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. 2019 Jul:209:234-244.
doi: 10.1016/j.schres.2019.02.003. Epub 2019 Feb 28.

Longitudinal trajectory of early functional recovery in patients with first episode psychosis

Mei-Hua Hall  1 , Kristina M Holton  2 , Dost Öngür  3 , Debra Montrose  4 , Matcheri S Keshavan  5
Affiliations

Longitudinal trajectory of early functional recovery in patients with first episode psychosis

Mei-Hua Hall et al. Schizophr Res. 2019 Jul.

Abstract

Background: There is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals' outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven methods, and to explore the potential risk /protective factors associated with each trajectory.

Methods: A total of 369 first episode patients (93% antipsychotic naive) were included in the baseline assessments and followed-up at 4-8 weeks, 6 months, and 1 year. K means cluster modeling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. Patients with at least 3 assessments were included in the trajectory analyses (N = 129). The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF).

Results: In each of the three predictor models, four distinct functional outcome trajectories emerged: "Poor", "Intermediate", High" and "Catch-up". Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery.

Conclusions: Functioning recovery in individuals with FEP is heterogeneous, although distinct recovery profiles are apparent. Data-driven trajectory analysis can facilitate better characterization of individual longitudinal patterns of functioning recovery.

Keywords: First episode psychosis; Functional recovery; K means clustering; Longitudinal study; Outcome trajectories.

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Conflict of interest statement

Financial Disclosures

The authors reported no biomedical financial interests or potential conflicts of interest.

Conflict of interest

One of the authors is an editor of this journal. All editorial process for this paper is handled by another editor.

Figures

Figure 1.
Figure 1.. SANS symptoms as predictor against GAF
RED: Poor; Green: Middle; Cyan: Catch-up; Purple: Good
Figure 2.
Figure 2.. SAPS symptoms as predictor against GAF
RED: Poor; Green: Middle; Cyan: Catch-up; Purple: Good
Figure 3.
Figure 3.. NSS symptoms as predictor against GAF
RED: Poor; Green: Middle; Cyan: Catch-up; Purple: Good
See this image and copyright information in PMC

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