C Morgan1, J Lappin2, M Heslin3, K Donoghue4, B Lomas5, U Reininghaus1, A Onyejiaka1, T Croudace6, P B Jones7, R M Murray2, P Fearon8, G A Doody5, P Dazzan2. 1. Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK. 2. National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London,UK. 3. Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK. 4. Addictions Department, Institute of Psychiatry,King's College London,UK. 5. Division of Psychiatry,University of Nottingham,UK. 6. Department of Health Sciences,University of York,UK. 7. Department of Psychiatry,University of Cambridge,UK. 8. Department of Psychiatry,Trinity College,Dublin,Ireland.
Abstract
BACKGROUND: Studies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare. METHOD: AESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews. RESULTS: At follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1-4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London. CONCLUSIONS: Sustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover.
BACKGROUND: Studies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare. METHOD: AESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews. RESULTS: At follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1-4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London. CONCLUSIONS: Sustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover.
Authors: Wenche Ten Velden Hegelstad; Tor K Larsen; Bjørn Auestad; Julie Evensen; Ulrik Haahr; Inge Joa; Jan O Johannesen; Johannes Langeveld; Ingrid Melle; Stein Opjordsmoen; Jan Ivar Rossberg; Bjørn Rishovd Rund; Erik Simonsen; Kjetil Sundet; Per Vaglum; Svein Friis; Thomas McGlashan Journal: Am J Psychiatry Date: 2012-04 Impact factor: 18.112
Authors: T K Larsen; I Melle; B Auestad; U Haahr; I Joa; J O Johannessen; S Opjordsmoen; B R Rund; J I Rossberg; E Simonsen; P Vaglum; S Friis; T McGlashan Journal: Psychol Med Date: 2010-10-14 Impact factor: 7.723
Authors: Tom K J Craig; Philippa Garety; Paddy Power; Nikola Rahaman; Susannah Colbert; Miriam Fornells-Ambrojo; Graham Dunn Journal: BMJ Date: 2004-10-14