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Predictors of outcome in first-episode schizophrenia over the first 4 years of illness

Published online by Cambridge University Press:  30 April 2008

P. Whitty ,
M. Clarke ,
O. McTigue ,
S. Browne ,
M. Kamali ,
A. Kinsella ,
C. Larkin  and
E. O'Callaghan
P. Whitty
Affiliation:
Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
M. Clarke
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
O. McTigue
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
S. Browne
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
M. Kamali
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
A. Kinsella
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland
C. Larkin
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland Department of Adult Psychiatry, University College Dublin, Ireland
E. O'Callaghan*
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre and St John of God Hospital, Co. Dublin, Ireland Department of Adult Psychiatry, University College Dublin, Ireland DELTA/DETECT Early Intervention in Psychosis Service, Blackrock, Co. Dublin, Ireland
*
*Address for correspondence: E. O'Callaghan, M.D., FRCPsych, DELTA/DETECT Early Intervention in Psychosis Service, Avila House, Block 5, The Bell Tower, Blackrock Business Park, Carysfort Avenue, Blackrock, Co. Dublin, Ireland. (Email: [email protected])
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Abstract

Background

The outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.

Method

We conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.

Results

There were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=−3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=−2.77, p<0.01) significantly predicted a better outcome at follow-up.

Conclusions

The outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.

Keywords

First episodeoutcomepsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1141 - 1146
Copyright
Copyright © 2008 Cambridge University Press

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