Alexander Wunderink

Treatment delay and response rate in first episode psychosis.

Objective:  There is no consistent evidence of long duration of untreated psychosis (DUP) predicting long time to response (TTR) in first psychosis. This study aims to investigate the predictors of DUP and TTR in a first episode patient population.

RECOVERY AND ITS RELATION TO SYMPTOMATIC AND FUNCTIONAL REMISSION IN FIRST EPISODE PSYCHOSIS

Introduction: Generally agreed outcome criteria in psychosis are required to evaluate the effectiveness of new treatment strategies and surmount therapeutic pessimism. The aim of this study is to explore recovery and its relation to symptomatic and functional remission in first episode patients and to find predictors of recovery. Methods: In a sample of first episode patients (N = 125) symptomatic and functional remission during the last nine months of a two years follow-up period were examined, as well as recovery and its predictors. Recovery was clinically defined by the two dimensions of symptomatic and functional remission. Results: Half the patients (52.0%) showed symptomatic remission, a quarter (26.4%) showed functional remission, while one fifth (19.2%) met both criteria-sets and were considered recovered. Functionally remitted patients recovered in 72.7% (OR = 2.7), symptomatically remitted patients in 36.9% (OR = 0.6). Recovery was significantly associated with short duration of untreated psychosis (OR = 0.531, df = 1, p = 0.008). No recovery occurred in patients with long duration of untreated psychosis (>6 months). Another significant predictor of recovery was better baseline functioning (OR = 0.858, df = 1, p = 0.021). Conclusions: Functional remission is more selectively associated with recovery than symptomatic remission. Treatment delay reduces chance of recovery. Baseline functioning levels also significantly predict recovery. Our results clearly show that social functioning is an important parameter in schizophrenia outcome research, both as a predictor of future course characteristics, and as a more selective index of recovery than symptom remission. References [1] Andreasen NC, Carpenter WT, Jr., Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005 Mar;162(3):441-9