Early recovery in the first 24 months of treatment in first-episode schizophrenia-spectrum disorders

Abstract

Studies assessing the treatment outcomes in first-episode schizophrenia have reported mixed results. While symptom improvement is frequently robust, when other domains are considered outcomes are generally poorer. We explored response trajectories, rates and predictors of recovery in the domains of core psychopathology, clinician-rated social and occupational functioning and patient-rated quality of life over 24 months of treatment in 98 patients with first-episode schizophrenia spectrum disorders who were treated with a long-acting antipsychotic medication. There was robust improvement in core psychopathology (effect size d = 3.36) and functionality (d = 1.78), with most improvement occurring within the first six months of treatment. In contrast, improvement in subjective quality of life was less marked (d = 0.37) and slower, only reaching significance after 12 months of treatment. Symptom remission was achieved by 70% of patients and over half met our criteria for functional remission and good quality of life. However, only 29% met the full criteria for recovery. Patients who met the recovery criteria had better premorbid adjustment, were less likely to be of mixed ethnicity and substance use emerged as the only modifiable predictor of recovery. Only 9% of our sample achieved both functional remission and good quality of life despite not being in symptom remission. We found high rates of symptom remission, functional remission and good quality of life in patients, although relatively few achieved recovery by meeting all three of the outcome criteria. Symptom remission is not a necessary prerequisite for functional remission and good quality of life, although few non-remitters achieve other recovery criteria.npj Schizophrenia (2020) 6:2 ; https://doi.

Premorbid Social Functioning and Affective Symptoms Predict Subjective Outcome Among Outpatients With Schizophrenia

“…The PAS covers two areas of functioning: academic functioning (achievements in school and adaption to school) and social functioning [sociability/withdrawal, peer relationships, and ability to establish interpersonal and sexual relationships (starting at age 12)]. Items are scored on a scale from 0 to 6, with 0 denoting the highest level of functioning and 6 the lowest.…”

“…Next to the side effects of treatment a failure to adequately treat symptoms has consistently been shown to be associated with poor subjective outcome such as QoL (5)(6)(7)(8)(9)(10)(11). A recent study by Phahladira and coworkers, for example, who followed 98 patients experiencing a first episode of schizophrenia spectrum disorders over 24 months of treatment showed that merely 9% of patients achieved both good QoL and functional remission despite not being in symptomatic remission (12). Findings on the associations between patients' QoL and specific symptoms are divergent.…”

Characteristics of delayed and timely treatment seekers for first-episode schizophrenia in Thailand

“…The World Health Organization and the International Early Psychosis Association have emphasised that patients with first-episode psychosis (FEP) should receive treatment within 3 months from the onset of symptoms to reduce the impact of the illness and increase the chance of recovery (Bertolote & Mcgorry, 2005;Phahladira et al, 2020). The earlier the treatment starts after the onset of FEP, the more effective the management of symptoms and improvement of outcomes will be during the course of the illness (Lieberman et al, 2019).…”

Neurocognition and Social Cognition Predicting 1-Year Outcomes in First-Episode Psychosis

“…Similarly, in some previous studies predicting functional outcomes in schizophrenia, cognitive testing often did not add predictive value when also accounting for negative symptoms (20,62). In a 2-year follow-up study among first-episode schizophrenia-spectrum disorders, symptomatic and functional remission, and quality of life were all associated with higher cognitive performance but associations did not remain significant in regression models controlling for symptoms (63).…”