Clinical trajectories in the ultra-high risk for psychosis population

Andrea Polari; Suzie Lavoie; Hok-Pan Yuen; Paul Amminger; Gregor Berger; Eric Chen; Lieuwe deHaan; Jessica Hartmann; Connie Markulev; Fritha Melville; Dorien Nieman; Merete Nordentoft; Anita Riecher-Rössler; Stefan Smesny; John Stratford; Swapna Verma; Alison Yung; Patrick McGorry; Barnaby Nelson

doi:10.1016/j.schres.2018.01.022

Clinical trajectories in the ultra-high risk for psychosis population

Andrea Polari, Suzie Lavoie, Hok-Pan Yuen, Paul Amminger, Gregor Berger, Eric Chen, Lieuwe deHaan, Jessica Hartmann, Connie Markulev, Fritha Melville, Dorien Nieman, Merete Nordentoft, Anita Riecher-Rössler, Stefan Smesny, John Stratford, Swapna Verma, Alison Yung, Patrick McGorry, Barnaby Nelson

Department of Clinical Medicine

21 Citations (Scopus)

Abstract

BACKGROUND: Traditionally, research in the ultra-high risk (UHR) for psychosis population has focused on the treatment of existing symptomatology and prevention of transition to psychosis. Recently, there has been an increase in focus on outcomes in individuals who do not transition to psychosis. However, there is a lack of standardised definitions of remission, recovery, recurrence and relapse in UHR, resulting in the inability to generalise and replicate outcomes.

METHOD: The aims of the current study were to develop definitions for remission, recovery, recurrence and relapse, and apply them to a UHR cohort allowing the identification of longitudinal clinical trajectories. Further stratification in broader categories of favourable and unfavourable outcomes was applied. The predictive value of various baseline factors on specific clinical trajectories was also assessed.

RESULTS: 17 different trajectories were identified in a cohort of 202 individuals within a 12-month period and classified according to the suggested definitions for recovery (35.7%), remission (7.5%), any recurrence (20%), no remission (17.3%), relapse (4.0%) and transition to psychosis (15.8%). Favourable and unfavourable trajectories represented 43.2% and 57.1% respectively. Long duration of untreated symptoms and high depression scores were associated with unfavourable outcomes.

DISCUSSION: It is possible to apply clear definitions of remission, recovery, recurrence, relapse and transition to psychosis to a UHR cohort to evaluate longitudinal clinical trajectories. Acceptance and use of these definitions will help to facilitate comparisons between trials and to improve clinical clarity across the range of available therapeutic options in UHR individuals.

Original language	English
Journal	Schizophrenia Research
Volume	197
Pages (from-to)	550-556
ISSN	0920-9964
DOIs	https://doi.org/10.1016/j.schres.2018.01.022
Publication status	Published - Jul 2018

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Polari, A., Lavoie, S., Yuen, H-P., Amminger, P., Berger, G., Chen, E., deHaan, L., Hartmann, J., Markulev, C., Melville, F., Nieman, D., Nordentoft, M., Riecher-Rössler, A., Smesny, S., Stratford, J., Verma, S., Yung, A., McGorry, P., & Nelson, B. (2018). Clinical trajectories in the ultra-high risk for psychosis population. Schizophrenia Research, 197, 550-556. https://doi.org/10.1016/j.schres.2018.01.022

Polari, A, Lavoie, S, Yuen, H-P, Amminger, P, Berger, G, Chen, E, deHaan, L, Hartmann, J, Markulev, C, Melville, F, Nieman, D, Nordentoft, M, Riecher-Rössler, A, Smesny, S, Stratford, J, Verma, S, Yung, A, McGorry, P & Nelson, B 2018, 'Clinical trajectories in the ultra-high risk for psychosis population', Schizophrenia Research, vol. 197, pp. 550-556. https://doi.org/10.1016/j.schres.2018.01.022

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title = "Clinical trajectories in the ultra-high risk for psychosis population",

abstract = "BACKGROUND: Traditionally, research in the ultra-high risk (UHR) for psychosis population has focused on the treatment of existing symptomatology and prevention of transition to psychosis. Recently, there has been an increase in focus on outcomes in individuals who do not transition to psychosis. However, there is a lack of standardised definitions of remission, recovery, recurrence and relapse in UHR, resulting in the inability to generalise and replicate outcomes.METHOD: The aims of the current study were to develop definitions for remission, recovery, recurrence and relapse, and apply them to a UHR cohort allowing the identification of longitudinal clinical trajectories. Further stratification in broader categories of favourable and unfavourable outcomes was applied. The predictive value of various baseline factors on specific clinical trajectories was also assessed.RESULTS: 17 different trajectories were identified in a cohort of 202 individuals within a 12-month period and classified according to the suggested definitions for recovery (35.7%), remission (7.5%), any recurrence (20%), no remission (17.3%), relapse (4.0%) and transition to psychosis (15.8%). Favourable and unfavourable trajectories represented 43.2% and 57.1% respectively. Long duration of untreated symptoms and high depression scores were associated with unfavourable outcomes.DISCUSSION: It is possible to apply clear definitions of remission, recovery, recurrence, relapse and transition to psychosis to a UHR cohort to evaluate longitudinal clinical trajectories. Acceptance and use of these definitions will help to facilitate comparisons between trials and to improve clinical clarity across the range of available therapeutic options in UHR individuals.",

author = "Andrea Polari and Suzie Lavoie and Hok-Pan Yuen and Paul Amminger and Gregor Berger and Eric Chen and Lieuwe deHaan and Jessica Hartmann and Connie Markulev and Fritha Melville and Dorien Nieman and Merete Nordentoft and Anita Riecher-R{\"o}ssler and Stefan Smesny and John Stratford and Swapna Verma and Alison Yung and Patrick McGorry and Barnaby Nelson",

year = "2018",

month = jul,

doi = "10.1016/j.schres.2018.01.022",

language = "English",

volume = "197",

pages = "550--556",

journal = "Schizophrenia Research",

issn = "0920-9964",

publisher = "Elsevier",

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TY - JOUR

T1 - Clinical trajectories in the ultra-high risk for psychosis population

AU - Polari, Andrea

AU - Lavoie, Suzie

AU - Yuen, Hok-Pan

AU - Amminger, Paul

AU - Berger, Gregor

AU - Chen, Eric

AU - deHaan, Lieuwe

AU - Hartmann, Jessica

AU - Markulev, Connie

AU - Melville, Fritha

AU - Nieman, Dorien

AU - Nordentoft, Merete

AU - Riecher-Rössler, Anita

AU - Smesny, Stefan

AU - Stratford, John

AU - Verma, Swapna

AU - Yung, Alison

AU - McGorry, Patrick

AU - Nelson, Barnaby

PY - 2018/7

Y1 - 2018/7

N2 - BACKGROUND: Traditionally, research in the ultra-high risk (UHR) for psychosis population has focused on the treatment of existing symptomatology and prevention of transition to psychosis. Recently, there has been an increase in focus on outcomes in individuals who do not transition to psychosis. However, there is a lack of standardised definitions of remission, recovery, recurrence and relapse in UHR, resulting in the inability to generalise and replicate outcomes.METHOD: The aims of the current study were to develop definitions for remission, recovery, recurrence and relapse, and apply them to a UHR cohort allowing the identification of longitudinal clinical trajectories. Further stratification in broader categories of favourable and unfavourable outcomes was applied. The predictive value of various baseline factors on specific clinical trajectories was also assessed.RESULTS: 17 different trajectories were identified in a cohort of 202 individuals within a 12-month period and classified according to the suggested definitions for recovery (35.7%), remission (7.5%), any recurrence (20%), no remission (17.3%), relapse (4.0%) and transition to psychosis (15.8%). Favourable and unfavourable trajectories represented 43.2% and 57.1% respectively. Long duration of untreated symptoms and high depression scores were associated with unfavourable outcomes.DISCUSSION: It is possible to apply clear definitions of remission, recovery, recurrence, relapse and transition to psychosis to a UHR cohort to evaluate longitudinal clinical trajectories. Acceptance and use of these definitions will help to facilitate comparisons between trials and to improve clinical clarity across the range of available therapeutic options in UHR individuals.

AB - BACKGROUND: Traditionally, research in the ultra-high risk (UHR) for psychosis population has focused on the treatment of existing symptomatology and prevention of transition to psychosis. Recently, there has been an increase in focus on outcomes in individuals who do not transition to psychosis. However, there is a lack of standardised definitions of remission, recovery, recurrence and relapse in UHR, resulting in the inability to generalise and replicate outcomes.METHOD: The aims of the current study were to develop definitions for remission, recovery, recurrence and relapse, and apply them to a UHR cohort allowing the identification of longitudinal clinical trajectories. Further stratification in broader categories of favourable and unfavourable outcomes was applied. The predictive value of various baseline factors on specific clinical trajectories was also assessed.RESULTS: 17 different trajectories were identified in a cohort of 202 individuals within a 12-month period and classified according to the suggested definitions for recovery (35.7%), remission (7.5%), any recurrence (20%), no remission (17.3%), relapse (4.0%) and transition to psychosis (15.8%). Favourable and unfavourable trajectories represented 43.2% and 57.1% respectively. Long duration of untreated symptoms and high depression scores were associated with unfavourable outcomes.DISCUSSION: It is possible to apply clear definitions of remission, recovery, recurrence, relapse and transition to psychosis to a UHR cohort to evaluate longitudinal clinical trajectories. Acceptance and use of these definitions will help to facilitate comparisons between trials and to improve clinical clarity across the range of available therapeutic options in UHR individuals.

U2 - 10.1016/j.schres.2018.01.022

DO - 10.1016/j.schres.2018.01.022

M3 - Journal article

C2 - 29463457

SN - 0920-9964

VL - 197

SP - 550

EP - 556

JO - Schizophrenia Research

JF - Schizophrenia Research

ER -

Clinical trajectories in the ultra-high risk for psychosis population

Abstract

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