New King’s College London research, published in the British Journal of Psychiatry, indicates a more positive outlook for people diagnosed with first episode psychosis (FEP) and first episode schizophrenia (FES) than has been suggested by previous studies.
Researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and the South London and Maudsley NHS Foundation Trust conducted the first meta-analysis of remission and recovery rates in FEP. The study found that 58 per cent of patients with FEP met the criteria for remission, whilst 38 per cent met the criteria for recovery over mean follow up periods of 5.5 years and 7.2 years respectively. This is higher than previously identified rates of 40 per cent for remission and just 13.5 per cent for recovery.
In addition, the study identified a recovery rate of 30 per cent for those with FES, a much more encouraging outcome than the one in seven with functional recovery in schizophrenia identified in a 2012 meta-analysis.
One of the reasons behind this difference in remission and recovery rates is that previous studies conducted included people with both first episode and multi episode disorder. Multi episode patients include those with more chronic or treatment resistant illnesses, who would by definition be expected to have lower recovery rates.
Dr John Lally from King’s College London said:
‘This is the first meta-analysis of remission and recovery rates focusing solely on people with a first episode of psychosis and/or schizophrenia.”
“We wanted to see if the low rate of remission and recovery identified in previous studies was consistent for people from the first episode of psychosis or schizophrenia. What we’ve found is evidence to suggest that a progressive deteriorating course of illness is not an inherent part of illness course for all. However, while remission rates have improved over time, recovery rates have not during the same time period. This raises questions about the effectiveness of specialist early intervention services in achieving improved recovery.”
Dr John Lally and his colleagues will now explore why recovery rates have not improved over the past twenty years. They will conduct a review and meta-analysis of social outcomes and re-hospitalisation rates for people with FEP, to begin to provide a comprehensive description of recovery related outcomes and ones which are important to patients and their families.
This was a study which was conducted and written in 2016/2017. Both Prof Kieran Murphy (Dept of Psychiatry) and Dr John Lally were based at RCSI, Dublin at the time of the study and it was completed in collaboration with colleagues at King’s College London. Dr John Lally also sits on the Editorial Board of the Irish Journal of Psychological Medicine, the official research journal of the College of Psychiatrists of Ireland.
The abstract can be read below.
Abstract
Background: Remission and recovery rates for people with first-episode psychosis (FEP) remain uncertain. Aims: To assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators. Method: We conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators. Results: Seventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions. Conclusions: Remission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery.
Paper reference: Lally, J et al (2017) Remission and recovery from first-episode psychosis in adults: A systematic review and meta-analysis of long term outcome studies British Journal of Psychiatry
