Negative symptoms ‘key to recovery’ in first-episode psychosis

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By Joanna Lyford, Senior medwireNews Reporter

The severity of negative symptoms in people with first-episode psychosis is a strong determinant of subsequent recovery, a long-term study has shown.

The finding, which is in line with previous research, suggests that better interventions to prevent or ameliorate negative symptoms may promote recovery, say Stephen Austin (Aarhus University, Denmark) and fellow authors.

Austin’s team conducted a 10-year follow-up of participants in the OPUS trial, a randomized controlled trial of brief antipsychotic medication for first-episode psychosis.

For this study, 304 of 496 trial participants were interviewed 10 years after randomization. At the time of interview, 7% of people were institutionalized, 39% reported sustained remission of positive and negative symptoms, 20% were functionally recovered, and just 14% met criteria for symptomatic and functional recovery.

Interestingly, rates of symptom remission and full recovery were stable at 2, 5, and 10 years, although it was not the same people who had achieved recovery at each follow-up.

“64% of participants achieved sustained symptom remission at least once in the past 10 years and nearly 30% of participants achieved full recovery at some time during the past 10 years,” write Austin et al in Schizophrenia Research.

For their primary analysis, the researchers looked at a range of baseline variables and associations with subsequent recovery. Logistic regression analysis identified two significant independent predictors of recovery, which together explained 22% of the variance in full recovery at 10 years.

These were younger age at inclusion into the trial (adjusted odds ratio [OR]=0.92) and lower severity of negative symptoms at baseline (OR=0.53). Negative symptoms at 1 year also predicted recovery at 10 years (OR=0.49).

Noting that a relatively small number of people achieved long-term recovery after first-episode psychosis, the researchers conclude: “Negative symptoms could play a central role in long-term outcomes within first episode psychosis.

“Current interventions for these symptoms appear to [be] relatively ineffective and future research should focus on the systematic measurement and treatment of negative psychopathology as a potential way to promote recovery.”

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