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Remission and relapse after the first hospital admission in psychotic depression: a 4-year naturalistic follow-up

Published online by Cambridge University Press:  05 March 2007

BUSHRA NAZ ,
THOMAS J. CRAIG ,
EVELYN J. BROMET ,
STEPHEN J. FINCH ,
LAURA J. FOCHTMANN  and
GABRIELLE A. CARLSON
BUSHRA NAZ
Affiliation:
Department of Psychiatry, State University of New York at Stony Brook, NY, USA
THOMAS J. CRAIG
Affiliation:
Department of Veterans Affairs, Office of Quality and Performance, Washington, DC, USA
EVELYN J. BROMET*
Affiliation:
Department of Psychiatry, State University of New York at Stony Brook, NY, USA
STEPHEN J. FINCH
Affiliation:
Department of Applied Mathematics and Statistics, State University of New York at Stony Brook, NY, USA
LAURA J. FOCHTMANN
Affiliation:
Department of Psychiatry, State University of New York at Stony Brook, NY, USA
GABRIELLE A. CARLSON
Affiliation:
Department of Psychiatry, State University of New York at Stony Brook, NY, USA
*
*Address for correspondence: E. J. Bromet, Ph.D., Department of Psychiatry, Putnam Hall – South Campus, SUNY at Stony Brook, Stony Brook, NY 11794-8790, USA. (Email: evelyn.bromet@stonybrook.edu)
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Abstract

Background

Few studies have examined the course of illness among severely depressed patients ascertained at first hospitalization. Using data from the Suffolk County Mental Health Project (SCMHP), we investigated the times to and predictors of the first full remission and the first relapse during a 4-year period in a first-admission cohort with major depressive disorder (MDD) with psychotic features.

Method

The cohort included 87 county-wide, first-admission patients with a longitudinal consensus diagnosis of MDD with psychotic features who were systematically followed over a 4-year period. We examined the associations of background, clinical and treatment factors, and time-varying indices of antidepressant (AD) and antipsychotic (AP) medication use to time to remission and relapse using Cox regression.

Results

By the 4-year follow-up, 60 respondents (69·0%) had achieved a period of full remission (median time of 22 weeks among remitters and 54 weeks in the full sample). In the multivariable analysis, longer time to remission was associated with longer latency between initial episode and hospitalization, lower pre-hospital Global Assessment of Functioning (GAF) score, and lack of insurance, but not use of medication. Twenty-six remitters (43·3%) relapsed (median time of 50 weeks among those who relapsed and 192 weeks among all remitters). None of the risk factors or time-varying medication variables was significantly associated with time to relapse.

Conclusion

Only two-thirds of the sample had at least one full remission by 4 years, and almost half of them subsequently relapsed. Poorer pre-hospital resources predicted remission but not relapse. Medication use over the follow-up was not associated with remission or relapse.

Type
Original Article
Information
Psychological Medicine , Volume 37 , Issue 8 , August 2007 , pp. 1173 - 1181
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

Andreasen, N. C. (1984). The Scale for the Assessment of Positive Symptoms (SAPS). The University of Iowa: Iowa City.Google Scholar
Andreasen, N. C., Endicott, J., Spitzer, R. L. & Winokur, G. (1977). The family history method using diagnostic criteria: reliability and validity. Archives of General Psychiatry 34, 1229–1235.CrossRefGoogle ScholarPubMed
Bromet, E. J., Finch, S. J., Carlson, G. A., Fochtmann, L., Mojtabai, R., Craig, T., Kang, S. & Ye, Q. (2005). Times to remission and relapse after the first hospital admission in severe bipolar disorder. Social Psychiatry and Psychiatric Epidemiology 40, 106–113.CrossRefGoogle ScholarPubMed
Bromet, E. J., Jandorf, L., Fennig, S., Lavelle, J., Kovasznay, B., Ram, R., Tanenberg-Karant, M. & Craig, T. (1996). The Suffolk County Mental Health Project: demographic, premorbid and clinical correlates of 6-month outcome. Psychological Medicine 26, 953–962.Google Scholar
Bromet, E. J., Mojtabai, R. & Fennig, S. (2002). Epidemiology of first-episode schizophrenia: the Suffolk County Mental Health Project. In The Early Stages of Schizophrenia (ed. Zipursky, R. and Schulz, S. C.), pp. 33–54. American Psychiatric Association Press: Washington, DC.Google Scholar
Carlson, G. A., Bromet, E. J., Driessens, C., Mojtabai, R. & Schwartz, J. E. (2002). Age at onset, childhood psychopathology, and 2-year outcome in psychotic bipolar disorder. American Journal of Psychiatry 159, 307–309.CrossRefGoogle ScholarPubMed
Cochran, S. D. (1986). Compliance with lithium regimens in the outpatient treatment of bipolar affective disorders. Journal of Compliance in Health Care 1, 153–170.Google Scholar
Coryell, W., Keller, M. B., Lavori, P. & Endicott, J. (1990). Affective syndromes, psychotic features and prognosis: depression. Archives of General Psychiatry 47, 651–657.CrossRefGoogle ScholarPubMed
Coryell, W., Leon, A., Winokur, G., Endicott, J., Keller, M., Akiskol, H. & Solomon, D. (1996). Importance of psychotic features to long-term course in major depressive disorder. American Journal of Psychiatry 153, 483–489.Google Scholar
Craig, T. J., Bromet, E. J., Jandorf, L., Fennig, S., Tanenberg-Karant, M., Ram, R. & Rosen, B. (1997). Diagnosis, treatment and six month outcome status in first-admission psychosis. Annals of Clinical Psychiatry 9, 89–97.CrossRefGoogle ScholarPubMed
Dolder, C. R., Lacro, J. P., Dunn, L. B. & Jeste, D. V. (2002). Antipsychotic medication adherence: is there a difference between typical and atypical agents? American Journal of Psychiatry 159, 103–108.CrossRefGoogle Scholar
Fennig, S., Bromet, E. J., Karant, M. T., Ram, R. & Jandorf, L. (1996). Mood congruent versus mood incongruent psychotic symptoms in first admission patients with affective disorder. Journal of Affective Disorders 37, 23–29.Google Scholar
Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., Rush, A. J. & Weissman, M. M. (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Archives of General Psychiatry 48, 851–855.CrossRefGoogle ScholarPubMed
Goldberg, J. F. & Harrow, M. (2004). Consistency of remission and outcome in bipolar and unipolar mood disorders: a 10-year prospective follow-up. Journal of Affective Disorders 81, 123–131.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.Google Scholar
Hosmer, D. W. Jr. & Lemeshow, S. (1999). Applied Survival Analysis: Regression Modeling of Time to Event Data. John Wiley and Sons: New York.Google Scholar
Keitner, G. I., Ryan, C. E., Miller, I. W. & Norman, W. H. (1992). Recovery and major depression: factors associated with twelve-month outcome. American Journal of Psychiatry 149, 93–99.Google Scholar
Keller, M. B., Lavori, P. W., Mueller, T. I., Endicott, J., Coyell, W., Hirschfeld, R. M. A. & Shea, T. (1992). Time to recovery, chronicity, and levels of psychopathology in major depression: a 5-year prospective follow-up study of 431 subjects. Archives of General Psychiatry 49, 809–816.CrossRefGoogle ScholarPubMed
Keller, M. B., Shapiro, R. W., Lavori, P. W. & Wolfe, N. (1982). Relapse in major depressive disorder. analysis with the life table. Archives of General Psychiatry 39, 911–915.CrossRefGoogle ScholarPubMed
Kennedy, N., Abbott, R. & Paykel, S. (2003). Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychological Medicine 33, 827–838.Google Scholar
Kravitz, H. M., Bloom, R. W. & Fawcett, J. (2000). Recovery from a recurrent major depressive episode. Depression and Anxiety 12, 40–43.Google Scholar
Lee, A. S. & Murray, R. M. (1988). The long term outcome of Maudsley depressives. British Journal of Psychiatry 153, 741–751.Google Scholar
Melfi, C. A., Chawla, A. J., Croghan, T. W., Hanna, M. P., Kennedy, S. & Sredl, K. (1998). The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Archives of General Psychiatry 55, 1128–1132.CrossRefGoogle ScholarPubMed
O'Leary, D., Costello, F., Gormley, N. & Webb, M. (2000). Remission onset and relapse in depression: an 18-month prospective study of course for 100 first admission patients. Journal of Affective Disorders 57, 159–171.CrossRefGoogle ScholarPubMed
Paykel, E. S. (1998). Remission and residual symptomatology in major depression. Psychopathology 31, 5–14.CrossRefGoogle ScholarPubMed
Pintor, L., Torres, X., Navarro, V., Matrai, S. & Gasto, C. (2004). Is the type of remission after a major depressive episode an important risk factor to relapses in a 4-year follow up? Journal of Affective Disorders 82, 291–296.Google Scholar
Rabinowitz, J., Bromet, E. J., Lavelle, J., Hornak, K. J. & Rosen, B. (2001). Changes in insurance coverage and extent of care during the two years after first hospitalization for a psychotic disorder. Psychiatric Services 52, 87–91.CrossRefGoogle ScholarPubMed
Ramana, R., Paykel, E. S., Cooper, Z., Hayhurst, H., Saxty, M. & Surtees, P. G. (1995). Remission and relapse in major depression: a two-year prospective follow-up study. Psychological Medicine 25, 1161–1170.CrossRefGoogle ScholarPubMed
Rothschild, A. J., Samson, J. A., Bond, T. C., Luciana, M. M., Schildkraut, J. J. & Schatzberg, A. F. (1993). Hypothalamic–pituitary–adrenal axis activity and 1-year outcome in depression. Biological Psychiatry 34, 392–400.Google Scholar
Rush, A. J., Trivedi, M. H., Wisnewski, S. R., Stewart, J. W., Nierenberg, A. A., Thase, M. E., Ritz, L., Biggs, M. M., Warden, D., Luther, J. F., Wilson, K. S., Niederehe, G. & Fava, M.; STAR*D Study Team (2006). Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine 354, 1231–1242.Google Scholar
Schwartz, J. E., Fennig, S., Tanenberg-Karant, M., Carlson, G., Craig, T., Galambos, N., Lavelle, J. & Bromet, E. J. (2000). Congruence of diagnosis 2 years after a first admission diagnosis of psychosis. Archives of General Psychiatry 57, 593–600.CrossRefGoogle ScholarPubMed
Simpson, H. B., Nee, J. C. & Endicott, J. (1997). First-episode major depression: few sex differences in course. Archives of General Psychiatry 54, 633–639.Google Scholar
Solomon, D. A., Keller, M. B., Leon, A. C., Mueller, T. I., Lavori, P. W., Shea, M. T., Coryell, W., Warshaw, M., Turvey, C., Maser, J. D. & Endicott, J. (2000). Multiple recurrences of major depressive disorder. American Journal of Psychiatry 157, 229–233.Google Scholar
Spitzer, R. L., Williams, J. B. W., Gibbon, M. & First, M. B. (1992). The structured clinical interview for DSM-III-R (SCID): history, rational, and description. Archives of General Psychiatry 49, 624–629.Google Scholar
Tohen, M., Hennen, J., Zarate, C. M. Jr., Baldessarini, R. J., Strakowski, S. M., Stoll, A. L., Faedda, G. L., Suppes, T., Gebre-Medhin, P. & Cohen, B. M. (2000). Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. American Journal of Psychiatry 157, 220–228.CrossRefGoogle ScholarPubMed
Tohen, M., Stoll, A. L., Strakowski, M., Faedda, G. L., Mayer, P. V., Goodwin, D. C., Kolbrener, M. L. & Madigan, A. M. (1992). The McLean First-Episode Psychosis Project: six-month recovery and recurrence outcome. Schizophrenia Bulletin 18, 273–282.Google Scholar
Trivedi, M. H., Fava, M., Wisnewski, S. P., Thase, M. F., Quitkin, F., Warden, D., Ritz, L., Nierenberg, A. A., Lebowitz, B. D., Biggs, M. M., Luther, J. F., Wilson, K. S. & Rush, A. J.; STAR*D Study Team (2006). Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine 354, 1241–1252.CrossRefGoogle ScholarPubMed
Tsuang, D. & Coryell, W. (1993). An 8-year follow-up of patients with DSM-III-R psychotic depression, schizoaffective disorder, and schizophrenia. American Journal of Psychiatry 150, 1182–1188.Google Scholar
Vythilingam, M., Chen, J., Bremner, J. D., Mazure, C. M., Maciejewski, P. K. & Nelson, J. C. (2003). Psychotic depression and mortality. American Journal of Psychiatry 160, 574–576.Google Scholar
Woerner, M., Manuzza, S. & Kane, J. (1988). Anchoring the BPRS: an aid to improved reliability. Psychopharmacology Bulletin 24, 112–124.Google Scholar