Delayed psychosis treatment harms chance of success

By Eleanor McDermid, Senior medwireNews Reporter

The longer patients with first-episode psychosis go untreated, the less likely they are to achieve remission within a year of starting treatment, report researchers.

In their study, the average duration of untreated psychosis was 8.8 months in patients who achieved remission versus 15.6 months in those who did not.

"Early intervention clinical programs should aim to reduce the length of DUP [duration of untreated psychosis] in order to provide a better outcome for patients," advise study author Benedicto Crespo-Facorro (University of Cantabria, Santander, Spain) and colleagues.

The team followed up 153 patients (62% men) who had undergone treatment for first-episode psychosis as part of a randomized, controlled trial. After 1 year of treatment, 54 of these patients achieved clinical remission, according to the Andreasen criteria.

Just three factors predicted remission: longer duration of untreated psychosis; worse negative symptoms (higher Scale for the Assessment of Negative Symptoms [SANS] scores); and having completed only primary education.

The average initial SANS score was 5.1 in patients who achieved remission, compared with 8.4 in those who had not. At the 1-year follow up, the average score had fallen to 1.9 in patients who remitted, but had barely changed, at 8.1, in patients who did not remit.

The researchers note that Andreasen's remission criteria require improvement in positive, negative, and disorganization symptoms, so patients may fail to achieve remission despite marked improvements in positive symptoms. Indeed, the average Scale for the Assessment of Positive Symptoms score in patients who did not achieve remission fell from 12.8 to 3.0, although their 1-year score remained higher than the score of 0.3 achieved by the remitted group.

Current antipsychotic treatments lack efficacy against negative symptoms, making it all the more difficult for patients to achieve Andreasen's remission criteria, note Crespo-Facorro et al in Psychiatry Research.

They add that effective treatment for negative symptoms is a "major unmet need in schizophrenia treatment."

Finally, the team notes that while 88% of nonremitted patients remained disabled according to the Disability Assessment Schedule at 1 year, so did 38% of the patients who achieved remission. "Therefore, although remission may be a necessary step to recovery, it is not sufficient as… patients that achieve symptomatic remission are not necessarily functioning well."

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