Long-Term Remission and Recovery in First-Episode Psychosis
Overview of Psychosis Prognosis
A recent review has aggregated prevalence rates of remission and recovery based on previous studies involving adults who experienced their first episode of psychosis. The prognosis for these individuals, including those diagnosed with schizophrenia, varies significantly and is challenging to predict. While some individuals manage to regain a degree of daily functioning, others face persistent symptoms that hinder their ability to engage in social and occupational activities.
The Need for Long-Term Data
Despite the critical importance of understanding long-term rates of remission and recovery in first-episode psychosis, there is a lack of comprehensive data in psychiatric literature. To fill this gap, researchers in the United Kingdom conducted a systematic review and meta-analysis aimed at examining the prevalence rates of remission and recovery in first-episode psychosis. They utilized previously published longitudinal studies with observational designs that had follow-up periods exceeding one year. The researchers also explored potential moderators influencing remission and recovery, such as the year of study, duration of follow-up, and the definitions of remission and recovery employed in these studies. Their findings were published in The British Journal of Psychiatry.
Research Hypotheses
The researchers proposed three primary hypotheses. First, they anticipated that studies conducted in the last 20 years would reveal higher prevalence rates of remission and recovery compared to those conducted over 20 years ago. Second, they hypothesized that longer follow-up periods would correlate with lower recovery rates. Lastly, they expected that using narrower criteria to define remission and recovery would result in lower rates of both outcomes.
Study Inclusion Criteria
The systematic review included both prospective and retrospective longitudinal studies that were observational in nature and reported remission rates for individuals aged 16 and older experiencing first-episode psychosis in any clinical setting. This included cases of affective psychosis and schizophrenia, with criteria for remission and recovery based on symptom severity and duration.
Study Findings
The review identified 79 studies encompassing a total of 19,072 patients that met the criteria for inclusion. Of these studies, 12,301 provided remission data, while 9,642 reported recovery data. The pooled remission rate for individuals with first-episode psychosis was found to be 58%, with a mean follow-up period of 5.5 years. The pooled recovery rate was reported at 38%, with a mean follow-up period of 7.2 years. Notably, studies conducted in North America indicated higher remission rates compared to those from other regions.
Hypothesis Outcomes
The findings partially supported the first hypothesis, revealing that more recent studies were linked to higher remission rates, though this was not the case for recovery rates. Conversely, the second hypothesis—that longer follow-up periods would be associated with lower recovery prevalence—was not substantiated. Furthermore, the criteria used for assessing remission did not significantly influence remission rates, although variations were noted concerning recovery.
Conclusions on Remission and Recovery Rates
Overall, the pooled prevalence data suggest that while remission rates in first-episode psychosis have increased over time, recovery rates have remained stagnant. Although this meta-analysis was enhanced by a variety of analytical methods, it lacked data concerning potential confounders related to treatment, adherence, and lifestyle factors that could affect remission and recovery rates. Future research is essential to explore these potential influences.
Author Information
Written by Suzanne M. Robertson, Ph.D.
Reference
Lally, John, Olesya Ajnakina, Brendon Stubbs, Michael Cullinane, Kieran C. Murphy, Fiona Gaughran, and Robin M. Murray. “Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies.” The British Journal of Psychiatry (2017): bjp-bp.