Rate of and time to symptomatic remission in first-episode psychosis in Northern Malawi

Abstract

Although longer duration of untreated psychosis (DUP) is associated with poor response to antipsychotic treatment, it remains unclear whether it independently influences time to symptomatic remission in first-episode psychosis (FEP). This study examined rate of symptomatic remission, and explored if DUP, premorbid functioning, global functioning, insight and socio-demographic characteristics were independently associated with time to symptomatic remission in FEP.This prospective study enrolled 126 FEP patients (aged 18–65) between June 2009 and September 2012. Subjects were followed-up monthly over 18 months after they had received antipsychotic medication. Remission in positive and negative symptoms was defined as in the Remission in Schizophrenia Working Group (RSWG) criteria. Subjects were defined as “in symptomatic remission” if they remitted in both negative and positive symptoms. At baseline, the following explanatory variables were measured: socio-demographic characteristics; DUP as short (≤5 months) and long (>5 months); premorbid functioning as deteriorating, stable poor, and stable good according to Cannon-Spoor Premorbid Adjustment Scale; global functioning as “worst (1–10) to serious (41–50)” and “moderate (51–60) to superior (91–100),” according to the Global Assessment of Functioning Scale; and insight as poor (≤8) and good (≥9) according to the Insight Scale (Birchwood). Univariate and multivariable analyses were used to generate results.Out of 126 subjects, 98 (78%) completed follow-up, of which 70 (71.4%) achieved symptomatic remission within mean duration of 8.05 (4.54) months. Besides, having long DUP and separated/divorced/widowed (adjusted hazard ratio [aHR] = 0.07, 95%CI = [0.01, 0.46]), long DUP and poor insight (aHR = 0.18, 95%CI = [0.04, 0.89]), poor insight and separated/divorced/widowed (aHR = 0.09, 95%CI = [0.01, 0.70]), deteriorating premorbid functioning (aHR = 0.47, 95%CI = [0.23, 0.97]), family history of psychiatric disorders (aHR = 0.52, 95%CI = (0.30, 0.93]), and being male (aHR = 0.47, 95%CI = [0.24, 0.92]) delayed symptomatic remission.These results propose that psychological interventions and social support for mental health problems are warranted and may enhance better response to antipsychotic medications among separated/divorced/widowed patients with long DUP or poor insight, and poor insight patients with long DUP. Deteriorating premorbid functioning, family history of psychiatric disorders and being male continue being important risk factors for poor odds of remission.

The Association of Social Support and Symptomatic Remission among Community-Dwelling Schizophrenia Patients: A Cross-Sectional Study

“…The remission rates in our study and the two aforementioned studies vary greatly when compared with the rates in three studies that enrolled participants with acute-phase first-episode schizophrenia, with 60–91.5% remission rates after hospitalization [ 20 , 21 , 22 ]. In the present study, we enrolled participants with chronic schizophrenia, which is a phase with residual symptoms; therefore, remission was less likely to be achieved for negative symptoms when compared with positive symptoms in the acute phase [ 24 , 26 ].…”

“…Social support is one of the key factors facilitating adaptation to adverse circumstances and symptomatic remission in schizophrenia patients in communities [ 31 , 32 , 33 ]. Social support is often derived from intimate relationships and is essential for mental health [ 22 ]. The significant association between the family domain of social support and symptomatic remission reveals the key role of family support for schizophrenia patients during illness when compared with other sources of support.…”

“…Another study on community-dwelling older schizophrenia patients reported 23.4% remission rates at baseline, and almost 86% of the patients maintained the remission status at five years; however, among 72.7% of patients who were not in remission, only 35.6% had achieved remission at 5 years [ 19 ]. Some longitudinal studies have reported 52–71% remission rates for patients with acute schizophrenia episodes and who had been discharged from hospital within a year [ 20 , 21 , 22 ], whereas other studies that followed up illness progression from 6 to 11 years reported 17.2–37% remission rates [ 23 , 24 ]. In a study in Taiwan, the remission rates in schizophrenia patients was 36.7% 1 month after discharge [ 25 ].…”

Proportion and predictors of remission and recovery in first-episode psychosis: Systematic review and meta-analysis

“…Accumulated evidence indicates that the early years after a FEP are critical for remission and recovery in psychosis [4,6]. Over the past decade, the criteria of The Remission Schizophrenia Working Group (RSWG) have been adopted as a common measure of symptomatic remission in clinical studies [7][8][9]. According to the RSWG, symptomatic remission is defined based on a fixed threshold for symptom severity (only mild or absent symptoms) and a time component (sustained for at least six months) [10].…”

Comparison of antipsychotic naïve first‐episode psychosis patients and healthy controls in Uganda

“…Few studies from low and middle‐income countries (LMICs) have described risk factors for antipsychotic naïve first episode of psychosis patients (Esan & Fawole, 2013; Kaminga et al, 2018; Kaminga et al, 2019;Mbewe et al, 2006; Paruk et al, 2015; Paruk et al, 2018). Most studies on FEP from sub‐Saharan Africa have been limited by sample size and so underpowered to determine risk factors for FEP (Mbewe et al, 2006; Paruk et al, 2015; Paruk et al, 2018).…”