Three-year outcomes and predictors for full recovery in patients with early-stage psychosis

Abstract

In the present study, various outcomes over 3-year period in patients with early stage psychosis including remission, recovery, relapse and medication adherence were investigated. Predictor for full recovery at year 3 was also examined. Three-year follow-up data in 534 patients with schizophrenia spectrum disorders (SSD) and psychotic disorder not otherwise specified (PNOS) were examined for overall outcome trajectories. The data of completers at year 3 (n = 157) were used to identify predictors for recovery using logistic regression. The rates of symptomatic remission and full recovery at 6-, 12-, 24-, and 36-month follow-up were 76.10, 69.20, 79.50, and 79.10%, and 22.80, 26.40, 28.60, and 39.60%, respectively. The rates of drop-out and relapse at 6-, 12-, 24-, and 36-month follow-up were 25.4, 29.5, 38.6, and 51.1%, and 3.7, 8.9, 19.0, and 38.9%, respectively. The rates of good adherence and prescription of Long-Acting Injectable Antipsychotics (LAIA) at 6-, 12-, 24- and 36-month follow-up were 87.8, 88.0, 91.9, and 93.9%, and 18.3, 21.7, 22.0, and 25.5%, respectively. Significant predictors for full recovery were duration of untreated psychosis (DUP), family intimacy and physical activity. We observed similar or better results on remission, recovery, and relapse rates compared to other previous studies. Effective psychosocial intervention should be provided to shorten the gap between remission and recovery rates and to address DUP, family issues, and exercise to enhance recovery.

Psychological/Personal recovery and its correlates in patients with first episode psychosis

“…Some of the previous studies report that longer DUP predict less recovery after 3 months of treatment even after controlling for all the determinants of DUP and severity of symptoms at baseline (Drake et al, 2000). Other studies report longer DUP to be a predictor of poorer long term social functioning and symptomatic as well as functional recovery (Li et al, 2022; Novak Sarotar et al (2008), Qin et al (2014); Sarotar et al, 2008). These findings taken together suggest that to improve personal recovery of patients with FEP, clinicians should lay emphasis on reducing the DUP.…”

“…The degree of basal impairment in cognitive functions and poorer premorbid adaptation also predict poor recovery after 3 years after a FEP (Treen Calvo et al, 2018). Studies have also found duration of untreated psychosis (DUP), family intimacy and physical activity as predictors of recovery in patients with FEP (Li et al, 2022). Family variables like expressed emotions have also been found to predict the FEP (Haidl et al, 2018).…”

The mourning process and its importance in mental illness: a psychoanalytic understanding of psychiatric diagnosis and classification

“…These defences do not require higher-level cognitive and symbolic functioning (Lucus 2009;Gabbard 2014). Around 30-40% of illnesses that present to mental health services with psychotic symptoms recover and full symbolic functioning is regained (Li 2022). It is worth noting that a transient psychotic state can occur when the brain is strained or tired and with some drugs, such as cannabis and alcohol.…”

Network biomarkers in recovered psychosis patients who discontinued antipsychotics

“…The life expectancy of patients with SZ is 15–20 years shorter than the life expectancy of the general population [ 1 ], and the age-standardized disability-adjusted life-years is reportedly 12.2% [ 2 ]. However, there is increasing evidence that psychotic patients, particularly individuals experiencing first-episode psychosis, can achieve favorable clinical outcomes, such as symptomatic remission and functional recovery [ 3 , 4 ]. For individuals who achieved both symptomatic and functional recovery, there is a need to determine when and how antipsychotic medication should be discontinued.…”

“…They showed altered functional connectivity (FC) [ 11 ], as well as changes in the activities of specific brain regions, while the patients performed tasks [ 10 , 12 ]. However, the participants in those studies did not meet our strict criteria for full recovery [ 3 , 5 ]. SZ has been explained in terms of aberrant interactions among brain regions, leading to the degeneration of brain networks; this degeneration is referred to as disconnection syndrome [ 13 – 15 ].…”