Proportion and predictors of remission and recovery in first-episode psychosis: Systematic review and meta-analysis

Abstract

Background To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP). Methods A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, and trial registries from database inception to November 5, 2020, was performed. Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. Two independent researchers searched, following PRISMA and MOOSE guidelines and using a PROSPERO protocol. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). Heterogeneity was measured employing Q statistics and I2 test. To identify potential predictors, meta-regression analyses were conducted, as well as qualitative reporting of studies included in a systematic review. Sensitivity analyses were performed regarding different times of follow-up and type of studies. Results One hundred articles (82 cohorts and 18 RCTs) were included in the meta-analysis. The pooled proportion of symptomatic remission was 54% (95%CI [30, 49–58]) over a mean follow-up period of 43.57 months (SD = 51.82) in 76 studies. After excluding RCT from the sample, the proportion of remission remained similar (55%). The pooled proportion of recovery was 32% (95%CI [27–36]) over a mean follow-up period of 71.85 months (SD = 73.54) in 40 studies. After excluding RCT from the sample, the recovery proportion remained the same. No significant effect of any sociodemographic or clinical predictor was found. Conclusions Half of the patients are in symptomatic remission around 4 years after the FEP, while about a third show recovery after 5.5 years.

Early identification of treatment non-response in first-episode psychosis

“…The statistically significant differences in premorbid adjustment, early illness features, and baseline clinical characteristics between the groups are consistent with previously identified predictors of long-term outcome [14, 29, 61] and, more specifically, longer-term CR and TR [10, 14, 16, 18]. This supports the validity of the identified outcome groups as early indicators of long-term outcomes [1, 2, 4, 62]. That a schizophrenia diagnosis per se did not have an individual contribution in the regression model shows that the underlying differences are not secondary but integral to the diagnosis.…”

“…The outcome trajectories of individual patients are difficult to predict. Accumulating evidence, however, indicates that clinical development over the first years of treatment is critical for longer-term outcomes [4][5][6]. Identifying early indicators of treatment response is thus essential to avoid prolonged exposure to ineffective treatments.…”

Psychometric and Clinical Evaluation of Schizophrenia Remission Criteria in Swedish Outpatients with Psychotic Disorders

“…Following their publication, the RSWG-cr have been widely employed to de ne remission in psychotic disorders (14). A recent meta-analysis of longitudinal studies of rst-episode psychosis found a 52% remission frequency over four years when using RSWG-cr, although the heterogeneity between studies was high (15). Symptomatic remission is considered a necessary step towards wider recovery, which also includes psychosocial functioning and well-being (10).…”

Mediating effects of care burden and sense of coherence between patients' disabilities and siblings' emotions in psychotic disorders

“…Data were collected online by screening a nationwide panel of survey participants in November 2021. The inclusion criteria were family members who (1) were aged between 18 and 74 years; (2) had patients diagnosed with schizophrenia or schizoaffective disorder; (3) were patients' siblings; (4) had patients being treated through regular visits, having had their last visit to a medical facility within the past year, or having been admitted to a medical facility within the past year; and (5) had patients aged between 16 and 74 years. We excluded family members who (1) had patients with depression or bipolar disorder, (2) were patients' parents or spouses, and (3) had patients who had their last visit to a medical facility over a year ago or were on an unknown treatment regimen.…”