Multiple dimensions of recovery in early psychosis

Abstract

Recovery is a complex individual process that unfolds over time and involves multiple dimensions. We propose operational criteria for defining recovery in five symptom dimensions and two functional dimensions including an overall functional dimension that we characterize as 'return to the life line'. The multi-dimensional model was used to organize the results gathered from 103 clients, not previously treated with antipsychotic medications, who enrolled in the Nova Scotia Early Psychosis Program and completed one year of treatment for schizophrenia or a related psychotic disorder.The subjects were assessed with the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Function scale (GAF) and the Social and Occupational Functional Assessment scale (SOFA) prior to starting antipsychotic medication and again at six and 12 months of treatment. After one year of treatment, 67% of subjects met our criterion for symptomatic recovery (no relevant PANSS item greater than 'mild') for both positive and negative symptoms. Forty-two percent met the recovery criteria for all five symptom dimensions. Most of the symptom improvement occurred during the first six months of treatment. At one year, 50% of subjects met our criterion (SOFA greater than 60) for overall functional recovery ('return to the life line'). Operational criteria can be applied to ratings from commonly used standardized scales to determine the percentages of clients achieving recovery in multiple symptom and functional dimensions. For clients completing the first year of treatment in an early psychosis program, approximately half achieve recovery in all dimensions.