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Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia

Published online by Cambridge University Press:  05 October 2015

K. Jaracz ,
K. Górna ,
J. Kiejda ,
B. Grabowska-Fudala ,
J. Jaracz ,
A. Suwalska  and
J.K. Rybakowski
K. Jaracz*
Affiliation:
Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland
K. Górna
Affiliation:
Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland
J. Kiejda
Affiliation:
Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland
B. Grabowska-Fudala
Affiliation:
Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Smoluchowski 11 street, 60-179, Poznan, Poland
J. Jaracz
Affiliation:
Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
A. Suwalska
Affiliation:
Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
J.K. Rybakowski
Affiliation:
Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
*
⁎Corresponding author. Tel.: +048 61 6559 267; fax: +048 61 6559 266. E-mail address:[email protected] (K. Jaracz).
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Abstract

Objectives

The aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.

Methods

Sixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4–6 years (T3), and 7–11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients’ psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.

Results

Among them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.

Conclusions

Our results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

Keywords

SchizophreniaFirst episodeRemissionSocial functioningQuality of lifeLong-term study
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 8 , November 2015 , pp. 907 - 913
Copyright
Copyright © European Psychiatric Association 2020

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References

Al Aqeel, B.Margolese, H.C.Remission in schizophrenia: critical and systematic review. Harv Rev Psychiatry 2013;20:281–297.CrossRefGoogle Scholar
Andreasen, N.C.Carpenter, W.T.Kane, J.M.Lasser, R.A.Marder, S.R.Weinberger, D.R.Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005;162:441–449.CrossRefGoogle ScholarPubMed
Austin, S.F.Mors, O.Secher, R.G.Hjorthøj, C.R.Albert, N.Bertelsen, M., et al.Predictors of recovery in first episode psychosis: the OPUS cohort at 10-year follow-up. Schizophr Res 2013;150:163–168.CrossRefGoogle ScholarPubMed
Bellack, A.S.Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull 2006;32:432–442.CrossRefGoogle ScholarPubMed
Birchwood, M.Smith, J.Cochrane, R.Wetton, S.Copestake, S.The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br J Psychiatry 1990;157:853–859.CrossRefGoogle ScholarPubMed
Birgenheir, G.D.Pepper, M.C.Social functioning across the course of schizophrenia. Curr Psychiatr Rev 2013;9:284–292.CrossRefGoogle Scholar
Bodén, R.Sundström, J.Lindström, E.Lindström, L.Association between symptomatic remission and functional outcome in first-episode schizophrenia. Schizophr Res 2009;107:232–237.CrossRefGoogle ScholarPubMed
Bottlender, R.Sato, T.Jäger, M.Wegener, U.Wittmann, J.Strauss, A., et al.The impact of the duration of untreated psychosis prior to first psychiatric admission on the 15-year outcome in schizophrenia. Schizophr Res 2003;62:37–44.CrossRefGoogle Scholar
Brissos, S.Balanzá-Martinez, V.Dias, V.V.Carita, A.I.Figueira, M.L.Is personal and social functioning associated with subjective quality of life in schizophrenia patients living in the community?. Eur Arch Psychiatry Clin Neurosci 2011;261:509–517.CrossRefGoogle ScholarPubMed
Brissos, S.Dias, V.V.Balanzá-Martinez, V.Carita, A.I.Figueira, M.L.Symptomatic remission in schizophrenia patients: relationship with social functioning, quality of life, and neurocognitive performance. Schizophr Res 2011;129:133–136.CrossRefGoogle ScholarPubMed
Cechnicki, A.Cichocki, Ł.Kalisz, A.Błądziński, P.Adamczyk, P.Franczyk-Glita, J.Duration of untreated psychosis (DUP) and the course of schizophrenia in a 20-year follow-up study. Psychol Res 2014;219:420–425.Google Scholar
Cichocki, Ł.Cechnicki, A.Franczyk-Glita, J.Błądziński, P.Kalisz, A.Wroński, K.Quality of life in a 20-year follow-up study of people suffering from schizophrenia. Compr Psychiatry 2015;56:133–140.CrossRefGoogle Scholar
Cummins, R.A.On the trail of the gold standard for subjective well-being. Soc Indic Res 1995;35:179–200.CrossRefGoogle Scholar
Davidson, L.Roe, D.Andres-Hyman, R.Ridgway, P.Applying stages of change models to recovery from serious mental illness: contributions and limitations. Isr J Psychiatry Relat Sci 2010;47:213–221.Google ScholarPubMed
de Haan, L.Nimwegen, L.Amelsvoort, T.Dingemans, P.Linszen, D.Improvement of subjective well-being and enduring symptomatic remission, a 5-year follow-up of first episode schizophrenia. Pharmacopsychiatry 2008;41:125–128.CrossRefGoogle ScholarPubMed
Díaz, I.Pelayo-Terán, J.M.Pérez-Iglesias, R.Mata, I.Tabarés-Seisdedos, R.Suárez-Pinilla, P., et al.Predictors of clinical remission following a first episode of non-affective psychosis: sociodemographics, premorbid and clinical variables. Psychiatry Res 2013;206:181–187.CrossRefGoogle ScholarPubMed
Eberhard, J.Levander, S.Lindström, E.Remission in schizophrenia: analysis in a naturalistic setting. Compr Psychiatry 2009;50:200–208.CrossRefGoogle Scholar
Emsley, R.Chiliza, B.Asmal, L.Lehloenya, K.The concepts of remission and recovery in schizophrenia. Curr Opin Psychiatry 2011;24:114–121.Google Scholar
Endicott, J.Spitzer, R.L.Fleiss, J.L.Cohen, J.The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976;33:766–771.CrossRefGoogle ScholarPubMed
Fervaha, G.Foussias, G.Agid, O.Remington, G.Impact of primary negative symptoms on functional outcomes in schizophrenia. Eur Psychiatry 2014;29:449–455.CrossRefGoogle Scholar
Figueira, M.L.Brissos, S.Measuring psychosocial outcomes in schizophrenia patients. Curr Opin Psychiatry 2011;24:91–99.Google ScholarPubMed
Gaebel, W.Riesbeck, M.Wölwer, W.Klimke, A.Eickhoff, M.von Wilmsdorff, M., et al.Rates and predictors of remission in first-episode schizophrenia within 1 year of antipsychotic maintenance treatment. Results of a randomized controlled trial within the German Research Network on Schizophrenia. Schizophr Res 2014;152:478–86.CrossRefGoogle ScholarPubMed
Górna, K.Jaracz, K.Rybakowski, F.Rybakowski, J.Determinants of objective and subjective quality of life in first-time-admission schizophrenic patients in Poland: a longitudinal study. Qual Life Res 2008;17:237–247.CrossRefGoogle ScholarPubMed
Górna, K.Jaracz, K.Jaracz, J.Kiejda, J.Grabowska-Fudala, B.Rybakowski, J.Social functioning and quality of life in schizophrenia patients–relationship with symptomatic remission and duration of illness. Psychiatr Pol 2014;48:277–288.Google ScholarPubMed
Häfner, H.Maurer, K.Löffler, W.van der Heiden, W.Hambrecht, M.Schultze-Lutter, F.Modeling the early course of schizophrenia. Schizophr Bull 2003;29:325–340.CrossRefGoogle ScholarPubMed
Harvey, P.Bellack, A.Towards a terminology for functional recovery in schizophrenia: is functional remission a viable concept? Schizophr Bull 2009;35:300–306.CrossRefGoogle Scholar
Heering, H.D.Janssens, M.Boyette, L.-L.van Haren Neeltje, E.M.G.R.O.U.P. investigators. Remission criteria and functional outcome in patients with schizophrenia, a longitudinal study. Aust NZ J Psychiatry 2015;49:266–274.CrossRefGoogle ScholarPubMed
Helldin, L.Kane, J.M.Hjärthag, F.Norlander, T.The importance of cross-sectional remission in schizophrenia for long-term outcome: a clinical prospective study. Schizophr Res 2009;115:67–73.CrossRefGoogle ScholarPubMed
Hill, M.Crumlish, N.Clarke, M.Whitty, P.Owens, E.Renwick, L., et al.Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12 years. Schizophr Res 2012;141:215–221.CrossRefGoogle ScholarPubMed
Ichinose, H.Nakane, Y.Nakane, H.Kinoshita, H.Ohta, Y.Honda, S., et al.Nagasaki Schizophrenia Study: relationship between ultralong-term outcome (after 28 years) and duration of untreated psychosis. Acta Med Nagasaki 2010;54:59–66.Google Scholar
Jaracz, K.Kalfoss, M.Górna, K.Bączyk, G.Quality of life in Polish respondents: psychometric properties of the Polish WHOQOL-Bref. Scand J Caring Sci 2006;20:251–260.CrossRefGoogle ScholarPubMed
Jaracz, K.Górna, K.Kiejda, J.Rybakowski, J.Prospective evaluation of the early course of schizophrenia in men and women after a first psychiatric hospitalization. Psychiatr Pol 2008;42:33–46.Google ScholarPubMed
Jobe, T.H.Harrow, M.Long-term outcome of patients with schizophrenia: a review. Can J Psychiatry 2005;50:892–900.CrossRefGoogle ScholarPubMed
Karadayi, G.Emiroğlu, B.Üçok, A.Relationship of symptomatic remission with quality of life and functionality in patients with schizophrenia. Compr Psychiatry 2011;52:701–707.CrossRefGoogle ScholarPubMed
Kay, S.R.Flszbein, A.Opfer, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.CrossRefGoogle Scholar
Lambert, M.Schimmelmann, B.G.Naber, D.Schacht, A.Karow, A.Wagner, T., et al.Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. J Clin Psychiatry 2006;67:1690–1697.CrossRefGoogle ScholarPubMed
Lambert, M.Naber, D.Schacht, A.Wagner, T.Hundemer, H.P.Karow, A.Rates and predictors of remission and recovery during 3 years in 392 never–treated patients with schizophrenia. Acta Psychiatr Scand 2008;118:220–229.CrossRefGoogle ScholarPubMed
Lambert, M.De Marinis, T.Pfeil, J.Naber, D.Schreiner, A.Establishing remission and good clinical functioning in schizophrenia: predictors of best outcome with long-term risperidone long-acting injectable treatment. Eur Psychiatry 2010;25:220–229.CrossRefGoogle ScholarPubMed
Lambert, M.Karow, A.Leucht, S.Schimmelmann, B.G.Naber, D.Remission in schizophrenia: validity, frequency, predictors, and patients’ perspective 5 years later. Dialogues Clin Neurosci 2010;12:393–407.Google ScholarPubMed
Lang, F.U.Kösters, M.Lang, S.Becker, T.Jäger, M.Psychopathological long-term outcome of schizophrenia–a review. Acta Psychiatr Scand 2013;127:173–182.CrossRefGoogle ScholarPubMed
Newman, S.C.Bland, R.C.Thompson, A.H.Long-term course and outcome in schizophrenia: a 34-year follow-up study in Alberta, Canada. Psychol Med 2012;42:2137–2143.CrossRefGoogle ScholarPubMed
Penttilä, M.Miettunen, J.Koponen, H.Kyllönen, M.Veijola, J.Isohanni, M., et al.Association between the duration of untreated psychosis and short-and long-term outcome in schizophrenia within the Northern Finland 1966 Birth Cohort. Schizophr Res 2013;143:3–10.CrossRefGoogle ScholarPubMed
Peuskens, J.Gorwood, P.EGOFORS Initiative. How are we assessing functioning in schizophrenia? A need for a consensus approach. Eur Psychiatry 2012;27:391–395.CrossRefGoogle ScholarPubMed
Remington, G.Foussias, G.Agid, O.Progress in defining optimal treatment outcome in schizophrenia. CNS Drugs 2010;24:9–20.CrossRefGoogle Scholar
Schennach-Wolff, R.Jäger, M.Obermeier, M.Schmauss, M.Laux, G.Pfeiffer, H., et al.Quality of life and subjective well-being in schizophrenia and schizophrenia spectrum disorders: valid predictors of symptomatic response and remission? World J Biol Psychiatry 2010;11:729–738.CrossRefGoogle ScholarPubMed
Skevington, S.M.Lotfy, M.O’Connell, K.A.The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from WHOQOL Group. Qual Life Res 2004;13:299–310.CrossRefGoogle Scholar
Verma, S.Subramaniam, M.Abdin, E.Poon, L.Y.Chong, S.A.Symptomatic and functional remission in patients with first-episode psychosis. Acta Psychiatr Scand 2012;126:282–289.CrossRefGoogle ScholarPubMed
Wolter, A.Preuss, U.Krischke, N.Wong, J.Langosch, J.M.Zimmermann, J.Recovery and remission in schizophrenia. Results from a naturalistic 2-year follow-up inpatient study. Fortschr Neurol Psychiatr 2010;78:468–474.CrossRefGoogle ScholarPubMed
Wolter, A.Preuss, U.Krischke, N.Wong, W.Zimmermann, J.Remission, prediction and stability of symptoms in schizophrenia: a naturalistic 12-month follow-up study. Int J Psychiatry Clin Pract 2010;14:160–167.CrossRefGoogle ScholarPubMed
Wunderink, L.Sytema, S.Nienhuis, F.J.Wiersma, D.Clinical recovery in first-episode psychosis. Schizophr Bull 2009;35:362–369.CrossRefGoogle ScholarPubMed
Załuska, M.Skala Funkcjonowania Społecznego (SFS) Birchwooda jako narzędzie oceny funkcjonowania chorych na schizofrenię. Post Psychiatr Neurol 1997;6:237–251.Google Scholar
Zimmermann, J.Wolter, A.Hannöver, W.Krischke, N.Remissionshäufigkeit bei schizophren erkrankten Patienten innerhalb eines Jahres nach der Klinikentlassung. Psychiat Prax 2009;36:182–188.CrossRefGoogle Scholar
Zipursky, R.B.Reilly, J.Murray, R.M.The myth of schizophrenia as a progressive brain disease. Schizophr Bull 2013;39:1363–1372.CrossRefGoogle ScholarPubMed
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