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Longitudinal Trajectory of Early Functional Recovery in Patients with First Episode Psychosis

By Mei-Hua Hall, Kristina M Holton, Dost Ongur, Debra Montrose, Matcheri S Keshavan

Posted 21 Jan 2019
bioRxiv DOI: 10.1101/525824 (published DOI: 10.1016/j.schres.2019.02.003)

There is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven methods, and to explore the potential risk /protective factors associated with each trajectory. Methods: A total of 369 first episode patients (93% antipsychotic naive) were included in the baseline assessments and followed-up at 4-8 weeks, 6 months, and 1 year. K means cluster modelling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. Patients with at least 3 assessments were included in the trajectory analyses (N=129). The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF). Results: In each of the three predictor models, four distinct functional outcome trajectories emerged: Poor, Intermediate, Good and Catch-up. Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery. Conclusions: Functioning recovery in individuals with FEP is heterogeneous, although distinct recovery profiles are apparent. Data-driven trajectory analysis can facilitate better characterization of individual longitudinal patterns of functioning recovery.

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