Predictors Of Outcome In Schizophrenia Research Articles

What is the best approach for patients with prolonged duration of untreated psychosis (DUP) - about 2 clinical cases with dup longer than 10 years

IntroductionStudies have consistently found that many individuals with psychosis experience significant delays before receiving treatment. DUP refers to the period between the emergence of psychotic symptoms and the initiation of appropriate clinical treatment.ObjectivesTo review current knowledge on the best approach for patients with schizophrenia (SCZ) and prolonged DUP.MethodsNon-systematic review of literature through search on PubMed database, following the terms “DUP and treatment” and “impact of longer DUP”. Two clinical cases are described.ResultsThe clinical cases describe patients with SCZ with DUPs older than 10 years, in whom we could not achieve complete clinical remission after several therapeutic trials and whose prognosis was admitted as reserved. Longer DUP is an independent predictor of poorer outcome in SCZ, including the poor response to treatment and difficulty in achieving remission, predicting treatment resistance. Identifying treatment-resistant patients is crucial due to the importance of initiating clozapine as early as possible since the chances of responding are higher.ConclusionsDUP is a key prognostic variable in psychosis, revealing the significance of early treatment. Patients with long DUP should be regarded as at high risk of poor recovery. The detection of these patients enables clinicians to avoid unnecessary exposure to ineffective treatments while effective interventions are delayed. However, in view of adverse side effects of clozapine, future studies need to examine relevant predictors to detect accurately non-responders. We also suggest further studies to understand if there is correspondence between DUP and different stages of the disease that justify these results.

Neurocognition as a predictor of outcome in schizophrenia in the Northern Finland Birth Cohort 1966

The purpose of this study was to study neurocognitive performance as a predictor of outcomes in midlife schizophrenia. There is a lack of studies with unselected samples and a long follow-up. The study is based on the prospective, unselected population-based Northern Finland Birth Cohort 1966. The study includes 43 individuals with schizophrenia and 73 controls, whose neurocognitive performance was assessed twice, at 34 and 43years. At both time points we used identical neurocognitive tests to assess verbal and visual memory and executive functions. Our main aim was to analyse neurocognitive performance at 34years as a predictor of clinical, vocational and global outcomes at 43years. Additionally, the analysis addressed cross-sectional associations between cognitive performance and clinical, vocational and global measures at 43years. The assessment of outcomes was performed in the schizophrenia group only. In the longitudinal analysis poorer visual memory predicted poorer vocational outcome and poorer long-term verbal memory predicted poorer global outcome. In the cross-sectional analysis poorer visual memory and lower composite score of neurocognition were associated with poorer global outcome. No individual neurocognitive test or the composite score of these predicted remission. These data indicate that neurocognition, especially memory function, is an important determinant of long-term functional outcome in midlife schizophrenia.

1642 – The association between duration of untreated psychosis (DUP) and long-term outcome in schizophrenia. A systematic review andmeta-analysis

Introduction Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcome in schizophrenia. The long DUP and its relation to poor short-term outcome of schizophrenia has been studied in meta-analyses, but the conclusions remain unclear regarding the long-term effects of DUP. Aim To study the association between DUP and long-term outcome in a meta-analysis. Methods A systematic literature search of studies on DUP and long-term outcome in schizophrenia was performed using seven electronic databases. Studies were included if the follow-up was at least two years, the majority of subjects had a diagnosis of schizophrenia and DUP was studied with at least one of the following outcome categories: positive, negative, general and total symptoms, need of treatment, social functioning, employment, global outcome, quality of life and remission. Random effect methods were used to pool the effects of original studies. Results 2636 unique publications were identified of which 37 met our pre-defined selection criteria. Long DUP correlated with more severe positive (number of studies n=16; r=0.17), negative (n=17; r=0.14), general (n=4; r=0.29) and total symptoms (n=7; r=0.14) and with poor social functioning (n=13; r=0.13), poor global outcome (n=15; r=0.22) and less likely remission (n=16; r=0.14). The association between long DUP and decreased need of treatment was close to statistical significance (n=12; r=0.12). Employment (n=5) and quality of life (n=5) were not associated with DUP. Conclusion Severe symptoms and decreased functionality does not seem to increase the need of treatment or decrease the quality of life or employment.

Global assessment of psychosocial functioning and predictors of outcome in schizophrenia

Objective. This study identified predictors of psychosocial outcome in schizophrenia. Method. A mixed group of patients diagnosed with schizophrenia were assessed as part of a routine clinical evaluation. A linear regression analysis was conducted in order to examine the effect of duration of untreated illness, number of previous hospitalisations, history of psychotic episodes and age at illness onset on patients’ functioning, as assessed with the Global Assessment of Functioning (GAF) scale. Results. Number of previous psychotic episodes as well as duration of untreated illness were the strongest predictors of patients’ levels of functioning amongst all main outcome measures. Older age at illness onset also predicted poorer functioning. Limitations. A principal limitation of our study is that our sample included predominantly Caucasian males; therefore, any extrapolation to other groups may remain speculative. Conclusions. Our preliminary results suggest that psychosocial outcome in schizophrenia may be affected by different factors. Longer history of psychotic episodes emerged as the most significant determinant of poorer outcome while longer duration of untreated illness and older age at illness onset were also associated with detrimental effects. Our findings may reflect the combined influences of neurodevelopmental abnormalities, exposure to psychotropic medication and psychosocial interventions as well as the vicissitudes of natural aging processes embedded in a chronic mental illness.

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.

P.2.034 Predictors of treatment outcome in schizophrenia — 1-year follow-up study of first-admitted patients

P.2.034 Predictors of treatment outcome in schizophrenia — 1-year follow-up study of first-admitted patients

Initial magnetic resonance imaging volumetric brain measurements and outcome in schizophrenia: a prospective longitudinal study with 5-year follow-up

Background Several demographic and phenomenological variables have been identified as predictors of outcome in schizophrenia. Far fewer studies have examined the relationships between brain morphology assessed at illness onset and subsequent outcome, and their results have been contradictory. Methods The relationships between magnetic resonance imaging (MRI) regional brain volumes at illness onset and outcome five years later were studied in 123 schizophrenia patients using regression and correlation analysis. Outcome measures included psychosocial functioning, weeks per year receiving inpatient treatment, and persistence of severe psychotic, disorganized and negative symptoms. Results Temporal lobe tissue volume at onset was predictive of outcome. Smaller temporal lobe gray matter volume (both left and right) was associated with persistence of hallucinations during follow-up. There were no significant associations between hallucinations and temporal white matter, or between delusions and temporal white or gray matter volumes. None of the other volumetric brain measures were predictive of outcome. Conclusions The association between initial temporal lobe gray matter volume and subsequent persistent hallucinations may help identify individuals who are at higher risk for poor outcome and help guide their treatment planning. However, regional brain volumes assessed near illness onset, in general, do not appear to be indicative of subsequent outcome in schizophrenia.

Predictors of Outcome in Schizophrenia

Several factors have been reported to be associated with poor outcome in psychosis. A prospective study was conducted to identify and subsequently assess the relative prognostic value of factors that might assist in the earlier identification of patients likely to have a poor outcome. The results confirmed that certain factors, including male gender, family history of schizophrenia, structural brain abnormalities, absence of adverse life events, and tardive dyskinesia, were indeed associated with poor outcome.

Brain morphology as a predictor of outcome in schizophrenia

Morphologic changes of cortico-limbic regions have been reported in bipolar disorder, but it remains unclear whether midline brain abnormalities relevant to cortico-limbic connectivity are also present.We used magnetic resonance imaging to investigate the size of the adhesio interthalamica (AI) and cavum septi pellucidi (CSP), as well as third ventricular volume, in 26 patients with bipolar I disorder and 24 matched controls.CSP length and prevalence of a large CSP did not differ between the groups, but bipolar patients had significantly shorter AI and larger third ventricles compared to controls.A comprehensive investigation of medication effects was not possible due to incomplete medication data.These findings implicate a role for the AI and connected brain regions in the neurobiology of bipolar disorder.

Premorbid adjustment as predictor of outcome in schizophrenia: results of a prospective study.

The present prospective follow-up study of 163 schizophrenic patients admitted to hospital for the first time examined the relationship between premorbid adjustment and different measures of the 3-year course and outcome. The same instruments had been used in all phases of the study. The Premorbid Adjustment Scale was used to assess premorbid social functioning. Outcome measures were positive symptoms, negative symptoms, social disability and number of rehospitalizations. The results of the multiple regression analyses showed that premorbid adjustment was the strongest overall predictor of outcome. Premorbid adjustment was significantly associated with negative symptoms and social disability over the 3-year course of illness. In a further step, we examined the relationship between good, moderate and poor premorbid adjustment and the course of positive symptoms, negative symptoms and social disability within the first 3 years after index admission. The most important finding was that premorbid functioning showed a stronger correlation with the course of negative symptoms and social disability than with the course of positive symptoms. Poor premorbid social functioning implies a poor social course of the illness. Female subjects showed better premorbid functioning than male subjects. Good premorbid adjustment was strongly associated with an acute onset of the illness, and poor premorbid adjustment with an insidious onset.

Biological predictors of one-year outcome in schizophrenia

Biological predictors of one-year outcome in schizophrenia

Prediction of Outcome Following a First Episode of Schizophrenia

Although previous studies have attempted to identify predictors of outcome in schizophrenia, few have prospectively studied first episode patients for an adequate follow-up period. The psychopathological predictors of outcome were investigated in a subgroup of 51 subjects, originally included in the Northwick Park study of first episode schizophrenia who were followed up 7.3 years (s.d. 1.1, range 5.3-10.3) after first admission in the Harrow study. Forty-four subjects (24 men, 20 women) were traced. Outcome measures were time to first readmission, occupational level and total duration of hospital admission at five years after first admission. A survival analysis of time to first relapse revealed that the presence of subjective feelings of depression (CATEGO syndrome SD) during the first admission was associated with early relapse while the presence of depressive delusions (CATEGO syndrome DD) and higher educational attainment protected against early relapse. Total duration of hospitalisation at five years after first onset was positively associated with the presence of CATEGO syndromes SD and OD (biological features of depression) and negatively associated with female sex. Poor occupational outcome was not significantly associated with any psychopathological predictors. Our findings challenge the conventional view that symptoms of depression are associated with better outcome in schizophrenia.

Predictors of outcome in schizophrenia

Predictors of outcome in schizophrenia

Predictors of outcome in schizophrenia: the process-reactive dimension.

Premorbid social-sexual competence and the process-reactive dimension, as assessed by the Phillips Scale, were investigated as predictors of posthospital adjustment in a prospective study of two samples of 141 young, early phase schizophrenics (a private hospital sample and a state hospital sample). The Phillips Scale predicted subsequent outcome at significant levels for one of the two samples of DSM-II schizophrenics (a "broad" construct of schizophrenia). It did not predict outcome as well for DSM-III schizophrenics (a "narrow" construct of schizophrenia). Mixed results emerged from separate analyses of first-admission schizophrenics only and for male schizophrenics only. The data indicated that marital status accounts for some of the positive relationship between the Phillips Scale and later outcome. A more focused measure of prehospital social adjustment successfully predicted social functioning at followup for both DSM-II and DSM-III schizophrenics (p less than .05). There were some significant and near-significant relationships, but overall results suggest that when the influence of chronicity and marital status is reduced, the relationship between the Phillips Scale and subsequent outcome is less robust than was once thought.

Schizophrenia and social networks: ex-patients in the inner city.

A high level of social contacts has been recognized as one of the main predictors of outcome in schizophrenia. However, a variety of issues concerning the sociability of schizophrenics still need to be clarified. Focusing on ex-mental patients residing in a large Manhattan hotel, an analysis is made of the relationship between several social network variables, psychopathology, and rehospitalization. The findings indicate that: (1) Schizophrenics have significantly fewer linkages than nonpsychotics, but even the most impaired schizophrenics are not totally isolated. (2) Within the schizophrenic spectrum there are differences with respect to network size, complexity, directionality, and interconnectedness. (3) Rehospitalization is dependent upon two factors, degree of psychopathology and hotel network size.

Prospective prediction of hospital stay in schizophrenia.

THE PREDICTORS of outcome in schizophrenia have been divided by investigators into two general and surprisingly separate groupings-presenting signs of the illness and level of psychosocial adjustment reached prior to the episode. The literature of the first grouping was reviewed by Chase and Silverman¹and significantly added to by Langfeldt²and Holmboe and Astrup.³Phillips⁴developed a scale, part I of which measured the level of premorbid social adjustment, which has been useful in predicting outcome. Parts II and III of his scale measure precipitating events and presenting signs of the disorder respectively. Despite his attempt to combine the premorbid and presenting picture into one instrument, only that part of the scale which deals with premorbid adjustment has gained general acceptance. The thought disorder was believed by Bleuler to be the primary psychological symptom of schizophrenia which accounted for the remaining fundamental and the accessory symptoms.