Outcome Trajectories for Patients With First Episode Psychosis

Psychiatry Advisor Contributing Writer
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Using 3 independent predictor variables, 4 distinct and reliable patterns developed for functional recovery trajectories after a first episode of psychosis, according to a study published in Schizophrenia Research.

Researchers used the K-means cluster modeling for longitudinal data 3D algorithm to assess functional outcome trajectories using the variables of positive symptoms, negative symptoms, and neurological examination abnormalities of patients after a first episode of psychosis. Using data from The Pittsburgh First Episode of Psychosis Longitudinal Cohort Study, patients who met the DSM-IV criteria for a psychotic disorder who were not previously treated for psychosis were included in this study. Social-demographic characteristics, clinical evaluations, illness severity, positive and negative symptoms, general psychopathology symptoms, depression, personality assessments, executive function, neurological examination abnormalities, and neurological “soft” signs were evaluated at baseline, 4 to 8 weeks, 6 months, and 12 months.

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Of the 129 patients included in this study, 46 were women, 76 were white, 82 were diagnosed with schizophrenia, and 47 were diagnosed with nonschizophrenia psychoses. The best fit solution included 4 trajectories:

  • poor outcome by having severe symptoms at baseline and poor functional recovery,
  • middle outcome by having moderate symptoms at baseline and a partial functional recovery,
  • good outcome by having mild symptoms at baseline and a high functional recovery, and
  • catch-up outcome by having severe symptoms at baseline and a good functional recovery.

Patients in the poor outcome category were more often men of an ethnic minority from a low socioeconomic status with personality disorder traits, substance use history, and low executive function and premorbid adjustment. Patients in the catch-up category were more often white women from a higher socioeconomic status with less substance use history and a higher IQ, executive function, and premorbid adjustment. Patients in the good outcome category were more often white women from a higher socioeconomic status with lower psychopathology traits, less substance use history, and a higher IQ and executive function.

Limitations to this study include the relatively short follow-up period with few patients being followed for the entire year, only using baseline characteristics to categorize patients, and not including outside social support and treatment adherence as a contributing factor.

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The researchers concluded they were able “to derive distinct, homogeneous clusters of short-term functional outcome trajectories in a sample of patients with [first episode of psychosis],” and these trajectories “can facilitate better characterization of individual longitudinal patterns of functioning recovery.”

Reference

Hall MH, Holton KM, Öngür D, Montrose D, Keshavan MS. Longitudinal trajectory of early functional recovery in patients with first episode psychosis [published February 28, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.02.003