Predictors of long-term outcomes of first episode schizophrenia-spectrum disorders

Abstract

Despite of the improvement in intervention, long term outcomes of patients with schizophrenia has not improved much. Early clinical characteristics has been suggested to predict the long-term outcomes. The current study is to look at predictors of early clinical characteristics including relapse and planned discontinuation of antipsychotic medications to long-term outcomes including suicide, treatment resistance and recovery in patients with schizophrenia-spectrum disorders. Apart from basic demographics, information of baseline clinical condition including positive and negative symptoms, duration of untreated psychosis (DUP), suicidal attempts during DUP; clinical characteristics during the first three years including number of relapse, number hospitalization, compliance, suicidal attempts, planned discontinuation of antipsychotic medications were obtained from clinical record review. The review was conducted at monthly basis with standardized entry form with operational definitions. Suicide information was obtained at 12-year follow up of 1400 patients. Results suggested number of relapse, premorbid functional impairment and compliance predicted suicide in year 4 to 12 (p=0.002), whereas suicide attempts in DUP and first three years predicted suicide in year 1-3(p=0.004). Among the 1400 patients, 165 patients were considered treatment resistant by 12-year follow up. Use case-control study approach with control patients who were randomly identified among the 1400 patients matched with diagnosis of patients with treatment resistance. A total of 290 patient control was identified. Results suggested patients with treatment resistant had younger age of onset, lower years of education, poorer premorbid adjustment, more number of hospitalization and relapse during the initial three years of treatment than the patient control.