Abstract
To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis. AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up. At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60-7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02-7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23-6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25-8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61-41.42). Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
Highlights
Our ability to predict outcome following a first psychotic episode remains limited
Longterm cohort studies of first-episode psychosis (FEP) to date have evaluated prevalence samples with schizophrenia only, which tend to have an over-representation of patients with poorer outcomes and an under-representation of those who do not remain in treatment
There were no systematic differences by age, gender, ethnicity, duration of untreated psychosis (DUP), baseline employment, baseline diagnosis, mode of initial contact with mental health services, or study centre between those with follow up information and those without (Morgan et al, 2014)
Summary
Decades of research have shown that factors such as earlier age of onset, male gender, longer duration of untreated illness, and insidious onset are each grossly associated with worse outcome in schizophrenia (Johnstone et al, 1989; Jablensky et al, 1992; Leung and Chue, 2000; Marshall et al, 2005; Rabinowitz et al, 2006) None of these factors, has proven sensitive or specific enough to be clinically useful in predicting the outcome for an individual. To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis. The concepts of clinical and functional recovery overlap but should be considered separately
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