM Chen ,
Edwin PF Pang ,
Simon SY Lui ,
Dicky WS Chung  and
WS Yeung
...Show all authors
Christy LM Hui*
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong
William G Honer
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, Canada
Edwin HM Lee
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong
WC Chang
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
Sherry KW Chan
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
Emily SM Chen
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong
Edwin PF Pang
Affiliation:
Department of Psychiatry, United Christian Hospital, Hong Kong
Simon SY Lui
Affiliation:
Department of Psychiatry, Castle Peak Hospital, Hong Kong
Dicky WS Chung
Affiliation:
Department of Psychiatry, Tai Po Hospital, Hong Kong
WS Yeung
Affiliation:
Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
Roger MK Ng
Affiliation:
Department of Psychiatry, Kowloon Hospital, Hong Kong
William TL Lo
Affiliation:
Department of Psychiatry, Kwai Chung Hospital, Hong Kong
Peter B Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, England
Pak Sham
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Centre for Genomic Sciences, University of Hong Kong, Hong Kong
Eric YH Chen
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
*
Author for correspondence: Christy LM Hui, E-mail: christy@lmhui.com
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Abstract

Background

Although relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode.

Method

Patients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning.

Results

Out of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders.

Conclusions

Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.

Keywords

Early psychosislong-term follow-uppredictorsrelapseschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 13 , October 2019 , pp. 2206 - 2214
Copyright
Copyright © Cambridge University Press 2018 

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References

Addington, D, Addington, J, Maticka-Tyndale, E and Joyce, J (1992) Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research 6, 201–208.Google Scholar
Alverez-Jimenez, M, Gleeson, JF, Henry, LP, Harrigan, SM, Harris, MG, Amminger, GP, Killackey, E, Yung, AR, Herrman, H, Jackson, HJ and McGorry, PD (2011) Prediction of a single psychotic episode: a 7.5-year, prospective study in first-episode psychosis. Schizophrenia Research 125, 236–246.Google Scholar
Amador, XF, Flaum, M, Andreasen, NC, Strauss, DH, Yale, SA, Clark, SC and Gorman, JM (1994) Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archives of General Psychiatry 51, 826–836.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn., revised. Washington, DC: American Psychiatric Association.Google Scholar
Andreasen, NC (1983) The Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, NC (1984) The Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Barnes, TR (1989) A rating scale for drug-induced akathisia. British Journal of Psychiatry 154, 672–676.Google Scholar
Bottlender, R, Sato, T, Jager, M, Wegener, U, Wittmann, J, Strauss, A and Moller, HJ (2003) The impact of the duration of untreated psychosis prior to first psychiatric admission on the 15-year outcome in schizophrenia. Schizophrenia Research 62, 37–44.Google Scholar
Cannon-Spoor, HE, Potkin, SG and Wyatt, RJ (1982) Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.Google Scholar
Chan, SKW, So, HC, Hui, CLM, Chang, WC, Lee, EHM, Chung, DWS, Tso, S, Hung, SF, Yip, KC, Dunn, E and Chen, EYH (2015) 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychological Medicine 45, 1181–1193.Google Scholar
Chen, E (2004) Developing an early intervention service in Hong Kong. In Ehmann, T, MacEwan, GW and Honer, WG (eds), Best Care in Early Psychosis Intervention. London: Taylor & Francis, pp. 125–130.Google Scholar
Chen, EYH, Dunn, EL, Miao, MY, Yeung, WS, Wong, CK, Chan, WF, Chen, RY, Chung, KF and Tang, WN (2005 a) The impact of family experience on the duration of untreated psychosis (DUP) in Hong Kong. Social Psychiatry and Psychiatric Epidemiology 405, 350–356.Google Scholar
Chen, EYH, Hui, CLM, Dunn, EL, Miao, MY, Yeung, WS, Wong, CK, Chan, WF and Tang, WN (2005 b) A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients. Schizophrenia Research 77, 99–104.Google Scholar
Chen, EYH, Hui, CLM, Lam, MML, Chiu, CPY, Law, CW, Chung, DWS, Tso, S, Pang, EPF, Chan, KT, Wong, YC, Mo, FYM, Chan, KPM, Yao, TJ, Hung, SF and Honer, WG (2010) Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial. British Medical Journal 341, c4024.Google Scholar
Crow, TJ, MacMillan, JF, Johnson, AL and Johnstone, EC (1986) The Northwick Park Study of first episodes of schizophrenia II. A randomized controlled trial of prophylactic neuroleptic treatment. British Journal of Psychiatry 148, 120–127.Google Scholar
Gaebel, W, Riesbeck, M, Wolwer, W, Klimke, A, Eickhoff, M, von Wilmsdorff, M, de Millas, W, Maier, W, Ruhrmann, S, Falkai, P, Sauer, H, Schmitt, A, Riedel, M, Klingberh, S and Moller, HJ (2016) Predictors for symptom re-exacerbation after targeted stepwise drug discontinuation in first-episode schizophrenia: results of the first-episode study within the German research network on schizophrenia. Schizophrenia Research 170, 168–176.Google Scholar
Goldman, HH, Skodol, AE and Lave, TR (1992) Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google Scholar
Guy, W (1976 a) Abnormal involuntary movements scale (AIMS). In Guy, W (ed.), The ECDEU Assessment Manual for Psychopharmacology, revised. Rockville, MD: Dept of Health, Education and Welfare, National Institute of Mental Health, pp. 534–537.Google Scholar
Guy, W (1976 b) Clinical global impression scale (CGI). In Guy, W (ed.), ECDEU Assessment Manual for Psychopharmacology, Revised. Rockville, MD: Dept of Health, Education and Welfare, National Institute of Mental Health, pp. 217–222.Google Scholar
Hafner, H, Riecher-Rossler, A, Hambrecht, M, Maurer, K, Meissner, S, Schmidtke, A, Fatkenheuer, B, Loffler, W and van der Heiden, W (1992) IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209–223.Google Scholar
Haro, JM, Kamath, SA, Ochoa, S, Novick, D, Rele, K, Fargas, A, Rodriguez, MJ, Rele, R, Orta, J, Kharbeng, A, Araya, S, Gervin, M, Alonso, J, Mavreas, V, Lavrentzou, E, Liontos, N, Gregor, K and Jones, PB, SOHO Study Group (2003) The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatrica Scandinavica Supplementum 416, 16–23.Google Scholar
Haro, JM, Novick, D, Bertsch, J, Karagianis, J, Dossenbach, M and Jones, PB (2011) Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. British Journal of Psychiatry 199, 194–201.Google Scholar
Hui, CLM, Wong, GHY, Tang, JYM, Chang, WC, Chan, SKW, Lee, EHM, Lam, MML, Chiu, CPY, Law, CW, Chung, DWS, Tso, S, Pang, EPF, Chan, KT, Wong, YC, Mo, FYM, Chan, KPM, Hung, SF, Honer, WG and Chen, EYH (2013) Predicting 1-year risk for relapse in patients who have discontinued or continued quetiapine after remission from first-episode psychosis. Schizophrenia Research 150, 297–302.Google Scholar
Hui, CLM, Li, YK, Li, AWY, Lee, EHM, Chang, WC, Chan, SKW, Lam, SY, Thornton, AE, Sham, P, Honer, WG and Chen, EYH (2016) Visual working memory deterioration preceding relapse in psychosis. Psychological Medicine 46, 2435–2444.Google Scholar
Hui, CLM, Honer, W, Lee, EHM, Chang, WC, Chan, SKW, Chen, ESM, Pang, EPF, Lui, SSY, Chung, DWS, Yeung, WS, Ng, RMK, Lo, WTL, Jones, PB, Sham, P and Chen, EYH (2018) Long-term effects of discontinuation from antipsychotic maintenance following first episode schizophrenia and related disorders. The Lancet. Psychiatry 5, 432–442.Google Scholar
Kay, SR, Fiszbein, A and Opler, LA (1987) Positive and Negative Symptom Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 21–76.Google Scholar
Larsen, TK, Moe, LC, Vibe-Hansen, L and Johannessen, JO (2000) Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophrenia Research 45, 1–9.Google Scholar
Lenior, ME, Dingemans, PMAJ, Schene, AH and Linszen, DH (2005) Predictors of the early 5-year course of schizophrenia: a path analysis. Schizophrenia Bulletin 31, 781–791.Google Scholar
Lingjaerde, O, Ahlfors, UG, Bech, P, Dencker, SJ and Elgen, K (1987) The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica Supplementum 334, 1–100.Google Scholar
Linszen, D, Dingemans, P and Lenior, M (2001) Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: ethical implications. Schizophrenia Research 51, 55–61.Google Scholar
Robinson, D, Woerner, MG, Alvir, JM, Bilder, R, Goldman, R, Geisler, S, Koreen, A, Sheitman, B, Chakos, M, Mayerhoff, D and Lieberman, JA (1999) Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry 56, 241–247.Google Scholar
Rund, BR, Melle, I, Friis, S, Johannessen, JO, Larsen, TK, Midbøe, LJ, Opjordsmoen, S, Simonsen, E, Vaglum, P and McGlashan, T (2007) The course of neurocognitive functioning in first-episode psychosis and its relation to premorbid adjustment, duration of untreated psychosis, and relapse. Schizophrenia Research 91, 132–140.Google Scholar
Rund, BR, Barder, HE, Evensen, J, Haahr, U, Hegelstad, WV, Joa, I, Johannessen, JO, Langeveld, J, Larsen, TK, Melle, I, Opyjordsmoen, S, Rossberg, JI, Simonsen, E, Sundet, K, Vaglum, P, McGlashan, T and Friis, S (2016) Neurocognition and duration of psychosis: a 10-year follow-up of first-episode patients. Schizophrenia Bulletin 42, 87–95.Google Scholar
Shepherd, M, Watt, D, Falloon, I and Smeeton, N (1989) The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychological Medicine Monograph Supplementary 15, 1–46.Google Scholar
Simpson, GM and Angus, JW (1970) A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica Supplementum 212, 11–19.Google Scholar
So, E, Kam, I, Leung, CM, Chung, D, Liu, Z and Fong, S (2003) The Chinese-bilingual SCID-I/P project: stage 1 - reliability for mood disorders and schizophrenia. Hong Kong Journal of Psychiatry 13, 7–18.Google Scholar
Strauss, JS and Carpenter, WT Jr (1972) The prediction of outcome in schizophrenia: i. Characteristics of outcome. Archives of General Psychiatry 27, 739–746.Google Scholar
Tang, JYM, Chang, WC, Hui, CLM, Wong, GHY, Chan, SKW, Lee, EHM, Yeung, WS, Wong, CK, Tang, WN, Chan, WF, Pang, EPF, Tso, S, Ng, RMK, Hung, SF, Dunn, ELW, Sham, PC and Chen, EYH (2014) Prospective relationship between duration of untreated psychosis and 13-year clinical outcome: a first-episode psychosis study. Schizophrenia Research 153, 1–8.Google Scholar
Thara, R and Eaton, WW (1996) Outcome of schizophrenia: the Madras longitudinal study. Australian and New Zealand Journal of Psychiatry 30, 516–522.Google Scholar
Verdoux, H, Lengronne, J, Liraud, F, Gonzales, B, Assens, F, Abalan, F and van Os, J (2000) Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects. Acta Psychiatrica Scandinavica 102, 203–210.Google Scholar
White, C, Stirling, J, Hopkins, R, Morris, J, Montague, L, Tantam, D and Lewis, S (2009) Predictors of 10-year outcome of first-episode psychosis. Psychological Medicine 39, 1447–1456.Google Scholar
Wölwer, W, Brinkmeyer, J, Riesbeck, M, Freimüller, L, Klimke, A, Wagner, M, Möller, HJ, Klingberg, S and Gaebel, W, German Study Group on First Episode Schizophrenia (2008) Neuropsychological impairments predict the clinical course in schizophrenia. European Archives of Psychiatry and Clinical Neuroscience 258, 28–34.Google Scholar
Wunderink, L, Nienhuis, FJ, Sytema, S, Slooff, CJ, Knegtering, R and Wiersma, D (2007) Guided discontinuation versus maintenance treatment in remitted first-episode psychosis: relapse rates and functional outcome. Journal of Clinical Psychiatry 68, 654–661.Google Scholar
Wunderink, L, Nieboer, RM, Wiersma, D, Sytema, S and Nienhuis, FJ (2013) Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70, 913–920.Google Scholar
Zipursky, RB, Menezes, NM and Streiner, DL (2014) Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophrenia Research 152, 408–414.Google Scholar