One-Year Outcome and Its Prediction in First-Episode Schizophrenia – A Naturalistic Study

Abstract

Background: The literature suggests that the early course of schizophrenia is a strong predictor of long-term outcome. We sought to test this notion in a sample of first-episode patients. Sampling and Methods: Forty patients with a first episode of DSM-IV diagnoses of schizophrenia, schizoaffective, or schizophreniform disorder were assessed with well-established instruments such as the Positive and Negative Syndrome Scale and the Strauss-Carpenter Scale. Reassessment was performed 14 months later and included the Global Assessment of Functioning Scale in addition to the aforementioned instruments and a psychiatric interview. Regression analyses for the Global Assessment of Functioning Scale and symptomatology were used to identify outcome predictors. Results: At follow-up, 27 patients (67.5%) were in remission. Women’s outcome was significantly better with respect to intimate relationships and domiciliary independence. Although symptomatology of the whole group remained stable during the follow-up period, a subgroup of patients experienced a significant decrease in symptom levels whereas symptoms increased in another subgroup. The most important predictor of outcome was compliance with atypical antipsychotic medication during the follow-up period. Conclusions: These results suggest that there is a prognostic divide early in the course of the disease, that compliance with medication is of overriding importance towards 1-year outcome, and that for the individual patient the question of chronicity may be answered very early in the course of the disease.

Which Aspects of Long-Term Outcome Are Predicted by Positive and Negative Symptoms in Early-Onset Psychosis? An Exploratory Eight-Year Follow-Up Study

“…These results go along with previous research in adults suggesting that the adherence to medications is one of the main factors associated with short-term outcome [40,41]. Recent observations suggest that outcome in early-onset psychosis in specific therapeutic settings may be better that in adult-onset psychoses [7]; the role of proper therapeutic intervention in this group of patients seems to be crucial.…”

MRI Predicts Remission at 1 Year in First-Episode Schizophrenia in Females with Larger Striato-Thalamic Volumes

“…Males also improved less, so after 1 year there were more males in the unremitted group (7/12, 56%) and more females in the remitted group (16/27, 60%). All this shows interaction between gender and remission, consistent with gender as a potent determinant of outcome [1,4,29,30]. Accordingly, we stratified our analysis by gender, using a median split of GAF at 1 year for males and females to minimize data skewness.…”

“…We know that factors generally conducive to a good response include being female [1], a shorter illness period [2], fewer negative symptoms and lower global psychopathology scores [3], accepting treatment [1,4], early response, lack of hospitalisation, preserved functioning, being married and having social support [5]. Historically, the course and outcome of schizophrenia was believed to be Kraepelinian, but this notion has been challenged by current nosological debate and awareness that ‘prognosis is better than traditionally assumed' [6].…”

Fourteen-Year Prospective Follow-Up Study of Positive and Negative Symptoms in Chronic Schizophrenic Patients Dying from Suicide Compared to Other Causes of Death

“…Another reason could be related to the heterogeneity of schizophrenia. A 1-year naturalistic study exploring the outcome of first-episode schizophrenia reported that subgroups of patients experienced a significant decrease in symptom levels, rated by the PANSS, whereas the symptoms increased in another subgroup [19] .…”