Outcome In First-episode Schizophrenia Research Articles

Duration of untreated illness in anxiety and mood disorders

A prolonged duration of untreated illness (DUI) has been indicated as a negative prognostic factor of clinical outcome in schizophrenia(1),affective(2) and anxiety disorders(3). The present study analyzes DUI in anxiety/mood disorders. Study sample included 729 patients:181 Major Depressive Disorder, 115 Bipolar I Disorder, 186 Bipolar II Disorder, 100 Generalized Anxiety Disorder, 96 Panic Disorder and 51 Obsessive-Compulsive Disorder. The main demographic and clinical (age at onset, age at first treatment, DUI) variables were compared between groups using oneway ANOVA, t-tests or chi-squared tests. DUI was defined as the interval between the onset of the disorder and the first adequate treatment.Patients with MDD showed a shorter DUI (F= 25.159; p> 0.0001) whereas patient with BDII showed a longer DUI (F= 12.680; p> 0.0001) compared to the other groups. Present findings indicate that patients with affective/anxiety disorders present significant differences in DUI. It is of clinical interest to assess the extent to which delays until beginning an appropriate treatment influence the course of these disorders.1. Altamura AC, Bassetti R, Sassella F, Salvatori D, Mundo E. Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study. Schizophr Res, 2001; 52 (1-2): 29-36.2. Altamura AC, Dell'Osso B, Mundo E, Dell'Osso L. Duration of untreated illness in major depressive disorder: a naturalistic study. Int J Clin Pract 2007 b, 61(10): 1697-700.3. Altamura AC, Santini A, Salvadori D, Mundo E. Duration of untreated illness in panic disorders: a poor outcome risk factor? Neuropsychiatric disease and treatment 2005, 1(4): 345-347.

Association Between Duration of Untreated Psychosis, Premorbid Functioning, and Cognitive Performance and the Outcome of First-Episode Schizophrenia in Japanese Patients: Prospective Study

The aim of the present study was to identify the relationship between duration of untreated psychosis (DUP), premorbid functioning, and cognitive dysfunction and the outcome of first-episode schizophrenia. Thirty-four neuroleptic-naïve patients who consulted hospitals in Tokyo and who were treated by psychiatrists for the first time were evaluated with regard to DUP, premorbid functioning, psychiatric symptoms, and global functioning. The neuropsychological test battery consisted of the Letter Cancellation Test, Trail-Making Test, Digit Span and Verbal Fluency Test. One year later, 24 of the subjects were reassessed for psychiatric symptoms, global functioning, and social functioning, and the relationships between DUP, premorbid functioning, and cognitive performance and the outcome was investigated. Short DUP, good premorbid functioning, and good Letter Cancellation Test, Digit Span and Verbal Fluency Test scores were significantly associated with good outcome. The present results in a Japanese sample are consistent with previous international evidence that delay of initial treatment, premorbid functioning, and cognitive deficits are associated with outcome. A major limitation of the present study was the small size of the subject group. But because the subjects were relatively homogeneous and not influenced by psychoactive substances, the results reflect the essence of the disorder.

Neurological soft signs and their relationship to 1-year outcome in first-episode schizophrenia

Objectives To examine the relationship between the severity of neurological soft signs at onset and at the 1-year follow-up of patients with schizophrenia, and to investigate temporal stability of neurological soft signs within 1 year from the onset of the first episode schizophrenia. Methods The study included 92 first-episode male schizophrenic patients. Neurological soft signs were assessed on the Neurological Evaluation Scale (NES) during index hospitalization and at a 1-year follow-up. The patients were divided into remitters and non-remitters according to their psychiatric status assessed at the 1-year follow-up, using the Positive and Negative Syndrome Scale (PANSS). Results A trend for a lower score for the NES item “others” in late remitters versus non-remitters at baseline was found during index hospitalization. At the 1-year follow-up, the overall severity of the neurological soft signs was statistically significantly higher in non-remitters than in remitters. Within 1 year after index hospitalization, a significant reduction of neurological soft signs, with the exception of sensory integration, occurred in remitters. Within 1 year after index hospitalization, the non-remitters reported a significant reduction of the overall NES score. Conclusion These findings in a population of patients with first episode schizophrenia are in accord with the findings of previous studies which found an association between neurological soft signs, treatment response and outcome. This association may characterize a subgroup of patients with a poor course of illness and outcome. Neurological soft signs might be regarded as one of the indicators of treatment outcome in patients suffering from their first episode of schizophrenia.

11-01 Identifying cognitive, affective and neural synchrony markers which predict real-world functional outcome in first-episode schizophrenia: an integrative neuroscience approach.

11-01 Identifying cognitive, affective and neural synchrony markers which predict real-world functional outcome in first-episode schizophrenia: an integrative neuroscience approach.

Implications for Future Research of "Medication-Free Research in Early Episode Schizophrenia"

As noted by Bola, 1 treatment with antipsychotics early in the course of a schizophrenic illness has implications both for clinical care and research. This commentary will focus on the implications for clinical trials with patients who are early in the course of their schizophrenic illness. But first, I want to comment on the 1967 article that had inadequate detail to allow formal inclusion in the meta-analysis. 2 Although the trial was originally designed as a ‘‘first-episode’’ study, it included a number of patients who were acutely symptomatic but not experiencing their first episode. Further, virtually all of the patients initially randomized to placebo received medication following their participation in the trial, and we observed that the length of index hospitalization for these patients was longer than for those initially randomized to receive medication. Although this group required more time prior to hospital discharge, they were less likely to relapse during the next year. It seems unlikely that this was ‘‘caused’’ by the initial medication-free period since all received antipsychotic drugs prior to discharge. We speculated that patients initially treated with placebo received an extra measure of psychosocial care before discharge that contributed to their lower likelihood of subsequent rehospitalization. In reviewing the Bola article, I am struck by the fact that only 1 study—that by May and colleagues 3 —lasted longer than 6 weeks. And bearing that point in mind, it is interesting that the 1 study that involved treatment for 6 to 12 months had a significant and positive effect size (.14), indicating better outcome for those treated with medication. With the exception of the Wirt and Simon study, 4 all the other effect sizes are negative, indicating better outcome for those treated without medication. The direction of these effects seems to parallel the findings of naturalistic studies that have examined the relationship between duration of untreated psychosis (DUP) and outcome in first-episode schizophrenia. The retrospectively reported durations range from several days to years, but the average duration is almost a year. Two recent meta-analytic studies conclude that a shorter duration of psychosis before treatment with antipsychotic medication is associated with a better long-term outcome and that a longer time before treatment adversely affects the course of illness. 5,6 The findings that Bola reports are consistent with that hypothesis. One implication that has been drawn from the DUP literature is that the sooner medication is initiated, the better—even to the point of intervening before there is firm evidence of a psychotic illness. A second implication is that delay of medication initiation in the context of a clinical trial would be the equivalent of increasing the duration of untreated psychosis. The studies reviewed by Bola suggest that brief increases are not harmful. Further, treatment without medication is not the same as not treating psychosis. In all reported clinical trials that involve a delay of antipsychotic medication initiation, the comparison treatment condition included substantial psychosocial interventions, either informal or structured.

Dorsolateral prefrontal cortex morphology and short-term outcome in first-episode schizophrenia

Several clinical predictors of outcome in schizophrenia have been described; however, very few studies have examined neurobiological factors that predict outcome. The objective of this study was to examine the value of the morphology of the dorsolateral prefrontal cortex (DLPFC) determined by magnetic resonance imaging (MRI) as a predictor of short-term functional outcome in antipsychotic-naive patients with first-episode schizophrenia or schizoaffective disorder. Twenty-seven consecutive patients with first-episode schizophrenia or schizoaffective disorder underwent structural MRI at baseline. Functional outcome – a composite measure of social and employment subscales of the Strauss–Carpenter Scale – was assessed at 1 and 2 years. Volume of the left DLPFC at baseline predicted functional outcome in schizophrenia at 1 but not at 2 years. Specific cognitive functions regulated by the left DLPFC may be critical for functional outcome.

Relationship Between Duration of Untreated Psychosis and Outcome in First-Episode Schizophrenia: A Critical Review and Meta-Analysis

The duration of untreated psychosis may influence response to treatment, reflecting a potentially malleable progressive pathological process. The authors reviewed the literature on the association of duration of untreated psychosis with symptom severity at first treatment contact and with treatment outcomes and conducted a meta-analysis examining these relationships. English-language articles on duration of untreated psychosis published in peer-reviewed journals through July 2004 were reviewed. Studies that quantitatively assessed the duration of untreated psychosis; identified study subjects who met the criteria for nonaffective psychotic disorders at or close to first treatment; employed cross-sectional analyses of duration of untreated psychosis and of baseline symptoms, neurocognition, brain morphology, or functional measures or prospectively analyzed symptom change, response, or relapse; assessed psychopathology with clinician-rated instruments; and reported subjects' diagnoses (a total of 43 publications from 28 sites) were included in the meta-analysis. Shorter duration of untreated psychosis was associated with greater response to antipsychotic treatment, as measured by severity of global psychopathology, positive symptoms, negative symptoms, and functional outcomes. At the time of treatment initiation, duration of initially untreated psychosis was associated with the severity of negative symptoms but not with the severity of positive symptoms, general psychopathology, or neurocognitive function. Duration of untreated psychosis may be a potentially modifiable prognostic factor. Understanding the mechanism by which duration of untreated psychosis influences prognosis may lead to better understanding of the pathophysiology of schizophrenia and to improved treatment strategies.

One year outcome in first episode schizophrenia

The aim of this study was to identify the predictors of outcome at one year follow-up after the first psychotic episode of schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow-up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.

Two-Year Outcome in First-Episode Schizophrenia: Predictive Value of Symptoms for Quality of Life

Objective: Many studies have validated the grouping of schizophrenic symptoms into three independent dimensions: negative, psychotic, and disorganized. Negative symptoms are considered to be an important prognostic indicator, but this clinical observation requires further empirical study, especially with respect to psychosocial functioning. When present at the onset of the first episode, negative symptoms suggest that the patient will develop significant psychosocial impairment. The predictive values of the psychotic and disorganized symptom dimensions, on the other hand, have been less certain. Method: In this study of 50 first-episode schizophrenic patients, who were mostly neuroleptic-naive at intake, the authors examined the relationship between the severity of these three symptom dimensions (measured by using the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms) at index hospitalization and quality of life at 2-year follow-up. Results: Negative symptom severity was positively and significantly correlated with later occupational impairment, financial dependence on others, impaired relationships with friends, impaired ability to enjoy recreational activities, and global assessment of functioning. The magnitudes of correlation between the levels of psychotic symptoms or disorganized symptoms and 2-year quality of life measures were comparatively lower. Analyses using multivariate regression statistics also revealed similar findings. Conclusions: Severity of negative symptoms at index hospitalization may be a portent of poor outcome. In general, severity of psychotic or disorganized symptoms at intake does not appear to predict subsequent quality of life.

Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort

The natural history of neurocognitive impairments in schizophrenia is unclear. We aimed to characterise this in an epidemiological first-episode cohort and relate it to long-term outcome. All but 1 of 112 first-episode psychosis cases ascertained from a geographical catchment area were traced at 10–12 years. Neurocognitive and multi-dimensional outcome assessments were made at interview in 49 cases with schizophrenia and related disorders. Twenty-four of these had completed the same neurocognitive battery at index admission. Comparisons with normative data showed impaired executive function in a proportion of the first episode (FE) sample at baseline. Significant deterioration was seen over the follow-up period in three of nine sub-tests: object assembly, picture completion and memory for designs. Neurocognitive impairments at outcome, but not baseline, correlated with clinical outcome. Poor outcome was associated with a decline in performance on visuo-spatial tasks and a failure to improve on frontal–temporal tasks during the follow-up period. Executive deficits may be present in the FE, but do not progress over 10–12 years. Visuo-spatial function is spared in the FE but may deteriorate over time. Changes in both these patterned deficits are predictive of clinical outcome.

Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study

The aim of this study was to investigate possible clinical predictors of the outcome of first-episode schizophrenia. The clinical charts of the first episode of psychosis and the follow-up period over at least 4 years for 67 DSM-III-R schizophrenic patients were reviewed. According to the number of psychotic relapses observed during the follow-up period, patients were sub-divided into two groups: mono- and multi-episode patients. The main demographic and clinical variables recorded at the first episode were compared between the two groups. A logistic regression analysis was performed to test a model for the possible predictors of the two different patterns of outcome. Multi-episode patients had an earlier onset of the illness and a longer “duration of untreated psychosis” (DUP), defined as the interval between the onset of the first psychotic symptoms and the first antipsychotic treatment. The Brief Psychiatric Rating Scale (BPRS) total scores were lower and the “avolition/apathy” scores of the scale for the assessment of negative symptoms (SANS) were higher in multi-episode patients. The logistic regression analysis results confirmed the DUP and the pre-treatment BPRS scores to be significant predictors of the outcome. These findings confirm that the timing in recognizing and treating the early symptoms of schizophrenia, even when subtle, is a core issue for the clinical management of the disorder.

Evil or Ill? Justifying the Insanity Defense

Evil or Ill? Justifying the Insanity Defense

Social support predicts 5-year outcome in first-episode schizophrenia.

Investigations of social support in schizophrenia have been relatively sparse. In this research, patients with 1st-episode schizophrenia or affective psychosis were asked to describe supportive social relationships immediately prior to their 1st lifetime treatment contact and were interviewed 18 months and 5 years later for assessment of their social and occupational functioning. The results indicated that 18-month adaptive functioning was lower than in the year prior to 1st treatment contact but at 5 years rose above that seen both at baseline and 18 months. Moreover, social support from nonfamily members of the social network predicted 5-year adaptive functioning in the schizophrenia (n = 54) group but not in the affective psychosis (n = 55) group. Support from family did not predict 5-year outcome in either group. Together, these findings replicate and extend earlier findings that social support predicts outcome in 1st-episode schizophrenia.

Two-year outcome in first-episode schizophrenia: predictive value of symptoms for quality of life.

Many studies have validated the grouping of schizophrenic symptoms into three independent dimensions: negative, psychotic, and disorganized. Negative symptoms are considered to be an important prognostic indicator, but this clinical observation requires further empirical study, especially with respect to psychosocial functioning. When present at the onset of the first episode, negative symptoms suggest that the patient will develop significant psychosocial impairment. The predictive values of the psychotic and disorganized symptom dimensions, on the other hand, have been less certain. In this study of 50 first-episode schizophrenic patients, who were mostly neuroleptic-naive at intake, the authors examined the relationship between the severity of these three symptom dimensions (measured by using the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms) at index hospitalization and quality of life at 2-year follow-up. Negative symptom severity was positively and significantly correlated with later occupational impairment, financial dependence on others, impaired relationships with friends, impaired ability to enjoy recreational activities, and global assessment of functioning. The magnitudes of correlation between the levels of psychotic symptoms or disorganized symptoms and 2-year quality of life measures were comparatively lower. Analyses using multivariate regression statistics also revealed similar findings. Severity of negative symptoms at index hospitalization may be a portent of poor outcome. In general, severity of psychotic or disorganized symptoms at intake does not appear to predict subsequent quality of life.

Predictive symptomatology, course and outcome in first-episode schizophrenia

The mechanism by which the prepsychotic state switches into psychosis is not understood, and little is known about the structure and functioning of the central nervous systems of individuals destined to become schizophrenic. Evidence from the National Child Development Study in Great Britain suggests that children destined to become schizophrenic in adulthood show differences from controls at the age of 7 years (greater anxiety for acceptance, hostility and inconsequential behavior). The Edinburgh High-Risk Study of subjects aged 16-24 years with at least two dose family members suffering from schizophrenia hopes to answer questions about predictive symptomatology and the onset of psychosis. Preliminary results suggest that subjects from the high-risk group have brain structural characteristics lying between those of normal controls and established schizophrenics, and show more abnormalities of executive functioning, reported sensitivity, abnormal effect and observed disorganization of speech than controls. More will be known about the effectiveness of these potential stuctural, neuropsychological and psychopathological predictors when the study is complete and subjects in the high-risk group have had time to become ill.

Social support also predicts five-year outcome in first-episode schizophrenia

Social support also predicts five-year outcome in first-episode schizophrenia

Social adjustment and outcome in first episode schizophrenia

Social adjustment and outcome in first episode schizophrenia

Duration of psychosis and outcome in first-episode schizophrenia.

This study was undertaken to assess the potential effect of duration of untreated illness on outcome in a group of first-episode schizophrenic patients. Seventy patients with schizophrenia diagnosed according to the Research Diagnostic Criteria entered the study and were followed for up to 3 years. All patients received standardized treatment and uniform assessments both during the acute phase of their illness and throughout the follow-up period. Outcome was measured in terms of time to remission of acute psychotic symptoms as well as degree of symptom remission. The mean duration of psychotic symptoms before initial treatment was 52 weeks, preceded by a substantial prepsychotic period. According to survival analysis, duration of illness before treatment was found to be significantly associated with time to remission as well as with level of remission. The effect of duration of illness on outcome remained significant when diagnosis and gender variables, themselves associated with outcome, were controlled in a regression analysis. Duration of illness was not correlated with age at onset, mode of onset, premorbid adjustment, or severity of illness at entry into the study. Duration of psychosis before treatment may be an important predictor of outcome in first-episode schizophrenia. Acute psychotic symptoms could reflect an active morbid process which, if not ameliorated by neuroleptic drug treatment, may result in lasting morbidity. Further implications of these findings are discussed.

Correlates of course and outcome in first-episode schizophrenia

Correlates of course and outcome in first-episode schizophrenia

Incidence, clinical characteristics, and short-term outcome of first-episode schizophrenia

All inpatients in three psychiatric centers in a mid-Norwegian county, referred over a period of 30 months, were diagnosed in accordance with DSM-IIIR criteria and assessed by rating scales for clinical history and sociodemographic data. They were followed up 1 year after first discharge. Of a total of 1081 (43%) first-admitted patients, 49 (2% of total) fulfilled DSM-IIIR criteria of schizophrenia, which is equivalent to an incidence of 0.0079% or about 20 patients every year in the catchment area of 1/4 million inhabitants. Mean onset age was 25.5 years (range, 17-42). The sample was quite heterogeneous with regard to psychosocial, clinical, and demographic data and short-term outcome. One year after first discharge 29 (59%) had been rehospitalized. The strongest predictive variable for rehospitalization was gradual versus acute type of first onset.