Functioning in early and late stages of schizophrenia

Abstract

Introduction: Schizophrenia is frequently associated with a debilitating course and prominent impairment in social and occupational functioning. Although the criteria for classification into stages have not been defined in the literature, illness duration and functioning seem to be good candidates. Objective: To compare functioning of patients with schizophrenia at different stages of the disease (early vs. late) and healthy sexand age-matched controls. Methods: This double-blinded, case-controlled study included 79 individuals: 23 patients with schizophrenia diagnosed up to 5 years earlier; 19 patients with schizophrenia diagnosed at least 20 years earlier; and healthy matched controls. Diagnoses were established using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I Disorder. Functioning was assessed using the Functioning Assessment Short Test (FAST). Results: Patients in the early stage had significantly higher scores than healthy controls in total FAST and in autonomy, occupational functioning, cognitive functioning and interpersonal relationships. Individuals in the late stage had significantly poorer functioning than controls in all domains. The comparison of functioning between the two groups of patients revealed no significant differences, except in occupational functioning, in which late stage patients had a poorer performance. Conclusion: Functioning impairment in schizophrenia tends to remain stable despite illness duration. Therefore, functioning should be effectively assessed at an early stage, as illness duration alone may not be the most reliable criterion to stage patients with schizophrenia.

The efficacy and safety of cariprazine in the early and late stage of schizophrenia: a post hoc analysis of three randomized, placebo-controlled trials

“…13 According to the results of this empirical research, schizophrenia is composed of four major stages starting with positive symptoms (stage 1, lasting 3 years), continuing with hostility (stage 2, lasting 9 years) and depressive symptoms (stage 3, lasting 13 years), and ending with cognitive symptoms (stage 4, lasting 55 years). 13 Indeed, according to the general literature, the first episode of schizophrenia dominated by mainly psychotic or positive symptoms has been estimated to last about 2 to 5 years after onset, [14][15][16] while someone is considered to have chronic schizophrenia after experiencing different symptoms for more than 15 to 20 years. 16 Cariprazine, a novel antipsychotic medication with potent dopamine D 3 -D 2 and serotonin 5HT 1A receptor partial agonism and preferential binding to the D 3 receptors, has been approved by the European Medicines Agency (EMA) for the treatment of adult schizophrenia patients (1.5-6.0 mg/day) and by the Food and Drug Administration (FDA) in the United States for the treatment of bipolar I disorder (3.0-6.0 mg/day) and schizophrenia in adults (1.5-6.0 mg/day).…”

“…13 Indeed, according to the general literature, the first episode of schizophrenia dominated by mainly psychotic or positive symptoms has been estimated to last about 2 to 5 years after onset, [14][15][16] while someone is considered to have chronic schizophrenia after experiencing different symptoms for more than 15 to 20 years. 16 Cariprazine, a novel antipsychotic medication with potent dopamine D 3 -D 2 and serotonin 5HT 1A receptor partial agonism and preferential binding to the D 3 receptors, has been approved by the European Medicines Agency (EMA) for the treatment of adult schizophrenia patients (1.5-6.0 mg/day) and by the Food and Drug Administration (FDA) in the United States for the treatment of bipolar I disorder (3.0-6.0 mg/day) and schizophrenia in adults (1.5-6.0 mg/day). The efficacy and safety of cariprazine in acute exacerbation of schizophrenia was assessed and demonstrated in three phase II/III clinical trials with a randomized, multicentered, double-blind and placebo-controlled design.…”

Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up

“…The GAF-F is a 100-point scale reflecting functioning which scores from 1, representing the most severe impairment, to 100, representing the least impaired individual. The FAST is a scale which was primarily developed to assess psychosocial functioning in bipolar disorder [49], but that was later validated for schizophrenia [51, 52]. This 24-items scale evaluates impairment during the last two weeks in six specific areas of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships and leisure time.…”

Clinical Staging in Schizophrenia Spectrum Disorders

“…Currently, there is no strong scientific evidence on the cut-off point for the end of the first episode, nonetheless, it is estimated to be within the first 2-5 years following the onset of the psychotic symptoms [43][44][45]. Indeed, Fountoulakis and colleagues found that the first stage of SSD lasts 3 years on average [25].…”

“…The chronic psychosis stage of SSD begins about 15-20 years after the first episode [25,45]. Patients in this late stage are usually disabled at a certain degree and are likely to be unemployed or retired [45].…”