Psychological Medicine

Original Articles

Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years

M. Álvarez-Jiméneza1a2 c1, J. F. Gleesona2a3, L. P. Henrya1a2, S. M. Harrigana1a2, M. G. Harrisa4, E. Killackeya1a2, S. Bendalla1a2, G. P. Ammingera1a2a5, A. R. Yunga1a2, H. Herrmana1a2, H. J. Jacksona6 and P. D. McGorrya1a2

a1 Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia

a2 Orygen Youth Health Research Centre, Melbourne, Australia

a3 Australian Catholic University, Department of Psychology, Melbourne, Australia

a4 School of Population Health, The University of Queensland, Brisbane, Australia

a5 Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria

a6 The Department of Psychology, The University of Melbourne, Melbourne, Australia

Abstract

Background In recent years there has been increasing interest in functional recovery in the early phase of schizophrenia. Concurrently, new remission criteria have been proposed and several studies have examined their clinical relevance for prediction of functional outcome in first-episode psychosis (FEP). However, the longitudinal interrelationship between full functional recovery (FFR) and symptom remission has not yet been investigated. This study sought to: (1) examine the relationships between FFR and symptom remission in FEP over 7.5 years; (2) test two different models of the interaction between both variables.

Method Altogether, 209 FEP patients treated at a specialized early psychosis service were assessed at baseline, 8 months, 14 months and 7.5 years to determine their remission of positive and negative symptoms and functional recovery. Multivariate logistic regression and path analysis were employed to test the hypothesized relationships between symptom remission and FFR.

Results Remission of both positive and negative symptoms at 8-month follow-up predicted functional recovery at 14-month follow-up, but had limited value for the prediction of FFR at 7.5 years. Functional recovery at 14-month follow-up significantly predicted both FFR and remission of negative symptoms at 7.5 years, irrespective of whether remission criteria were simultaneously met. The association remained significant after controlling for baseline prognostic indicators.

Conclusions These findings provided support for the hypothesis that early functional and vocational recovery plays a pivotal role in preventing the development of chronic negative symptoms and disability. This underlines the need for interventions that specifically address early psychosocial recovery.

(Received April 07 2011)

(Revised June 23 2011)

(Accepted July 05 2011)

(Online publication August 19 2011)

Correspondence

c1 Address for correspondence: Dr M. Álvarez-Jiménez, Centre for Youth Mental Health, The University of Melbourne, Australia. (Email: malvarez@unimelb.edu.au)

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