Early Predictors of Ten-Year Course in First-Episode Psychosis

Friis, Svein; Melle, Ingrid; Johannessen, Jan Olav; Røssberg, Jan Ivar; Barder, Helene Eidsmo; Evensen, Julie; Haahr, Ulrik; Hegelstad, Wenche ten Velden; Joa, Inge; Langeveld, Johannes; Larsen, Tor Ketil; Opjordsmoen, Stein; Rund, Bjørn Rishovd; Simonsen, Erik; Vaglum, Per; McGlashan, Thomas H.

doi:10.1176/appi.ps.201400558

Cited by 50 publications

(41 citation statements)

References 30 publications

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“…The model uses a cohort of 10 000 hypothetical patients. Although they differ with respect to DUP at treatment entry, patients are assumed to have comparable sociodemographic and clinical characteristics associated with long‐term outcomes such as age, premorbid social functioning, and symptom profile (eg, severity of negative symptoms; Friis et al, ).…”

Section: Methodsmentioning

confidence: 99%

“…We use the term "Time in Uncontrolled Psychosis" to refer to the sum of DUP and time in psychosis accrued due to inadequate symptom control following treatment entry. The TUP concept is supported by evidence that time in psychosis accrued immediately after entering treatment is at least as consequential for long-term outcomes as the DUP (Friis et al, 2016), suggesting a critical role for overall time in psychosis at this early stage.…”

Section: Calibration Phasementioning

confidence: 99%

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Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

Horvitz-Lennon

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Orr

et al. 2018

Early Intervention Psych

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Aim Duration of untreated psychosis in early schizophrenia impacts long‐term outcomes. Because long‐acting injectable (LAI) antipsychotic drugs improve adherence in early‐stage patients, they could reduce additional time in uncontrolled psychosis (TUP) during the critical period of the illness. However, the long‐term benefit of early LAI use over oral formulations has not been quantified. This study explores the potential magnitude of the benefit with a simulation approach. Methods A microsimulation models the effects of 11 treatment pathways reflecting alternative decisions on whether and when LAI agents are used during a “calibration phase” that starts at treatment entry and lasts until the end of the 3‐year critical period. Treatment failure prolongs time in psychosis. Long‐term outcomes are predicted over the ensuing 7‐year period as a function of TUP. Results An “early LAI” pathway where LAI treatment follows the second oral treatment failure is compared to an oral‐only pathway. Under these pathways, 69% and 46% of patients, respectively, are estimated to exit the calibration phase with adequate symptom control (total positive and negative syndrome scale score below 68). Relative to the oral‐only pathway, the early LAI pathway is predicted to increase competitive employment by 39% (25% vs 18%) and independent or family living by 22% (71% vs 58%), and to decrease receipt of disability benefits by 36% (42% vs 66%) and hospital admissions per 1000 patient‐years by 15% (249% vs 294%). Conclusions While these simulation results need to be confirmed empirically, they suggest that earlier use of LAI antipsychotics can meaningfully improve patient outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Calibration Phasementioning

confidence: 99%

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

Horvitz-Lennon

Predmore

Orr

et al. 2018

Early Intervention Psych

View full text Add to dashboard Cite

show abstract

“…The effects of DUP and other variables on outcome were examined by Friis et al in a study that was a part of the Scandinavian TIPS project mentioned above (see Hegelstad et al and Weibell et al). Four variables provided significant, additive predictors of longer time in psychosis during the 10‐year follow‐up: DUP of ≥26 weeks, diagnosis of core schizophrenia spectrum disorder, no remission within the first 3 months of illness and deterioration in premorbid social functioning.…”

Section: Resultsmentioning

confidence: 99%

Very long-term outcome of schizophrenia

Volavka

Vevera

2018

Int J Clin Pract

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The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.

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“…Pasientene oppga at de hadde brukt antipsykotika i 65,7 % av oppfølgingstiden på ti år (6,16,17). Det er altså ikke slik at en person med en psykoselidelse trenger medikamenter for alltid, og det er mulig å få behandling uten antipsykotika.…”

Section: Tidlig Intervensjonunclassified