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Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort

Published online by Cambridge University Press:  18 November 2019

Rosa Ayesa-Arriola Open the ORCID record for Rosa Ayesa-Arriola [Opens in a new window] ,
Víctor Ortíz-García de la Foz ,
Obdulia Martínez-García ,
Esther Setién-Suero ,
María Luz Ramírez ,
Paula Suárez-Pinilla ,
Jacqueline Mayoral-van Son ,
Javier Vázquez-Bourgon ,
María Juncal-Ruiz  and
Marcos Gómez-Revuelta
...Show all authors
Rosa Ayesa-Arriola*
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
Víctor Ortíz-García de la Foz
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
Obdulia Martínez-García
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
Esther Setién-Suero
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
María Luz Ramírez
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
Paula Suárez-Pinilla
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
Jacqueline Mayoral-van Son
Affiliation:
CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain Sierrallana Hospital, Torrelavega, Cantabria, Spain
Javier Vázquez-Bourgon
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
María Juncal-Ruiz
Affiliation:
CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain Sierrallana Hospital, Torrelavega, Cantabria, Spain
Marcos Gómez-Revuelta
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
Diana Tordesillas-Gutiérrez
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
Benedicto Crespo-Facorro
Affiliation:
Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
*
Author for correspondence: Rosa Ayesa-Arriola, E-mail: rayesa@humv.es
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Abstract

Background

The aim of the current study was to examine the heterogeneity of functional outcomes in first episode psychosis (FEP) patients and related clinical, neurocognitive and sociodemographic factors using a cluster analytic approach.

Method

A large sample of FEP patients (N = 209) was functionally reassessed 10 years after the first contact with an early intervention service. Multiple baseline, 3-year and 10-year follow-up variables were explored.

Results

The cluster analysis emphasized the existence of six independent clusters of functioning: one cluster was normal overall (42.16%), two clusters showed moderate interpersonal (9.63%) or instrumental (12.65%) deficits, two clusters showed more severe interpersonal (12.05%) or interpersonal and instrumental (13.85%) deficits and there was a significantly overall impaired cluster (9.63%). Cluster comparisons showed that several baseline and follow-up factors were differentially involved in functional outcomes.

Conclusions

The current study demonstrated that distinct clusters of functioning in FEP patients can be identified. The fact that a variety of profiles was observed contributes to a better understanding of the nature of the heterogeneity characterizing FEP patients and has clinical implications for developing individualized treatment plans.

Keywords

Clustersfirst episode psychosisoutcomeschizophreniasubtyping
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 2 , January 2021 , pp. 264 - 277
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Copyright
Copyright © Cambridge University Press 2019

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Footnotes

The online version of this article has been updated since original publication. A notice detailing the changes has also been published at https://doi.org/10.1017/S0033291719003854.

References

Addington, D, Addington, J, Maticka-Tyndale, E and Joyce, J (1992) Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Bulletin 6, 201–208.CrossRefGoogle ScholarPubMed
Addington, DE, McKenzie, E, Norman, R, Wang, J and Bond, GR (2013) Essential evidence-based components of first-episode psychosis services. Psychiatric Services 64, 452–457.CrossRefGoogle ScholarPubMed
Andreasen, NC (1983) Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, NC (1984) Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Andreasen, NC, Carpenter, WTJ, Kane, JM, Lasser, RA, Marder, SR and Weinberger, DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.CrossRefGoogle ScholarPubMed
Austin, SF, Mors, O, Secher, RG, Hjorthoj, CR, Albert, N, Bertelsen, M, Jensen, H, Jeppesen, P, Petersen, L, Randers, L, Thorup, A and Nordentoft, M (2013) Predictors of recovery in first episode psychosis: the OPUS cohort at 10 year follow-up. Schizophrenia Research 150, 163–168.CrossRefGoogle ScholarPubMed
Austin, SF, Mors, O, Budtz-Jorgensen, E, Secher, RG, Hjorthoj, CR, Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A and Nordentoft, M (2015) Long-term trajectories of positive and negative symptoms in first episode psychosis: a 10 year follow-up study in the OPUS cohort. Schizophrenia Research 168, 84–91.CrossRefGoogle Scholar
Cannon-Spoor, HE, Potkin, SG and Wyatt, RJ (1982) Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.CrossRefGoogle ScholarPubMed
Chan, SKW, Hui, CLM, Chang, WC, Lee, EHM and Chen, EYH (2018) Ten-year follow up of patients with first-episode schizophrenia spectrum disorder from an early intervention service: predictors of clinical remission and functional recovery. Schizophrenia Research 204, 65–71.CrossRefGoogle ScholarPubMed
Clemmensen, L, Vernal, DL and Steinhausen, HC (2012) A systematic review of the long-term outcome of early onset schizophrenia. BMC Psychiatry 12, 150.CrossRefGoogle ScholarPubMed
Cole, VT, Apud, JA, Weinberger, DR and Dickinson, D (2012) Using latent class growth analysis to form trajectories of premorbid adjustment in schizophrenia. Journal of Abnormal Psychology 121, 388–395.CrossRefGoogle Scholar
Correll, CU, Galling, B, Pawar, A, Krivko, A, Bonetto, C, Ruggeri, M, Craig, TJ, Nordentoft, M, Srihari, VH, Guloksuz, S, Hui, CLM, Chen, EYH, Valencia, M, Juarez, F, Robinson, DG, Schooler, NR, Brunette, MF, Mueser, KT, Rosenheck, RA, Marcy, P, Addington, J, Estroff, SE, Robinson, J, Penn, D, Severe, JB and Kane, JM (2018) Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry 75, 555–565.CrossRefGoogle ScholarPubMed
Crespo-Facorro, B, Gonzalez-Blanch, C and Pelayo-Teran, JM (eds) (2005) Programa asistencial para las fases iniciales de psicosis de Cantabria (PAFIP). Barcelona: Masson.Google Scholar
Crespo-Facorro, B, Perez-Iglesias, R, Ramirez-Bonilla, M, Martinez-Garcia, O, Llorca, J and Luis Vazquez-Barquero, J (2006) A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. The Journal of Clinical Psychiatry 67, 1511–1521.CrossRefGoogle ScholarPubMed
Csillag, C, Nordentoft, M, Mizuno, M, McDaid, D, Arango, C, Smith, J, Lora, A, Verma, S, Di Fiandra, T and Jones, PB (2017) Early intervention in psychosis: from clinical intervention to health system implementation. Early Intervention in Psychiatry 12, 757–764.CrossRefGoogle ScholarPubMed
Cuesta, MJ, Sanchez-Torres, AM, Cabrera, B, Bioque, M, Merchan-Naranjo, J, Corripio, I, Gonzalez-Pinto, A, Lobo, A, Bombin, I, de la Serna, E, Sanjuan, J, Parellada, M, Saiz-Ruiz, J and Bernardo, M (2015) Premorbid adjustment and clinical correlates of cognitive impairment in first-episode psychosis. The PEPsCog Study. Schizophrenia Research 164, 65–73.CrossRefGoogle ScholarPubMed
De Maio, M, Graham, P, Vaughan, D, Haber, L and Madonick, S (2015) Review of international early psychosis programmes and a model to overcome unique challenges to the treatment of early psychosis in the United States. Early Intervention in Psychiatry 9, 1–11.CrossRefGoogle Scholar
Dominguez, MD, Saka, MC, Lieb, R, Wittchen, HU and van Os, J (2010) Early expression of negative/disorganized symptoms predicting psychotic experiences and subsequent clinical psychosis: a 10-year study. American Journal of Psychiatry 167, 1075–1082.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (1996) Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, DC: American Psychiatric Press, Inc.Google Scholar
Flemenbaum, A and Zimmermann, RL (1973) Inter- and intra-rater reliability of the Brief Psychiatric Rating Scale. Psychological Reports 32, 783–792.CrossRefGoogle ScholarPubMed
Galderisi, S, Mucci, A, Bitter, I, Libiger, J, Bucci, P, Fleischhacker, WW and Kahn, RS (2013) Persistent negative symptoms in first episode patients with schizophrenia: results from the European First Episode Schizophrenia Trial. European Neuropsychopharmacology 23, 196–204.CrossRefGoogle ScholarPubMed
Galderisi, S, Mucci, A, Buchanan, RW and Arango, C (2018) Negative symptoms of schizophrenia: new developments and unanswered research questions. Lancet Psychiatry 5, 664–677.CrossRefGoogle ScholarPubMed
Grube, BS, Bilder, RM and Goldman, RS (1998) Meta-analysis of symptom factors in schizophrenia. Schizophrenia Research 31, 113–120.CrossRefGoogle Scholar
Harvey, PD and Bellack, AS (2009) Toward a terminology for functional recovery in schizophrenia: is functional remission a viable concept? Schizophrenia Bulletin 35, 300–306.CrossRefGoogle Scholar
Harvey, PD, Heaton, RK, Carpenter, WT Jr, Green, MF, Gold, JM and Schoenbaum, M (2012) Functional impairment in people with schizophrenia: focus on employability and eligibility for disability compensation. Schizophrenia Research 140, 1–8.CrossRefGoogle ScholarPubMed
Heinrichs, DW, Hanlon, TE and Carpenter, WT Jr (1984) The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388–398.CrossRefGoogle ScholarPubMed
Laloyaux, J, Laroi, F, Nuyens, F and Billieux, J (2018) Subtyping attenuated psychotic symptoms: a cluster analytic approach. Journal of Clinical Psychology 74, 2117–2133.CrossRefGoogle ScholarPubMed
Larsen, TK, Friis, S, Haahr, U, Johannessen, JO, Melle, I, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, PV and McGlashan, TH (2004) Premorbid adjustment in first-episode non-affective psychosis: distinct patterns of pre-onset course. British Journal of Psychiatry 185, 108–115.CrossRefGoogle ScholarPubMed
Lewandowski, KE, Sperry, SH, Cohen, BM and Ongur, D (2014) Cognitive variability in psychotic disorders: a cross-diagnostic cluster analysis. Psychological Medicine 44, 3239–3248.CrossRefGoogle ScholarPubMed
Mañá, S, Ivorra, J and Girón, M (1998) Adaptación y fiabilidad de la entrevista para la evaluación de la discapacidad social en pacientes psiquiátricos (OMS). Revista de Psiquiatría de la Facultad de Medicina de Barcelona 25, 43–48.Google Scholar
McGorry, PD (2015) Early intervention in psychosis: obvious, effective, overdue. Journal of Nervous and Mental Disease 203, 310–318.CrossRefGoogle ScholarPubMed
McGorry, PD, Killackey, E and Yung, A (2008) Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 7, 148–156.CrossRefGoogle ScholarPubMed
McGrath, J (2008) Dissecting the heterogeneity of schizophrenia outcomes. Schizophrenia Bulletin 34, 247–248.CrossRefGoogle ScholarPubMed
Menezes, NM, Arenovich, T and Zipursky, RB (2006) A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36, 1349–1362.CrossRefGoogle ScholarPubMed
Pedersen, G, Hagtvet, KA and Karterud, S (2007) Generalizability studies of the Global Assessment of Functioning-Split version. Comprehensive Psychiatry 48, 88–94.CrossRefGoogle ScholarPubMed
Pelayo-Teran, JM, Perez-Iglesias, R, Ramirez-Bonilla, M, Gonzalez-Blanch, C, Martinez-Garcia, O, Pardo-Garcia, G, Rodriguez-Sanchez, JM, Roiz-Santianez, R, Tordesillas-Gutierrez, D, Mata, I, Vazquez-Barquero, JL and Crespo-Facorro, B (2008 a) Epidemiological factors associated with treated incidence of first-episode non-affective psychosis in Cantabria: insights from the Clinical Programme on Early Phases of Psychosis. Early Intervention in Psychiatry 2, 178–187.CrossRefGoogle ScholarPubMed
Pelayo-Teran, JM, Perez-Iglesias, R, Ramirez-Bonilla, ML, Gonzalez-Blanch, C, Martinez-Garcia, O, Pardo-Garcia, G, Rodriguez-Sanchez, J, Roiz-Santianez, R, Tordesillas-Gutierrez, D, Mata, I, Vazquez-Barquero, JL and Crespo-Facorro, B (2008 b) Epidemiological factors associated with treated incidence of first-episode non-affective psychosis in Cantabria: insights from the Clinical Programme on Early Phases of Psychosis. Early Intervention in Psychiatry 2, 178–187.CrossRefGoogle ScholarPubMed
Quee, PJ, Meijer, JH, Islam, MA, Aleman, A, Alizadeh, BZ, Meijer, CJ and van den Heuvel, ER (2014) Premorbid adjustment profiles in psychosis and the role of familial factors. Journal of Abnormal Psychology 123, 578–587.CrossRefGoogle ScholarPubMed
R Development Core Team (2010) R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Reichenberg, A, Harvey, PD, Bowie, CR, Mojtabai, R, Rabinowitz, J, Heaton, RK and Bromet, E (2009) Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. Schizophrenia Bulletin 35, 1022–1029.CrossRefGoogle ScholarPubMed
Santesteban-Echarri, O, Paino, M, Rice, S, Gonzalez-Blanch, C, McGorry, P, Gleeson, J and Alvarez-Jimenez, M (2017) Predictors of functional recovery in first-episode psychosis: a systematic review and meta-analysis of longitudinal studies. Clinical Psychology Review 58, 59–75.CrossRefGoogle ScholarPubMed
Saxena, S, Thornicroft, G, Knapp, M and Whiteford, H (2007) Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370, 878–889.CrossRefGoogle ScholarPubMed
Secher, RG, Hjorthoj, CR, Austin, SF, Thorup, A, Jeppesen, P, Mors, O and Nordentoft, M (2015) Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Schizophrenia Bulletin 41, 617–626.CrossRefGoogle ScholarPubMed
Silverman, MM, Berman, AL, Sanddal, ND, O'Carroll, PW and Joiner, TE (2007 a) Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: background, rationale, and methodology. Suicide and Life-Threatening Behavior 37, 248–263.CrossRefGoogle Scholar
Silverman, MM, Berman, AL, Sanddal, ND, O'Carroll, PW and Joiner, TE (2007 b) Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: suicide-related ideations, communications, and behaviors. Suicide and Life-Threatening Behavior 37, 264–277.CrossRefGoogle Scholar
Velthorst, E, Fett, AJ, Reichenberg, A, Perlman, G, van Os, J, Bromet, EJ and Kotov, R (2017) The 20-year longitudinal trajectories of social functioning in individuals with psychotic disorders. American Journal of Psychiatry 174, 1075–1085.CrossRefGoogle ScholarPubMed
WHO (2008) Mental Health Gap Action Programme: Scaling up Care for Mental, Neurological, and Substance use Disorders. Geneva: WHO Press.Google Scholar
Young, RC, Biggs, JT, Ziegler, VE and Meyer, DA (1978) A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed
Zipursky, RB, Agid, O and Remington, G (2018) Improving outcomes in schizophrenia by preventing early relapses. Lancet Psychiatry 5, 384–386.CrossRefGoogle ScholarPubMed