Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis

Abstract

These results provide qualified support for the critical period hypothesis. The critical period could be extended to include the prodrome as well as early psychosis.

Does the scientific evidence support the recovery model?

“…An 8-year follow-up of 67 individuals with non-affective psychosis in Dublin found 39% to be in social recovery. 7 These recent results are closely in line with the results of the 20th-century meta-analysis. 4 It emerges that one of the most robust findings about schizophrenia is that a substantial proportion of those who present with the illness will recover completely or with good functional capacity.…”

The use of clinical and biological characteristics to predict outcome following First Episode Psychosis

“…It is noteworthy that, for the majority of patients, these disease trajectories emerge only after an initial period of clinical and functional instability (Robinson et al, 2004), lasting 3-4 years on average (Bertelsen et al, 2009;Crumlish et al, 2009;Levine et al, 2011). This time has been referred to as the 'critical period', during which biological, psychological, and social reactions to the illness develop and reach their maximum plasticity (Birchwood et al, 1998).…”

“…Another emerging predictor for long-term illness course and outcome in schizophrenia is the functional status achieved within 12-24 months of FEP onset, which strongly predicted long-term functional recovery in Australian (Alvarez-Jimenez et al, 2012), Danish (Bertelsen et al, 2009), and Irish (Crumlish et al, 2009) cohorts. While the presence of negative symptoms of schizophrenia after 12-24 months worsened the functional prognosis significantly in these studies, this was not the case for residual positive symptoms.…”

Personalizing Antipsychotic Treatment of Schizophrenia: Monitoring Plasma Levels for Improved Treatment Decisions

“…25,26 In first-episode schizophrenia, longer duration of untreated psychosis can significantly impact short-and long-term prognosis. [27][28][29][30][31] In chronic schizophrenia, each relapse contributes additional illness-related disability and complicates ensuing treatment efforts. 32,33 Paraphrasing a slogan from cardiology, where prompt treatment of acute myocardial infarctions is summarized as "time is muscle," the cumulative effects of delays in implementing optimal 38 Additionally, most of the direct costs associated with social services and the criminal justice system are incurred by or on behalf of patients who are not doing well.…”