Abstract
To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP). A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, and trial registries from database inception to November 5, 2020, was performed. Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. Two independent researchers searched, following PRISMA and MOOSE guidelines and using a PROSPERO protocol. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). Heterogeneity was measured employing Q statistics and I2 test. To identify potential predictors, meta-regression analyses were conducted, as well as qualitative reporting of studies included in a systematic review. Sensitivity analyses were performed regarding different times of follow-up and type of studies. One hundred articles (82 cohorts and 18 RCTs) were included in the meta-analysis. The pooled proportion of symptomatic remission was 54% (95%CI [30, 49-58]) over a mean follow-up period of 43.57months (SD=51.82) in 76 studies. After excluding RCT from the sample, the proportion of remission remained similar (55%). The pooled proportion of recovery was 32% (95%CI [27-36]) over a mean follow-up period of 71.85months (SD=73.54) in 40 studies. After excluding RCT from the sample, the recovery proportion remained the same. No significant effect of any sociodemographic or clinical predictor was found. Half of the patients are in symptomatic remission around 4years after the FEP, while about a third show recovery after 5.5years.
Highlights
After the first-episode of psychosis (FEP), the disorder can display a severe cognitive and behavioral decline that worsens symptoms and poor functioning [1,2]
A systematic literature search was performed by two independent researchers (A.C., A.R.) using the following search terms: “predictor*” “response” OR “outcome” OR “prognosis” OR “response” OR “remission” OR “recovery” AND “psychosis” OR “schizophrenia” OR “schizophreniform” OR “first-episode psychosis” OR “early psychosis” AND “cohort” OR “case-control” OR “randomized control trials (RCT)” OR “clinical trial.”
Of 7267 articles identified, 100 (RCTs k = 18, observational studies k = 82) studies were included in the meta-analysis (n = 25375 FEP individuals; Figure 1)
Summary
After the first-episode of psychosis (FEP), the disorder can display a severe cognitive and behavioral decline that worsens symptoms and poor functioning [1,2]. To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP). Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). The pooled proportion of symptomatic remission was 54% (95%CI [30, 49,50,51,52,53,54,55,56,57,58]) over a mean followup period of 43.57 months (SD = 51.82) in 76 studies. The pooled proportion of recovery was 32% (95%CI [27,28,29,30,31,32,33,34,35,36]) over a mean follow-up period of 71.85 months (SD = 73.54) in 40 studies. Half of the patients are in symptomatic remission around 4 years after the FEP, while about a third show recovery after 5.5 years
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