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Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study.

Revier CJ, Reininghaus U, Dutta R, Fearon P, Murray RM, Doody GA, Croudace T, Dazzan P, Heslin M, Onyejiaka A, Kravariti E, Lappin J, Lomas B, Kirkbride JB, Donoghue K, Morgan C, Jones PB - J. Nerv. Ment. Dis. (2015)

Bottom Line: It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome.Symptomatic remission and recovery were more common than previously believed.Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement.

View Article: PubMed Central - PubMed

Affiliation: *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King's College, London, UK.

ABSTRACT
It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome. We have synthesized information on mortality, clinical and social outcomes from the ÆSOP-10 multicenter study, a 10-year follow-up of a large epidemiologically characterized cohort of 557 people with first-episode psychosis. Symptomatic remission and recovery were more common than previously believed. Distinguishing between symptom and social recovery is important given the disparity between these; even when symptomatic recovery occurs social inclusion may remain elusive. Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement. These results suggest that researchers, clinicians and those affected by psychosis should countenance a much more optimistic view of symptomatic outcome than was assumed when these conditions were first described.

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Related in: MedlinePlus

Time to first remission and illicit drug use at baseline; rates of mortality by cause.
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Figure 1: Time to first remission and illicit drug use at baseline; rates of mortality by cause.

Mentions: The Kaplan-Meier survival curves show evidence that a long DUP (Supplementary Figure 3, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014) and a long time to first remission (Supplementary Figure 4, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014) were associated with an increased risk of all- and natural-cause death over time. Findings from Cox regression indicated that the association between time to first remission and natural-cause death over time held after adjusting for age at baseline and sex (Fig. 1; Adj. HR 6.76; p = 0.02) (Supplementary Table 4, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014). Further, illicit drug use in the year before baseline was associated with an increased risk of all- and unnatural-cause death over time, while adjusting for age and sex (Fig. 1; all-cause Adj. HR 2.30; p = 0.04 and unnatural-cause Adj. HR 3.04; p = 0.05) (Supplementary Table 4, http://links.lww.com/JNMD/A5 and Supplementary Figure 5, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014). In addition, researchers found strong evidence of reduced risk of unnatural death over time for cases with full family involvement at first contact with services (family actively sought help for individual), which remained when adjusted for age at baseline and sex, as reflected in Figure 2 (Adj. HR 0.09; p = 0.02) (Supplementary Table 4, http://links.lww.com/JNMD/A5 and Supplementary Figure 6, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014).


Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study.

Revier CJ, Reininghaus U, Dutta R, Fearon P, Murray RM, Doody GA, Croudace T, Dazzan P, Heslin M, Onyejiaka A, Kravariti E, Lappin J, Lomas B, Kirkbride JB, Donoghue K, Morgan C, Jones PB - J. Nerv. Ment. Dis. (2015)

Time to first remission and illicit drug use at baseline; rates of mortality by cause.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4414339&req=5

Figure 1: Time to first remission and illicit drug use at baseline; rates of mortality by cause.
Mentions: The Kaplan-Meier survival curves show evidence that a long DUP (Supplementary Figure 3, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014) and a long time to first remission (Supplementary Figure 4, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014) were associated with an increased risk of all- and natural-cause death over time. Findings from Cox regression indicated that the association between time to first remission and natural-cause death over time held after adjusting for age at baseline and sex (Fig. 1; Adj. HR 6.76; p = 0.02) (Supplementary Table 4, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014). Further, illicit drug use in the year before baseline was associated with an increased risk of all- and unnatural-cause death over time, while adjusting for age and sex (Fig. 1; all-cause Adj. HR 2.30; p = 0.04 and unnatural-cause Adj. HR 3.04; p = 0.05) (Supplementary Table 4, http://links.lww.com/JNMD/A5 and Supplementary Figure 5, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014). In addition, researchers found strong evidence of reduced risk of unnatural death over time for cases with full family involvement at first contact with services (family actively sought help for individual), which remained when adjusted for age at baseline and sex, as reflected in Figure 2 (Adj. HR 0.09; p = 0.02) (Supplementary Table 4, http://links.lww.com/JNMD/A5 and Supplementary Figure 6, http://links.lww.com/JNMD/A5 in Reininghaus et al., 2014).

Bottom Line: It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome.Symptomatic remission and recovery were more common than previously believed.Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement.

View Article: PubMed Central - PubMed

Affiliation: *Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK; †Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK; ‡Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; §Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK; ∥Department of Psychiatry, Trinity College, Dublin, Ireland; ¶NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College, London, UK; #Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK; **Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; ††Department of Nursing and Midwifery, University of Dundee, Dundee, UK; ‡‡Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK; §§Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ∥∥Institute of Psychiatry, Psychology & Neuroscience at King's College, London, UK; ¶¶Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia; ##Division of Psychiatry, University College London, London, UK; and ***Addictions Department, Institute of Psychiatry, King's College, London, UK.

ABSTRACT
It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome. We have synthesized information on mortality, clinical and social outcomes from the ÆSOP-10 multicenter study, a 10-year follow-up of a large epidemiologically characterized cohort of 557 people with first-episode psychosis. Symptomatic remission and recovery were more common than previously believed. Distinguishing between symptom and social recovery is important given the disparity between these; even when symptomatic recovery occurs social inclusion may remain elusive. Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement. These results suggest that researchers, clinicians and those affected by psychosis should countenance a much more optimistic view of symptomatic outcome than was assumed when these conditions were first described.

Show MeSH
Related in: MedlinePlus