First-episode Schizophrenia Spectrum Disorders Research Articles

Antipsychotic Prescribing Patterns in First-episode Schizophrenia: A Five-year Comparison.

ObjectiveEarly treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively.MethodsWe reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5.ResultsThe rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic poly-pharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003).ConclusionThe practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.

Altered Neural Correlate of the Self-Agency Experience in First-Episode Schizophrenia-Spectrum Patients: An fMRI Study

The phenomenology of the clinical symptoms indicates that disturbance of the sense of self be a core marker of schizophrenia. To compare neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia-spectrum disorders (FES, n = 35) and healthy controls (HC, n = 35). A functional magnetic resonance imaging (fMRI) using motor task with temporal distortion of the visual feedback was employed. A task-related functional connectivity was analyzed with the use of independent component analysis (ICA). (1) During self-agency experience, FES showed a deficit in cortical activation in medial frontal gyrus (BA 10) and posterior cingulate gyrus, (BA 31; P < .05, Family-Wise Error [FWE] corrected). (2) Pooled-sample task-related ICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task. During self-agency experience, FES demonstrate deficit in engagement of cortical midline structures along with substantial attenuation of anti-correlated DMN/CEN activity underlying normal self/other-agency discriminative processes.

Short term effectiveness of haloperidol versus risperidone in first-episode schizophrenia

Aim: The supposed superiority of second-generation antipsychotic medication over first-generation antipsychotic medication has been challenged recently by several studies. This naturalistic retrospective study aims to compare outcomes between patients admitted for the first time with first-episode schizophrenia-spectrum disorders who were started on either haloperidol or risperidone. Would choice of antipsychotic affect length of admission and three-month outcome? Methods: Seventy-seven patients from the Early Psychosis Intervention Programme at the Institute of Mental Health were included in this study. Length of stay was obtained from hospital electronic records. Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores at three months were used to assess severity of psychopathology and level of functioning respectively. A secondary analysis was also done to measure time to discontinuation for any reason. Results: There was a significant reduction in PANSS total, positive, negative and general psychopathology scores in both groups at three months, with the patients on risperidone showing a greater reduction in PANSS negative scores compared to the patients on haloperidol. However, there were no statistically significant differences between length of hospitalization and total PANSS score at three months between the two groups. Time to discontinuation was longer in the risperidone group compared to the haloperidol group. Conclusion: The findings of this study suggest that risperidone has a better effect on negative symptoms and is better tolerated, resulting in a longer time to discontinuation. Thus, starting a patient with first-episode schizophrenia-spectrum disorder on risperidone would result in a better short-term outcome as compared to starting the same patient on haloperidol.

Relationship of Cognition to Clinical Response in First-Episode Schizophrenia Spectrum Disorders.

First-episode schizophrenia (FES) spectrum disorders are associated with pronounced cognitive dysfunction across all domains. However, less is known about the course of cognitive functioning, following the first presentation of psychosis, and the relationship of cognition to clinical course during initial treatment. The present longitudinal study examined the magnitude of neurocognitive impairment, using the MATRICS Consensus Cognitive Battery, in patients experiencing their first episode of psychosis at baseline and after 12 weeks of randomized antipsychotic treatment with either aripiprazole or risperidone. At baseline, FES patients evidenced marked impairments in cognitive functioning. Notably, performance on the mazes task of planning and reasoning significantly predicted the likelihood of meeting stringent criteria for positive symptom remission during the first 12 weeks of the trial. Performance on indices of general cognitive function, working memory, and verbal learning improved over time, but these improvements were mediated by improvements in both positive and negative symptoms. We did not detect any differential effects of antipsychotic medication assignment (aripiprazole vs risperidone) on cognitive functioning. Our results suggest that a brief paper-and-pencil measure reflecting planning/reasoning abilities may index responsivity to antipsychotic medication. However, improvements in cognitive functioning over time were related to clinical symptom improvement, reflecting "pseudospecificity."

Premorbid adjustment and clinical correlates of cognitive impairment in first-episode psychosis. The PEPsCog Study

BackgroundThe extent to which socio-demographic, clinical, and premorbid adjustment variables contribute to cognitive deficits in first-episode schizophrenia spectrum disorders remains to be ascertained. AimsTo examine the pattern and magnitude of cognitive impairment in first-episode psychosis patients, the profile of impairment across psychosis subtypes and the associations with premorbid adjustment. Methods226 first-episode psychosis patients and 225 healthy controls were assessed in the PEPsCog study, as part of the PEPs study. ResultsPatients showed slight to moderate cognitive impairment, verbal memory being the domain most impaired compared to controls. Broad affective spectrum patients had better premorbid IQ and outperformed the schizophrenia and other psychosis groups in executive function, and had better global cognitive function than the schizophrenia group. Adolescent premorbid adjustment together with age, gender, parental socio-economic status, and mean daily antipsychotic doses were the factors that best explained patients' cognitive performance. General and adolescent premorbid adjustment, age and parental socio-economic status were the best predictors of cognitive performance in controls. ConclusionsPoorer premorbid adjustment together with socio-demographic factors and higher daily antipsychotic doses were related to a generalized cognitive impairment and to a lower premorbid intellectual reserve, suggesting that neurodevelopmental impairment was present before illness onset.

Anti-correlated Brain Networks and Self-agency Experience in First-episode Schizophrenia-spectrum Patients. an FMRI Study.

AbstractIn this study we sought to explore patterns of neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia spectrum disorders (FES) and healthy controls (HC). ParticipantsThirty-five FES patients and 35 age-, gender- and education-matched healthy controls. Main Outcome MeasuresA task-related functional connectivity analysis with the use of independent component analysis (ICA). ResultsICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task.Time-courses of DMN/CEN activity has been analyzed by means of signal power and spectral coherence. There was statistically significant difference in the variable (anti-correlation index, AI) between FES and HC. AI correlated with self-agency judgment task performance in FES. ConclusionsThis finding suggests that the main site of pathology in schizophrenia-spectrum disorders may originate in higher-order regulatory mechanisms subserving DMN/CEN orchestration. Funding/SupportThe study was supported by the IGA Ministry of Health, Czech Republic, grant NT/14291.

The association between working alliance and clinical and functional outcome in a cohort of 400 patients with first-episode psychosis: a cross-sectional study.

Working alliance between patients with a first-episode psychosis and their case manager is regarded as a key element in specialized early intervention services. The impact of this patient-case manager dyad on functional and clinical outcome is unknown. We aimed to investigate if a strong working alliance was associated with fewer clinical symptoms and better social functioning. In a cross-sectional design, patients with first-episode schizophrenia spectrum disorders (ICD-10, F20-29) were included after 18 months of treatment (N = 400). Baseline data were collected between June 2009 and December 2011. Symptoms were assessed using Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment of Functioning (GAF), Brief Assessment of Cognition in Schizophrenia (BACS), Working Alliance Inventory (WAI), and General Self-Efficacy (GSE). Linear regression analyses were adjusted for age, sex, cognition, and self-efficacy. Results revealed significant associations between working alliance and fewer negative (β = -0.12; 95% CI, -0.19 to -0.04) and disorganized symptoms (β = -0.06; 95% CI, -0.11 to -0.01), and between working alliance and better social functioning (β = 1.45; 95% CI, 0.55 to 2.36). General self-efficacy mediated the effect of working alliance, explaining 14%-18% of the variance in associated outcomes. Global level of cognitive functioning, compliance, and self-efficacy influenced clinical and functional outcome more strongly than working alliance. Better working alliance was weakly associated with fewer negative and disorganized symptoms and better social functioning. A strong working alliance may be a prerequisite for adherence to the specialized early intervention services treatment, providing the basis for positive treatment outcome. ClinicalTrials.gov identifier: NCT00914238.

High levels of anomalous self-experience are associated with longer duration of untreated psychosis.

To investigate the relationship between anomalous self-experiences and duration of untreated psychosis in a sample of patients with first-episode schizophrenia spectrum disorders. Anomalous self-experiences were assessed by means of the Examination of Anomalous Self-Experience manual in 55 patients referred to their first adequate treatment for schizophrenia. Diagnoses, symptom severity, functioning and childhood trauma were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Premorbid Adjustment Scale, Social Functioning Scale and Childhood Trauma Questionnaire. Substance misuse was measured with the Drug Use Disorder Identification Test, and alcohol use was measured with the Alcohol Use Disorder Identification Test. Duration of untreated psychosis was measured in accordance with a standardized procedure. High levels of anomalous self-experiences are significantly associated with longer duration of untreated psychosis, an association which held after correcting for other variables associated with long duration of untreated psychosis. The field of early detection in psychosis is in need of additional clinical perspectives to make further progress. Improved understanding and assessment of anomalous self-experiences may help clinicians to detect these important phenomena and provide earlier help, and thus reduce treatment delay.

Some Psychosis Prescribing Not Concordant With Guidelines

However, some antipsychotic prescribing practices that do not follow guidelines may be clinically appropriate.

Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study

Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study

Why Are Prescribing Patterns for First-Episode Psychoses So Varied?

Prescribing practices differ considerably, even for conditions with established clinical guidelines. These investigators used study data from 34 sites in 21 states to examine prescribing patterns in 404 patients experiencing first-episode schizophrenia or schizophrenia spectrum disorder (mean age, 24; 72% male; 78% with psychiatric-hospitalization histories). No patients had received antipsychotic medications for >6 months at study entry (mean cumulative antipsychotic treatment, 47 days). Allowed diagnoses included schizoaffective disorder, psychosis not …

Prescription practices in the treatment of first-episode schizophrenia spectrum disorders: data from the national RAISE-ETP study.

Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for first-episode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients. Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project's Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with first-episode schizophrenia spectrum disorders. Treatment with antipsychotics did not exceed 6 months at study entry. The authors identified 159 patients (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these, 8.8% received prescriptions for recommended antipsychotics at higher than recommended dosages; 32.1% received prescriptions for olanzapine (often at high dosages), 23.3% for more than one antipsychotic, 36.5% for an antipsychotic and also an antidepressant without a clear indication, 10.1% for psychotropic medications without an antipsychotic, and 1.2% for stimulants. Multivariate analysis showed evidence for sex, age, and insurance status effects on prescription practices. Racial and ethnic effects consistent with effects reported in previous studies of multiepisode patients were found in univariate analyses. Despite some regional variations in prescription practices, no region consistently had different practices from the others. Diagnosis had limited and inconsistent effects. Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve prescription practices for first-episode schizophrenia patients.

Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study.

The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear. To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity. Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment. Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision. Body composition and fasting lipid, glucose, and insulin parameters. In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P<.01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P=.04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P≤.01). In multivariable analyses, olanzapine was significantly associated with higher triglycerides, insulin, and insulin resistance, whereas quetiapine fumarate was associated with significantly higher triglycerides to HDL-C ratio (all P≤.02). In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.

Clinical and cognitive predictors of vocational outcome in first-episode schizophrenia: A prospective 3 year follow-up study

Schizophrenia is associated with pronounced vocational impairment. Previous research has mostly focused on chronic patients and few studies were conducted to investigate predictors of work outcome in first-episode populations. The impact of cognitive dysfunction on employment outcome in early psychosis was under‐studied. In this study, we prospectively followed up 93 patients aged 18–55 years presented with first-episode schizophrenia-spectrum disorder for 3 years with an aim to identify early clinical and cognitive predictors of vocational outcome. Pre-morbid adjustment, baseline symptomatology and cognitive functions, and employment outcome were assessed. Result indicated that approximately half of the patients (53.8%) were engaged in full-time work at intake and at 3 years. Pre-morbid adjustment, baseline occupational status and Wisconsin Card Sorting Test (WCST) performance were found to predict vocational outcome. Analysis on a subgroup of patients who were unemployed at intake showed that subjects who remained unemployed over 3 years had poorer WCST performance and more severe positive symptoms at baseline than those having job attainment during follow-up. Our results thus confirmed predictive value of pre-morbid functioning and baseline occupational status on vocational outcome. In addition, our findings suggested that executive function might be a critical cognitive determinant of employment outcome in the early course of schizophrenia.

Executive function as predictors of persistent thought disorder in first-episode schizophrenia: A one-year follow-up study

Language disorganization is an important clinical indicator of acute psychosis, yet the longitudinal course and pathogenesis are not well understood. Executive dysfunction has been suggested as a vital contributor to formal thought disorder (FTD) and may serve as a stable predictor of symptomatic risk. The paper reports a one-year prospective study of language disorganization in sixty patients with first-episode schizophrenia-spectrum disorders and investigates executive function as a predictor of persistent FTD one year after illness onset. FTD was captured using the Clinical Language Disorder Rating Scale (CLANG), which segregates language abnormalities into three empirically validated levels: syntactic, semantic, and production.After one year, patients' syntactic and semantic deficits were substantially reduced, but production impairments persisted. Patients' improvement of semantic impairment was associated with reduced disorganized symptoms while production impairment was associated with negative symptoms. We further identified two different patterns of baseline executive function predictors for both residual semantic and production impairment. We found that sustained FTD at the semantic level was predicted by both sustained attention and planning at illness onset, while residual production failure was only predicted by sustained attention.In conclusion, the present paper documents the distinct characteristics of psycholinguistic levels in FTD and isolates two different patterns of executive function predictors for persistent semantic and production language disorganization at follow-up. The findings help to disentangle FTD dimensions at different levels of language production processes, which provide clinical implications for targeting patients at risk for prolonged FTD concordant upon executive dysfunction at illness onset.

What determines continuing grey matter changes in first-episode schizophrenia and affective psychosis?

Magnetic resonance imaging (MRI) studies have shown that brain abnormalities in psychosis might be progressive during the first years of illness. We sought to determine whether first-episode psychosis (FEP) subjects show progressive regional grey matter (GM) changes compared with controls, and whether those changes are associated with diagnosis, illness course or antipsychotic (AP) use. Thirty-two subjects with first-episode schizophrenia-spectrum disorders (FESZ), 24 patients with first-episode affective psychoses (FEAP) and 34 controls recruited using a population-based design underwent structural MRI scanning at baseline and at a 5-year follow-up. Regional GM volumes were assessed with voxel-based morphometry (VBM). Patients were treated at community settings, and about half of them remained mainly untreated. No significant progressive changes in GM regional volumes were observed in either the FESZ or FEAP group overall. However, FESZ subjects with a non-remitting course showed GM decrements in the left superior temporal gyrus (STG) and insula relative to remitted FESZ subjects. Non-remitted FEAP subjects exhibited a GM decrease in the dorsolateral prefrontal cortex (DLPFC) bilaterally in comparison to remitted FEAP subjects. Among FESZ subjects, AP use was associated with regional GM decrements in the right insula and increments in the cerebellum. Our results suggest that the progression of brain abnormalities in FEP subjects is restricted to those with a poor outcome and differs between diagnosis subgroups. AP intake is associated with a different pattern of GM reductions over time.

Clinical Spanish norms of the Stroop test for traumatic brain injury and schizophrenia.

The Stroop Color-Word Test is a useful tool to evaluate executive attention and speed of processing. Recent studies have provided norms for different populations of healthy individuals to avoid misinterpretation of scores due to demographic and cultural differences. In addition, clinical norms may improve the assessment of cognitive dysfunction severity and its clinical course. Spanish normative data are provided for 158 closed traumatic brain injury (TBI) and 149 first-episode schizophrenia spectrum disorder (SCH) patients. A group of 285 Spanish healthy individuals (HC) was also considered for comparison purposes. Differences between groups were found in all Stroop scores with HC outperforming both clinical groups (p .3 in all cases). TBI patients scored lower than SCH patients in word-reading (p < .001 and d = .6), and color-naming conditions (p < .001 and d = .4), but not in the color-word condition (p = .34 and d = .03). However, SCH patients exhibited a higher interference effect as compared to TBI (p < .002 and d = .5). Three sets of norms stratified by age and education (HC), and by education (TBI and SCH) are presented for clinical use.

Relationship between diminished expression and cognitive impairment in first-episode schizophrenia: A prospective three-year follow-up study

BackgroundDiminished expression (DE) is a core sub-domain of negative symptoms construct in schizophrenia. There is limited, yet inconsistent data regarding DE and its associations with cognition, particularly in the early illness course. This study aimed to examine cross-sectional and longitudinal relationships of DE with cognitive functions in first-episode schizophrenia utilizing a prospective design. MethodNinety-three Hong Kong Chinese aged 18 to 55years presenting with first-episode schizophrenia-spectrum disorder were studied. Severity of DE was measured as sum of individual item scores indicative of affect flattening and alogia. Symptom evaluation was conducted at intake, after clinical stabilization of first psychotic episode, at 12, 24 and 36months. Cognitive functions were evaluated at clinical stabilization, 12, 24 and 36months. ResultsDE was significantly correlated with various cognitive functions in successive follow-up assessments. Regression analyses adjusting confounding effects of sex, pre-morbid adjustment, duration of untreated psychosis and chlorpromazine equivalents showed that DE was associated with performance on verbal fluency at 12 (p<0.01) and 24months (p<0.05), visual reproduction at 24 (p<0.05) and 36months (p<0.01), logical memory at 36months (p<0.05) and Modified Wisconsin Card Sorting test at 24 (p<0.05) and 36months (p<0.05). Neither cross-lagged associations between DE and cognition nor significant correlations between changes in these two domains over three years were observed. ConclusionsDE and cognitive functions were correlated concurrently but no longitudinal associations between these two domains could be demonstrated. Our findings indicated that DE and cognitive impairment represented relatively independent domains of the illness with potentially distinctive therapeutic implications.

Correlates of insight with symptomatology and executive function in patients with first-episode schizophrenia-spectrum disorder: A longitudinal perspective

The present study aimed to examine the relationships of insight with symptomatology and executive function, both cross-sectionally and longitudinally in patients with first-episode schizophrenia-spectrum disorders. Ninety-two medication-naïve patients were recruited and 71 completed the assessments. Insight, symptoms and executive function were assessed at baseline, 6 months and 1 year. Insight was measured with the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Executive function was measured with the Modified Wisconsin Card Sorting Test (MCST). The most significant improvement of insight and symptomatology was found over the first 6 months, whereas the perseverative errors of MCST were significantly improved between 6 and 12 months. Differential correlations of perseverative errors of the MCST and PANSS scores with SUMD were found at different time points. This suggests the involvement of different mechanisms in insight deficit at different stages of the illness. The baseline MCST perseverative errors were correlated significantly with the SUMD total score at 6 months and the change of SUMD scores over the first 6 months. Although the variance explained was small, it suggests better set-shifting capacity facilitates the improvement of insight at an early stage of the illness.

Symptomatic Remission and Cognitive Impairment in First-Episode Schizophrenia

Cognitive impairment is a core feature of schizophrenia, but its relationship with symptomatic remission has been understudied. This study aimed to examine the concurrent and longitudinal relationships between cognitive functioning and symptomatic remission in first-episode schizophrenia. The sample comprised 92 Chinese patients, aged 18 to 55 years, who presented with first-episode DSM-IV schizophrenia spectrum disorder and were recruited from both outpatient and inpatient psychiatric units covering a defined catchment area in Hong Kong. The study commenced in September 1997 and ended in March 2005. Psychopathological evaluation was conducted using the Positive and Negative Syndrome Scale (PANSS) and the High Royds Evaluation of Negativity (HEN) scale at intake, after clinical stabilization of the first psychotic episode, and at 12, 24, and 36 months. Cognitive functions were measured at clinical stabilization and at 12, 24, and 36 months. Sustained symptomatic remission was operationally defined as fulfillment of mild severity ratings or less at 24 and 36 months on selected PANSS items for positive symptoms and on the basis of Andreasen's criteria and HEN subscales for negative symptoms. At the end of the 3-year follow-up, 44.6% of patients achieved sustained symptomatic remission. Remitted patients had significantly better concurrent verbal memory (F = 4.6, P < .01) and functional (t = -2.4, P < .05) and vocational (t = 4.8, P < .01) outcomes at 36 months than nonremitted counterparts. Sustained remission attainment was associated with better premorbid adjustment (t = -3.1, P < .01), better baseline occupational status (χ(2) = 4.7, P < .05), better 1-year verbal memory (F = 6.4, P < .01), and fewer 1-year positive (t = -2.9, P < .01) and negative (t = -4.7, P < .01) symptoms. Logistic regression indicated that verbal memory impairment, premorbid functioning, and negative symptom severity independently predicted remission status (Nagelkerke R(2) = 0.425, P < .0001). Our findings provide supportive evidence that verbal memory impairment might be specifically related to attainment of sustained remission in the early stage of schizophrenia.