The evidence for illness progression after relapse in schizophrenia

Emsley, Robin; Chiliza, Bonginkosi; Asmal, Laila

doi:10.1016/j.schres.2013.05.016

Cited by 107 publications

(65 citation statements)

References 36 publications

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“…Although it has been suggested that acute psychotic exacerbations represent active periods of a morbid process that leads to disease progression (the “neurotoxic hypothesis of psychosis”), to date there is limited empirical evidence to support illness progression after each relapse. The mechanisms of toxicity have not been described and supporting evidence is conflicting. On the one hand, based on limited data, times to remission are significantly longer for the second and third episodes; treatment discontinuation and the effective dose are higher during the subsequent episodes compared to the first one (suggesting reduced effectiveness of antipsychotics when reintroduced after illness recurrence); and relapse duration (but not frequency) is associated with gray matter alterations.…”

Section: Early Intervention and Secondary/tertiary Preventionmentioning

confidence: 99%

Improving outcomes of first‐episode psychosis: an overview

2017

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Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state-of-the-art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients' satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well-being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre-emptive interventions to high-risk groups identified across the early stages of the disorder. Only a systematic implementation of these models of care in the national health care systems will render these strategies accessible to the 23 million people worldwide suffering from the most severe psychiatric disorders.

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Section: Early Intervention and Secondary/tertiary Preventionmentioning

confidence: 99%

Improving outcomes of first‐episode psychosis: an overview

2017

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“…In the multinational incident cohorts of the World Health Organization, an average of 25.5% of patients with schizophrenic European Psychiatry 36 (2016) [7][8][9][10][11][12][13][14] Background: Due to the paucity of previous studies, we wanted to elucidate the pharmacoepidemiology of antipsychotics in schizophrenia in a general population sample, and the association between long-term antipsychotic use and outcomes. Methods: The sample included 53 schizophrenia subjects from the Northern Finland Birth Cohort 1966 with at least ten years of follow-up (mean 18.6 years since illness onset).…”

Section: Introductionmentioning

confidence: 99%

Long-term antipsychotic use and its association with outcomes in schizophrenia – the Northern Finland Birth Cohort 1966

et al. 2016

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In our population-based sample, the use of antipsychotics increased during the first five years of illness and was relatively stable after that. Our results suggest that both low dose and proportion of use, and having no drug-free periods, are associated with better outcomes, which concords with current treatment recommendations and algorithms. High long-term doses and polypharmacy may relate to poor outcomes.

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“…Schizophrenia is a chronic and disabling disease in which repeated relapses have a negative impact on patients’ functioning and are disruptive for patients’ education and employment [1]. Unemployment is a large burden for patients as well as for society, and on average, the worldwide proportion of patients with schizophrenia who are not undertaking any paid employment is around 80% [2].…”

Section: Introductionmentioning

confidence: 99%

Relationship between response to aripiprazole once-monthly and paliperidone palmitate on work readiness and functioning in schizophrenia: A post-hoc analysis of the QUALIFY study

et al. 2017

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Schizophrenia is a chronic disease with negative impact on patients’ employment status and quality of life. This post-hoc analysis uses data from the QUALIFY study to elucidate the relationship between work readiness and health-related quality of life and functioning. QUALIFY was a 28-week, randomized study (NCT01795547) comparing the treatment effectiveness of aripiprazole once-monthly 400 mg and paliperidone palmitate once-monthly using the Heinrichs-Carpenter Quality-of-Life Scale as the primary endpoint. Also, patients’ capacity to work and work readiness (Yes/No) was assessed with the Work Readiness Questionnaire. We categorized patients, irrespective of treatment, by work readiness at baseline and week 28: No to Yes (n = 41), Yes to Yes (n = 49), or No at week 28 (n = 118). Quality-of-Life Scale total, domains, and item scores were assessed with a mixed model of repeated measures. Patients who shifted from No to Yes in work readiness showed robust improvements on Quality-of-Life Scale total scores, significantly greater than patients not ready to work at week 28 (least squares mean difference: 11.6±2.6, p<0.0001). Scores on Quality-of-Life Scale instrumental role domain and items therein–occupational role, work functioning, work levels, work satisfaction–significantly improved in patients shifting from No to Yes in work readiness (vs patients No at Week 28). Quality-of-Life Scale total scores also significantly predicted work readiness at week 28. Overall, these results highlight a strong association between improvements in health-related quality of life and work readiness, and suggest that increasing patients’ capacity to work is an achievable and meaningful goal in the treatment of impaired functioning in schizophrenia.

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The evidence for illness progression after relapse in schizophrenia

Cited by 107 publications

References 36 publications

Improving outcomes of first‐episode psychosis: an overview

Improving outcomes of first‐episode psychosis: an overview

Long-term antipsychotic use and its association with outcomes in schizophrenia – the Northern Finland Birth Cohort 1966

Relationship between response to aripiprazole once-monthly and paliperidone palmitate on work readiness and functioning in schizophrenia: A post-hoc analysis of the QUALIFY study

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