Very long-term outcome of psychotic disorders

Abstract

Background: The outcome of schizophrenia and related psychoses is generally modest, and patients display high rates of disability. Aims: The aim of the review is to present an up-to-date account of the research on the very long-term outcome of psychotic disorders. Method: We conducted a search in the PubMed and Scopus databases for articles published since the publication of the very long-term data of the World Health Organization’s International Study of Schizophrenia (the ISoS study), over the last 18 years (from 2002 to 2019). Studies were included if they reported on at least 15-year outcome and if they had used valid and reliable tools for the estimation of the patients’ outcome in terms of symptomatology and functioning. Results: A total of 16 studies were included in this review, involving 1,391 patients with schizophrenia and related psychoses. Most were single-center studies, with moderate size samples of patients, and 11 were prospective studies. Very long-term outcome of psychotic disorders varies considerably among studies. Good outcome ranges from 8% to 73.8%, and it appears to be better in developing countries, whereas differences are less apparent among Western countries (8%–40.3%). Studies in different settings have used different methods involving a variety of samples of patients to estimate their outcome, whereas definitions of good and poor outcome also varied among studies. Longer duration of untreated psychosis was associated with worse outcome in some studies. Schizophrenia was found to have poorer long-term prognosis compared to other schizophrenia spectrum disorders. A large proportion of patients, ranging from 19% to 48.2%, were not on medication. Conclusion: Recent evidence on the very long-term outcome of psychotic disorders is in line with previous reports and suggests that prognosis remains rather modest. There are several limitations of current research regarding outcome definitions and study design that should be addressed by future research.

Clinical Recovery and Long-Term Association of Specialized Early Intervention Services vs Treatment as Usual Among Individuals With First-Episode Schizophrenia Spectrum Disorder

“…The following registers hold complete and updated data in real time on all participants (not deceased or emigrated) on a range of relevant outcomes: (1) addresses and vital status was drawn from the Danish Civil Registration System, 34 (2) information about psychiatric service use (days of psychiatric hospitalizations, number of psychiatric outpatient contacts) was extracted from the Danish Psychiatric Central Register, 35 (3) use of supported housing and homeless shelters at the previous year up to 20-year follow-up was obtained by linking information from the official Danish national website Tilbudsportalen with addresses of all supported housing facilities and homeless shelters in Denmark with individual-level address information in the Danish Civil Registration System register 34 as described in a previous publication, 36 (4) mortality and cause of death was drawn from the Cause of Death Registry, 37 and (5) vocational status was available from the DREAM database. 38 Registry data were collected for all individuals regardless of participation in the assessments and is thus free from attrition.…”

“…2 The lifetime risk for receiving a diagnosis of schizophrenia has been estimated to be 1.8%. 3 A recent review including 16 studies with at least 15 years of follow-up found individuals with schizophrenia to have a poorer long-term prognosis than individuals diagnosed with other schizophrenia spectrum disorders 4 with inconsistencies of good outcomes ranging from 8% to 74%. 4 Also, metaanalyses on recovery after a schizophrenia diagnosis have been inconsistent with rates ranging from 14% to 57%.…”

“…3 A recent review including 16 studies with at least 15 years of follow-up found individuals with schizophrenia to have a poorer long-term prognosis than individuals diagnosed with other schizophrenia spectrum disorders 4 with inconsistencies of good outcomes ranging from 8% to 74%. 4 Also, metaanalyses on recovery after a schizophrenia diagnosis have been inconsistent with rates ranging from 14% to 57%. [5][6][7][8] Several individual cohort studies among individuals with first-episode psychosis have in general found bleaker and less favorable outcomes among individuals with schizophrenia compared with affective disorders and other related psychoses after 10 years 9,10 and 20 years.…”

Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management

“…Among psychiatric disorders schizophrenia and related syndromes are still the most devastating, according to the recent Global Burden of Disease Study [ 4 ]. Schizophrenia is a severe and chronic mental illness, with generally modest prognosis and often poor long-term outcome [ 5 , 6 ]. The syndrome comprises a wide range of symptoms, such as positive and negative symptoms and cognitive impairment, that adversely affect social and occupational functioning of patients [ 7 ].…”

Research on psychotic disorders in rural areas: Recent advances and ongoing challenges

“…Schizophrenia and related syndromes (the so-called psychotic disorders) are severe and chronic mental disorders that are characterized by a wide range of disabling symptoms. The prognosis of these disorders is generally modest, outcomes are often poor, and patients may display high rates of disability (Jääskeläinen et al, 2013; Peritogiannis, Gogou, et al, 2020). Research on these severe disorders is growing over the last decades, and has addressed several issues regarding incidence and prevalence, underlying pathophysiological mechanisms, and treatment (Marder & Cannon, 2019; Owen et al, 2016).…”