Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T13:43:36.642Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 January 2008

A. Malla ,
R. Norman ,
L. Bechard-Evans ,
N. Schmitz ,
R. Manchanda  and
C. Cassidy
A. Malla*
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada Division of Clinical Research, Douglas Mental Health University Institute, Montreal, Quebec, Canada PEPP Montreal, Douglas Hospital, Montreal, Quebec, Canada
R. Norman
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada Department Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
L. Bechard-Evans
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada PEPP Montreal, Douglas Hospital, Montreal, Quebec, Canada
N. Schmitz
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada Division of Clinical Research, Douglas Mental Health University Institute, Montreal, Quebec, Canada
R. Manchanda
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
C. Cassidy
Affiliation:
Division of Clinical Research, Douglas Mental Health University Institute, Montreal, Quebec, Canada PEPP Montreal, Douglas Hospital, Montreal, Quebec, Canada
*
*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: [email protected])
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

First-episode psychosisrelapsesubstance abuse
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 11 , November 2008 , pp. 1585 - 1593
Copyright
Copyright © 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreasen, NC (1983). Scale for Assessment of Negative Symptoms (SANS). Department of Psychiatry, College of Medicine, The University of Iowa: Iowa City.Google Scholar
Andreasen, NC (1984). Scale for the Assessment of Positive Symptoms (SAPS). Department of Psychiatry, College of Medicine, The University of Iowa: Iowa City.Google Scholar
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, 441–449.CrossRefGoogle ScholarPubMed
Bartko, JJ, Carpenter, WT Jr. (1976). On the methods and theory of reliability. Journal of Nervous and Mental Disease 163, 307–317.CrossRefGoogle ScholarPubMed
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.CrossRefGoogle ScholarPubMed
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, 69–82.CrossRefGoogle Scholar
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, 1067–1069.CrossRefGoogle ScholarPubMed
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, 621–628.CrossRefGoogle ScholarPubMed
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.Google Scholar
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, 209–223.CrossRefGoogle ScholarPubMed
Hambrecht, M, Hafner, H (1996). Substance abuse and the onset of schizophrenia. Biological Psychiatry 40, 1155–1163.CrossRefGoogle ScholarPubMed
Harrigan, SM, McGorry, PD, Krstev, H (2003). Does treatment delay in first-episode psychosis really matter? Psychological Medicine 33, 97–110.CrossRefGoogle ScholarPubMed
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, 137–143.CrossRefGoogle ScholarPubMed
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, 176–183.CrossRefGoogle ScholarPubMed
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, 161–163, 166.CrossRefGoogle ScholarPubMed
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, 757–769.CrossRefGoogle ScholarPubMed
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, 141–148.CrossRefGoogle ScholarPubMed
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, 1–9.CrossRefGoogle ScholarPubMed
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), 84–89.CrossRefGoogle ScholarPubMed
Linszen, DH, Dingemans, PM, Lenior, ME (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273–279.CrossRefGoogle ScholarPubMed
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, 1183–1188.Google ScholarPubMed
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, 407–413.CrossRefGoogle ScholarPubMed
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, 649–658.CrossRefGoogle ScholarPubMed
Malla, A, Payne, J (2005). First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin 31, 650–671.CrossRefGoogle ScholarPubMed
Malla, AK, Norman, RM, Manchanda, R, Townsend, L (2002). Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychological Medicine 32, 1109–1119.CrossRefGoogle ScholarPubMed
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, 975–983.CrossRefGoogle ScholarPubMed
McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305–326.CrossRefGoogle ScholarPubMed
Norman, RM, Lewis, SW, Marshall, M (2005). Duration of untreated psychosis and its relationship to clinical outcome. British Journal of Psychiatry 48, s19–s23.CrossRefGoogle ScholarPubMed
Norman, RM, Malla, AK (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381–400.CrossRefGoogle ScholarPubMed
Owen, RR, Fischer, EP, Booth, BM, Cuffel, BJ (1996). Medication noncompliance and substance abuse among patients with schizophrenia. Psychiatry Services 47, 853–858.Google ScholarPubMed
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, 1785–1804.CrossRefGoogle ScholarPubMed
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, 602–605.CrossRefGoogle ScholarPubMed
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, 185–207.CrossRefGoogle ScholarPubMed
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, 241–247.CrossRefGoogle ScholarPubMed
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, 473–479.CrossRefGoogle ScholarPubMed
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, 133–136.CrossRefGoogle ScholarPubMed
Spitzer, RL, Cohen, J, Fleiss, JL, Endicott, J (1967). Quantification of agreement in psychiatric diagnosis. A new approach. Archives of General Psychiatry 17, 83–87.CrossRefGoogle ScholarPubMed
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, 67–77.CrossRefGoogle ScholarPubMed
Swofford, CD, Kasckow, JW, Scheller-Gilkey, G, Inderbitzin, LB (1996). Substance use: a powerful predictor of relapse in schizophrenia. Schizophrenia Research 20, 145–151.CrossRefGoogle ScholarPubMed
Van Mastrigt, S, Addington, J, Addington, D (2004). Substance misuse at presentation to an early psychosis program. Social Psychiatry and Psychiatric Epidemiology 39, 69–72.CrossRefGoogle Scholar
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, 203–210.CrossRefGoogle ScholarPubMed
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, 231–241.CrossRefGoogle ScholarPubMed
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, 229–234.CrossRefGoogle ScholarPubMed
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.Google Scholar