Treatment of the patient with long-term schizophrenia

1997 ◽  
Vol 3 (6) ◽  
pp. 339-346 ◽  
Author(s):  
Ann Mortimer
Keyword(s):  
Negative Symptoms ◽  
Chronic Illnesses ◽  
First Episode ◽  
Positive Symptoms ◽  
Loss Of Self ◽  
Appropriate Treatment ◽  
Community Skills ◽  
First Episode Of Schizophrenia ◽  
Over Time

At most, 15% of patients in Western countries remain free of relapse after their first episode of schizophrenia (Crow et al, 1986). Like many chronic illnesses, schizophrenia can be controlled by appropriate treatment, but there may be a gradual deterioration over time. This encompasses problems such as loss of self-care, communication and community skills; negative symptoms of poverty of affect and ideation; cognitive impairment; behaviour problems such as aggression; and poorly controlled positive symptoms.

scholarly journals S121. OPUS 20, 20 YEAR FOLLOW-UP ON THE OPUS TRIAL

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Marie Starzer ◽  
Carsten Hjorthøj ◽  
Nikolai Albert ◽  
Merete Nordentoft ◽  
Helene Lund Sørensen
Keyword(s):  
Negative Symptoms ◽  
Participation Rate ◽  
First Episode ◽  
Episode Psychosis ◽  
Health Project ◽  
Gaf Scores ◽  
Positive And Negative Symptoms ◽  
Over Time

Abstract Background Since the first OPUS trial 20 years ago, structured clinical assessments have been collected from a cohort of first episode psychosis patients at 2, 5 and 10 years follow-up. They found that the symptomatology of patients clustered in distinct groups, and they were able to determine stable long-term trajectories of positive and negative symptoms. The Suffolk County Medical health project has followed patients after a first episode psychosis for 20 years. They also found a stable course of trajectories but with an overall significant worsening of symptom severity over time. The 20 year OPUS follow-up will give us the first opportunity to assess the long term outcome in a large representative cohort treated within modern mental health services with treatment available for all. Methods From 1998 to 2000 578 participants were randomized to OPUS or TAU. Baseline characteristics of the cohort were as follows: mean age 26.6 years, 59% were males, 66% had a diagnosis of schizophrenia and 27% had a secondary diagnosis of alcohol or substance abuse At the 20 year follow-up the investigators will be blinded to the original treatment allocation. The patients who wish to participate will be assessed using SAPS, SANS, SCAN, PSP and GAF. Socio-demographic factors and suicidal ideation will be register via self report. Cognitive function will be tested using BACS and all participants will be asked to fill out a number of self-rating questioners including WHO quality of life-BREF, self-perceived health, strengths and difficulties, the parenting scale and self-perceived negative symptoms. Using national Danish registers we can collect information on all former participants regarding the use of psychiatric and general healthcare services, medication, supported housing or homelessness, employment status, substance abuse and mortality. Results The OPUS 20 study started collecting data in Jan 2018. We are attempting to contact as many patients as possible from the 578 participants in the original OPUS cohort. At the time of writing we had included data and attempted contact to 322 participants. Overall 104 people (31,7%) have agreed to participate in the interviews. In the follow-up 10 years ago, the participation-rate was 60% so this is a big drop in participation rate. 41 (14%) have died, 31 (9,5%) were lost due to emigration, homelessness or hidden identity and/or disempowerment. 70 (21,3%) didn’t wish to participate and 76 (23,2%) never responded. Discussion Psychotic disorders and schizophrenia in particular are associated with progressive worsening of symptoms and profound social impairment, and as such are still very stigmatized. Results from the 10 year OPUS follow-up found stable trajectories of positive and negative symptoms over time, with a tendency of reduction and stabilization of positive symptoms but less variation of negative symptoms. They found poor but stable social functioning with a mean GAF score of 55 after 10 years. The Suffolk County mental health project also found stable trajectories of psychopathology measured with SAPS and SANS. They however found progressive worsening of GAF scores declining form 49 points at the beginning to 36 after 20 years. So far we have seen stable GAF scores and SAPS and SANS scores compared to OPUS 10. This gives rise to some optimism about the prognosis for schizophrenia compared to the findings of the Suffolk study. In our study the extensive interviews combined with the data collected form Danish registers give us a unique opportunity to look at the long term course of illness after FEP. The ability to test if previous findings are robust over time will be essential to the development of targeted interventions, differentiated to the needs of different patient groups.

scholarly journals S115. EVALUATION OF THE CLINICAL UTILITY OF SYMPTOM DIMENSIONS ON LONG-TERM CLINICAL AND FUNCTIONAL OUTCOMES IN FIRST EPISODE PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S78-S78
Author(s):  
Ege Bor ◽  
Diego Quattrone ◽  
Victoria Rodriguez ◽  
Luis Alameda ◽  
Sinan Guloksuz ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Utility ◽  
Negative Symptoms ◽  
First Episode ◽  
Global Functioning ◽  
Symptom Dimensions ◽  
Episode Psychosis ◽  
Over Time

Abstract Background Current clinical utility of diagnostic categories in patients with psychosis is in debate. Alternatively, symptom-based dimensional approaches are suggested, but research on their utility and longitudinal stability is at its early phases, showing lack of consistencies. The aims of this prospective study are: 1) to test the stability of structure of symptom dimensions in first episode psychosis patients; 2) to explore the utility of symptom dimensions in predicting clinical and functional outcomes. Methods This study included a total of 208 with first episode of psychosis-spectrum disorders aged 18–65 years who presented to psychiatric services in South London, recruited as part of the Genetics and Psychosis Outcome (GAP) case-control study and EU-GEI multicentre case-control study. A subsample of 114 patients were traced after a mean of 6.5 years. Psychopathology was assessed at baseline and at follow-up using OPCRIT and tested with bifactor model, encompassing one general psychosis dimension and five specific symptom dimensions (positive, negative, disorganisation, mania, and depression). Follow up measures on functional outcome (assessed with GAF scale) and clinical outcomes (number and total length of hospitalisations) were derived from clinical records. Predictor role of baseline symptom dimensions was tested by multiple linear regression to predict global functioning; and by negative binomial regression for length of hospitalisation and number of hospital admissions. Results Factor loadings of disorganisation dimension were most likely to change longitudinally while loadings of positive dimension were most stable. Regarding dimension stability over time, all positive, disorganised and depressive symptoms significantly improved over time while manic and negative symptoms did not significantly differ. In terms of prediction of outcome, baseline manic symptoms were associated with reduced risk of hospitalisation (adj OR 1.56; 95% CI 1.01–2.38), reduced length of hospitalisation (adj IRR= 0.73; 95% CI 0.56–0.95) and better global functioning (β=5.21; 95% CI 2.46–7.95) at follow up. Similarly, depressive symptoms were associated with reduced length of hospitalisation (adj IRR= 0.77; CI 0.61–0.97). On the other hand, baseline positive symptoms were associated with increased risk of hospitalisation (adj OR 1.93; 95% CI 1.25–2.96). No other significant associations were found between the rest of symptom dimensions and outcomes. Discussion This study provides new evidence on the longitudinal stability of bifactor model of psychosis and, shows that all except manic and negative symptoms significantly improved over time. Whereas affective symptoms (including mania and depression) were associated with good prognosis, positive symptoms seem to predict poor clinical outcomes. The particular and different influence of affective and psychotic symptoms on long-term functional and clinical outcomes may have therapeutic implications and support the potential clinical utility of incorporating symptom-based approach in further outcome research.

Characteristics of Outcome in Schizophrenia at 13 Years

1995 ◽  
Vol 167 (5) ◽  
pp. 596-603 ◽  
Author(s):  
Peter Mason ◽  
Glynn Harrison ◽  
Cristine Glazebrook ◽  
Ian Medley ◽  
Tim Dalkin ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Follow Up Studies ◽  
Long Term Follow Up ◽  
Lost To Follow Up ◽  
Representative Cohort ◽  
First Episode Of Schizophrenia

BackgroundThis paper describes the 13-year outcome of an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia.MethodIn a 13-year follow-up study of a cohort identified in Nottingham in 1978–80, the outcome (symptoms, disability, residence and treatment) was assessed using standardised instruments.ResultsFour of the original 67 patients with ICD–9 schizophrenia were lost to follow-up and five were dead: 52% were without psychotic symptoms in the last two years of follow-up, 52% were without negative symptoms and 55% showed good/fair social functioning. However, only 17% were alive at follow-up, without symptoms and disability, and receiving no treatment.ConclusionsThe findings reported are similar to those of other long-term follow-up studies of schizophrenia and also to 5-year follow-up studies. Kraepelin's emphasis on the longitudinal implications of a diagnosis of schizophrenia are supported, but may be over-pessimistic.

Positive and Negative Symptom Course in Chronic Community-Based Patients

1995 ◽  
Vol 166 (5) ◽  
pp. 634-641 ◽  
Author(s):  
Donald M. Quinlan ◽  
David Schuldberg ◽  
Hal Morgenstern ◽  
William Glazer
Keyword(s):  
Maintenance Treatment ◽  
Negative Symptoms ◽  
Positive Symptoms ◽  
Community Based ◽  
Symptom Profile ◽  
Schizophrenic Patients ◽  
Positive And Negative Symptoms ◽  
Over Time

BackgroundThe long-term symptom profile of chronic out-patients was studied.Method. 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over out-patient maintenance treatment.ResultsOverall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P< 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change.ConclusionSupport is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of ‘progressive downward course’ in schizophrenia.

The core dimensions of schizophrenia

2020 ◽  
pp. 565-573
Author(s):  
Nancy C Andreasen
Keyword(s):  
Intelligence Quotient ◽  
Negative Symptoms ◽  
Three Dimensions ◽  
Psychotic Symptoms ◽  
Outcome Predictors ◽  
Positive Symptoms ◽  
Illness Onset ◽  
Premorbid Adjustment ◽  
High Intelligence ◽  
Over Time

Schizophrenia is a devastating illness that usually affects many aspects of a person’s life. The symptoms may be divided into two groups. ‘Positive’ symptoms include a variety of psychotic symptoms such as delusions and hallucinations. Although severe, they are less handicapping than negative symptoms such as avolition or anhedonia. Positive symptoms involve the presence of things that should be absent, while negative symptoms involve the absence of things that should be present. Dimensional approaches for classifying symptoms have also become popular in current nosology, proposing three dimensions: positive, negative, and disorganized. The course of the illness evolves over time; a prodrome is often present, followed by illness onset and a variable outcome. Good outcome predictors include good premorbid adjustment, high intelligence quotient, and good social relationships. The pathophysiology of the illness includes genetic, neuropathological, and neurodevelopmental components. A possible association with creativity may suggest reasons why the illness has persisted over many centuries.

First-episode schizophrenia

1998 ◽  
Vol 172 (S33) ◽  
pp. 77-83 ◽  
Author(s):  
Richard Jed Wyatt ◽  
L. Michelle Damiani ◽  
Ioline D. Henter
Keyword(s):  
Early Intervention ◽  
Response To Treatment ◽  
First Episode ◽  
Antipsychotic Medications ◽  
First Episode Schizophrenia ◽  
First Episode Of Schizophrenia

BackgroundThe concept that early intervention with antipsychotic medications improves the long-term course of schizophrenia is discussed.MethodThis report reviews the literature concerning early intervention with antipsychotic medications for people with firstepisodes, and how it affects long-term morbidity. It also studies the effects of discontinuing antipsychotic medications on relapse for people with first episodes.ResultsEarly intervention with antipsychotic medications appears to decrease the long-term morbidity of schizophrenia.ConclusionsEarly intervention with antipsychotic medications should be encouraged for people experiencing their first episode of schizophrenia. This report proposes that studying the various phases of subject response to treatment can be helpful in elucidating when antipsychotic medications should be tapered or withdrawn.

Theory of mind in the early course of schizophrenia: stability, symptom and neurocognitive correlates, and relationship with functioning

2015 ◽  
Vol 45 (10) ◽  
pp. 2031-2043 ◽  
Author(s):  
J. Ventura ◽  
A. Ered ◽  
D. Gretchen-Doorly ◽  
K. L. Subotnik ◽  
W. P. Horan ◽  
...  
Keyword(s):  
Theory Of Mind ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
First Episode ◽  
Positive Symptoms ◽  
Healthy Controls ◽  
Role Functioning ◽  
Recent Onset ◽  
Early Course ◽  
The Relationship

BackgroundNumerous studies have reported links between theory of mind (ToM) deficits, neurocognition and negative symptoms with functional outcome in chronic schizophrenia patients. Although the ToM deficit has been observed in first-episode patients, fewer studies have addressed ToM as a possible trait marker, neurocognitive and symptom correlations longitudinally, and associations with later functioning.MethodRecent-onset schizophrenia patients (n = 77) were assessed at baseline after reaching medication stabilization, and again at 6 months (n = 48). Healthy controls (n = 21) were screened, and demographically comparable with the patients. ToM was assessed with a Social Animations Task (SAT), in which the participants’ descriptions of scenes depicting abstract visual stimuli ‘interacting’ in three conditions (ToM, goal directed and random) were rated for degree of intentionality attributed to the figures and for appropriateness. Neurocognition, symptoms and role functioning were also assessed.ResultsOn the SAT, patients had lower scores than controls for both intentionality (p < 0.01) and appropriateness (p < 0.01) during the ToM condition, at baseline and 6 months. The ToM deficit was stable and present even in remitted patients. Analyses at baseline and 6 months indicated that for patients, ToM intentionality and appropriateness were significantly correlated with neurocognition, negative symptoms and role functioning. The relationship between ToM and role functioning was mediated by negative symptoms.ConclusionsThe ToM deficit was found in recent-onset schizophrenia patients and appears to be moderately trait-like. ToM is also moderately correlated with neurocognition, negative and positive symptoms, and role functioning. ToM appears to influence negative symptoms which in turn makes an impact on role functioning.

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