Very long-term outcome of schizophrenia

Volavka, Jan; Vevera, Jan

doi:10.1111/ijcp.13094

Cited by 28 publications

(17 citation statements)

References 64 publications

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“…In the cluster with generalized and severe deficit (Cluster 3) one of the most impaired domains was verbal memory, and as expected in first episodes, this group was the least represented in the whole sample. The small representation of the sample in this cluster was expected, since the subjects are at the early stages of their illness, and are not affected by the collateral effects of the course of the illness (Volavka and Vevera, 2018). The longitudinal stability of cognitive cluster subtypes becomes later, with the trajectory of the disorder (Heinrichs et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

Cognitive Profiles and Functional Connectivity in First-Episode Schizophrenia Spectrum Disorders – Linking Behavioral and Neuronal Data

et al. 2019

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The character of cognitive deficit in schizophrenia is not clear due to the heterogeneity in research results. In heterogeneous conditions, the cluster solution allows the classification of individuals based on profiles. Our aim was to examine the cognitive profiles of first-episode schizophrenia spectrum disorder (FES) subjects based on cluster analysis, and to correlate these profiles with clinical variables and resting state brain connectivity, as measured with magnetic resonance imaging. A total of 67 FES subjects were assessed with a neuropsychological test battery and on clinical variables. The results of the cognitive domains were cluster analyzed. In addition, functional connectivity was calculated using ROI-to-ROI analysis with four groups: Three groups were defined based on the cluster analysis of cognitive performance and a control group with a normal cognitive performance. The connectivity was compared between the patient clusters and controls. We found different cognitive profiles based on three clusters: Cluster 1: decline in the attention, working memory/flexibility, and verbal memory domains. Cluster 2: decline in the verbal memory domain and above average performance in the attention domain. Cluster 3: generalized and severe deficit in all of the cognitive domains. FES diagnoses were distributed among all of the clusters. Cluster comparisons in neural connectivity also showed differences between the groups. Cluster 1 showed both hyperconnectivity between the cerebellum and precentral gyrus, the salience network (SN) (insula cortex), and fronto-parietal network (FPN) as well as between the PreCG and SN (insula cortex) and hypoconnectivity between the default mode network (DMN) and seeds of SN [insula and supramarginal gyrus (SMG)]; Cluster 2 showed hyperconnectivity between the DMN and cerebellum, SN (insula) and precentral gyrus, and FPN and IFG; Cluster 3 showed hypoconnectivity between the DMN and SN (insula) and SN (SMG) and pallidum. The cluster solution confirms the prevalence of a cognitive decline with different patterns of cognitive performance, and different levels of severity in FES. Moreover, separate behavioral cognitive subsets can be linked to patterns of brain functional connectivity.

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Section: Discussionmentioning

confidence: 99%

Cognitive Profiles and Functional Connectivity in First-Episode Schizophrenia Spectrum Disorders – Linking Behavioral and Neuronal Data

et al. 2019

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“…Importantly, in some studies, a large proportion of patients, ranging from 19% (Moilanen et al, 2016) to 48.2% (Kua et al, 2003), were not on medication at the time of evaluation. In a recent review on the long-term outcome of schizophrenia, it was found that about 20% of first-episode patients do not need long-term maintenance antipsychotic treatment, and that this proportion may be higher in schizophrenia spectrum patients (Volavka & Vevera, 2018). Still, a large proportion of patients need indefinite maintenance antipsychotic treatment, and this would better be a low-dose regimen, as supported by the Moilanen et al (2016) study.…”

Section: Data On Medicationmentioning

confidence: 99%

Very long-term outcome of psychotic disorders

Peritogiannis¹,

Gogou²,

Samakouri

2020

Int J Soc Psychiatry

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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.

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“…However, some patients had extended periods of recovery, and, contrary to the commonly held view, patients with schizophrenia were not characterized by a progressive decline. More recently, Volavka and Vevera [24] concluded that symptomatic remission in long-term follow-up studies ranged between 16.4% in never-treated patients to 37.5% in patients who received antipsychotics. Better outcomes were associated with early detection and treatment of the first episode, and continuous psychosocial support over subsequent years [24].…”

Section: Introductionmentioning

confidence: 99%

Improvement of Theory of Mind in Schizophrenia: A 15-Year Follow-Up Study

Kelemen

Máttyássy

Kéri

2019

Psych

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Neurocognitive and social cognitive deficits are a hallmark of schizophrenia. The purpose of the present study was to investigate long-term changes in theory of mind (ToM), executive functions, lexical retrieval, and speed of information processing/attention in schizophrenia. We followed-up 31 outpatients with schizophrenia and 31 healthy control subjects for 15 years. ToM was assessed with the Reading the Mind from the Eyes Test (RMET), whereas neurocognitive functions were measured with the verbal fluency (VF) task (executive functions and lexical retrieval) and with the Digit-Symbol Substitution Test (DSST) (speed of information processing/attention). Clinical symptoms and general functioning were rated with the Positive and Negative Syndrome Scale (PANSS) and with the Global Assessment of Functioning (GAF) scale, respectively. At baseline assessment, patients with schizophrenia exhibited significant and generalized impairments on all measures. At follow-up, relative to the baseline, we observed marked improvements in ToM (RMET), stability in executive functions and lexical retrieval (VF), and a significant decline in psychomotor speed/attention (DSST) in schizophrenia. Clinical symptoms and psychosocial functions did not differ at baseline and at follow-up examinations (mild-to-moderate symptoms on the PANSS and moderate difficulty in social and occupational functions on the GAF). These results indicate that patients with schizophrenia with mild-to-moderate symptoms and functional deficits are characterized by improved ToM during over a decade.

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Very long-term outcome of schizophrenia

Cited by 28 publications

References 64 publications

Cognitive Profiles and Functional Connectivity in First-Episode Schizophrenia Spectrum Disorders – Linking Behavioral and Neuronal Data

Cognitive Profiles and Functional Connectivity in First-Episode Schizophrenia Spectrum Disorders – Linking Behavioral and Neuronal Data

Very long-term outcome of psychotic disorders

Improvement of Theory of Mind in Schizophrenia: A 15-Year Follow-Up Study

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