Remission and recovery during the first outpatient year of the early course of schizophrenia

Abstract

Background Although in the early course of schizophrenia relapse prevention is of paramount importance, there is an increasing emphasis on establishing and maintaining sustained periods of symptom remission. Recovery in the early course of illness is also possible, although the rates of recovery are lower than for symptom remission. Symptom remission and recovery rates vary considerably across recent-onset schizophrenia studies because of lack of consistency in treatment interventions and in applying operational outcome criteria. Method Patients who were within two years of their first psychotic episode (N=77) who were treated with continuous antipsychotic medication in conjunction with psychosocial interventions (without targeted work rehabilitation) were assessed during the first outpatient year after hospital discharge. Published operational criteria were used to classify symptom remission and recovery. Results The rate of full symptom remission maintained for 6 months was 36%, while the rate of recovery for 6 months was 10%. When the same criteria were applied for a continuous period of one year, 22% of patients were found to achieve symptom remission but only 1% of patients met recovery criteria. Using multivariate prediction, the WAIS Comprehension score was a significant predictor of 6 months of good functional outcome. Conclusions Although some schizophrenia patients can achieve both symptom remission and recovery in the early course of illness, the overall rate of symptom remission during the first post-hospitalization year is much higher than the rate of recovery. This suggests that interventions targeting work and social functioning are likely necessary to raise the chances of recovery. Cognitive factors can be predictive of good functional outcome even in the early course of schizophrenia.

Psychotic symptoms, cognition and affect as predictors of psychosocial problems and functional change in first-episode psychosis

“…This is especially true for positive symptoms. In concordance with the literature, the present analyses show that negative symptoms are more consistently related to both current (Chang et al, 2011;Bourdeau et al, 2012;Evensen et al, 2012a,b) and future levels (Albert et al, 2011;Álvarez-Jiménez et al, 2012;Vesterager et al, 2012;González-Ortega et al, 2013) of psychosocial functioning than positive symptoms (Albert et al, 2011;Faber et al, 2011;Ventura et al, 2011;Chang et al, 2012). Also, severity levels of both positive and negative symptoms do not appear to be strong predictors of psychosocial functioning after 12 months (Albert et al, 2011;Faber et al, 2011;Chang et al, 2012).…”

Executive Impairment Predicts Schizophrenia Diagnosis and Treatment Status in Mid-Term Follow-Up of Early-Onset Psychosis

“…A similar association was observed in adult studies, where cognitive impairment was not only associated with worse outcome in psychotic [16] and prodromal subjects [27], but also with a higher probability of developing psychosis in high-risk subjects [28]. Thus, the lack of a significant association between parameters of functional outcome analyzed in the current study and baseline executive functioning contrasted with most previous findings in adults [16,] [29,30] and the unique long-term study on EOS [17]. …”

Twenty year multi-follow-up of different types of hallucinations in schizophrenia, schizoaffective disorder, bipolar disorder, and depression

“…This included auditory hallucinations, such as audible thoughts, voices commenting, voices conversing, voices arguing; visual hallucinations; and olfactory hallucinations. Hallucinations were rated on a 3-point scale as follows: 1 = Hallucination Absent; 2 = Weak or Equivocal Hallucination; 3 = Full Hallucination Present (Marengo et al, 2000;Ventura et al, 2011).…”