Wing Chung Chang1, Vivian Wing Yan Kwong2, Gloria Hoi Kei Chan2, Olivia Tsz Ting Jim2, Emily Sin Kei Lau2, Christy Lai Ming Hui2, Sherry Kit Wa Chan3, Edwin Ho Ming Lee2, Eric Yu Hai Chen3. 1. Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong. Electronic address: changwc@hku.hk. 2. Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. 3. Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
Abstract
BACKGROUND:Functional remission (FR) is an intermediate and necessary step toward recovery, but is understudied in first-episode psychosis (FEP). We aimed to examine the rate and predictors of FR in FEP patients in the context of a randomized-controlled trial (RCT) comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS:One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment and personality, clinical profiles, functioning, and treatment characteristics were conducted. FR was operationalized as simultaneous fulfillment of attaining adequate functional levels (measured by Social and Occupational Functioning Scale and Role Functioning Scale) and competitive employment at 6 and 12 months. Data analysis was based on 156 subjects who completed follow-up functional assessments. RESULTS:Thirty-one (19.9%) patients achieved FR status. Multivariate binary regression analysis showed that female gender, lower degrees of premorbid schizoid-schizotypal traits, Extended EI treatment condition, lower levels of positive symptoms at intake, and better baseline functioning independently predicted FR. CONCLUSION: This is the first RCT providing supportive evidence to an extension of EI service beyond 2-year treatment duration on further enhancing the likelihood of FR attainment in FEP. Our findings that only approximately 20% of patients achieved FR indicate an unmet therapeutic need for promoting sustained adequate functional improvement in the early stage of psychotic illness.
RCT Entities:
BACKGROUND: Functional remission (FR) is an intermediate and necessary step toward recovery, but is understudied in first-episode psychosis (FEP). We aimed to examine the rate and predictors of FR in FEP patients in the context of a randomized-controlled trial (RCT) comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS: One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment and personality, clinical profiles, functioning, and treatment characteristics were conducted. FR was operationalized as simultaneous fulfillment of attaining adequate functional levels (measured by Social and Occupational Functioning Scale and Role Functioning Scale) and competitive employment at 6 and 12 months. Data analysis was based on 156 subjects who completed follow-up functional assessments. RESULTS: Thirty-one (19.9%) patients achieved FR status. Multivariate binary regression analysis showed that female gender, lower degrees of premorbid schizoid-schizotypal traits, Extended EI treatment condition, lower levels of positive symptoms at intake, and better baseline functioning independently predicted FR. CONCLUSION: This is the first RCT providing supportive evidence to an extension of EI service beyond 2-year treatment duration on further enhancing the likelihood of FR attainment in FEP. Our findings that only approximately 20% of patients achieved FR indicate an unmet therapeutic need for promoting sustained adequate functional improvement in the early stage of psychotic illness.
Authors: Ashok Malla; Ridha Joober; Srividya Iyer; Ross Norman; Norbert Schmitz; Thomas Brown; Danyael Lutgens; Eric Jarvis; Howard C Margolese; Nicola Casacalenda; Amal Abdel-Baki; Eric Latimer; Sally Mustafa; Sherezad Abadi Journal: World Psychiatry Date: 2017-10 Impact factor: 49.548
Authors: Dost Öngür; Cameron S Carter; Raquel E Gur; Diana Perkins; Akira Sawa; Larry J Seidman; Carol Tamminga; Wayne Huggins; Carol Hamilton Journal: Biol Psychiatry Cogn Neurosci Neuroimaging Date: 2019-06-29
Authors: Christoph U Correll; Britta Galling; Aditya Pawar; Anastasia Krivko; Chiara Bonetto; Mirella Ruggeri; Thomas J Craig; Merete Nordentoft; Vinod H Srihari; Sinan Guloksuz; Christy L M Hui; Eric Y H Chen; Marcelo Valencia; Francisco Juarez; Delbert G Robinson; Nina R Schooler; Mary F Brunette; Kim T Mueser; Robert A Rosenheck; Patricia Marcy; Jean Addington; Sue E Estroff; James Robinson; David Penn; Joanne B Severe; John M Kane Journal: JAMA Psychiatry Date: 2018-06-01 Impact factor: 21.596