medigraphic.com
ISSN 0185-3325 (Print)
Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2010, Number 6

<< Back Next >>

Salud Mental 2010; 33 (6)

Predictors of short-term course in Mexican first-episode psychosis patients

Gómez-de-Regil L, Kwapil TR, Rosado-Franco A, Barrantes-Vidal N

Language: English
References: 46
Page: 507-515
PDF size: 110.56 Kb.


ABSTRACT


Background and objectives
The identification of prognostic factors in patients with schizophrenia and related psychotic disorders should enhance our understanding of the aetiology of these disorders and improve their treatment. The first years following an initial episode of psychosis are a «critical period» for biological and psychosocial influences that affect future outcome. Both, short-term outcome and baseline predictors, have been defined by different measures, making the comparison among studies difficult. Studies of the predictive value of baseline demographic and clinical characteristics in the Mexican population are still limited. Hence, the present study aims to: 1. replicate the prognostic value of selected patient characteristics previously related to the short-term course of psychosis in Mexican first-episode psychosis patients, and 2. retrospectively assess their prognostic value in the prediction of diagnosis, presence of psychotic residual symptoms, and number of psychotic episodes at least three-years later.
Methods
Information on baseline predictor variables (sociodemographic, premorbid phase, context of the first episode, dimensions of psychopathology) and clinical outcome (diagnosis, residual symptomatology, psychotic episodes) was obtained from the clinical records of 51 patients with a short-term course of psychosis and whose available follow-up period was at least three years long (mean=5.8, SD=2.1).
Results
Poor premorbid adjustment and hospitalization at first psychotic episode were significant predictors of a schizophrenia diagnosis. Lower educational level and an insidious type of onset significantly predicted the presence of residual symptoms. Hospitalization at first psychotic episode and higher scores on the psychotic dimension at onset significantly predicted subsequent psychotic episodes.
Discussion
Low educational level increased the risk of residual symptoms, possibly because it hinders treatment continuity. Poor premorbid adjustment was related to a schizophrenia diagnosis at the follow-up assessment, supporting previous findings of their high ratings for premorbid impairment, including social withdrawal and dysfunctional peer relationship. Insidious onset was predictive of persistent residual symptoms; an association possibly mediated by the duration of untreated psychosis (DUP). Being hospitalized at first episode was a significant prognostic factor for schizophrenia diagnosis and multiple psychotic episodes; the severity and nature of symptoms at first episode that require hospitalization might account for these associations. Replicating previous findings, multiple-episode patients scored significantly higher than the single-episode patients on the psychoticism dimension. Most baseline factors did not predict diagnosis. This seems congruent with a dimensional view of psychosis suggesting that even though schizophrenic and non-schizophrenic psychoses are classified as separate families of disorders, they exist along a continuum of psychosis that crosses diagnostic boundaries, sharing aetiological and risk factors. Currently, both the amelioration of severe psychotic symptoms and the improvement of psychosocial functioning and quality of life are feasible aims. Symptom exacerbation and hospitalizations might cause cumulative deterioration and impair the patient’s social reintegration. Thus, relapse prevention is an important objective in treatment. The identification of reliable predictors of illness course has significant implications for treatment and service planning.
Conclusions
The predictive value of several factors was replicated in this sample of patients with psychotic illnesses, although predictors seem to relate differently to the three short-term course measures. Comprehensively mapping the development and outcome of the first episode of psychosis requires the use of standardized measurement tools and the longitudinal assessment of multiple outcome measures.


REFERENCES

  1. Penn DL, Waldheter EJ, Perkins DO, Mueser KT et al. Psychosocial treatment for first-episode psychosis: A research update. Am J Psychiatry 2005;162(12):2220-2232.

  2. Shepherd M, Watt D, Falloon I, Smeeton N. The natural history of schizophrenia: A five-year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychol Med 1989;15:1-46.

  3. Barnes TRE, Pant A. Long-term course and outcome of schizophrenia. Psychiatry 2005;4(10):29-32.

  4. Rosen K, Garety P. Predicting recovery from schizophrenia: A retrospective comparison of characteristics at onset of people with singe and multiple episodes. Schizophr Bull 2005;31(3):735-7750.

  5. Birchwood M. The critical period for early intervention. In: Birchwood M, Fowler D, Jackson C (eds.). Early intervention in psychosis: A guide to concepts, evidence and interventions. Chichester, UK: John Wiley & Sons Ltd; 2000; pp.28-63.

  6. Wiersma D, Nienhuis FJ, Slooff CJ, Giel R. Natural course of schizophrenic disorders: A 15-year follow-up of a Dutch incidence cohort. Schizophr Bull 1998;24(1):75-85.

  7. Malla AK, Norman RMG, Joober R. First-episode psychosis, early intervention, and outcome: What have we learned? Can J Psychiatry 2005;50(14):881-891.

  8. Menezes NM, Arenovich T, Zipursky RB. A systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med 2006;36(10):1349-1362.

  9. McGorry PD, Killackey E, Yung A. Early intervention in psychosis: Concepts, evidence and future directions. World Psychiatry 2008;7:148- 156.

  10. Marneros A, Deister A, Rohde A. Psychopathological and social status of patients with affective, schizophrenic and schizoaffective disorders after long-term course. Acta Psychiatr Scand. 1990;82(5):352-358.

  11. Möller H, Bottlender R, Wegner U, Wittmann J et al. Long-term course of schizophrenic, affective and schizoaffective psychosis: Focus on negative symptoms and their impact on global indicators of outcome. Acta Psychiatr Scand 2000;102:54-57.

  12. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington, DC; 2000.

  13. Vázquez-Barquero JL, Cuesta-Nuñez MJ, De la Varga M, Herrera-Castanedo S et al. The Cantabria first episode schizophrenia study: A summary of general findings. Acta Psychiatr Scand 1995;91(3):156-162.

  14. Altamura AC, Bassetti R, Sassella F, Salvadori D et al. Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: A retrospective study. Schizophr Res 2001;52(1):29-36.

  15. Gómez-de-Regil L, Kwapil TR, Blanqué JM, Vainer E et al. Predictors of outcome in the early course of first-episode psychosis. Eur J Psychiat 2010 (in press).

  16. Apiquian R, Ulloa RE, Páez F, Nicolini H. The Mexican first-episode psychotic study: Clinical characteristics and premorbid adjustment. Schizophr Res 2002;53(1):161-163.

  17. Apiquián-Guitart R, Fresán-Orellana A, García-Anaya M, Lóyzaga- Mendoza C et al. Impacto de la duración de la psicosis no tratada en pacientes con primer episodio psicótico. estudio de seguimiento a un año. Gac Méd Méx 2006;142(2):113-120.

  18. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-276.

  19. Andreasen NC, Carpenter WTJ, Kane JM, Lasser RA et al. Remission in schizophrenia: Proposed criteria and rationale for consensus. Am J Psychiatry 2005;162(3):441-449.

  20. SPSS Inc. SPSS base 15.0 Users’s guide. USA: Prentice-Hall; 2006.

  21. Apiquián R, Páez F, Loyzaga C, Cruz E et al. Estudio mexicano sobre el primer episodio psicótico: Resultados preliminares, características sociodemográficas y clínicas. Salud Mental 1997 10;20:1-7.

  22. Nosé M, Barbui C, Tansella M. How often do patients with psychosis fail to adhere to treatment programmes? A systematic review. Psychol Med 2003;33(7):1149-1160.

  23. Haim R, Rabinowitz J, Bromet E. The relationship of premorbid functioning to illness course in schizophrenia and psychotic mood disorders during two years following first hospitalization. J Nerv Ment Dis 2006;194(10):791-795.

  24. Caton CLM, Hasin DS, Shrout PE, Drake RE et al. Predictors of psychosis remission in psychotic disorders that co-occur with substance use. Schizophr Bull 2006;32(4):618-625.

  25. Werry JS, McClellan JM, Chard L. Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: A clinical and outcome study. J Am Acad Child Adolesc Psychiatry 1991;30(3):457-465.

  26. McClellan J, McCurry C. Early onset psychotic disorders: Diagnostic stability and clinical characteristics. Eur Child Adolesc Psychiatry 1999;8(1): 13-19.

  27. Morgan C, Abdul-Al R, Lappin JM, Jones P et al. Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study. Br J Psychiatry 2006;189:446-452.

  28. Bromet EJ, Naz B, Fochtmann LJ, Carlson GA et al. Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia. Schizophr Bull 2005;31(3):639-649.

  29. De Haan L, Linszen DH, Lenior ME, Doderlein de Win E et al. Duration of untreated psychosis and outcome of schizophrenia: Delay in intensive psychosocial treatment versus delay in treatment with antipsychotic medication. Schizophr Bull 2003;29(2):341-348.

  30. Miettunen J, Lauronen E, Veijola J, Koponen H et al. Patterns of psychiatric hospitalizations in schizophrenic psychoses within the Northern Finland 1966 birth cohort. Nord J Psychiatry 2006;60(4):286-293.

  31. Jablensky A, Sartorius N. What did the WHO studies really find? Schizophr Bull 2008;34(2):253-255.

  32. Braw Y, Bloch Y, Mendelovich S, Ratzoni G et al. Cognition in young schizophrenia outpatients: Comparison of first-episode with multiepisode patients. Schizophr Bull 2008;34(3):544-554.

  33. Saeedi H, Addington J, Addington D. The association of insight with psychotic symptoms, depression, and cognition in early psychosis: A 3- year follow-up. Schizophr Res 2007;89(1):123-128.

  34. Drake RJ, Dunn G, Tarrier N, Bentall RP et al. Insight as a predictor of the outcome of first-episode nonaffective psychosis in a prospective cohort study in England. J Clin Psychiatry 2007;68(1):81-86.

  35. McEvoy JP, Johnson J, Perkins D, Lieberman JA et al. Insight in firstepisode psychosis. Psychol Med 2006;36(10):1385-1393.

  36. Lincoln TM, Lüllmann E, Rief W. Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull 2007;33(6):1324-1342.

  37. Murray RM, Sham P, Van Os J, Zanelli J et al. A developmental model for similarities and dissimilarities between schizophrenia and bipolar disorder. Schizophr Res 2004;71(2):405-416.

  38. Tsuang MT, Stone WS, Faraone SV. Toward reformulating the diagnosis of schizophrenia. Am J Psychiatry 2000;157(7):1041-1050.

  39. Di Michele V, Bolino F, Mazza M, Roncone R et al. Relapsing versus non relapsing course of schizophrenia: A cohort study in a community based mental health service. Epidemiol Psichiatr Soc 2007;16(1):50-58.

  40. Cuesta MJ, Peralta V, Gil P, Artamendi M. Premorbid negative symptoms in first-episode psychosis. Eur J Psychiat 2007;21(3):220-229.

  41. Heinrichs RW, Ammari N, Vaz SM, Miles AA. Are schizophrenia and schizoaffective disorder neuropsychologically distinguishable? Schizophr Res 2008;99(1):149-154.

  42. Mojtabai R, Bromet EJ, Harvey PD, Carlson GA et al. Neurological differences between first-admission schizophrenia and psychotic affective disorders. Am J Psychiatry 2000;157(9):1453-1460.

  43. Jäger M, Bottlender R, Strauss A, Möller H. Fifteen-year follow-up of ICD-10 schizoaffective disorders compared with schizophrenia and affective disorders. Acta Psychiatr Scand 2004;109(1):30-37.

  44. Nasrallah HA, Lasser R. Improving patient outcomes in schizophrenia: Achieving remission. J Psychopharmacol 2006; 11;20(6):57-61.

  45. Üçok A, Polat A, Çakir S, Genç A. One year outcome in first episode schizophrenia: Predictors of relapse. Eur Arch Psychiatry Clin Neurosci 2006;256(1):37-43.

  46. Taylor M, Chaudhry I, Cross M, McDonald E et al. Towards consensus in the long-term management of relapse prevention in schizophrenia. Hum Psychopharmacol Clin Exp 2005;20(3):175-181.




2020     |     www.medigraphic.com