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To analyse associations between brain morphology and longitudinal and cross-sectional measures of outcomes in schizophrenia in a general population sample.
The sample was the Northern Finland 1966 Birth Cohort. In 1999–2001, structural brain MRI and measures of clinical and functional outcomes were analysed for 54 individuals with schizophrenia around the age of 34. Sex, total grey matter, duration of illness and the use of antipsychotic medication were used as covariates.
After controlling for multiple covariates, increased density of the left limbic area was associated with less hospitalisations and increased total white matter volume with being in remission. Higher density of left frontal grey matter was associated with not being on a disability pension and higher density of the left frontal lobe and left limbic area were related to better functioning. Higher density of the left limbic area was associated with better longitudinal course of illness.
This study, based on unselected general population data, long follow-up and an extensive database, confirms findings of previous studies, that morphological abnormalities in several brain structures are associated with outcome. The difference in brain morphology in patients with good and poor outcomes may reflect separable aetiologies and developmental trajectories in schizophrenia.
We analyzed longitudinal course of illness in schizophrenia until age 43 years, and its correlates to antipsychotic medication and cognition.
Northern Finland 1966 Birth Cohort Study has been followed serially since mid-pregnancy. Structural and functional MRI, cognitive, and clinical examinations were performed at ages 34 (73 schizophrenic psychoses, 104 controls) and 43 (63 schizophrenic psychoses, 192 controls); 40 cases and 75 controls participated in both surveys. Psychiatric outcomes have been ascertained through data linkage to a national case registers, hospital charts and clinical evaluations.
Prognosis of schizophrenia is heterogeneous: minority of individuals experience recovery, some achieve remission, but many are on disability pension, and excess mortality (especially suicides) is common. Long duration of untreated psychosis, early age of illness onset and presence of suicidal ideation associated with poorer long-term outcome. Both cases and non-psychotic controls show a small decline in verbal learning and memory, but the difference in decline is not significantly more pronounced in cases. Higher doses of antipsychotics at age 43-years associated to lower education and poorer clinical and functional outcomes, and high cumulative life-time use of antipsychotics associated to decrease of verbal learning and memory in 9-year follow-up.
Based on this naturalistic sample, midlife progression of schizophrenia may follow a variety of different trajectories. Poor clinical course is common but not necessary outcome. Compared to controls, more pronounced cognitive decline was not seen in schizophrenia cases. However, high doses of antipsychotics may relate to a decrease of verbal learning and memory.
We have previously investigated the association between family history of psychosis and long-term outcome in schizophrenia in a systematic review and found no studies that focused on social outcome.
To study effect of family history on long-term occupational, social, clinical and global outcome in schizophrenia.
Aims: In this study we aimed to investigate how family history affects long-term occupational, social, clinical and global outcome in schizophrenia in a population-based cohort study.
Sixty nine persons with schizophrenia spectrum diagnosis from the Northern Finland Birth Cohort 1966 were examined at around 43 years of age, in average 17 years since onset of psychosis. A Strauss-Carpenter Outcome Scale –interview was conducted to gather information regarding occupational, social, clinical and global outcome. The family history of psychosis was examined based on register data and interviews.
Seventeen (24.6%) of the schizophrenia cases had family history of psychosis. The presence of family history of psychosis did not associate statistically significantly to occupational (FH+ vs FH-: mean 24.9 vs. 28.4; p = 0.470), social (34.5 vs. 33.2; p = 0.811), clinical (29.9 vs. 33.4; p = 0.510) or global outcome (22.2 vs. 22.7; p = 0.827).
This was the first original study on effects of family history of psychosis on long-term social outcome in schizophrenia. We did not find statistically significant association between family history of psychosis and long-term outcome in schizophrenia. Since the number of subjects with family history of psychosis was quite low, a study with larger sample size is desirable.
Since the outcome in schizophrenia is heterogeneous and often poor, identification of specific predictors of outcome would be useful in clinical practice.
Subjects with schizophrenic psychoses (n = 103) included in the Northern Finland 1966 Birth Cohort (n = 12,058), representing the general population, were followed-up for an average of 16.4 years. Predictor and outcome data were collected from the nationwide Finnish Hospital Discharge Register, hospital records and interviews.
Insidious onset of illness predicted a rehospitalization due to psychosis in the 2 years after the initial discharge. Being single, having an early onset, insidious onset, suicidal ideations upon the first admission, a rehospitalization and a high number of treatment days due to psychosis in the early stages of the illness all predicted a poorer clinical outcome in the longer term, after a minimum follow-up of 10 years.
This population-based study indicates that clinical and sociodemographic factors around the onset of illness have significance for the long-term outcome in schizophrenia. These prognostic factors should be taken into account in clinical practice.
The Temperament and Character Inventory (TCI) is used to measure novelty seeking (NS), harm avoidance (HA), reward dependence RD), and persistence (P).
We will study temperament in individuals with psychosis and healthy controls.
We aim to study the stability of temperament in individuals with psychotic disorders (with onset of illness before and after first follow-up) and in healthy controls.
As part of the 31-year follow-up survey of the prospective population based Northern Finland 1966 Birth Cohort, the TCI was filled by a large sample of individuals. A subsample of psychotic individuals, with the onset of illness before (n=16) or after (n=15) the 31-year follow-up, and healthy controls (n=117) filled in these scales again at the age of 43. We studied also the association between psychotic symptoms and premorbid temperament.
The 31-year and 43-year temperament scores correlated strongly among controls (Pearson's r: NS 0.68, HA 0.60, RD 0.56, P 0.54), whereas correlations among psychotic individuals with the onset of psychosis before first follow-up were weaker (NS 0.38, HA 0.50, RD 0.17, P 0.53). High HA before the onset of illness (at age of 31 years) associated significantly with a lower likelihood of remission and with more negative, disorganization and total symptoms in the PANSS. High NS before illness associated with a higher likelihood of remission according to the PANSS.
Temperament was stable among controls, and more unstable in individuals with psychoses. Premorbid harm avoidance and novelty seeking predicts the clinical outcome in schizophrenia.
Though neurocognitive dysfunctions are common in schizophrenia, the course and predictors of change of cognition remain uncertain.
To understand the longitudinal changes and their predictors in cognition, which is important for the etiological investigation of schizophrenia.
Aims. To analyse if premorbid school performance, age of illness onset and the severity of illness predicts change in cognition in schizophrenia in a general population sample.
The sample included cases with schizophrenia spectrum disorder from the Northern Finland 1966 Birth Cohort. Data on school marks at age 16 yearsand severity of symptoms and occupational functioning around first episode and after years of illness were gained from national registers, hospital notes and interviews. Verbal and visual memory and executive functioning were measured twice, at ages 34 and 43 years. The number of cases varied in analyses from 29 to 41, depending on the analysed cognitive test.
Association between lower school marks at age 16-years and decrease in executive functioning (p=0.032) and visual learning and memory (p=0.039) was found, even when adjusted by age of illness onset and cognitive functioning at age 34-years. Change of cognition was not predicted by severity of symptoms nor occupational functioning. Male gender associated to decrease of executive functioning (p=0.032) and earlier age of illness onset to decrease of visual learning and memory (p=0.045).
School performance at age 16 years associates to later longitudinal change of cognition. Based on our results, later cognitive functioning may reflect the evolution of schizophrenia illness.
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