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Factors influencing relapse during a 2-year follow-up of first-episode psychosis in a specialized early intervention service

  • A. Malla (a1) (a2) (a3), R. Norman (a4) (a5), L. Bechard-Evans (a1) (a3), N. Schmitz (a1) (a2), R. Manchanda (a4) and C. Cassidy (a2) (a3)...

Abstract

Background

Differential association of risk factors associated with relapse following treatment of first-episode psychosis (FEP) have not been studied adequately, especially for patients treated in specialized early intervention (SEI) services, where some of the usual risk factors may be ameliorated.

Method

Consecutive FEP patients treated in an SEI service over a 4-year period were evaluated for relapse during a 2-year follow-up. Relapse was based on ratings on the Scale for Assessment of Positive Symptoms (SAPS) and weekly ratings based on the Life Chart Schedule (LCS). Predictor variables included gender, duration of untreated psychosis (DUP), total duration of untreated illness (DUI), age of onset, pre-morbid adjustment, co-morbid diagnosis of substance abuse during follow-up and adherence to medication. Univariate analyses were followed by logistic regression for rate of relapse and survival analysis with the Cox proportional-hazards regression model for time to relapse as the dependent variables.

Results

Of the 189 eligible patients, 145 achieved remission of positive symptoms. A high rate of medication adherence (85%) and relatively low relapse rates (29.7%) were observed over the 2-year follow-up. A higher relapse rate was associated with a co-morbid diagnosis of substance abuse assessed during the follow-up period [odds ratio (OR) 2.84, 95% confidence interval (CI) 1.24–6.51]. The length of time to relapse was not associated with any single predictor.

Conclusions

Specialized treatment of substance abuse may be necessary to further reduce risk of relapse even after improving adherence to medication.

Copyright

Corresponding author

*Address for correspondence: A. Malla, Professor of Psychiatry, McGill University, Director, Division of Clinical Research, Douglas Mental Health University Institute, 6875 Boul. Lasalle, Montreal, Qc, Canada H4H 1R3. (Email: ashok.malla@douglas.mcgill.ca)

References

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Andreasen, NC (1983). Scale for Assessment of Negative Symptoms (SANS). Department of Psychiatry, College of Medicine, The University of Iowa: Iowa City.
Andreasen, NC (1984). Scale for the Assessment of Positive Symptoms (SAPS). Department of Psychiatry, College of Medicine, The University of Iowa: Iowa City.
Andreasen, NC, Carpenter, WT Jr., Kane, JM, Lasser, RA, Marder, SR, Weinberger, DR (2005). Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441449.
Bartko, JJ, Carpenter, WT Jr. (1976). On the methods and theory of reliability. Journal of Nervous and Mental Disease 163, 307317.
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.
Cantor-Graae, E, Nordstrom, LG, McNeil, TF (2001). Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophrenia Research 48, 6982.
Craig, TK, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M, Dunn, G (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 10671069.
David, A, van Os, J, Jones, P, Harvey, I, Foerster, A, Fahy, T (1995). Insight and psychotic illness. Cross-sectional and longitudinal associations. British Journal Psychiatry 167, 621628.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID). New York State Psychiatric Institute, Biometrics Research: New York.
Hafner, H, Riecher-Rossler, A, Hambrecht, M, Maurer, K, Meissner, S, Schmidtke, A, Fatkenheuer, B, Loffler, W, van der Heiden, W (1992). IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209223.
Hambrecht, M, Hafner, H (1996). Substance abuse and the onset of schizophrenia. Biological Psychiatry 40, 11551163.
Harrigan, SM, McGorry, PD, Krstev, H (2003). Does treatment delay in first-episode psychosis really matter? Psychological Medicine 33, 97110.
Hides, L, Dawe, S, Kavanagh, DJ, Young, RM (2006). Psychotic symptom and cannabis relapse in recent-onset psychosis. Prospective study. British Journal of Psychiatry 189, 137143.
Jarbin, H, Ott, Y, Von Knorring, AL (2003). Adult outcome of social function in adolescent-onset schizophrenia and affective psychosis. Journal of the American Academy of Child and Adolescent Psychiatry 42, 176183.
Kamali, M, Kelly, L, Gervin, M, Browne, S, Larkin, C, O'Callaghan, E (2001). Psychopharmacology: insight and comorbid substance misuse and medication compliance among patients with schizophrenia. Psychiatry Services 52, 161163, 166.
Keshavan, MS, Haas, G, Miewald, J, Montrose, DM, Reddy, R, Schooler, NR, Sweeney, JA (2003). Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychoses. Schizophrenia Bulletin 29, 757769.
Lambert, M, Conus, P, Lubman, DI, Wade, D, Yuen, H, Moritz, S, Naber, D, McGorry, PD, Schimmelmann, BG (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatrica Scandinavica 112, 141148.
Larsen, TK, Moe, LC, Vibe-Hansen, L, Johannessen, JO (2000). Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophrenia Research 45, 19.
Linszen, D, Lenior, M, De Haan, L, Dingemans, P, Gersons, B (1998). Early intervention, untreated psychosis and the course of early schizophrenia. British Journal Psychiatry 172 (Suppl. 33), 8489.
Linszen, DH, Dingemans, PM, Lenior, ME (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273279.
Loebel, AD, Lieberman, JA, Alvir, JM, Mayerhoff, DI, Geisler, SH, Szymanski, SR (1992). Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry 149, 11831188.
Malla, A, Norman, R, McLean, T, Scholten, D, Townsend, L (2003). A Canadian programme for early intervention in non-affective psychotic disorders. Australian and New Zealand Journal of Psychiatry 37, 407413.
Malla, A, Norman, R, Schmitz, N, Manchanda, R, Bechard-Evans, L, Takhar, J, Haricharan, R (2006). Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study. Psychological Medicine 36, 649658.
Malla, A, Payne, J (2005). First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin 31, 650671.
Malla, AK, Norman, RM, Manchanda, R, Townsend, L (2002). Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychological Medicine 32, 11091119.
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975983.
McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305326.
Norman, RM, Lewis, SW, Marshall, M (2005). Duration of untreated psychosis and its relationship to clinical outcome. British Journal of Psychiatry 48, s19s23.
Norman, RM, Malla, AK (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381400.
Owen, RR, Fischer, EP, Booth, BM, Cuffel, BJ (1996). Medication noncompliance and substance abuse among patients with schizophrenia. Psychiatry Services 47, 853858.
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 17851804.
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Ohlenschlaeger, J, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 602605.
Ram, R, Bromet, EJ, Eaton, WW, Pato, C, Schwartz, JE (1992). The natural course of schizophrenia: a review of first-admission studies. Schizophrenia Bulletin 18, 185207.
Robinson, D, Woerner, MG, Alvir, JM, Bilder, R, Goldman, R, Geisler, S, Koreen, A, Sheitman, B, Chakos, M, Mayerhoff, D, Lieberman, JA (1999). Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry 56, 241247.
Robinson, DG, Woerner, MG, McMeniman, M, Mendelowitz, A, Bilder, RM (2004). Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry 161, 473479.
Sorbara, F, Liraud, F, Assens, F, Abalan, F, Verdoux, H (2003). Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects. European Psychiatry 18, 133136.
Spitzer, RL, Cohen, J, Fleiss, JL, Endicott, J (1967). Quantification of agreement in psychiatric diagnosis. A new approach. Archives of General Psychiatry 17, 8387.
Susser, E, Finnerty, M, Mojtabai, R, Yale, S, Conover, S, Goetz, R, Amador, X (2000). Reliability of the life chart schedule for assessment of the long-term course of schizophrenia. Schizophrenia Research 42, 6777.
Swofford, CD, Kasckow, JW, Scheller-Gilkey, G, Inderbitzin, LB (1996). Substance use: a powerful predictor of relapse in schizophrenia. Schizophrenia Research 20, 145151.
Van Mastrigt, S, Addington, J, Addington, D (2004). Substance misuse at presentation to an early psychosis program. Social Psychiatry and Psychiatric Epidemiology 39, 6972.
Verdoux, H, Lengronne, J, Liraud, F, Gonzales, B, Assens, F, Abalan, F, van Os, J (2000). Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects. Acta Psychiatrica Scandinavica 102, 203210.
Verdoux, H, Liraud, F, Bergey, C, Assens, F, Abalan, F, van Os, J (2001). Is the association between duration of untreated psychosis and outcome confounded? A two year follow-up study of first-admitted patients. Schizophrenia Research 49, 231241.
Wade, D, Harrigan, S, Edwards, J, Burgess, PM, Whelan, G, McGorry, PD (2006). Substance misuse in first-episode psychosis: 15-month prospective follow-up study. British Journal of Psychiatry 189, 229234.
Wade, D, Harrigan, SM, Whelan, G, Burgess, P, McGorry, PD (2004). The impact of substance use disorders on clinical outcome in first-episode psychosis. Schizophrenia Research 67 (Suppl. 1), B172.

Keywords

Factors influencing relapse during a 2-year follow-up of first-episode psychosis in a specialized early intervention service

  • A. Malla (a1) (a2) (a3), R. Norman (a4) (a5), L. Bechard-Evans (a1) (a3), N. Schmitz (a1) (a2), R. Manchanda (a4) and C. Cassidy (a2) (a3)...

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