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

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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An update of the long-term outcome of patients with nonspecific pleurisy at medical thoracoscopy

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01596-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yan-Xia Yu ◽

Yuan Yang ◽

Yan-Bing Wu ◽

Xiao-Juan Wang ◽

Li-Li Xu ◽

...

Keyword(s):

Pleural Effusion ◽

Malignant Disease ◽

Long Term Outcomes ◽

Benign Diseases ◽

Term Outcome ◽

Long Term Outcome ◽

Medical Thoracoscopy ◽

One Year

Abstract Background Medical thoracoscopy (MT) is recommended in patients with undiagnosed exudative pleural effusion and offers a degree of diagnostic sensitivity for pleural malignancy. However, not all patients who undergo MT receive an exact diagnosis. Our previous investigation from 2014 summarized the long-term outcomes of these patients with nonspecific pleurisy (NSP); now, we offer updated data with the goal of refining our conclusions. Methods Between July 2005 and August 2018, MT with pleural biopsies were performed in a total of 1,254 patients with undiagnosed pleural effusions. One hundred fifty-four patients diagnosed with NSP with available follow-up data were included in the present study, and their medical records were reviewed. Results A total of 154 patients were included in this study with a mean follow-up duration of 61.5 ± 43.7 months (range: 1–180 months). No specific diagnosis was established in 67 (43.5%) of the patients. Nineteen patients (12.3%) were subsequently diagnosed with pleural malignancies. Sixty-eight patients (44.2%) were diagnosed with benign diseases. Findings of pleural nodules or plaques during MT and the recurrence of pleural effusion were associated with malignant disease. Conclusions Although most NSP patients received a diagnosis of a benign disease, malignant disease was still a possibility, especially in those patients with nodules or plaques as noted on the MT and a recurrence of pleural effusion. One year of clinical follow-up for NSP patients is likely sufficient. These updated results further confirm our previous study’s conclusions.

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Hyperglycemia in the Posttransplant Period: NODAT vs Posttransplant Diabetes Mellitus

Journal of the Endocrine Society ◽

10.1210/js.2018-00227 ◽

2018 ◽

Vol 2 (11) ◽

pp. 1314-1319 ◽

Cited By ~ 2

Author(s):

Suruchi Gupta ◽

Teresa Pollack ◽

Candice Fulkerson ◽

Kathleen Schmidt ◽

Diana Johnson Oakes ◽

...

Keyword(s):

Insulin Resistance ◽

Liver Transplant ◽

Controlled Trial ◽

Organ Transplant ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Persistent Hyperglycemia

Abstract Objective To characterize the types of hyperglycemia that occur up to 1 year following liver transplant and to clarify the nomenclature for posttransplant hyperglycemia. Design We analyzed 1-year glycemic follow-up data in 164 patients who underwent liver transplant and who had been enrolled in a randomized controlled trial comparing moderate to intensive insulin therapy to determine if patients had preexisting known diabetes, transient hyperglycemia, persistent hyperglycemia, or new-onset diabetes after transplantation (NODAT). Results Of 119 patients with posttransplant hyperglycemia following hospital discharge, 49 had preexisting diabetes, 5 had insufficient data for analysis, 48 had transient hyperglycemia (16 resolved within 30 days and 32 resolved between 30 days and 1 year), 13 remained persistently hyperglycemic out to 1 year and most likely had preexisting diabetes that had not been diagnosed or insulin resistance/insulinopenia prior to transplant, and 4 had NODAT (i.e., patients with transient hyperglycemia after transplant that resolved but then later truly developed sustained hyperglycemia, meeting criteria for diabetes). Conclusions Distinct categories of patients with hyperglycemia following organ transplant include known preexisting diabetes, persistent hyperglycemia (most likely unknown preexisting diabetes or insulin resistance/insulinopenia), transient hyperglycemia, and NODAT. Those with preexisting diabetes for many years prior to transplant may well have very different long-term outcomes compared with those with true NODAT. Therefore, it would be prudent to classify patients more carefully. Long-term outcome studies are needed to determine if patients with true NODAT have the same poor prognosis as patients with preexisting diabetes (diagnosed and undiagnosed) undergoing transplant.

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Long-Term Outcomes After Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽

10.1161/strokeaha.119.027703 ◽

2020 ◽

Vol 51 (2) ◽

pp. 670-673 ◽

Cited By ~ 4

Author(s):

Rosalie Boitet ◽

Solène de Gaalon ◽

Claire Duflos ◽

Grégory Marin ◽

Jérôme Mawet ◽

...

Keyword(s):

Thunderclap Headache ◽

Reversible Cerebral Vasoconstriction Syndrome ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Follow Up Study ◽

Cerebral Vasoconstriction ◽

History Of

Background and Purpose— We aimed to further investigate the long-term outcomes after reversible cerebral vasoconstriction syndrome (RCVS). Methods— A longitudinal follow-up study was conducted in 173 RCVS patients. Results— Of the 172 patients who completed a mean follow-up of 9.2±3.3 years, 10 had a recurrent RCVS that was benign in all. Independent predictors of relapse were having a history of migraine and having exercise as a trigger for thunderclap headache during initial RCVS. After new delivery, the rate of postpartum RCVS was 9%. Conclusions— Overall, long-term outcome after RCVS is excellent.

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Sleep symptoms and long-term outcome in adolescents with major depressive disorder: a naturalistic follow-up study

European Child & Adolescent Psychiatry ◽

10.1007/s00787-019-01436-z ◽

2019 ◽

Vol 29 (5) ◽

pp. 595-603 ◽

Cited By ~ 1

Author(s):

Anna S. Urrila ◽

◽

Olli Kiviruusu ◽

Henna Haravuori ◽

Linnea Karlsson ◽

...

Keyword(s):

Major Depressive Disorder ◽

Young Adulthood ◽

Psychosocial Functioning ◽

Anxiety Symptoms ◽

Depression And Anxiety ◽

Major Depressive ◽

Term Outcome ◽

Long Term Outcome

Abstract Sleep abnormalities in major depressive disorder (MDD) have been suggested to represent a vulnerability trait, which might predispose the individual to long-term psychiatric morbidity. In this study, we sought to assess whether the presence of sleep symptoms among adolescents with MDD is associated with poorer long-term outcome in young adulthood during naturalistic follow-up. Adolescent outpatients diagnosed with MDD (n = 166; age 13–19 years, 17.5% boys) were followed up during 8 years in naturalistic settings. N = 112 adolescents (16.1% boys) completed the 8-year assessment. Sleep symptoms and psychosocial functioning were assessed with structured clinical interviews, and depressive and anxiety symptoms with questionnaires. The severity of sleep symptoms at baseline was not associated with worse outcome at 8 years in terms of any of the outcome measures tested. In particular, the presence of a disturbed sleep–wake rhythm at baseline was associated with a more favourable outcome at 8 years: less depression and anxiety symptoms and higher level of psychosocial functioning. The presence of sleep symptoms in young adulthood was associated with the presence of current depression and anxiety symptoms and poorer psychosocial functioning. The presence of sleep symptoms at follow-up seems to be state-dependent: they are observed in conjunction with other psychiatric symptoms. Contrary to our hypothesis, our results suggest that sleep complaints among adolescents with MDD do not lead to poorer long-term clinical outcome in young adulthood. The link between sleep–wake rhythm disturbance and better long-term outcome needs to be confirmed and examined in detail in further studies, but here we speculate about possible explanations.

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Results of Reinsertion of the Distal Achilles Tendon

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0783-2869 ◽

2018 ◽

Vol 157 (03) ◽

pp. 246-253 ◽

Cited By ~ 1

Author(s):

Heinz Lohrer

Keyword(s):

Achilles Tendon ◽

Long Term Outcomes ◽

Heel Spur ◽

Tendon Tear ◽

Double Row ◽

Term Outcome ◽

Long Term Outcome ◽

Tendon Tears

Abstract Background Reattachment of the distal Achilles tendon to the posterior calcaneus following distal Achilles tendon tears/avulsions or after excision of large posterior heel spurs is a challenging task for the orthopaedic surgeon. Patients/Material and Methods Between 2005 and the end of 2015, 22 patients who underwent repair/reconstruction of a lesion of the distal Achilles tendon were identified from our electronic records. Calcaneal reinsertions were performed following distal Achilles tendon tears/avulsions (n = 15) or following excision of a large symptomatic posterior heel spur (n = 7). The respective outcome was evaluated comparatively using the VISA-A – G (Victorian Institute of Sports Assessment-Achilles tendon, German version) questionnaire (100 = maximum). Data were collected preoperatively (n = 11/22), and prospectively at three, six, and 12 months postoperatively (n = 5 – 11/22). Two further retrospective follow-ups were performed 12 – 114 and 21 – 149 months postoperatively (n = 17/22 and 22/22, respectively). All data were analysed retrospectively. Complications were searched from the electronic files. Results Transosseous sutures and different anchor techniques (Panalok®, Corkscrew®, SpeedBridge®) were generally performed. Preoperatively, the VISA-A – G score was 27.3 ± 13.5 (6 – 45) following distal Achilles tendon reinsertions for avulsions and 45.3 ± 49.0 (0 – 100) when reattachment was performed after resection of a large posterior heel spur (p = 0.831). At the final follow-up, VISA-A – G values were 89.4 ± 13.9 (54 – 100) following distal Achilles tendon tear/avulsion and 82.5 ± 24.5 (51 – 100), when Achilles tendons were reattached after posterior heel spur excisions (p = 0.969). There were no complications in the “heel spur group”. In the Achilles tendon tear/avulsion group, four out of seven patients with Panalok® repairs developed a fistula. One patient suffered a thromboembolism. None of these complications affected the long-term outcome. Conclusions This study demonstrates good long-term outcomes after distal Achilles tendon reinsertion. Knotless double row anchor repair provides a greater area of compression, simplifies and standardises the repair/reconstruction, and provides safety against fistula. These implants are therefore recommended for safe and effective reattachment of the distal Achilles tendon.

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Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2015.08.001 ◽

2015 ◽

Vol 30 (8) ◽

pp. 907-913 ◽

Cited By ~ 15

Author(s):

K. Jaracz ◽

K. Górna ◽

J. Kiejda ◽

B. Grabowska-Fudala ◽

J. Jaracz ◽

...

Keyword(s):

Social Functioning ◽

Psychosocial Functioning ◽

Early Stage ◽

First Episode ◽

Term Outcome ◽

Long Term Outcome ◽

Poor Outcome ◽

Remission Status ◽

Symptomatic Remission

AbstractObjectivesThe aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.MethodsSixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4–6 years (T3), and 7–11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients’ psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.ResultsAmong them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.ConclusionsOur results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

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Long Term Outcomes of Hematopoietic Stem Cell Transplantation in Patients with Severe Phenotype Hurler Syndrome: an International Multi-Center Study

Blood ◽

10.1182/blood.v120.21.1958.1958 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1958-1958

Author(s):

Mieke Aldenhoven ◽

Maria Escolar ◽

Robert Wynn ◽

Ed Wraith ◽

Anne O'Meara ◽

...

Keyword(s):

Mixed Chimerism ◽

Hurler Syndrome ◽

Long Term Outcomes ◽

Term Outcome ◽

Hematopoietic Stem ◽

Long Term Outcome ◽

Donor Chimerism ◽

Normal Enzyme

Abstract Abstract 1958 Background: Hurler syndrome (HS), the most severe phenotype in the spectrum of Mucopolysaccharidosis type I, is caused by a deficiency of the lysosomal enzyme alpha-L-iduronidase. HS is clinically characterized by a progressive and ultimately fatal multi-system deterioration with involvement of the central nervous system. At present, hematopoietic stem cell transplantation (HSCT) is the only treatment that prevents disease progression in the central nervous system and is therefore considered the treatment of choice in HS. Long-term follow-up of outcomes of HSCT for HS are sparse and risk factors for favorable long-term outcomes are still largely unknown. Therefore, an international multicenter study was initiated to describe the long-term outcomes of successfully transplanted HS patients. Methods: HS-patients transplanted between 1980 and 2007 within the leading transplantation centers in Europe and the United States were include in this study. Patient, donor, and transplantation-related variables which may influence long-term outcome were analyzed. Patients who were ‘alive and engrafted (donor-chimerism >10%)’ with a follow up of at least three years after HSCT were included. The functional outcomes assessed for the various organ systems - orthopedic, cardiac, ophthalmologic, respiratory and audiologic - were analyzed using multivariate Cox proportional hazards and logistic regression models. Results: 197 Hurler patients were included from 8 different transplant centers. This is estimated to be about 70–80% of the successfully transplanted HS patients worldwide during that time period. These patients had a median age of 16 (2–80) months at HSCT with a median follow up of 88 (36–258) months after successful HSCT. Seventy-nine % of the patients received a graft from an unaffected (non-carrier) donor. Seventy-two % of the patients achieved full (>95%)-donor-chimerism and 28% mixed-chimerism. After HSCT, normal enzyme-levels (EL; according to the local reference range) were found in 75% of the patients while 25% had EL below lower limit of normal; either due to mixed-chimerism or carrier-donorship). Multivariate analyses (table 1) showed having a “normal EL” after HSCT and younger (below the median age of 16mths) “age at transplantation” were associated with less serious orthopedic complications requiring surgical interventions; e.g. cord compression, genu-valgum surgery, carpal tunnel surgery. Genotype (double non-sense vs. any other genotype) was associated with a lower probability of requiring hip dysplasia surgery as well as with the occurrence of retinopathy. For other endpoints; e.g progression valve insufficiency, progression corneal clouding and development of retinopathy and the need for hearing aids having a normal EL as well as age at HSCT (<16mths) were predictors for better outcome. Furthermore, growth at the age of 60mths was influenced by EL (−1.93 SDS vs. −1,09 SDS; p=0.042). Conclusion: The long-term outcome of clinical manifestations in HS-patients after successful HSCT is promising although residual disease burden remains. Predictors, favorably influencing the long-term outcomes are suggested to be 1) enzyme level (normal vs. below LLN) after HSCT, 2) genotype and 3) age at HSCT. Achieving normal enzyme levels at an early age might significantly impact the prognosis of Hurler syndrome patients. Newborn screening (resulting in early HSCT), the use of non-carrier donors and achieving full-donor chimerism may be crucial in optimizing long-term outcomes. Disclosures: No relevant conflicts of interest to declare.

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Clinical and functional ultra-long-term outcome of patients with a clinical high risk (CHR) for psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2019.08.005 ◽

2019 ◽

Vol 62 ◽

pp. 30-37 ◽

Cited By ~ 6

Author(s):

Katharina Beck ◽

Erich Studerus ◽

Christina Andreou ◽

Laura Egloff ◽

Letizia Leanza ◽

...

Keyword(s):

High Risk ◽

Psychosocial Functioning ◽

Original Sample ◽

Clinical High Risk ◽

Term Outcome ◽

Risk Status ◽

Long Term Outcome ◽

Long Term Follow Up

Abstract Background: Few studies have followed up patients with a clinical high risk (CHR) for psychosis for more than 2–3 years. We aimed to investigate the rates and baseline predictors for remission from CHR and transition to psychosis over a follow-up period of up to 16 years. Additionally, we examined the clinical and functional long-term outcome of CHR patients who did not transition. Methods: We analyzed the long-term course of CHR patients that had been included in the longitudinal studies “Früherkennung von Psychosen” (FePsy) or “Bruderholz” (BHS). Those patients who had not transitioned to psychosis during the initial follow-up periods (2/5 years), were invited for additional follow-ups. Results: Originally, 255 CHR patients had been included. Of these, 47 had transitioned to psychosis during the initial follow-ups. Thus, 208 were contacted for the long-term follow-up, of which 72 (34.6%) participated. From the original sample of 255, 26%, 31%, 35%, and 38% were estimated to have transitioned after 3, 5, 10, and 16 years, respectively, and 51% had remitted from their high risk status at the latest follow-up. Better psychosocial functioning at baseline was associated with a higher rate of remission. Of the 72 CHR patients re-assessed at long-term follow-up, 60 had not transitioned, but only 28% of those were fully recovered clinically and functionally. Conclusions: Our study shows the need for follow-ups and clinical attention longer than the usual 2–3 years as there are several CHR patients with later transitions and only a minority of CHR those without transition fully recovers.

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Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417724139 ◽

2017 ◽

Vol 43 (2) ◽

pp. 168-173 ◽

Cited By ~ 4

Author(s):

Ngoc B. Ha ◽

Joideep Phadnis ◽

Simon B. M. MacLean ◽

Gregory I. Bain

Keyword(s):

Long Term Outcomes ◽

Level Of Evidence ◽

Term Outcome ◽

Long Term Outcome ◽

Distal Pole ◽

Long Term Follow Up ◽

Radioscapholunate Fusion ◽

The Mean

The purpose of this study was to assess the long-term outcomes of radioscapholunate fusion, with and without distal pole of scaphoid excision and excision of the triquetrum. These compromised three operative groups. Seventeen patients were identified with a minimum of 10 years follow-up, with a mean of 15 years (range 10–19). Fifteen of the 17 patients were satisfied with their outcome. Two were converted to total wrist fusion. The mean outcomes scores were; pain visual analogue scale score 2.1/10, Quick Disabilities of the Arm, Shoulder, and Hand 29 and Modified Mayo Wrist score 60. Patients with excision of the triquetrum had a mean radial–ulnar arc increase of 10° compared with the other two groups, but this was not statistically significant. The mean space for the scaphocapitate joint was 1.7 mm and lunocapitate joint was 1.3 mm at latest follow-up. Close adherence to the indications and surgical technique provided a sustainable good clinical outcome. Patients who obtained a good result at 2 years were likely to achieve a good long-term outcome. Level of evidence: IV

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Review and Long-Term Outcomes of Cruciate Ligament Reconstruction versus Conservative Treatment in Siblings with Congenital Anterior Cruciate Ligament Aplasia

Case Reports in Orthopedics ◽

10.1155/2017/1636578 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Diego Davanzo ◽

Paolo Fornaciari ◽

Geoffroy Barbier ◽

Mauro Maniglio ◽

Daniel Petek

Keyword(s):

Anterior Cruciate Ligament ◽

Conservative Treatment ◽

Cruciate Ligament ◽

Patient Counseling ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Anterior Cruciate

There is no consensus on the best treatment for anterior cruciate ligament hypoplasia or aplasia. To our knowledge, no comparative study between operative and conservative treatment of this condition has ever been performed. Conservative treatment is a viable alternative to surgery for ACL aplasia. Two siblings were examined at our outpatient clinic. The male patient underwent bilateral ACL reconstruction, while his sister was treated conservatively. Our results show a worse long-term outcome for the operative patient. At her last follow-up, the female patient treated conservatively showed subjective improvement in stability and gait. A review of the literature shows inconsistent outcomes after reconstruction in contrast to reports with cruciate ligament agenesis that did not undergo reconstruction with acceptable to good outcomes. Cruciate reconstruction should be reserved for cases of impaired articular instability, objectively manifest in the frequency of giving-way episodes. Treatment depends on the patient’s condition and expectations. Surgery should therefore only be suggested after proper patient counseling.

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