Svein Friis1, Ingrid Melle1, Jan Olav Johannessen1, Jan Ivar Røssberg1, Helene Eidsmo Barder1, Julie Horgen Evensen1, Ulrik Haahr1, Wenche Ten Velden Hegelstad1, Inge Joa1, Johannes Langeveld1, Tor Ketil Larsen1, Stein Opjordsmoen1, Bjørn Rishovd Rund1, Erik Simonsen1, Per Wiggen Vaglum1, Thomas H McGlashan1. 1. Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail: svein.friis@medisin.uio.no ). Dr. Friis, Dr. Melle, and Dr. Røssberg are also with the Institute of Clinical Medicine, University of Oslo, where Dr. Evensen and Dr. Opjordsmoen are affiliated. Dr. Evensen is also with the Adult Psychiatric Department Vinderen, Diakonhjemmet Hospitals, Oslo. Dr. Johannessen, Dr. ten Velden Hegelstad, Dr. Joa, Dr. Langeveld, and Dr. Larsen are with the Division of Psychiatry, Network of Clinical Psychosis Research, Stavanger University Hospital, Stavanger, Norway. Dr. Johannessen and Dr. Joa are also with the Faculty of Social Sciences, University of Stavanger. Dr. Larsen is also with the Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Haahr is with the Early Psychosis Intervention Center, Psychiatry East-Region Zealand, Roskilde, Denmark. Dr. Haahr is also with the Faculty of Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Denmark, where Dr. Simonsen is affiliated. Dr. Simonsen is also with the Psychiatric Research Unit, Region Zealand, Roskilde, Denmark. Dr. Rund is with the Department of Psychology, University of Oslo, and with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo. Dr. McGlashan is with the Department of Social and Behavioral Health, Yale School of Medicine, Yale University, New Haven, Connecticut.
Abstract
OBJECTIVE: Identifying patients at risk of poor outcome at an early stage of illness can aid in treatment planning. This study sought to create a best-fit statistical model of known baseline and early-course risk factors to predict time in psychosis during a ten-year follow-up period after a first psychotic episode. METHODS: Between 1997 and 2000, 301 patients with DSM-IV nonorganic, nonaffective first-episode psychosis were recruited consecutively from catchment area-based sectors in Norway and Denmark. Specialized mental health personnel evaluated patients at baseline, three months, and one, two, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores ≥4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses. RESULTS: Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow-up: deterioration in premorbid social functioning, duration of untreated psychosis (DUP) of ≥26 weeks, core schizophrenia spectrum disorder, and no remission within three months. CONCLUSIONS: First-episode psychosis patients should be followed carefully after the start of treatment. If symptoms do not remit within three months with adequate treatment, there is a considerable risk of a poor long-term outcome, particularly for patients with a deterioration in premorbid social functioning, a DUP of at least half a year, and a diagnosis within the core schizophrenia spectrum.
OBJECTIVE: Identifying patients at risk of poor outcome at an early stage of illness can aid in treatment planning. This study sought to create a best-fit statistical model of known baseline and early-course risk factors to predict time in psychosis during a ten-year follow-up period after a first psychotic episode. METHODS: Between 1997 and 2000, 301 patients with DSM-IV nonorganic, nonaffective first-episode psychosis were recruited consecutively from catchment area-based sectors in Norway and Denmark. Specialized mental health personnel evaluated patients at baseline, three months, and one, two, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores ≥4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses. RESULTS: Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow-up: deterioration in premorbid social functioning, duration of untreated psychosis (DUP) of ≥26 weeks, core schizophrenia spectrum disorder, and no remission within three months. CONCLUSIONS: First-episode psychosispatients should be followed carefully after the start of treatment. If symptoms do not remit within three months with adequate treatment, there is a considerable risk of a poor long-term outcome, particularly for patients with a deterioration in premorbid social functioning, a DUP of at least half a year, and a diagnosis within the core schizophrenia spectrum.
Authors: Melissa A Weibell; Wenche Ten Velden Hegelstad; Bjørn Auestad; Jørgen Bramness; Julie Evensen; Ulrik Haahr; Inge Joa; Jan Olav Johannessen; Tor Ketil Larsen; Ingrid Melle; Stein Opjordsmoen; Bjørn Rishovd Rund; Erik Simonsen; Per Vaglum; Thomas McGlashan; Patrick McGorry; Svein Friis Journal: Schizophr Bull Date: 2017-07-01 Impact factor: 9.306
Authors: Paola Dazzan; Julia M Lappin; Margaret Heslin; Kim Donoghue; Ben Lomas; Uli Reininghaus; Adanna Onyejiaka; Tim Croudace; Peter B Jones; Robin M Murray; Paul Fearon; Gillian A Doody; Craig Morgan Journal: Psychol Med Date: 2019-07-25 Impact factor: 7.723
Authors: Jaana Suvisaari; Outi Mantere; Jaakko Keinänen; Teemu Mäntylä; Eva Rikandi; Maija Lindgren; Tuula Kieseppä; Tuukka T Raij Journal: Front Psychiatry Date: 2018-11-13 Impact factor: 4.157