Ethnicity and long-term course and outcome of psychotic disorders in a UK sample: The ÆSOP-10 study

BackgroundThe incidence of psychotic disorders is elevated in some minority ethnic populations. However, we know little about the outcome of psychoses in these populations.AimsTo investigate patterns and determinants of long-term course and outcome of psychoses by ethnic group following a first episode.MethodÆSOP-10 is a 10-year follow-up of an ethnically diverse cohort of 532 individuals with first-episode psychosis identified in the UK. Information was collected, at baseline, on clinical presentation and neurodevelopmental and social factors and, at follow-up, on course and outcome.ResultsThere was evidence that, compared with White British, Black Caribbean patients experienced worse clinical, social and service use outcomes and Black African patients experienced worse social and service use outcomes. There was evidence that baseline social disadvantage contributed to these disparities.ConclusionsThese findings suggest ethnic disparities in the incidence of psychoses extend, for some groups, to worse outcomes in multiple domains.

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Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study

Psychological Medicine ◽

10.1017/s0033291714000282 ◽

2014 ◽

Vol 44 (13) ◽

pp. 2713-2726 ◽

Cited By ~ 98

Author(s):

C. Morgan ◽

J. Lappin ◽

M. Heslin ◽

K. Donoghue ◽

B. Lomas ◽

...

Keyword(s):

Service Use ◽

Psychotic Disorders ◽

Hospital Admissions ◽

Median Number ◽

First Episode ◽

Sustained Remission ◽

The Uk ◽

Incident Cases

BackgroundStudies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare.MethodAESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews.ResultsAt follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1–4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London.ConclusionsSustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover.

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Longitudinal follow-up in acute and transient psychotic disorders and schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.187.3.286 ◽

2005 ◽

Vol 187 (3) ◽

pp. 286-287 ◽

Cited By ~ 37

Author(s):

Frank Pillmann ◽

Andreas Marneros

Keyword(s):

Psychotic Disorders ◽

First Episode ◽

Control Group ◽

Level Of Functioning ◽

General Functioning ◽

And Gender ◽

High Level ◽

Observation Period

SummaryWe prospectively studied the long-term course of individuals with acute and transient psychotic disorders and a control group with positive schizophrenia matched for age and gender. Follow-up investigations using standardised instruments were performed at three time-points covering 7 years after the index episode or 12 years after the first episode. During follow-up, those with positive schizophrenia experienced a deterioration in their general functioning whereas those with acute and transient psychotic disorders retained their high level of functioning. At the end of the observation period, 12 out of 39 (31%) of those with acute and transient psychotic disorders were functioning well without medication compared with 0 out of 38 with positive schizophrenia.

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Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission

The British Journal of Psychiatry ◽

10.1192/bjp.186.4.281 ◽

2005 ◽

Vol 186 (4) ◽

pp. 281-289 ◽

Cited By ~ 109

Author(s):

Craig Morgan ◽

Rosemarie Mallett ◽

Gerard Hutchinson ◽

Hemant Bagalkote ◽

Kevin Morgan ◽

...

Keyword(s):

Pathways To Care ◽

First Episode ◽

Compulsory Admission ◽

Sampling Frame ◽

Black African ◽

Epidemiological Sample ◽

African Caribbean ◽

Sample Characteristics ◽

African Patients ◽

The Uk

BackgroundMany studies have found high levels of compulsory admission to psychiatric hospital in the UK among African–Caribbean and Black African patients with a psychotic illness.AimsTo establish whether African–Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres.MethodAll patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (ÆSOP) study. For this analysis we included all White British, other White, African–Caribbean and Black African patients from the ÆSOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.ResultsAfrican–Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African–Caribbean men were the most likely to be compulsorily admitted.ConclusionsThese findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African–Caribbean and Black African patients.

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Suicide among people with psychosis in schizophrenia spectrum

Oxford Textbook of Suicidology and Suicide Prevention ◽

10.1093/med/9780198834441.003.0034 ◽

2021 ◽

pp. 285-292

Author(s):

Merete Nordentoft ◽

Trine Madsen

Keyword(s):

High Risk ◽

Psychotic Disorders ◽

First Episode ◽

Positive Effects ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Long Term Follow Up ◽

Lethal Means

This text summarizes the literature regarding suicide among people with psychosis. Psychotic disorders on schizophrenia spectrum are among the most severe psychiatric disorders, and are associated with a particularly high risk of suicide. Long-term follow-up studies have found that up to 6% of people with these disorders die from suicide. Young people with psychotic disorders have a 25-fold higher risk of suicide compared to age-matched people in the general population. Being recently diagnosed, an inpatient, or recently discharged from psychiatric with a psychotic disorder, all represent high-risk periods for suicide. Indicated prevention in these high-risk periods is crucial, but also selective interventions such as early detection and intensive treatment of first episode psychosis, have shown to have positive effects on suicidal behaviour. Moreover, universal interventions aimed at the whole population, such as restricting access to lethal means, are important to implement to prevent suicide in people with psychotic disorders.

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Unmet needs in patients with brief psychotic disorders: Too ill for clinical high risk services and not ill enough for first episode services

European Psychiatry ◽

10.1016/j.eurpsy.2018.12.006 ◽

2019 ◽

Vol 57 ◽

pp. 26-32 ◽

Cited By ~ 14

Author(s):

Amedeo Minichino ◽

Grazia Rutigliano ◽

Sergio Merlino ◽

Cathy Davies ◽

Dominic Oliver ◽

...

Keyword(s):

Mental Health ◽

High Risk ◽

Clinical Outcomes ◽

Psychotic Disorders ◽

Pathways To Care ◽

First Episode ◽

Clinical High Risk ◽

Early Intervention Services

AbstractBackground:Patients with acute and transient psychotic disorders (ATPDs) are by definition remitting, but have a high risk of developing persistent psychoses, resembling a subgroup of individuals at Clinical High Risk for Psychosis (CHR-P). Their pathways to care, treatment offered and long-term clinical outcomes beyond risk to psychosis are unexplored. We conducted an electronic health record-based retrospective cohort study including patients with ATPDs within the SLaM NHS Trust and followed-up to 8 years.Methods:A total of 2561 ATPDs were included in the study. A minority were detected (8%) and treated (18%) by Early Intervention services (EIS) and none by CHR-P services. Patients were offered a clinical follow-up of 350.40 ± 589.90 days. The cumulative incidence of discharges was 40% at 3 months, 60% at 1 year, 69% at 2 years, 77% at 4 years, and 82% at 8 years. Treatment was heterogeneous: the majority of patients received antipsychotics (up to 52%), only a tiny minority psychotherapy (up to 8%).Results:Over follow-up, 32.88% and 28.54% of ATPDS received at least one mental health hospitalization or one compulsory hospital admission under the Mental Health Act, respectively. The mean number of days spent in psychiatric hospital was 66.39 ± 239.44 days.Conclusions:The majority of ATPDs are not detected/treated by EIS or CHR-P services, receive heterogeneous treatments and short-term clinical follow-up. ATPDs have a high risk of developing severe clinical outcomes beyond persistent psychotic disorders and unmet clinical needs that are not targeted by current mental health services.

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Prospective Long-Term Cohort Study of Subjects With First-Episode Psychosis Examining Eight Major Outcome Domains and Their Predictors: Study Protocol

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.643112 ◽

2021 ◽

Vol 12 ◽

Author(s):

Victor Peralta ◽

Lucía Moreno-Izco ◽

Elena García de Jalón ◽

Ana M. Sánchez-Torres ◽

Lucía Janda ◽

...

Keyword(s):

Psychosocial Functioning ◽

Psychotic Disorders ◽

First Episode ◽

Naturalistic Study ◽

Personal Recovery ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome

Background: Our current ability to predict the long-term course and outcome of subjects with a first-episode of psychosis (FEP) is limited. To improve our understanding of the long-term outcomes of psychotic disorders and their determinants, we designed a follow-up study using a well-characterized sample of FEP and a multidimensional approach to the outcomes. The main goals were to characterize the long-term outcomes of psychotic disorders from a multidimensional perspective, to address the commonalities and differential characteristics of the outcomes, and to examine the common and specific predictors of each outcome domain. This article describes the rationale, methods, and design of a longitudinal and naturalistic study of subjects with epidemiologically defined first-admission psychosis.Methods: Eligible subjects were recruited from consecutive admissions between January 1990 and December 2009. Between January 2018 and June 2021, we sought to trace, re-contact, and re-interview the subjects to assess the clinical course, trajectories of symptoms and functioning, and the different outcomes of psychotic disorders. Since this is a naturalistic study, the research team will not interfere with the subjects' care and treatment. Predictors include antecedent variables, first-episode characteristics, and illness-related variables over the illness course. We assess eight outcome domains at follow-up: psychopathology, psychosocial functioning, self-rated personal recovery, self-rated quality of life, cognitive performance, neuromotor dysfunction, medical and psychiatric comorbidities, and mortality rate. The range of the follow-up period will be 10–31 years with an estimated mean of 20 years. We estimate that more than 50% of the baseline sample will be assessed at follow-up.Discussion: The study design was driven by the increasing need to refine the ability to predict the different clinical outcomes in FEP, and it aims to close current gaps in knowledge, with a broad approach to both the definition of outcomes and their determinants. To the best of our knowledge, this study is one of the few attempting to characterize the very long-term outcome of FEP and the only study addressing eight major outcome domains. We hope that this study helps to better characterize the long-term outcomes and their determinants, enabling better risk stratification and individually tailored, person-based interventions.

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Rethinking the course of psychotic disorders: modelling long-term symptom trajectories

Psychological Medicine ◽

10.1017/s0033291720004705 ◽

2021 ◽

pp. 1-10

Author(s):

Craig Morgan ◽

Paola Dazzan ◽

Julia Lappin ◽

Margaret Heslin ◽

Kim Donoghue ◽

...

Keyword(s):

Psychotic Disorders ◽

Quadratic Growth ◽

Psychotic Symptoms ◽

First Episode ◽

Specific Symptom ◽

Symptom Trajectories ◽

Growth Mixture ◽

Incident Cases

Abstract Background The clinical course of psychotic disorders is highly variable. Typically, researchers have captured different course types using broad pre-defined categories. However, whether these adequately capture symptom trajectories of psychotic disorders has not been fully assessed. Using data from AESOP-10, we sought to identify classes of individuals with specific symptom trajectories over a 10-year follow-up using a data-driven approach. Method AESOP-10 is a follow-up, at 10 years, of 532 incident cases with a first episode of psychosis initially identified in south-east London and Nottingham, UK. Using extensive information on fluctuations in the presence of psychotic symptoms, we fitted growth mixture models to identify latent trajectory classes that accounted for heterogeneity in the patterns of change in psychotic symptoms over time. Results We had sufficient data on psychotic symptoms during the follow-up on 326 incident patients. A four-class quadratic growth mixture model identified four trajectories of psychotic symptoms: (1) remitting-improving (58.5%); (2) late decline (5.6%); (3) late improvement (5.4%); (4) persistent (30.6%). A persistent trajectory, compared with remitting-improving, was associated with gender (more men), black Caribbean ethnicity, low baseline education and high disadvantage, low premorbid IQ, a baseline diagnosis of non-affective psychosis and long DUP. Numbers were small, but there were indications that those with a late decline trajectory more closely resembled those with a persistent trajectory. Conclusion Our current approach to categorising the course of psychotic disorders may misclassify patients. This may confound efforts to elucidate the predictors of long-term course and related biomarkers.

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