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Predicting first-episode psychosis patients who will never relapse over 10 years

Published online by Cambridge University Press:  30 October 2018

Christy LM Hui*
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong
William G Honer
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, Canada
Edwin HM Lee
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong
WC Chang
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
Sherry KW Chan
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
Emily SM Chen
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong
Edwin PF Pang
Affiliation:
Department of Psychiatry, United Christian Hospital, Hong Kong
Simon SY Lui
Affiliation:
Department of Psychiatry, Castle Peak Hospital, Hong Kong
Dicky WS Chung
Affiliation:
Department of Psychiatry, Tai Po Hospital, Hong Kong
WS Yeung
Affiliation:
Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
Roger MK Ng
Affiliation:
Department of Psychiatry, Kowloon Hospital, Hong Kong
William TL Lo
Affiliation:
Department of Psychiatry, Kwai Chung Hospital, Hong Kong
Peter B Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, England
Pak Sham
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Centre for Genomic Sciences, University of Hong Kong, Hong Kong
Eric YH Chen
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
*
Author for correspondence: Christy LM Hui, E-mail: christy@lmhui.com

Abstract

Background

Although relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode.

Method

Patients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning.

Results

Out of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders.

Conclusions

Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2018 

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