Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study

Malla, Ashok; Norman, Ross; Schmitz, N.; Manchanda, Rahul; Béchard-Evans, Laura; Takhar, Jatinder; Haricharan, Raj

doi:10.1017/s0033291706007379

Cited by 190 publications

(155 citation statements)

References 28 publications

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“…Such early nonadherence has been shown to significantly influence rate and time to remission even in specialized early intervention services. 7 It is likely these rates improve after the first 6 months, later in the course of treatment.…”

Section: Discussionmentioning

confidence: 99%

Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis

et al. 2009

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Objective: To examine the hypothesis that poorer social and family support, identifiable at the onset of treatment, is associated with nonadherence in the first 6 months of treatment of patients with first-episode psychosis (FEP), independent of other patient-related factors.Method: Consecutive patients (n = 100) admitted to a specialized early intervention service for FEP who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for either a schizophrenia spectrum disorder or an affective psychosis were evaluated monthly for 6 months regarding their adherence to medications. Using sociodemographic and illness-related factors, including social and family support, as independent variables and adherence as the dependent variable, univariate analyses were followed by logistic regression.Results: Fifty-six patients (54.9%) were adherent (76% to 100% of doses taken) and 46 (45.1%) nonadherent (less than 76% of doses taken). Nonadherent patients were less likely to have received a good level of social support (c 2 = 5.89, df = 1, P = 0.02), as rated by their respective case manager, and more likely to be single (Fisher exact test, P = 0.019) and to have refused medication at the first offer of treatment (c 2 = 19.70, df = 1, P = 0.001). Using logistic regression, both the level of social support (OR = 3.552, P = 0.03) and early medication acceptance (OR = 11.092, P < 0.001) were significant as predictors of adherence. Conclusion Clinical Implications· Social and family support may be an important determinant of adherence to medication very early in the course of treatment of FEP. · Refusal to be treated at the first offer of treatment remains the most likely reason for nonadherence to medication, at least in the first 6 months of treatment of FEP. · Interventions may need to be designed to influence adherence to medication very early in the course of treatment. Limitations· The measure of social and family support used may have been too brief and not able to tap into different aspects of support from family and others in the social environment. · The absence of influence of insight on adherence to medication might have resulted from using the one item from the Positive and Negative Symptom Scale for assessing insight and not using a more detailed measure of insight. · The relatively high level of nonadherence may be a reflection of a very conservative measure of adherence to medication (taking greater than 75% of doses of medication prescribed).

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Section: Discussionmentioning

confidence: 99%

Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis

et al. 2009

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“…Overall functional disability was assessed using the Global Assessment of Functioning (GAF). Duration of untreated psychosis (DUP) was defined as the difference between the date of onset of psychotic symptoms to the date of treatment with antipsychotic medications (Malla et al, 2006, Singh et al, 2005 (Wechsler, 2001). Premorbid and current IQ estimates, and the difference in IQ estimate between the premorbid and current IQ were compared between the TR and non TR groups.…”

Section: Data Ascertainment At Baselinementioning

confidence: 99%

Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses

et al. 2016

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BackgroundClozapine remains the only evidence-based antipsychotic for treatment-resistant schizophrenia (TRS). The ability to predict which patients with their first onset of schizophrenia would subsequently meet criteria for treatment resistance (TR) could help to diminish the severe functional disability which may ensue if TR is not recognized and correctly treated.MethodThis is a 5-year longitudinal assessment of clinical outcomes in a cohort of 246 first-episode schizophrenia spectrum patients recruited as part of the NIHR Genetics and Psychosis (GAP) study conducted in South London from 2005 to 2010. We examined the relationship between baseline demographic and clinical measures and the emergence of TR. TR status was determined from a review of electronic case records. We assessed for associations with early-, and late-onset TR, and non-TR, and differences between those TR patients treated with clozapine and those who were not.ResultsSeventy per cent (n = 56) of TR patients, and 23% of the total study population (n = 246) were treatment resistant from illness onset. Those who met criteria for TR during the first 5 years of illness were more likely to have an early age of first contact for psychosis (<20 years) [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.25–4.94] compared to those with non-TR. The relationship between an early age of first contact (<20 years) and TR was significant in patients of Black ethnicity (OR 3.71, 95% CI 1.44–9.56); and patients of male gender (OR 3.13 95% CI 1.35–7.23).ConclusionsFor the majority of the TR group, antipsychotic TR is present from illness onset, necessitating increased consideration for the earlier use of clozapine.

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“…Scores on Global Assessment of Functioning (GAF) were obtained based on ratings conducted at the time of the first assessment. Patients were administered a semi-structured interview schedule, the Circumstances of Onset and Relapse Schedule (Norman et al, 2004;Malla et al, 2006), to provide estimates of the time of onset of psychosis, of the duration of untreated psychosis (DUP) and of the duration of untreated illness (DUI). DUP was defined as the period between the time of onset of psychotic symptoms and the commencement of adequate treatment (taking anti-psychotic medication for a period of one month or until significant response, which ever came first).…”

Section: Participantsmentioning

confidence: 99%

P300 asymmetry and positive symptom severity: A study in the early stage of a first episode of psychosis

Renoult

Prévost

Brodeur

et al. 2007

Schizophrenia Research

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The amplitude of the P300 event-related potential (ERP) has been reported to be reduced over left compared to right temporal sites in schizophrenia patients. This left temporal P300 reduction has been associated with positive symptom severity and gray matter reduction in the left superior temporal gyrus. We investigated a group of patients with a first episode of schizophrenia spectrum psychosis and a group of normal controls to verify if P300 amplitude asymmetry already exists around the time of presentation for treatment. Relative to normal control subjects, no P300 asymmetry was found in patients. Nevertheless, P300 asymmetry was correlated with the severity of positive symptoms and worse global functioning (GAF), a good predictor of poor outcome.

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Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study

Abstract: Improving adherence to medication early in the course of treatment may be an important intervention to improve short-term outcome.

Cited by 190 publications

References 28 publications

Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis

Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis

Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses

P300 asymmetry and positive symptom severity: A study in the early stage of a first episode of psychosis

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