Over half of FEP patients achieve symptomatic remission

By Mark Cowen

More than half of patients with a first episode of psychosis (FEP) achieve symptomatic remission after 2 years of treatment, but recovery rates are lower, results from a Singaporean study show.

"Female gender, shorter duration of untreated psychosis, fewer negative symptoms at baseline, and early response at 3 months were found to be significant factors associated with both symptomatic and functional remission as well as recovery at 2 years," comment the researchers.

The findings come from a study of 1175 patients who experienced a FEP between 2001 and 2008 and who were treated as part of the Singapore Early Psychosis Intervention Programme.

Symptomatic remission after 2 years was defined as achieving and maintaining a Positive and Negative Syndrome Scale (PANSS) score of 3 or less for at least 6 months on the following items: delusions, unusual thought contents, hallucinatory behavior, conceptual disorganization, mannerisms, blunted affect, social withdrawal, and lack of spontaneity.

Functional remission was defined by a disability score of 61 or higher on the Global Assessment of Functioning (GAF) plus being gainfully employed or studying.

Patients who fulfilled the criteria for both symptomatic and functional remission were classified as being in recovery.

In total, 636 (54.1%) patients had achieved symptomatic remission, 686 (58.4%) had achieved functional remission, and 345 (29.4%) were classified as being in recovery after 2 years.

Multiple logistic regression analysis revealed that female gender, being married, having a tertiary education, and early response to treatment (at 3 months) were significant predictors for recovery, at odds ratios of 1.47, 1.49, 1.56, and 1.78, respectively.

Other predictors for recovery included younger age, a shorter duration of untreated psychosis, and lower baseline PANSS negative subscale scores.

Swapna Verma (Institute of Mental Health, Singapore) and team conclude in Acta Scandinavica Psychiatrica: "Our results indicate that strategies to reduce duration of untreated psychosis and achieve early response could improve remission rates in FEP patients."

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