Abstract
Objective: Multiple relapses over time are common in both affective and non-affective psychotic disorders. Characterizing the temporal nature of these relapses may be crucial to understanding the underlying neurobiology of relapse.Materials and Methods: Anonymized records of patients with affective and non-affective psychotic disorders were collected from SA Mental Health Data Universe and retrospectively analyzed. To characterize the temporal characteristic of their relapses, a relapse trend score was computed using a symbolic series-based approach. A higher score suggests that relapse follows a trend and a lower score suggests relapses are random. Regression models were built to investigate if this score was significantly different between affective and non-affective psychotic disorders.Results: Logistic regression models showed a significant group difference in relapse trend score between the patient groups. For example, in patients who were hospitalized six or more times, relapse score in affective disorders were 2.6 times higher than non-affective psychotic disorders [OR 2.6, 95% CI (1.8–3.7), p < 0.001].Discussion: The results imply that the odds of a patient with affective disorder exhibiting a predictable trend in time to relapse were much higher than a patient with recurrent non-affective psychotic disorder. In other words, within recurrent non-affective psychosis group, time to relapse is random.Conclusion: This study is an initial attempt to develop a longitudinal trajectory-based approach to investigate relapse trend differences in mental health patients. Further investigations using this approach may reflect differences in underlying biological processes between illnesses.
Highlights
Temporal characteristics of symptom onset have played an important role in the classification of psychiatric disorders
Harrow et al found in a 15 year follow up of patients with schizophrenia treated with contemporary interventions that while over 40% cumulatively had a period of recovery, this was followed in 60% by a period of symptom recurrence [2]
We investigated for differences if any, in relapse trend score for patients with recurrent non-affective psychosis compared with patients with recurrent affective disorder
Summary
Temporal characteristics of symptom onset have played an important role in the classification of psychiatric disorders. Kraepelin’s original distinction between manic depression and dementia praecox was based on the idea of manic depression, known as bipolar disorder, being a recurrent illness with periods of complete recovery alternating. It has been shown that children who go on to develop schizophrenia [4] have evidence of cognitive and neurodevelopmental impairment and this is not evident in children who go on to develop bipolar disorder These children who develop schizophrenia are more likely to have a history of obstetric complications that could affect neurological development [5]. Patients with schizophrenia had more impaired trajectories, and those with mood disorders had better functioning trajectories Such studies generally compare trajectories of distinct groups based on symptom clustering and or level of function, rather than examining any periodicity within the illness trajectory [8, 9]. To our knowledge there have been no studies where patterns in time between relapse have been examined in nonaffective psychosis
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