Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies

Abstract

BackgroundRemission and recovery rates for people with first-episode psychosis (FEP) remain uncertain.AimsTo assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators.MethodWe conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators.ResultsSeventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions.ConclusionsRemission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery.

Forward Thinking - NIHR research on support for people with severe mental illness

“…A significant number of people with SMI can experience a reduction of both symptoms and associated impairments over time and make a full recovery. Research suggests that remission and recovery rates in first episode psychosis may be more favourable than previously thought, suggesting that a progressive deteriorating course of illness is not typical 3,4 . Indeed, for those who continue to live with the symptoms of psychosis, recovery in terms of personal, social and occupational aspirations is a realistic goal and sets the context for the recovery approach.…”

Defining Treatment Response, Remission, Relapse, and Recovery in First-Episode Psychosis: A Survey among Korean Experts

“…23 This innovative approach for standardizing the definition of outcome in schizophrenia could facilitate research and support a positive, longer-term approach of studying the outcome in patients with schizophrenia. 4 Although symptomatic improvement is maintained after treatment, worsening of psychotic symptoms could be observed in clinical practice. It is important to determine whether it constitutes a relapse to plan the next appropriate treatment step for the patient.…”

“…For example, the reported rates of remission in FEP range between 17% and 78%. 4,25 Furthermore, the rate of recovery ranges from 13.5% to 42%. 4 These inconsistencies can confuse clinicians in the field and make it impossible to comprehensively compare results among studies.…”

“…4,25 Furthermore, the rate of recovery ranges from 13.5% to 42%. 4 These inconsistencies can confuse clinicians in the field and make it impossible to comprehensively compare results among studies. 26 In view of this, the Committee of Treatment Guidelines for First-Episode Psychosis in Korea was formed to establish consensus criteria to standardize the definition of treatment response, remission, relapse, and recovery.…”

“…2 Although several studies have attempted to derive definitions of the numerous treatment outcomes, objective and clear definitions of treatment response, remission, relapse, and recovery in the treatment of FEP have yet to be established. [3][4][5] This ambiguity hampers comparisons between study results and has Objective For the proper treatment of first-episode psychosis, assessment of treatment response, remission, relapse, and recovery is important. Therefore, the present study aimed to develop operational definitions of clinical outcomes in first-episode psychosis.…”