Evaluation of patients 10 years after a first psychotic episode

The IDIVAL Psychiatry group has published the article “Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort” in the journal Psychological Medicine. The objective of the study was to assess the functionality of patients with a diagnosis of schizophrenia spectrum disorder 10 years after having had a first psychotic episode (PEP). The hypothesis of the study was that early intervention programs in psychosis (ITP) have changed the course of schizophrenia, considered a progressive and deteriorating disease, by a condition in which functional normalization is achieved in the vast majority of patients cases.

To carry out the study, patients were contacted who had been in the Initial Psychosis Attention Program (PAFIP), carried out in the Psychiatry Service of the Marqués de Valcedilla University Hospital, between 2001 and 2008 and that, once informed of the objectives of the study, they agreed to complete an analysis and a clinical interview, and perform a battery of neuropsychological tests and an MRI. The entire visit lasted about 3 hours and a nurse, a psychiatrist, a psychologist and a physicist participated for each individual.

In total, 210 patients were reevaluated and, with the data collected, numerous statistical analyzes were analyzed that allowed these patients to be classified into 6 functional clusters 10 years after having debuted with a PEP, and having been in follow-up in PAFIP, which provided ITP for 3 years. These 6 groups represented: those patients with a normalized evolution (42%); to those with slight interpersonal (10%) or instrumental (13%) deficits; to those with severe instrumental deficits (12%); to those with more severe instrumental and interpersonal deficits (14%); and finally to those with generalized functional deficits (9%).

The results obtained show that a high percentage of patients (42%) have reached functional milestones in the family, educational, vocational and social fields, questioning some work in which it is indicated that long-term recovery is only reached in 15% of patients with schizophrenia. The most remarkable of these findings is that patients have great variability and cannot be classified in two groups: good or bad evolution.

A final aspect that should be noted is the role of ITP programs in relapse prevention. Systematic reviews on this topic highlight the differences between usual treatment and ITP. In cases treated with usual treatment, the average relapse rates are 14% at 9 months, 49% at 24 months and 76% after 10 years; while in those served by specialized ITP services they are 17% at 9 months, 38% at 24 months and 54% beyond 10 years. These data coincide with those of one of our recently published studies in which a relapse rate of 56% was demonstrated in the 3-year follow-up, one of the main predictors of these being the lack of adherence to treatment. Relapses are the aspect that most difficult the complete recovery, and its rate continues to be high even in the ITP programs, so its prevention is possibly the aspect that needs more improvements.

In conclusion, there is no doubt that the diffusion of ITP in many countries has led to improvements in the treatment and evolution of PEP. However, these improvements do not necessarily mean that the course of the disease is radically changed or that the overall outcome of the disease can be described as positive. There remains a crucial need for new treatment approaches to improve long-term functionality taking into account the individual variability of patients.
With the information obtained in this PAFIP-10 cohort there are other studies underway, specifically the morphometric evolution of brain structures and metabolic evolution, led by Dr. Diana Tordesillas-Gutiérrez, and Dr. Javier Vázquez-Bourgon respectively.

Ref. Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort. Rosa Ayesa-Arriola , Víctor Ortíz-García de la Foz, Obdulia Martínez-García, Esther Setién-Suero. DOI: https://doi.org/10.1017/S0033291719003179. Published online by Cambridge University Press: 18 November 2019