What Courses and Outcomes are Possible in Schizophrenia?

Schizophrenia ◽  
2019 ◽  
Author(s):  
Stephen J. Glatt ◽  
Stephen V. Faraone ◽  
Ming T. Tsuang
Keyword(s):  
Social Functioning ◽  
Acute Onset ◽  
Psychotic Symptoms ◽  
Course Of Illness ◽  
Good Outcome ◽  
Complex Picture ◽  
Episodic Course ◽  
Number Of Individuals

Kraepelin described one of the core features of schizophrenia to be its progres­sively worsening course with little chance of recovery. In contrast, mood dis­orders were thought to have an episodic course with good functioning between bouts of mania and depression, and a relatively good outcome. The ensuing dec­ades of research have painted a more complex picture of the course and outcome of schizophrenia. Most notably, in contrast to Kraepelin’s bleak outlook, a fair number of individuals can more or less successfully recover from schizophrenia. Dr Manfred Bleuler, son of Dr Eugen Bleuler, reported a 20- year follow-up of over 200 individuals with schizophrenia excluding those who had either died or shown little psychiatric stability over the previous 5 years. Bleuler noted that one in five patients had recovered to normal levels of social functioning and were free of psychotic symptoms. Furthermore, one in three patients had a relatively good outcome. Thus, while patients still experienced hallucinations and delu­sions, they showed only mild problems in social functioning and very few visible behavioural problems. These results are quite remarkable given that the study was completed prior to the discovery of antipsychotic medications.Dr Luc Ciompi was able to follow nearly 300 patients for as long as 50 years after hospitalization. Using Bleuler’s categories of outcome, Ciompi found 27% of the patients to be fully recovered, 22% to have mild symptoms, 24% to have moderately severe symptoms, and 18% to have severe symptoms. Nine per cent of the sample had an uncertain outcome. A progressively worsening, gradual, and serious onset was seen in about half of the affected individuals, while a sudden or acute onset of illness with little or no problems in premorbid func­tioning was found for the rest of the sample. About half of the individuals with schizophrenia had a continuous course of illness, and the remainder had an episodic course. In addition, an episodic course was more likely among patients with acute onset. Acute onset and episodic course were both associated with better long- term outcome.A study performed by Dr Ming Tsuang and team, known as the Iowa 500 study, followed 186 individuals with schizophrenia, 86 with bipolar disorder, and 212 with major depressive disorder for 35– 40 years.

Behcet Disease: Long-term Follow-up of Three Children and Review of the Literature

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 986-992
Author(s):  
Yardena Rakover ◽  
Hanna Adar ◽  
Itamar Tal ◽  
Yaron Lang ◽  
Amos Kedar
Keyword(s):  
Fever Of Unknown Origin ◽  
Age Of Onset ◽  
Unknown Origin ◽  
Behçet Disease ◽  
Behcet Disease ◽  
Cns Involvement ◽  
Course Of Illness ◽  
Long Term Follow Up

Behcet disease is rare in children. There are only two reports of Behcet disease in childhood, describing seven patients. Three pediatric patients are described, in whom the age of onset ranged from 6 to 11 years. Aphthous stomatitis and arthritis were present in all of the patients; genital ulcers, iridocylitis, erythema nodosum, and CNS involvement were present in two patients. Other manifestations included Stevens-Johnson-like eruption, fever of unknown origin, and testicular involvement. All of the patients responded to glucocorticoids; two were also treated with colchicine and one was treated with chlorambucil. In two patients, follow-up of more than 10 years was done, with complete cure in one patient and benign course of illness in the other. Because of the rarity of the disease in childhood and the difficulty in making the diagnosis, there is not enough awareness by pediatricians concerning this disease.

scholarly journals Long term outcomes of acute and transient psychotic disorders: The missed opportunity of preventive interventions

2018 ◽  
Vol 52 ◽  
pp. 126-133 ◽  
Author(s):  
Grazia Rutigliano ◽  
Sergio Merlino ◽  
Amedeo Minichino ◽  
Rashmi Patel ◽  
Cathy Davies ◽  
...  
Keyword(s):  
High Risk ◽  
Psychotic Disorders ◽  
Cumulative Risk ◽  
Acute Onset ◽  
Kaplan Meier ◽  
Schizophrenia Spectrum ◽  
National Health Service Trust ◽  
Icd 10

AbstractBackground:Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.Methods:Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.Results:A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).Conclusions:Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.

scholarly journals Development of Executive Functions as Reflected in Daily Life Behaviors in Young Adults at Ultra-High Risk for Psychosis: Associations With Symptoms and Functioning

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Louise Birkedal Glenthøj ◽  
Carsten Hjorthøj ◽  
Tina Dam Kristensen ◽  
Christina Wenneberg ◽  
Merete Nordentoft ◽  
...  
Keyword(s):  
High Risk ◽  
Executive Functions ◽  
Social Functioning ◽  
Clinical Symptoms ◽  
Daily Life ◽  
Real Life ◽  
Psychotic Symptoms ◽  
Ultra High Risk ◽  
Behaviour Rating

Abstract There is a paucity of evidence on executive functions (EF) as reflected in daily life behaviors in individuals at ultra-high risk (UHR) for psychosis. This prospective follow-up study investigated the 1-year development in EF in UHR compared to healthy controls (HC) and how this change may relate to change in severity of clinical symptoms, social communication, and functioning. UHR (N = 132) and HC (N = 66) were assessed with the Behaviour Rating Inventory of Executive Function–Adult version (BRIEF-A) self and informant report at baseline and 12 months follow-up comprising the Behavioral Regulation Index (BRI) and the Metacognition Index (MI). Additionally, data on depressive-, negative-, and attenuated psychotic symptoms and everyday social functioning were collected. The study found UHR to display large baseline impairments in EF in real life on both self- and informant reports. UHR and HC showed a significantly different development of EF over time, with UHR displaying greater improvements in EF compared to HC. Change in clinical symptoms did not relate to improvements in EF, except for depressive symptoms negatively associating with the development of the MI. Improvements on the BRI and MI were significantly associated with improvements in social functioning. Findings suggest the potential of UHR individuals displaying a larger ongoing maturational development of daily life EF than HC that seems predominantly independent of development of clinical symptoms. If replicated, this supports a maturational trajectory of daily life EF in UHR that approaches, but do not reach, the level of HC and may indicate a window of opportunity for targeted remediation approaches.

scholarly journals 13-year Follow-up of Treatment of Osteochondral Lesions with MACI

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004 ◽  
Author(s):  
Chris Kreulen ◽  
Trevor Shelton ◽  
Jacqueline Nguyen ◽  
Eric Giza ◽  
Martin Sullivan
Keyword(s):  
Social Functioning ◽  
Physical Functioning ◽  
Bodily Pain ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Sf 36 ◽  
Significant Difference ◽  
And Function

Category: Ankle, Arthroscopy, Hindfoot, Sports, Trauma Introduction/Purpose: Surgical management of osteochondral lesions of the talus (OLT) present an ongoing treatment challenge. Previously, matrix-induced autologous chondrocyte implantation (MACI) demonstrated improved pain and function at 7-years postoperative, providing evidence that MACI is a reliable method for treating cartilage. However, it is unknown the long- term results of MACI in OLT. The purpose of this study was to assess 13-year clinical follow-up data and the long-term success of this implant by comparing patient reported outcome measures (PROMs) pre-operatively, at 7-years post-operative, and at 13- years post-operative. Methods: A prospective investigation of MACI was performed on 10 patients with OLTs who had failed previous arthroscopic treatment. Of the 10 patients, 9 were available for 7-year and 13-year follow-up. Short Form Health Survey (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot evaluation were utilized at pre-operative, 7-year, a 13-year postoperative. For each patient, a paired t-test was used to compare 13-year post-operative PROMs to pre-operative PROMs. A single factor analysis of variance (ANOVA) determined whether PROMs were different between pre-operative, 7-year post- operative, and 13-year post-operative time intervals. When a significant difference was detected, a post-hoc Tukey’s determined which time periods were different. Results: SF-36 data at 13-years showed significant improvements in Physical Functioning (p=0.012), Lack of Bodily Pain (p=0.017), and Social Functioning (p=0.007) compared with preoperative data. There were no differences in other components of the SF-36 outcomes (p>0.05). Although the AOFAS was on average 12 points higher at 13-years postoperative, this was not statistically significant (p=0.173). As for comparing PROMs over time, 13-years post-operative PROMs were comparable to 7-years post- operative (Table 1). There were better PROMs for Physical Functioning, Bodily Pain, and Social Functioning at 7- and 13-years post-operative compared to pre-operative while Physical Role Functioning was also better at 7-years post-operative compared to pre-operative. Conclusion: This study shows MACI provides greater pain relief and function at 13-years post-operative with stable long-term follow-up. MACI should be considered for osteochondral lesions that fail initial microfracture.

scholarly journals Living alone is associated with all-cause and cardiovascular mortality: 32 years of follow-up in the Copenhagen Male Study

2019 ◽  
Vol 5 (3) ◽  
pp. 208-217 ◽  
Author(s):  
Magnus T Jensen ◽  
Jacob L Marott ◽  
Andreas Holtermann ◽  
Finn Gyntelberg
Keyword(s):  
Cardiovascular Mortality ◽  
Regression Models ◽  
Cox Regression ◽  
Urban Life ◽  
Living Alone ◽  
Policy Initiatives ◽  
All Cause Mortality ◽  
Number Of Individuals

Abstract Aims As a consequence of modern urban life, an increasing number of individuals are living alone. Living alone may have potential adverse health implications. The long-term relationship between living alone and all-cause and cardiovascular mortality, however, remains unclear. Methods and results Participants from The Copenhagen Male Study were included in 1985–86 and information about conventional behavioural, psychosocial, and environmental risk factors were collected. Socioeconomic position (SEP) was categorized into four groups. Multivariable Cox-regression models were performed with follow-up through the Danish National Registries. A total of 3346 men were included, mean (standard deviation) age 62.9 (5.2) years. During 32.2 years of follow-up, 89.4% of the population died and 38.9% of cardiovascular causes. Living alone (9.6%) was a significant predictor of mortality. Multivariable risk estimates were [hazard ratio (95% confidence interval)] 1.23 (1.09–1.39), P = 0.001 for all-cause mortality and 1.36 (1.13–1.63), P = 0.001 for cardiovascular mortality. Mortality risk was modified by SEP. Thus, there was no association in the highest SEP but for all other SEP categories, e.g. highest SEP for all-cause mortality 1.01 (0.7–1.39), P = 0.91 and 0.94 (0.6–1.56), P = 0.80 for cardiovascular mortality; lowest SEP 1.58 (1.16–2.19), P = 0.004 for all-cause mortality and 1.87 (1.20–2.90), P = 0.005 for cardiovascular mortality. Excluding participants dying within 5 years of inclusion (n = 274) did not change estimates, suggesting a minimal influence of reverse causation. Conclusions Living alone was an independent risk factor for all-cause and cardiovascular mortality with more than three decades of follow-up. Individuals in middle- and lower SEPs were at particular risk. Health policy initiatives should target these high-risk individuals.

scholarly journals T214. ANTIPSYCHOTIC TREATMENT PATTERNS AND EFFECTS DURING THE EARLY YEARS AMONG 316 NEWLY DIAGNOSED PATIENTS WITH SCHIZOPHRENIA FROM THE OPUS TRIAL

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S314-S314
Author(s):  
Nikolai Albert ◽  
Karl Ole Köhler-Forsberg ◽  
Carsten Hjorthøj ◽  
Merete Nordentoft
Keyword(s):  
Early Intervention ◽  
Medical Treatment ◽  
Relapse Rate ◽  
Antipsychotic Medication ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
Follow Up Studies ◽  
Long Term Follow Up

Abstract Background In studies investigating the relapse rate of psychotic symptoms in patients diagnosed with schizophrenia there is a discrepancy between discontinuation studies finding a relapse rate up to 90% after discontinuation of antipsychotic medication and long-term follow-up studies finding approx. 30% of patients living without antipsychotic medication and psychotic symptoms. Long-term follow-up studies often have multiple follow-up assessments, but little is known about the use of medication in the intervals between the follow-up points. While register studies can follow large cohorts of patients, they are unable to investigate psychopathology and level of functioning in patients who discontinue their medication. In this study we use data from a clinical cohort with information on participants symptoms and functioning and combine them with register data on the individual participants prescriptions and hospitalizations. Methods The present study represents a combination of a clinical study from early intervention settings and register-based information on antipsychotic drug use and hospital contacts. For the present study, patients were included 18 months into their 24 months early intervention treatment and followed up 3 ½ year later. At baseline and follow-up we performed clinical assessments with all patients and via the Danish National Hospital Register and the Danish National Prescription Register, we had complete nationwide information for all patients identifying all redeemed prescriptions for antipsychotic drugs from 6 to 42 months after inclusion into the study. Based on medication information from the Danish National Prescription Register, we divided participants in the following four groups: 1) Non-users, 2) compliant on medication, 3) stopped but resumed later with medication, and 4) stopped with medication. Results Of the 316 participants included in this study 94.3% had I diagnosis of schizophrenia. In the 3 years preceding the 5 years follow-up 28.2% did not redeem any prescriptions for antipsychotics drugs while 21.2% discontinued their treatment during the follow-up, 20.9% discontinued their treatment but resumed later and 29.7% remained in stable treatment. At the 5 years follow-up the 30.3% of the Never-users where in competitive employment, the mean psychotic symptom score were 1.4 SD (1.4) and negative symptoms 1.1 SD (0.9). Whiles these results were worse for patients Compliant on medication (17%, 1.9 SD (1.3), 1.8 SD (1.0)), Stopped but resumed medication (10.6%, 22.4 SD (1.4), 1.5 SD (1.0)) and Stopped medication (17%, 1.6 SD (1.3), 1.3 SD (1.0)), respectively. Of the Never-user 23.6% were in remission of both positive and negative symptoms, while this was only the case for 12.8% of those compliant on medication. Discussion This study is a naturalistic cohort study and we are unable to draw any conclusion regarding the causality between symptoms remission and use of antipsychotic medication. The study shows that a substantial proportion of patients, for several years, can discontinue their medical treatment without being re-hospitalized and with lower symptoms burden then patients who continue their medical treatment. Some patients discontinue their treatment but resume it later. These patients have approximately the same functional level and psychotypological scores as those who are compliant with their medical treatment and are treated with equivalent doses of antipsychotic at the time of the follow-up.

scholarly journals Long-Term Ultrasound Follow-Up of Thyroid Colloid Cysts

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Dong Wook Kim
Keyword(s):  
Gradual Increase ◽  
Acute Onset ◽  
Papillary Thyroid ◽  
Abrupt Increase ◽  
Interval Change ◽  
Thyroid Microcarcinoma ◽  
Colloid Cysts ◽  
Thyroid Colloid

Objective. This study aimed to assess the interval changes of thyroid colloid cysts (TCCs) by performing long-term ultrasound (US) follow-up examinations.Methods. From 2007 to 2008, 437 patients underwent a lobectomy for the treatment of papillary thyroid microcarcinoma. Among them, 268 patients underwent 4 or more postoperative US follow-ups after surgery. This study investigated the prevalence and interval changes of TCCs≥3 mm by using US follow-ups.Results. Among 268 patients, 35 (13.1%) had TCCs≥3 mm by a preoperative thyroid US, and 6 (2.2%) had newly detected TCCs at a US follow-up. Through long-term US follow-up, the interval changes for TCCs were classified as follows: no interval change (n=8), gradual increase (n=8), gradual decrease (n=5), positive fluctuation (n=3), negative fluctuation (n=6), disappearance (n=5), and new detection (n=6). None of the TCC cases had a TCC that was ≥10 mm at its largest diameter, and no patient complained of any relevant symptoms pertaining to the TCCs.Conclusions. In this study, TCCs demonstrated various interval changes, but no abrupt increase was found or acute onset of symptoms occurred.

scholarly journals Correction: Cognitive Performance and Long-Term Social Functioning in Psychotic Disorder: A Three-Year Follow-Up Study

PLoS ONE ◽  
2018 ◽  
Vol 13 (11) ◽  
pp. e0208347 ◽  
Author(s):  
Claudia J. P. Simons ◽  
Agna A. Bartels-Velthuis ◽  
Gerdina H. M. Pijnenborg ◽  
Keyword(s):  
Social Functioning ◽  
Cognitive Performance ◽  
Psychotic Disorder ◽  
Follow Up Study

The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

2012 ◽  
Vol 38 (6) ◽  
pp. 634-639 ◽  
Author(s):  
M. Berger ◽  
M. Vermeulen ◽  
J. H. T. M. Koelman ◽  
I. N. van Schaik ◽  
Y. B. W. E. M. Roos
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Initial Response ◽  
Response To Treatment ◽  
Good Outcome ◽  
Tunnel Syndrome ◽  
Corticosteroid Injections

The objective of this prospective study was to investigate the long-term effect of one or more local corticosteroid injections in patients with carpal tunnel syndrome and whether a good response can be predicted. Follow-up visits took place at 3 weeks, 6 months, and 1 year after the first corticosteroid injection. Thirty of the 120 patients (25%) had a good outcome with a single injection, 11 additional patients (9%) needed a second injection, and five patients (4%) needed a third injection to reach a good outcome after 1 year. Of patients with an initial good treatment response, 28 (52%) had a good outcome after 1 year compared with 18 (27 %) who had an initially moderate or no response to treatment. One-third of patients with carpal tunnel syndrome had a long-term beneficial effect from corticosteroid injection, especially when they had a good initial response.

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