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Can adults recover from a first episode of psychosis?

A recent review pooled prevalence rates of remission and recovery using previous studies of adults who experienced a first episode of psychosis.

The prognosis of individuals who experience a first episode of psychosis, including schizophrenia, is variable and difficult to predict. While certain individuals will resume some degree of daily functioning, others will encounter more persistent symptoms that interfere with their abilities to participate in social and occupational activities.

A need to address long-term rates of remission and recovery

Little is known about long-term rates of remission and recovery in first-episode psychosis in the psychiatric literature. To address these gaps, a group of researchers in the United Kingdom conducted a systematic review and meta-analysis to examine prevalence rates of remission and recovery in first-episode psychosis. They used previously published longitudinal studies with observational designs and more than one year of follow-up. They also investigated potential moderators of remission and recovery, including the year of study, the duration of follow-up, and the definitions of remission and recovery used by the researchers. Their review was published in The British Journal of Psychiatry.

The researchers had three primary hypotheses. First, compared to studies conducted more than 20 years ago, they hypothesized that studies conducted in the past 20 years would show greater prevalence rates of remission and recovery. Second, they hypothesized that longer, rather than shorter, follow-up periods would be associated with lower rates of recovery. Third, they expected that rates of remission and recovery would be lower when researchers used more narrow criteria to define remission and recovery.

The researchers included prospective or retrospective longitudinal studies that were observational in nature and reported remission rates of individuals over 16 years of age with first-episode psychosis in any clinical setting. First-episode psychosis included affective psychosis or schizophrenia. Criteria for remission and recovery were based on symptom severity and duration.

The researchers identified 79 studies with a total of 19,072 patients that met their criteria for inclusion. Of these studies, 12,301 reported remission data, and 9,642 reported recovery data. The pooled rate of remission for individuals with first-episode psychosis was 58% with a mean follow-up period of 5.5 years, and the pooled recovery rate was 38% with a mean follow-up period of 7.2 years. North American studies reported higher remission rates than studies from other regions.

In partial support of the first hypothesis, more recent studies were associated with higher rates of remission but not recovery. The second hypothesis that longer follow-up periods would be associated with a lower prevalence of recovery was not supported. The criteria used to assess remission also did not impact remission rates, although differences were found with regard to recovery.

Remission rates have increased, but recovery rates have not improved

Overall, pooled prevalence data from previous studies on remission and recovery in first-episode psychosis suggest that remission rates have increased over time but recovery rates have not improved.

While this meta-analysis was strengthened by the use of various analytical methods, data on potential confounders, especially those related to treatment, treatment adherence, and lifestyle factors that may have impacted remission and recovery rates, was not included. Further research is needed to investigate potential factors associated with remission and recovery.

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.



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