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Predictors of symptomatic and functional outcome after a first episode of psychosis:towards the construction of a prognostic model.

(2017) Brink, V. (Vera)

INTRODUCTION The notion that psychotic disorders are deteriorating, life-long diseases, has been revised during the last two decades. Currently, a more optimistic view on the outcome of patients after a first episode of psychosis (FEP) is being put forward. Nevertheless, there is still a large group of FEP patients that does not reach remission. In order to improve the probability of remission, early individualized intervention is needed. Patients who need more intensive treatment early in the disease can be identified with outcome predictors. More knowledge of these predictors, however, has to be gathered. Therefore, this study aims to reevaluate currently accepted predictors and to identify yet unknown predictors of symptomatic and functional outcome after a FEP in a longitudinal naturalistic patient cohort.
METHODS Data from 408 affective and non-affective FEP patients enrolled in both the ‘Psychosis Recent Onset GRoningen Survey’ (PROGR-S) and the ‘Pharmacotherapy Outcome and Monitoring Survey’ (PHAMOUS) was analyzed. These naturalistic prospective cohort studies provided socio-demographic, premorbid, diagnostic, clinical and cognitive baseline characteristics, and yearly follow-up measurements respectively. Associations between the potential predictors and poor symptomatic and functional remission between baseline and 5 years (short/medium-term) and between 5 and 17 years (long-term) after inclusion were investigated with uni- and multivariable logistic regression analyses.
RESULTS In the current study, 184 patients were included in the short/medium-term outcome analysis and 239 patients were included in the long-term outcome analysis. More negative symptoms were associated with poor short/medium-term symptomatic (OR=1.16, 95%CI=1.01-1.33, p=0.040) and functional outcome (OR=1.32, 95%CI=1.11-1.57, p=0.002). Poor overall role functioning (OR=1.18, 95%CI=1.04-1.35, p=0.014), using less reassuring thoughts as coping style (OR=0.75, 95%CI=0.60-0.95, p=0.015), poor recognition memory (OR=0.72, 95%CI=0.54-0.96, p=0.024) and poor global functioning (OR=0.96, 95%CI=0.92-1.00, p=0.037) predicted poor long-term symptomatic outcome. More negative symptoms (OR=1.08, 95%CI=1.00-1.16, p=0.047) and having repeated a grade (OR=0.96, 95%CI=0.92-1.00, p=0.037) were associated with poor long-term functional outcome.
CONCLUSION This study identified variables associated with poor symptomatic and functional outcome after a FEP. Knowledge of outcome predictors contributes to the future development of a risk calculator that enables clinicians to make individualized treatment plans based on the probability of poor functional or symptomatic outcome.





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ID 3551
Moeder ID 3463
Volgorde Brink, V.
Naam BrinkV
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2017/BrinkV/
Gemaakt op: 2017-08-22 07:55:25
Gemodificeerd op: 2017-08-22 07:55:25
Digitaal ID 599be36c58271
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel Predictors of symptomatic and functional outcome after a first episode of psychosis:towards the construction of a prognostic model.
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 61
Publicatiejaar 2017
Taal en
Engelse samenvatting INTRODUCTION The notion that psychotic disorders are deteriorating, life-long diseases, has been revised during the last two decades. Currently, a more optimistic view on the outcome of patients after a first episode of psychosis (FEP) is being put forward. Nevertheless, there is still a large group of FEP patients that does not reach remission. In order to improve the probability of remission, early individualized intervention is needed. Patients who need more intensive treatment early in the disease can be identified with outcome predictors. More knowledge of these predictors, however, has to be gathered. Therefore, this study aims to reevaluate currently accepted predictors and to identify yet unknown predictors of symptomatic and functional outcome after a FEP in a longitudinal naturalistic patient cohort.
METHODS Data from 408 affective and non-affective FEP patients enrolled in both the ‘Psychosis Recent Onset GRoningen Survey’ (PROGR-S) and the ‘Pharmacotherapy Outcome and Monitoring Survey’ (PHAMOUS) was analyzed. These naturalistic prospective cohort studies provided socio-demographic, premorbid, diagnostic, clinical and cognitive baseline characteristics, and yearly follow-up measurements respectively. Associations between the potential predictors and poor symptomatic and functional remission between baseline and 5 years (short/medium-term) and between 5 and 17 years (long-term) after inclusion were investigated with uni- and multivariable logistic regression analyses.
RESULTS In the current study, 184 patients were included in the short/medium-term outcome analysis and 239 patients were included in the long-term outcome analysis. More negative symptoms were associated with poor short/medium-term symptomatic (OR=1.16, 95%CI=1.01-1.33, p=0.040) and functional outcome (OR=1.32, 95%CI=1.11-1.57, p=0.002). Poor overall role functioning (OR=1.18, 95%CI=1.04-1.35, p=0.014), using less reassuring thoughts as coping style (OR=0.75, 95%CI=0.60-0.95, p=0.015), poor recognition memory (OR=0.72, 95%CI=0.54-0.96, p=0.024) and poor global functioning (OR=0.96, 95%CI=0.92-1.00, p=0.037) predicted poor long-term symptomatic outcome. More negative symptoms (OR=1.08, 95%CI=1.00-1.16, p=0.047) and having repeated a grade (OR=0.96, 95%CI=0.92-1.00, p=0.037) were associated with poor long-term functional outcome.
CONCLUSION This study identified variables associated with poor symptomatic and functional outcome after a FEP. Knowledge of outcome predictors contributes to the future development of a risk calculator that enables clinicians to make individualized treatment plans based on the probability of poor functional or symptomatic outcome.
Nederlandse samenvatting INTRODUCTIE De afgelopen twee decennia is men de opvatting dat psychotische stoornissen aftakelende, levenslange ziektes zijn gaan herzien. Inmiddels kijkt men met een optimistischere blik naar de uitkomst van patiënten na een eerste psychotische episode (EPE). Desalniettemin blijft er een grote groep patiënten die slecht herstelt na de EPE. Om de kans op remissie te vergroten is het nodig om vroeg in te grijpen. Welke patiënten intensieve vroege interventie behoeven, kan worden bepaald op basis van variabelen die de uitkomst na een EPE voorspellen. Echter is er meer kennis nodig met betrekking tot deze voorspellers. Het doel van deze studie is dan ook om huidige voorspellers te her evalueren en om tot dusver onbekende voorspellers voor symptomatische en functionele uitkomst na een EPE te identificeren in een longitudinaal naturalistisch cohort.
METHODEN Data is geanalyseerd van 208 affectieve en non-affectieve EPE patiënten, die geïncludeerd zijn in zowel de ‘Psychosis Recent Onset GRoningen Survey’ (PROGR-S) als/en de ‘Pharmacotherapy Outcome and Monitoring Survey’ (PHAMOUS). Deze naturalistische prospectieve cohort studies leverden respectievelijk socio-demografische, pre morbide, diagnostische, klinische en cognitieve baseline karakteristieken, en jaarlijkse follow-up gegevens. Associaties tussen de potentiële voorspellers en slechte symptomatische en functionele remissie tot 5 jaar na baseline (korte/medium termijn) en tussen 5 en 17 jaar (lange termijn) na inclusie werden onderzocht met behulp van uni- en multivariabele logistische regressie analyses.
RESULTATEN Er zijn 184 patiënten in de analyses voor korte/medium termijn uitkomst en 239 patiënten in de analyses voor de lange termijn uitkomst geïncludeerd. Meer negatieve symptomen waren geassocieerd met slechte korte/medium termijn symptomatische (OR=1.16, 95%CI=1.01-1.33, p=0.040) en functionele uitkomst (OR=1.32, 95%CI=1.11-1.57, p=0.002). Slechter functioneren in sociale rollen (OR=1.18, 95%CI=1.04-1.35, p=0.014), minder gebruik van geruststellende gedachten als coping stijl (OR=0.75, 95%CI=0.60-0.95, p=0.015), slechter herkenningsgeheugen (OR=0.72, 95%CI=0.54-0.96, p=0.024) en slechter algeheel functioneren (OR=0.96, 95%CI=0.92-1.00, p=0.037) voorspelden slechte lange termijn symptomatische uitkomst. Meer negatieve symptomen (OR=1.08, 95%CI=1.00-1.16, p=0.047) en ten minste één keer zijn blijven zitten (OR=0.96, 95%CI=0.92-1.00, p=0.037) waren geassocieerd met slechte lange termijn functionele uitkomst.
CONCLUSIE Deze studie heeft variabelen die geassocieerd zijn met een slechte symptomatische en functionele uitkomst na een EPE geïdentificeerd. Kennis van voorspellers van uitkomst draagt bij aan de toekomstige ontwikkeling van een risico calculator die clinici helpt om op basis van de kans op een slechte symptomatische of functionele uitkomst, een individueel behandelplan op te stellen.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Brink, V. (Vera)
UMCG begeleider(s) Faculty supervisor:; Veling, Dr W.A.; Second supervisor:; Driel, C.M.G. van; Location: University Center Psychiatry,; UMCG Groningen
Auteur(s) Brink, V. (Vera)
UMCG begeleider(s) Faculty supervisor:; Veling, Dr W.A.; Second supervisor:; Driel, C.M.G. van; Location: University Center Psychiatry,; UMCG Groningen


 
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