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Association between symptomatic remission and functional outcome in first-episode schizophrenia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital. (Psykiatri Ulleråker)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Department of Psychiatry and Forensic Psychiatry, Malmö University Hospital. (Psykiatri Ulleråker)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital. (Psykiatri Ulleråker)
2009 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 107, no 2-3, 232-237 p.Article in journal (Refereed) Published
Abstract [en]

Although operational criteria for remission in schizophrenia have recently been proposed, the association of this definition with broader functional outcome has not yet been established in first-episode patients. The severity criteria for remission consist of a score of mild or less on eight core symptoms of schizophrenia. We applied the severity criteria for remission to a sample of patients with first-episode schizophrenia (n = 76) in order to explore the association with functional outcome five years after first presentation to mental healthcare. We evaluated whether other factors than those included in the remission definition predicted good function in logistic regression models. The discriminatory capacities for remission and other factors for good function were tested using C-statistics. The proportions of remitters and non-remitters having good function were 73% and 17%, respectively. Furthermore, remitters had a higher level of subjective satisfaction with life. In comparison with non-remission, symptomatic remission was strongly associated with good function: odds ratio 13.2, 95% confidence interval, 4.3 to 40.3. A duration of untreated psychosis of three months or less as compared with a longer duration was associated with having good function at a five-year follow-up independently of remission status. The discriminatory capacity for symptomatic remission between having good function vs. not was acceptable (C-statistic = 0.78), which was significantly improved to an excellent discriminatory capacity by adding duration of untreated psychosis less than three months (C-statistic = 0.83, p = 0.04). In conclusion, core symptoms of schizophrenia have an important limiting effect on functioning and subjective life satisfaction in the early course of the illness.

Place, publisher, year, edition, pages
2009. Vol. 107, no 2-3, 232-237 p.
Keyword [en]
Remission, Functional outcome, First-episode, Schizophrenia
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-88211DOI: 10.1016/j.schres.2008.10.004ISI: 000263397600019PubMedID: 18957275OAI: oai:DiVA.org:uu-88211DiVA: diva2:139668
Available from: 2009-01-26 Created: 2009-01-26 Last updated: 2010-12-29Bibliographically approved
In thesis
1. Prognostic Factors in First-Episode Schizophrenia: Five-year Outcome of Symptoms, Function and Obesity
Open this publication in new window or tab >>Prognostic Factors in First-Episode Schizophrenia: Five-year Outcome of Symptoms, Function and Obesity
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Our knowledge of prognostic factors and optimal treatment organisation in schizophrenia is incomplete. The disparity of outcome measures used has been a major obstacle for research. Increasing evidence has shown that schizophrenia is associated with increased cardiovascular mortality, development of obesity and autonomic nervous system imbalance. Assertive community treatment (ACT) has been suggested as a promising direction for organising treatment services for first-episode schizophrenia, but its long-term effect has not been evaluated.

One aim of the present thesis was to investigate prognostic factors for 5-year symptomatic and functional outcome and obesity development. A further aim was to evaluate a recently proposed definition of remission and examine the long-term effects of introducing a modified ACT programme (mACT). Thus, we performed a follow-up study of all consecutive first-episode psychosis patients in Uppsala County, Sweden during 1995-2000 (n=144).

In the first study we investigated the changes in a broad 5-year outcome of symptoms and function among patients presenting first time ever to psychiatric health care during 3 years before and during 3 years after the implementation of mACT. This change in the psychiatric service, however, was not followed by any long-term clinical benefits.

In the second study, we examined the association between remission of eight core schizophrenia symptoms and functional outcome. Remission was strongly associated with having good function and having a higher self-rated satisfaction with life.

In the third study, we explored a set of biochemical markers as predictors of weight gain and development of obesity. Haemoglobin, red blood cell count, hematocrit, γ-glutamyltransferase and creatinine were associated with the development of obesity in first-episode schizophrenia.

In the fourth and final study, we tested electrocardiographic measures of autonomic imbalance as predictors of symptomatic remission. Higher heart rate and high ST and T-wave amplitudes were related to symptomatic remission, indicating that cardiac autonomic imbalance at baseline may have a prognostic value in first-episode schizophrenia.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 63 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 521
First-episode, psychosis, schizophrenia, community mental health services, remission, functional outcome, biochemistry, obesity, weight-gain, prediction, autonomic balance, electrocardiography
National Category
Research subject
urn:nbn:se:uu:diva-113797 (URN)978-91-554-7719-6 (ISBN)
Public defence
2010-03-26, Sal X, Universitetshuset, Övre Slottsgatan, Uppsala, 09:15 (Swedish)
Available from: 2010-03-05 Created: 2010-02-04 Last updated: 2010-03-05Bibliographically approved

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