Early Predictors of Ten-Year Course in First-Episode Psychosis

Svein Friis; Ingrid Melle; Jan Olav Johannessen; Jan Ivar Røssberg; Helene Eidsmo Barder; Julie Horgen Evensen; Ulrik Haahr; Wenche Ten Velden Hegelstad; Inge Joa; Johannes Langeveld; Tor Ketil Larsen; Stein Opjordsmoen; Bjørn Rishovd Rund; Erik Simonsen; Per Wiggen Vaglum; Thomas H McGlashan

doi:10.1176/appi.ps.201400558

Early Predictors of Ten-Year Course in First-Episode Psychosis

Svein Friis, Ingrid Melle, Jan Olav Johannessen, Jan Ivar Røssberg, Helene Eidsmo Barder, Julie Horgen Evensen, Ulrik Haahr, Wenche Ten Velden Hegelstad, Inge Joa, Johannes Langeveld, Tor Ketil Larsen, Stein Opjordsmoen, Bjørn Rishovd Rund, Erik Simonsen, Per Wiggen Vaglum, Thomas H McGlashan

Institut for Klinisk Medicin

30 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	Psychiatric Services
Vol/bind	67
Udgave nummer	4
Sider (fra-til)	438-43
Antal sider	6
ISSN	1075-2730
DOI	https://doi.org/10.1176/appi.ps.201400558
Status	Udgivet - 1 apr. 2016

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10.1176/appi.ps.201400558

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Friis, S., Melle, I., Johannessen, J. O., Røssberg, J. I., Barder, H. E., Evensen, J. H., Haahr, U., Ten Velden Hegelstad, W., Joa, I., Langeveld, J., Larsen, T. K., Opjordsmoen, S., Rund, B. R., Simonsen, E., Vaglum, P. W., & McGlashan, T. H. (2016). Early Predictors of Ten-Year Course in First-Episode Psychosis. Psychiatric Services, 67(4), 438-43. https://doi.org/10.1176/appi.ps.201400558

Friis, S, Melle, I, Johannessen, JO, Røssberg, JI, Barder, HE, Evensen, JH, Haahr, U, Ten Velden Hegelstad, W, Joa, I, Langeveld, J, Larsen, TK, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, PW & McGlashan, TH 2016, 'Early Predictors of Ten-Year Course in First-Episode Psychosis', Psychiatric Services, bind 67, nr. 4, s. 438-43. https://doi.org/10.1176/appi.ps.201400558

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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.",

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author = "Svein Friis and Ingrid Melle and Johannessen, {Jan Olav} and R{\o}ssberg, {Jan Ivar} and Barder, {Helene Eidsmo} and Evensen, {Julie Horgen} and Ulrik Haahr and {Ten Velden Hegelstad}, Wenche and Inge Joa and Johannes Langeveld and Larsen, {Tor Ketil} and Stein Opjordsmoen and Rund, {Bj{\o}rn Rishovd} and Erik Simonsen and Vaglum, {Per Wiggen} and McGlashan, {Thomas H}",

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month = apr,

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doi = "10.1176/appi.ps.201400558",

language = "English",

volume = "67",

pages = "438--43",

journal = "Psychiatric Services",

issn = "1075-2730",

publisher = "American Psychiatric Publishing, Inc.",

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T1 - Early Predictors of Ten-Year Course in First-Episode Psychosis

AU - Friis, Svein

AU - Melle, Ingrid

AU - Johannessen, Jan Olav

AU - Røssberg, Jan Ivar

AU - Barder, Helene Eidsmo

AU - Evensen, Julie Horgen

AU - Haahr, Ulrik

AU - Ten Velden Hegelstad, Wenche

AU - Joa, Inge

AU - Langeveld, Johannes

AU - Larsen, Tor Ketil

AU - Opjordsmoen, Stein

AU - Rund, Bjørn Rishovd

AU - Simonsen, Erik

AU - Vaglum, Per Wiggen

AU - McGlashan, Thomas H

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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.

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1176/appi.ps.201400558

DO - 10.1176/appi.ps.201400558

M3 - Journal article

C2 - 26567932

SN - 1075-2730

VL - 67

SP - 438

EP - 443

JO - Psychiatric Services

JF - Psychiatric Services

IS - 4

ER -

Early Predictors of Ten-Year Course in First-Episode Psychosis

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