Factors Predicting Favorable Outcomes in First-Episode Psychosis Without Medication

Researchers from Switzerland, Australia, and Germany identified several predictors of favorable outcomes in young adults who had a first episode of psychosis but who did not take antipsychotic medication.

Predictors of symptomatic remission were a better premorbid functioning level, higher education, and employment status at baseline. Predictors of functional recovery were a shorter duration of the prodrome phase, less severe psychopathology at baseline, and lower cannabis use.

Philippe Conus, MD, from the University of Lausanne in Switzerland, and colleagues collected data from the files of 786 patients with first-episode psychosis who were admitted to the EPPIC (Early Psychosis Prevention and Intervention Centre) between 1998 and 2000.

Of the 786 patients, data on medication adherence were available for 584 of them. During the entire treatment phase, 17.9% of patients consistently refused medication. The researchers compared those who had favorable symptomatic and functional outcomes with those who did not.

Of the 17.9% of patients who refused medication, 41% achieved symptomatic remission and 33% achieved functional recovery.

The researchers noted 3 main findings in their study: nearly 20% of patients who were treated at this center specializing in first-episode psychosis did not take antipsychotic medication for an adequate length of time during the study period; although the group that did not take medication for an adequate length of time had significantly poorer outcomes than those who took antipsychotic medication, some of them did have favorable short-term outcomes (41% had symptom remission and 33% achieved functional recovery); and several characteristics may help profile which young adults may do well without antipsychotic medication:

• Favorable symptomatic outcome was related to better premorbid functional level, number of years of education, and employment or activity status at baseline.
• Good functional outcome was predicted by shorter duration of the prodrome, lower intensity of symptoms, lack of cannabis use, and better vocational status at baseline.

“Our observation that better premorbid functional level, higher number of years of education and employment or activity status at entry to the program predicted symptomatic remission suggests that such individuals are likely to have been exempt from manifestations of the illness during some of the critical years of their school and professional training, and that they may have displayed a relatively swift onset of symptoms,” the investigators wrote. “The observation that favorable functional outcome was related to shorter duration of prodrome, lower intensity of symptoms, and better vocational status at baseline is in line with this hypothesis.”

Limitations

• The validity of file audit studies can be limited by the quality of file entries.
• Prospective adherence ratings were not available to validate file-based assessment.
• This study is not a randomized controlled trial, but this natural setting allows for exploration of the characteristics of those who refuse medication.
• The group who did not receive adequate medication spent significantly less time in treatment, which may bias outcome assessment.
• The researchers did not have data on some demographic factors, such as socioeconomic status.

Reference

Conus P, Cotton SM, Francey SM, et al. Predictors of favourable outcome in young people with a first episode psychosis without antipsychotic medication [published online January 5, 2017]. Schizophr Res. doi: 10.1016/j.schres.2016.12.029