LONG TERM FOLLOW UP OF AN ULTRA HIGH RISK ("PRODROMAL") GROUP
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out of ten patients has enduring OCS symptoms and is diagnosed with co-morbid OCD. OCS/OCD co-morbidity was not associated with a more severe course of psychotic symptoms and relapse, although premorbid functioning and social outcome of patients with OCD and enduring OCS symptoms is worse. doi:10.1016/j.schres.2010.02.216 ANALYSES OF PROTECTIVE FACTORS FOR PATIENTS WITH AGOOD OUTCOME FIVE YEAR AFTER FIRST EPISODE PSYCHOSIS Nikolai Albert, Mette Bertelsen, Anne Thorup, Lone Petersen, Pia Jeppesen, Gertrud Krarup, Torben Christensen, Merete Nordentoft University of Copenhagen Copenhagen Denmark Background: There is an ongoing debate whether psychosis and schizophrenia is a progressive deteriorating illness or an illness with multiple outcome options. Until the development of anti- psychotics the prognosis of schizophrenia were grim. Most long- itudinal studies now conclude that approximately a quarter too one third of the patients recover, in one way or another, and one third is considered chronically ill. It has also been suggested that the course of illness reaches a natural plateau of psychopathology and disability early in the course, and that this phase, "the critical period", has a direct effect on the long-term trajectory of the psychosis. Most studies are mainly occupied with risk factors for a chronic outcome. Even though the predictors of a good outcome might be the inverse of these, this relation is not fully investigated. Methods: The OPUS trial is one of very few long-term prospective follow-up studies of first-episode psychotic with multiple follow-up points. It offers an important contribution to the literature since the sample has been followed after one, two and five years. This paper aims to investigate the predictors of good outcome after first episode psychosis. In the OPUS trial 468 first episode psychotic patients were included at baseline, 362 (77.4%) with schizophrenia and 104 (22.6%) with other psychosis in the schizophrenia spectrum. At the five year follow up 255 was interviewed, 76 (29.8%) of these were working or studying and 40 (15.7%) were considered fully recovered. Recovery was defined as working or studying, having a GAF- score of 60 or above, no hospitalisation and living independently for the last two years and having stable remission of negative and positive symptoms over the last two years. Results: The analysis was made in two steps, first with the social and demographic variables and then with the clinical variables. Of the socio-demographic variables: premorbid social function, mea- sured with premorbid adjustment scale, social dimension (OR 0.009, 95% CI 0.001 to 0.165), growing up with your mother and father (OR 2.7, 95% CI 1.1 to6.9), being a parent (OR 9.8, 95%CI 1.8 to 55.1), being in a relationship (OR 3.1, 95% CI 1.2 to 7.8) and a higher number of friends (OR 1.2, 95% CI 1.0 to 1.5), all at baseline, were found to predict recovery after five years. Strangely however, a higher number of friends and family contacts (OR 0.81, 95% CI 0.68 to 0.98) decreased chances for recovery. In the multivariate analysis of the clinical variables only a higher severity of negative symptoms (OR 0.60, 95% CI 4.3 to 8.7) were significant associated with decreased change of recovery. Discussion: The rate of recovery (15.7 %) and working or studying (29.8%) contradicts the presumption that psychosis or schizophre- nia is a chronic or progressive deteriorating illness. The predictors are consistent with earlier findings, which suggest that a stable social life with a normal level of social functioning (a partner, friends, kids) have a predicative value on good outcome. These measures might be a pseudo measurement of negative symptoms and thus not having a protective value in their own. But in the multivariate analysis with negative symptoms included they still stand out. doi:10.1016/j.schres.2010.02.217 LONG TERM FOLLOW UP OF AN ULTRA HIGH RISK ("PRODROMAL") GROUP Barnaby Nelson, Alison R. Yung, Hok Pan Yuen, Daniela Spiliotacopoulos, Ashleigh Lin, Annie L. Bruxner, Christina M. Broussard, Magenta B. Simmons, Patrick D. McGorry University of Melbourne Parkville, Vic, Australia Background: Criteria have now been developed that identify individuals at "ultra high risk" (UHR) or clinical high risk (CHR) of psychotic disorder. That is they are thought to be in the prodromal stage. These individuals have been found to have a rate of "transition" to psychotic disorder of about 35% over 1 year, with risk decreasing over the next 2.5 years. The longest follow up to date of a UHR cohort has been 3.5 years. In this study we sought to determine the longer term (5-15 year) outcome of a UHR sample. Methods: An extensive tracking procedure was followed to trace individuals who had previously participated in research studies at the PACE UHR Clinic in Melbourne Australia (n=416). At the time of the original research studies (conducted between 1994 and 2006) participants had given consent for long term follow up. The CAARMS (Comprehensive Assessment of At Risk Mental States) was used to determine whether transition to a previously defined psychosis threshold had occurred, and if so the date of onset. Results: 311/416 individuals (74.8%) were directly assessed by interview. Taking into account all sources (interview, clinical database, past research), data on transition status was available for 411 subjects (98.8%). Rates of transition to psychotic disorder were: within the first year after entry: 17.1%, within 2years after entry: 20.9%, within 3 years after entry: 25%, within 5 years or more after entry: 29.3%. Rates of transition tailed off after 5 years. The overall transition rate was lower than expected. Thus we then assessed whether year of recruitment affected transition rate, as we have previously found that transition rates are decreasing over time. It was found that the participants recruited earlier, between 1994 and 2000, had a significantly higher transition rate than later cohorts, recruited between 2001 and 2006. Discussion: This long tern follow up study suggests that UHR individuals continue to be at risk of psychosis even 5 years and more after initial presentation. However the risk is greatest in the early years after recruitment. The transition rate appeared to have decreased over the past 15 years. This may be partly because later cohorts have not yet moved through the period of greatest risk, especially given the reduced period of time between symptom onset and entry into PACE. For example, previously we had found that subjects recruited before 1998 had a significantly higher transition rate compared to those recruited between 1998 and 2000. However this longer term follow up found that the transition rate in the 1998-2000 cohort caught up to the earlier cohort, suggesting a lead time effect. It is also possible that changes in recruitment and clinical practice over time may have decreased the rate of transition to psychotic disorder. doi:10.1016/j.schres.2010.02.218 Abstracts 179
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Transcript of LONG TERM FOLLOW UP OF AN ULTRA HIGH RISK ("PRODROMAL") GROUP
out of ten patients has enduring OCS symptoms and is diagnosedwith co-morbid OCD. OCS/OCD co-morbidity was not associatedwith a more severe course of psychotic symptoms and relapse,although premorbid functioning and social outcome of patientswith OCD and enduring OCS symptoms is worse.
doi:10.1016/j.schres.2010.02.216
ANALYSES OF PROTECTIVE FACTORS FOR PATIENTS WITH A GOODOUTCOME FIVE YEAR AFTER FIRST EPISODE PSYCHOSIS
Nikolai Albert, Mette Bertelsen, Anne Thorup, Lone Petersen, PiaJeppesen, Gertrud Krarup, Torben Christensen, Merete NordentoftUniversity of Copenhagen Copenhagen Denmark
Background: There is an ongoing debate whether psychosis andschizophrenia is a progressive deteriorating illness or an illnesswith multiple outcome options. Until the development of anti-psychotics the prognosis of schizophrenia were grim. Most long-itudinal studies now conclude that approximately a quarter too onethird of the patients recover, in one way or another, and one third isconsidered chronically ill. It has also been suggested that the courseof illness reaches a natural plateau of psychopathology anddisability early in the course, and that this phase, "the criticalperiod", has a direct effect on the long-term trajectory of thepsychosis. Most studies are mainly occupied with risk factors for achronic outcome. Even though the predictors of a good outcomemight be the inverse of these, this relation is not fully investigated.Methods: The OPUS trial is one of very few long-term prospectivefollow-up studies of first-episode psychotic with multiple follow-uppoints. It offers an important contribution to the literature since thesample has been followed after one, two and five years. This paperaims to investigate the predictors of good outcome after first episodepsychosis. In the OPUS trial 468 first episode psychotic patients wereincluded at baseline, 362 (77.4%)with schizophrenia and 104 (22.6%)with other psychosis in the schizophrenia spectrum. At the five yearfollow up 255 was interviewed, 76 (29.8%) of these were working orstudying and 40 (15.7%) were considered fully recovered. Recoverywas defined as working or studying, having a GAF- score of 60 orabove, no hospitalisation and living independently for the last twoyears and having stable remission of negative and positive symptomsover the last two years.Results: The analysis was made in two steps, first with the socialand demographic variables and then with the clinical variables. Ofthe socio-demographic variables: premorbid social function, mea-sured with premorbid adjustment scale, social dimension (OR0.009, 95% CI 0.001 to 0.165), growing up with your mother andfather (OR 2.7, 95% CI 1.1 to 6.9), being a parent (OR 9.8, 95%CI 1.8 to55.1), being in a relationship (OR 3.1, 95% CI 1.2 to 7.8) and a highernumber of friends (OR 1.2, 95% CI 1.0 to 1.5), all at baseline, werefound to predict recovery after five years. Strangely however, ahigher number of friends and family contacts (OR 0.81, 95% CI 0.68to 0.98) decreased chances for recovery. In the multivariate analysisof the clinical variables only a higher severity of negative symptoms(OR 0.60, 95% CI 4.3 to 8.7) were significant associated withdecreased change of recovery.Discussion: The rate of recovery (15.7 %) and working or studying(29.8%) contradicts the presumption that psychosis or schizophre-nia is a chronic or progressive deteriorating illness. The predictorsare consistent with earlier findings, which suggest that a stablesocial life with a normal level of social functioning (a partner,friends, kids) have a predicative value on good outcome. Thesemeasures might be a pseudo measurement of negative symptoms
and thus not having a protective value in their own. But in themultivariate analysis with negative symptoms included they stillstand out.
doi:10.1016/j.schres.2010.02.217
LONG TERM FOLLOW UP OF AN ULTRA HIGH RISK("PRODROMAL") GROUP
Barnaby Nelson, Alison R. Yung, Hok Pan Yuen, DanielaSpiliotacopoulos, Ashleigh Lin, Annie L. Bruxner, Christina M.Broussard, Magenta B. Simmons, Patrick D. McGorryUniversity of Melbourne Parkville, Vic, Australia
Background: Criteria have now been developed that identifyindividuals at "ultra high risk" (UHR) or clinical high risk (CHR)of psychotic disorder. That is they are thought to be in theprodromal stage. These individuals have been found to have a rateof "transition" to psychotic disorder of about 35% over 1 year, withrisk decreasing over the next 2.5 years. The longest follow up todate of a UHR cohort has been 3.5 years. In this study we sought todetermine the longer term (5-15 year) outcome of a UHR sample.Methods: An extensive tracking procedure was followed to traceindividuals who had previously participated in research studies atthe PACE UHR Clinic in Melbourne Australia (n=416). At the timeof the original research studies (conducted between 1994 and2006) participants had given consent for long term follow up. TheCAARMS (Comprehensive Assessment of At Risk Mental States) wasused to determine whether transition to a previously definedpsychosis threshold had occurred, and if so the date of onset.Results: 311/416 individuals (74.8%) were directly assessed byinterview. Taking into account all sources (interview, clinicaldatabase, past research), data on transition status was availablefor 411 subjects (98.8%). Rates of transition to psychotic disorderwere: within the first year after entry: 17.1%, within 2 years afterentry: 20.9%, within 3 years after entry: 25%, within 5 years or moreafter entry: 29.3%. Rates of transition tailed off after 5 years. Theoverall transition rate was lower than expected. Thus we thenassessed whether year of recruitment affected transition rate, as wehave previously found that transition rates are decreasing over time.It was found that the participants recruited earlier, between 1994and 2000, had a significantly higher transition rate than latercohorts, recruited between 2001 and 2006.Discussion: This long tern follow up study suggests that UHRindividuals continue to be at risk of psychosis even 5 years andmore after initial presentation. However the risk is greatest in theearly years after recruitment. The transition rate appeared to havedecreased over the past 15 years. This may be partly because latercohorts have not yet moved through the period of greatest risk,especially given the reduced period of time between symptomonset and entry into PACE. For example, previously we had foundthat subjects recruited before 1998 had a significantly highertransition rate compared to those recruited between 1998 and2000. However this longer term follow up found that the transitionrate in the 1998-2000 cohort caught up to the earlier cohort,suggesting a lead time effect. It is also possible that changes inrecruitment and clinical practice over time may have decreased therate of transition to psychotic disorder.
doi:10.1016/j.schres.2010.02.218
Abstracts 179
