scholarly journals The iHOPE-20 study: Relationships between and prospective predictors of remission, clinical recovery, personal recovery and resilience 20 years on from a first episode psychosis

2019 ◽  
Vol 53 (11) ◽  
pp. 1080-1092 ◽  
Author(s):  
Donal O’Keeffe ◽  
Ailish Hannigan ◽  
Roisin Doyle ◽  
Anthony Kinsella ◽  
Ann Sheridan ◽  
...  
Keyword(s):  
Mental Health ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Full Time ◽  
Personal Recovery ◽  
Clinical Recovery ◽  
Episode Psychosis

Objective: Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap. Method: iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort ( N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them. Results: At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5–11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores. Conclusion: Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services.

scholarly journals Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Chen-Chung Liu ◽  
Chih-Min Liu ◽  
Yi-Ling Chien ◽  
Yi-Ting Lin ◽  
Ming H. Hsieh ◽  
...  
Keyword(s):  
Low Dose ◽  
First Episode Psychosis ◽  
Fine Tuning ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Full Time ◽  
Episode Psychosis ◽  
Employment Education

Background: Contradictory messages regarding the necessity of long-term antipsychotic treatment after first episode psychosis arouse deliberations in clinical practice. We explored if there is an alternative beyond the dichotomy of maintenance treatment and discontinuation of medications.Methods: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special interests in patients able to maintain good functioning under treatment with a low antipsychotic dose.Results: Of the 81 patients with first-episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n = 46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit; among them, 15 patients received dosage of antipsychotics no more than the minimum effective dose [chlorpromazine equivalent (CPZE) dose, 200 mg/day]. Besides, 10 of 55 patients (18.2%) only received very low dose antipsychotics (CPZE < 50 mg/day) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization, and being on clozapine therapy were correlated to poorer functioning. Antipsychotic-free status was achieved only in two non-psychotic patients.Conclusions: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first-episode psychosis, even if they could not completely withdraw antipsychotics in the long term. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.

scholarly journals S122. TEN-YEAR FOLLOW-UP AFTER FIRST EPISODE PSYCHOSIS: FOCUSED ON LOW DOSE ANTIPSYCHOTIC MAINTENANCE AND FUNCTIONING

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Chen-Chung Liu ◽  
Chih-Min Liu ◽  
Yi-Ling Chien ◽  
Yi-Ting Lin ◽  
Ming H Hsieh ◽  
...  
Keyword(s):  
Low Dose ◽  
First Episode Psychosis ◽  
Fine Tuning ◽  
Careful Examination ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Full Time ◽  
Episode Psychosis

Abstract Background Patients’ long-term phenomenology and outcomes after first episode psychosis are of great interest to patients, their caregivers and care providers. Contradictory messages regarding the necessity of long-term antipsychotic treatment and the factors affecting outcomes warrant careful examination. Methods We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special focus on patients maintaining very low dose antipsychotics and their functioning. Results Of the 81 patients with first episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n=46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit and 10 patients (18.2%) received very low dose antipsychotics (chlorpromazine equivalent [CPZE] dose < 50 mg/d) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization and being on clozapine therapy were correlated to poorer functioning. Fifteen of the 20 good-functioning patients received dosage of antipsychotics no more than the reported minimum effective dose (CPZE 200 mg/d). Antipsychotic-free status was achieved only in two non-psychotic patients. Discussion A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first episode psychosis, even if they cannot successfully discontinue antipsychotic treatment in the long run. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.

scholarly journals A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis

2021 ◽  
Author(s):  
Donal O’Keeffe ◽  
Ann Sheridan ◽  
Aine Kelly ◽  
Roisin Doyle ◽  
Kevin Madigan ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Service Users ◽  
Personal Recovery ◽  
Potential Influence ◽  
Psychotic Illness ◽  
Clinical Recovery ◽  
Episode Psychosis

Abstract Purpose Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery). Methods Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full ‘functional recovery criteria’ (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups. Results Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group. Conclusion Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.

Stability and development of psychotic symptoms and the use of antipsychotic medication – long-term follow-up

2017 ◽  
Vol 47 (12) ◽  
pp. 2118-2129 ◽  
Author(s):  
D. R. Gotfredsen ◽  
R. S. Wils ◽  
C. Hjorthøj ◽  
S. F. Austin ◽  
N. Albert ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Illness ◽  
Multi Centre Study ◽  
Episode Psychosis ◽  
Long Term Treatment

BackgroundFew studies have evaluated the development in the use of antipsychotic medication and psychotic symptoms in patients with first-episode psychosis on a long-term basis. Our objective was to investigate how psychotic symptoms and the use of antipsychotic medication changed over a 10-year period in a cohort of patients with first-episode psychosis.MethodThe study is a longitudinal prospective cohort study over 10 years with follow-ups at years 1, 2, 5 and 10. A total of 496 patients with first-episode psychosis were included in a multi-centre study initiated between 1998 and 2000 in Copenhagen and Aarhus, Denmark.ResultsAt all follow-ups, a large proportion (20–30%) of patients had remission of psychotic symptoms without use of antipsychotic medication at the time of the follow-up. Patients who were in this group at the 5-year follow-up had an 87% [95% confidence interval (CI) 77–96%] chance of being in the same group at the 10-year follow-up. This stability was also the case for patients who had psychotic symptoms and were treated with antipsychotic medication at year 5, where there was a 67% (95% CI 56–78%) probability of being in this group at the consecutive follow-up.ConclusionsA large group of patients with psychotic illness were in remission without the use of antipsychotic medication, peaking at year 10. Overall there was a large degree of stability in disease courses over the 10-year period. These results suggest that the long-term outcome of psychotic illness is heterogeneous and further investigation on a more individualized approach to long-term treatment is needed.

scholarly journals Recorded poor insight as a predictor of service use outcomes: cohort study of patients with first-episode psychosis in a large mental healthcare database

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028929 ◽  
Author(s):  
Neha Ramu ◽  
Anna Kolliakou ◽  
Jyoti Sanyal ◽  
Rashmi Patel ◽  
Robert Stewart
Keyword(s):  
Mental Health ◽  
Health Service ◽  
Service Use ◽  
Hospital Admissions ◽  
First Episode Psychosis ◽  
Mental Health Service Use ◽  
Secondary Outcome ◽  
First Episode ◽  
Episode Psychosis

ObjectivesTo investigate recorded poor insight in relation to mental health and service use outcomes in a cohort with first-episode psychosis.DesignWe developed a natural language processing algorithm to ascertain statements of poor or diminished insight and tested this in a cohort of patients with first-episode psychosis.SettingThe clinical record text at the South London and Maudsley National Health Service Trust in the UK was used.ParticipantsWe applied the algorithm to characterise a cohort of 2026 patients with first-episode psychosis attending an early intervention service.Primary and secondary outcome measuresRecorded poor insight within 1 month of registration was investigated in relation to (1) incidence of psychiatric hospitalisation, (2) odds of legally enforced hospitalisation, (3) number of days spent as a mental health inpatient and (4) number of different antipsychotic agents prescribed; outcomes were measured over varying follow-up periods from 12 months to 60 months, adjusting for a range of sociodemographic and clinical covariates.ResultsRecorded poor insight, present in 46% of the sample, was positively associated with ages 16-35, bipolar disorder and history of cannabis use and negatively associated with White ethnicity and depression. It was significantly associated with higher levels of all four outcomes over all five follow-up periods.ConclusionsRecorded poor insight in people with recent onset psychosis predicted subsequent legally enforced hospitalisations and higher number of hospital admissions, number of unique antipsychotics prescribed and days spent hospitalised. Improving insight might benefit patients’ course of illness as well as reduce mental health service use.

Long-term follow-up of all-cause and unnatural death in young people with first-episode psychosis

2014 ◽  
Vol 159 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Kally Yuen ◽  
Susy M. Harrigan ◽  
Andrew J. Mackinnon ◽  
Meredith G. Harris ◽  
Hok Pan Yuen ◽  
...  
Keyword(s):  
Young People ◽  
First Episode Psychosis ◽  
First Episode ◽  
Unnatural Death ◽  
Episode Psychosis ◽  
Long Term Follow Up

Differential predictors of critical comments and emotional over-involvement in first-episode psychosis

2008 ◽  
Vol 40 (1) ◽  
pp. 63-72 ◽  
Author(s):  
M. Álvarez-Jiménez ◽  
J. F. Gleeson ◽  
S. M. Cotton ◽  
D. Wade ◽  
K. Crisp ◽  
...  
Keyword(s):  
Family Stress ◽  
First Episode Psychosis ◽  
Therapeutic Interventions ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Future Research ◽  
Burden Of Care ◽  
Related Factors ◽  
Episode Psychosis

BackgroundLittle research has focused on delineating the specific predictors of emotional over-involvement (EOI) and critical comments (CC) in the early course of psychosis. The purpose of this study was to investigate the differential relationships of EOI and CC with relevant predictors in relatives of first-episode psychosis (FEP) patients.MethodBaseline patient-related factors including psychotic symptoms, depression and duration of untreated psychosis (DUP) and carer attributes comprising CC, EOI, burden of care and carers' stress and depression were assessed in a cohort of 63 remitted FEP patients and their relatives. Carers were reassessed at 7 months follow-up.ResultsBaseline analysis showed that EOI was more strongly correlated with family stress compared with CC, whereas CC yielded a stronger association with DUP than EOI. Carers' CC at follow-up was not significantly predicted by either baseline family stress, burden of care or patient-related variables. Conversely, baseline EOI predicted both family stress and burden of care at 7 months follow-up. Finally, family burden of care at follow-up was a function of baseline EOI and patients' depressive symptoms.ConclusionsThis study provides preliminary support to the postulate that EOI and CC may be influenced by separate factors early in the course of psychosis and warrant future research and therapeutic interventions as separate constructs. Implications for family interventions in the early phase of psychosis and the prevention of CC and EOI are discussed.

scholarly journals Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

2019 ◽  
Vol 50 (6) ◽  
pp. 991-1001 ◽  
Author(s):  
Olesya Ajnakina ◽  
Brendon Stubbs ◽  
Emma Francis ◽  
Fiona Gaughran ◽  
Anthony S. David ◽  
...  
Keyword(s):  
Systematic Review ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Hospitalised Patients ◽  
Episode Psychosis ◽  
Over Time

AbstractBackgroundReducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.MethodsStudies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.Results81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.ConclusionOne in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.

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