Onset Pattern and Long-Term Prognosis in Schizophrenia: 10-Year Longitudinal Follow-Up Study

Abstract

BackgroundAlthough the duration of untreated psychosis (DUP) plays an important role in the short-term prognosis of patients with schizophrenia, their long-term prognosis generally is not determined by DUP alone. It is important to explore how other clinical factors in the early stage are related to DUP and consequent disease courses.MethodsA total of 664 patients with untreated psychosis were surveyed for this study. At the first examination, we divided them into the severe positive symptoms cases (SC) or the less severe cases (NonSC) and compared the prognosis among the two groups after a 10-year follow-up. In all, 113 patients in the SC group and 43 patients in the NonSC group were follow-up completers.ResultsWhereas DUP was not different between the two groups, patients with nonacute onset in both groups had significantly longer DUP than those in patients with acute onset. For all clinical measures, there was no difference in prognosis between the two groups or among the four groups classified by mode of onset (MoO) and initial severity of positive symptoms. However, the degree of improvement of global assessment of functioning (GAF) was significantly smaller in the NonSC-nonacute group than in the SC-acute and SC-nonacute groups.ConclusionsThese results suggest that neither DUP nor MoO alone necessarily affects the initial severity of positive symptoms. Moreover, it is possible that patients with low impetus of positive symptoms onset within long DUP experience profound pathologic processes. Therefore, the current study results indicated that long DUP and nonacute onset were related to poor long-term prognosis, regardless of initial positive symptoms.

Medication adherence in first episode psychosis: the role of pre‐onset subthreshold symptoms

“…STPS− participants (who recalled no subthreshold psychotic symptoms before their FEP onset) may experience psychotic symptoms as being more abrupt in onset (regardless of severity) and could thus be more likely to continue their medications. These results are also consistent with previous literature on the association between insidious onset of psychosis and poorer outcomes ; our work complements this literature by reflecting symptoms that have been operationalized through the CHR construct.…”

“…For example, FEP patients who experienced pre‐onset STPS and have comorbid substance use disorder and milder positive symptoms at baseline might benefit from encouragement or psychoeducation around adherence, or even neutral approaches such as motivational interviewing which attempts to identify sources of ambivalence . And regardless of STPS status, efforts made by FEP services to engage relatives from the beginning of treatment may contribute to medication adherence .…”

A comparative study of cognitive insight in schizophrenia patients with and without depression

“…Our study was supported by a study done by Kanahara et al on onset pattern and long-term prognosis in schizophrenia. 10 This was a 10 years longitudinal study done in japan. They found that non-acute mode of onset could cause a significant poor total psychopathology and negative symptoms.…”

A review on schizophrenia and relapse—a quest for user‐friendly psychopharmacotherapy

“…Further, it is critically important to be aware of the fact that we can only know of the patients who come to our clinical attention; this leaves us almost blind to those remaining in the community without receiving any special care. Related to this, prognosis for patients whose onset was non-acute with less severe psychotic symptoms was reported to be relatively worse (Kanahara et al, 2013). Acute salient episodes such as emergency psychotic agitation will usually bring people to psychiatric attention.…”