PROTECTIVE AND RISK FACTORS FOR PSYCHOSIS RELAPSE IN PATIENTS WITH FIRST EPISODE SCHIZOPHRENIA SPECTRUM PSYCHOSIS: 3 YEARS FOLLOW-UP

Abstract

Background: For a majority of patients, schizophrenia is a chronic recurrent disease that leads to significant residual morbidity which occurs trough a process of behavioral deterioration. The factors influencing the course of schizophrenia after its onset and the ability of treatment in modifying the effects of the patients illness are not well understood. Remission and relapse are clinical outcomes of increasing interest in schizophrenia. Premorbid adjustment, age and mode of onset of illness, gender, duration of untreated psychosis, schizophrenia subtype, primary type of symptoms (negative or positive), treatment compliance, comorbid disorder, may influence illness course and outcome, both favorable and adversely. Our hypotheses were that insidious onset, duration of untreated psychosis DUP, long episode, family history for psychiatric disorders, negative symptoms, young age of onset, substance misuse, poor compliance, poor premorbid adjustment, bad psychosocial functioning during follow-up period would be associated with increased risk of in-patient admission, a longer time to remission of psychotic symptoms, and earlier and increased risk of relapse. The aim of our prospective study was determination the protective and risk factors for relapse in patients with first episode schizophrenia spectrum disorders. Methods: We analyzed remission and relapse, and the sociodemographic and clinical factors associated with these outcomes, in the usual care of 50 in-patients with patients with first episode schizophrenia spectrum disorders, using the 5-year follow-up data of pateints treated at Psychiatric Clinic Nis. All patients received standardized treatment and uniform assessments both during the acute phase of their illness and throughout the follow-up period (at base line, after 3 monts and after each 6 monts during follow-up). Outcome was measure in terms of time to remission of acute psychotic symptoms as well as degree of symptom remission. The evaluation process incluted clinical interview, BPRS, PANSS, premorbid adjustment scale-PAS, GAF. Results: Narly 20% of evaluated patients achieved and maintained in remission during the 5-year, follow-up period. Longer DUP, poor compliance, poor premorbid adjustment, negative symptoms, young age of onset, substance misuse, bad psychosocial functioning during follow-up period, lack of family history for psychotic disorders would be associated with a higher risk of relapse, whereas good level of social functioning and the use of clozapine and long-acting injections of antipsychotics were associated with a lower risk of relapse. Discussion: The results of this study are therefore consistent with the large body of research in finding a considerable number of sociodemographic and clinical variables to be associated with better or worse outcome in schizophrenia spectrum psychosis. In our study, a number of factors were found to be associated with the best outcome of single episode with no persistent symptoms, including premorbid adjustment, age and mode of onset of illness, gender, duration of untreated psychosis, schizophrenia subtype, primary type of symptoms (negative or positive), treatment compliance, comorbid disorder. Understanding the risk and protective factors for schizophrenia may lead to better understanding of the pathophysiology of schizophrenia and to improved treatment strategies. It is necessary to develop therapeutic strategies that minimize the morbidity of the illness. More comprehensive early intervention services, providing effective pharmacological and psychological treatments and follow-up from onset, together with social support and vocational programs, might also be expected to reduce relapses.